PURPOSE
1. To maintain dialysis machines clean, sterile, and trouble free during the treatment.
2. To maintain the fluid and fluid path way sterile and free from contaminates
3. To remove precipitates due to the low solubility of calcium carbonate.
4. To remove blood spills and other solutions from the machine.
CONDITIONS
1. This procedure (except external cleaning) should be performed by Renal Dialysis Technician.
2. The machine should be serviced every 2000 hours (mechanical servicing).
3. Strict safety measures should be taken during the procedure
4. Heat disinfection should be performed after each dialysis
Alert
1. Chemical disinfection should be performed weekly if the machine undergoes heat disinfection otherwise two times a week.
2. Decalcification should be performed minimum 3 times /week .
3. For positive patient, chemical disinfection should be done for the machine after each dialysis.
4. The machine should be disinfected if not used more than 24 hours.
EQUIPMENT
1. Disinfectant and cleaning solutions.
2. Tools for maintenance.
3. Test equipment.
4. Charts for service and performance.
PROCEDURE
I – Disinfection
A- Heat Disinfection
Note
Some machines can be put directly to heat disinfection. Step 1 and 2 will be done automatically.
| SN | Action | Rationale |
| 01 | After dialysis, drain or rinse the machine. | To remove used dialysate from the inside of the machine. |
| 02 | Put the machine on heat disinfection. This procedure will take 40 – 45 minutes. | To sterilize the machine |
B- Chemical Disinfection
Note
Sodium hypochlorite or diastral can be used as disinfectant and cleaning solution as it kills microorganisms and removes contaminants organic origin such as proteins and glucose deposited in the fluid pathway.
Note
Citrostril, Puristril, and Diulox are disinfectant but they do not remove organic origin.
| SN | Action | Rationale |
| 01 | Prepare the machine for chemical disinfection (drain or rinse the machine). | To remove used dialyzate from the inside of the machine. |
| 02 | Prepare the solution. Sodium hypochlorite (5.25% diluted to 5% for some machines) or use the disinfectant recommended by the manufacturer. Refer to the machine manufacturer before performing this procedure. | . |
| 03 | Put the pick up tube designated for chemical intake (disinfecting pot) into the solution. | For filling the machine with chemical. |
| 04 | Press the chemical disinfecting button. | To activate the function. |
| 05 | When disinfection finishes the alarm light will flash, then the machine has to go for a mandatory rinse program. This procedure will take 45-60 minutes. | To flush out chemicals from the machine |
II – Cleaning
| SN | Action | Rationale |
| 01 | Prepare the machine for cleaning (drain or rinse for removal of used fluid). | To remove contaminants, organic origin such as proteins and glucose deposited in the fluid pathway. To remove microorganisms |
| 02 | Prepare the solution (Sodium Hypochlorite). Refer to the machine manufacturer before performing this procedure. | |
| 03 | Put the designated tube to the solution, and put the machine on cleaning mode. | To fill the machine with solution. |
| 04 | After filling finish, the machine must go for a mandatory rinse This procedure will take 40-45 minutes. | To flush out the cleaning solution. |
III – Decalcification
Purpose
- To remove the precipitate from the machine
- This procedure integrated with heat disinfections in Gambro machine and in Fresenius hot disinfections is enough.
| SN | Action | Rationale |
| 01 | Prepare the machine for decalcification (drain or rinse the machine. | To remove used dialyzate fluid from the machine. |
| 02 | Prepare the solution. Citric acid 20% solution or Diasteril. Refer to the machine manufacturer before performing this procedure. | |
| 03 | Put the designated tubes in the Citric Acid solution. Select heat with Citric acid in Gambro machine . | |
| 04 | Drain and rinse the machine. | To flush out the solution. |
IV – Cleaning (External)
Purpose
1. To clean the external parts of the machine from blood and fluid spills.
Note
The procedure is to be performed by Nursing Staff or Medical Orderly.
| SN | Action | Rationale |
| 01 | Prepare the machine for cleaning. Remove items e.g. disposable, extracorporeal line, forceps, etc. | To be able to clean the machine properly. |
| 02 | Prepare the solution Use soap and water for ordinary cleaning Dilute (Milton 1%) into .5% when there is blood spillage. Refer to the machine manufacturer before performing this procedure. | |
| 03 | Wipe the whole machine including dialyzate line with J cloth. | |
| 04 | Soak the J. Cloth with the solution and remove the excessive water. | |
| 05 | Wipe again the machine with J. Cloth.. | To remove soap solution. |
V – MAINTENANCE (Service and Performance)
| SN | Action | Rationale |
| 01 | The machine should be serviced every 2000 hours. Refer to the machine manufacturer before performing this procedure. | To maintain the machine trouble free during treatment. To overall check the machine and complete calibration. |
| 02 | Electronic calibration. Check voltage and calibration. |
| SN | Action | Rationale |
| 03 | Change the old and / or discolored part which needs replacement. | Discoloration may occur due to prolonged use and heat disinfection. |
| 04 | Check each part of the machine with the test equipment. Performance test should be performed every two months. | Check and test main functions of the machine e.g. conductivity, temperature, pressure, and calibration. |
| 05 | Clean internal and external filters. | Some filters may clog with organic parcipitate needs cleaning. |
| 07 | Check overall performance of the machine | To ascertain that the machine is working properly. |
Approved by Renal dialysis in charges
Renal Dialysis Technician