Fresenius Hemodialysis Study Guide Latest update 2023

Fresenius Hemodialysis Study Guide Types of water sources? - Surface and Ground Examples of surface water? - lakes, streams, rivers, reservoirs Examples of ground water? - Wells, springs FMC follows water quality standards according to who's standards? - AAMI Bone disease can be caused by ________ in product water? - Aluminum Aluminum in product water put the patient at risk for ________? - Anemia Aluminum, chloramphenicol, copper or zinc may cause _______ when present in water used for dialysis? - Hemolysis The presence of bacteria in the bloodstream is? - Sepsis Parts of a bacteria cell wall, released from dead bacteria is? - Endotoxin What are characteristics of bacteria/viruses? - 1. Grows rapidly 2. Too large to cross an intact dialysis membrane, but can cross a damaged/torn membrane 3. May produce endotoxins or biofilm Safe range for total chlorine is? - Less than 0.1 ppm (0.00-0.09 ppm) A serious side effect if chlorine crosses the dialyzer membrane is? - Hemolysis Chloramphenicol is a combination of ________ and _________ ? - Chlorine and Ammonia Chlorine and chloramphenicol are added to city water for what reason? - To reduce or eliminate bacteria A patient complication due to the exposure of blood to chlorine an chloramines is? - Hemolysis Examples of the symptoms the patient might experience from Hemolysis. - 1. Chest pain 2. Shortness of breath 3. Cherry pop red / translucent blood Where does the water pathway start in the dialysis facility? - City Water Inlet The first piece of equipment that the water goes through in the dialysis facility is the? - Backflow Preventer What is the function of the backflow preventer? - Prevents water from flowing back into the city's water suppl. The recommended water temperature for ideal RO operation is? - 77 degrees F What is the function of the water booster pump? - Boosts incoming city water pressure What is the function of the Captive Air Tank (bladder tank)? - Help maintain a minimum pressure What is the function of the Chemical Feed pump? - Help adjust the pH level of the water What is the function of the Sediment Filters? - Removes larger particles from the incoming water What is the function of the multimedia filter? - Removes particles 10 microns in size or larger What is the size of particulate matter removed by the multimedia filter? - 10 What is the function of the Carbon Filter/Tank? - To remove chlorine and Chloramines and other organic materials. Carbon filters remove chlorine and chloramines by the process of? - Adsorbtion What is the "Empty Bed Contact Time?" - The length of time that the water is exposed to carbon AAMI requires a minimum EBCT of __ minutes, FMC requires a minimum EBCT of __ minutes for new water treatment systems. - 10, 12 RPC Ultra-Low Total Chlorine test strips are used to test for? - Total Chlorine in the water after GAC #1 and Post RO. When and at what frequency is routine total chlorine testing performed per FMS policy? - Prior to the initiation of treatment and at least every 4 hours. The reverse osmosis (RO) machine runs for __ minutes before performing any total chlorine testing. - 15 Total chlorine testing for a central water system must be performed and documented by __ qualified staff members. - 2 A sample container is always rinsed __ times before a sample is collected for testing. - 3 ___ ml is the correct amount of water to collect for total chlorine testing when using RPC Ultra-Low Total Chlorine test strips - 100 How long is the RPC Ultra-Low Total Chlorine test stripe immersed in the sample? - 60 seconds If a chlorine breakthrough occurs post GAC (Carbon) Filter #1, what are the several steps that are taken to ensure patients are safe from harm? - 1. Place all machines in bypass 2. Repeat test (optional) 3. Immediately test after GAC#2/Carbon Tank#2 4. If results are less than 0.1, notify the CM, MD, and ATOM/BMT If total chlorine testing after the second carbon tank shows results above the action limit, what action is immediately taken? - Immediately stop treatments _______ and _______ are removed from water by the softener by the process of ion exchange? - Calcium and Magnesium Water hardness is measured in parts per million (PPM). The FMS acceptable limit for water hardness post softener is __ PPM. Normally, there are __ water hardness tests done daily. - 10, 2 What do hardness strips test for? - Calcium and magnesium The RO must run for how long prior to testing water? - 15 minutes. What is "product water" ? - Water exiting the RO that meets the AAMI standards for water to be used for dialysis. RO performance is measured by what? - Percent rejection. The full calibration of the TDS meter is required how often? - Weekly UV light is a form of? - Invisible Radiation UV lights are effective when they have a wave length of ___ nanometers - 254 The low level alarm on the holding tank must be set (or on) when? - Always Where are the ultrafiltration located in the water treatment system? - In the loop What method of water treatment component is used during RO failure and is part of the "Alternate Water Supply Plan"? - Demonization Tanks Piping within the water treatment distribution lop is made of what material? - PVC, Stainless Steel, PEX. Teflon What causes a progenitor reaction in patients? - Exposure to bacteria and endotoxins Watch at are some of the symptoms of a pyrogens can reaction? - 1. Fever and chills 2. Nausea and vomiting 3. Hypotension CFU is an abbreviation for? - Colony Forming Unit The FMS action level for bacteria in product water exiting the RO is __ cfu/ml - 20 The FMS action level for bacteria for water in the tank, piping and distribution loop is __ cfu/ml - 20 The FMS action level for Endotoxin in product water exiting the RO is __ EU/ml - 0.125 The FMS action level for Endotoxin for water in the tank, piping and distribution loop is __ EU/ml - 0.125 Routine testing for bacteria and Endotoxin should take place how often? - Monthly What is the frequency of routine holding tank and water distribution loop disinfections? - Monthly What is the purpose of Residual Chlorine strips? - Test for residual bleach What does a pHoenix meter measure? - 1. Conductivity 2. pH 3. Temperature When is the pHoenix meter verified? - Daily, before use. When is the pHoenix meter is calibrated? - When daily verification indicates the meter is not within acceptable limits. Three pieces of personal protective equipment that are mandatory for use in the patient care area are: - Gown, gloves, face shield The function of Erythropoietin is - Stimulate production of RBC's, tells bone marrow to make RBC's Hepatitis is an inflammation of the liver caused by - most commonly a viral infection Max Chlorine level in H2O room - 0.09 ppm Albumin is - a protein that helps fight infections and aids in healing and tissue formation. Gets fluid back into the blood, an osmotic agent. HD patient range for Albumin - ≥ 4.0 Potassium is - an electrolyte that regulates cardiac action