Fresenius water system

action limit for endotoxin

0.125 EU/ml

the hard water limit after the softener is

10 ppm

the delta pressure across a softener should not exceed

10 psi

TDS settings on the RO should be ___ times the normal product TDS

2

action limit for bacteria is

20 cfu/ml

the RO pre filter protects the RO machine from particles up to

5 micron

if RO rejection rate reaches _____ the membranes must be replaced

80%

the over temp alarm is set at

90 deg F

multimedia sediment filter

AKA sand, depth or bed filters, remove large particles, contains multiple layers with each layer retaining smaller particles as small as 10 micron

booster pump

Boosts feed water pressure

deionization tank

DI is emergency backup for RO, rarely used as primary treatment, uses beds of resin beads to remove ions, these are exchanged for hydrogen and hydroxide ions to form water

brine tank

Holds salt pellets mixed with water for the softener

delta pressure

Pressure difference pre and post filter, limit 10psi

a decrease in temperature will decrease the efficiency of an ____

RO membrane

_____ is used to measure total dissolved solids in the water

TDS meter

bicarbonate

a buffer, neutralizes acids that form when the body breaks down proteins

colony forming units

a measure of the number of living bacteria

total chlorine testing algorithm

a tool used by staff in guiding them thru routine testing and what to do if results are at or above 0.10 ppm

endotoxin is

a toxic substance bound to the bacterial cell wall and released when the bacterium ruptures

sepsis is

a whole body inflammation caused by severe infection

conductivity

ability of a fluid to transfer electrical charge

UV light

administers a lethal dose of radiation to eradicate bacteria

RPC ultra low total chlorine strips

another way of testing total chlorine, backup for hach colorimeter

alternative water supply plan

approved by the medical director, provides instructions if city water is interrupted, insures facility meets AAMI standards even if one or more components of the locations system fail, posted in water treatment area

chlorine and chloramines

are harmful to patients, causing hemolysis, together chlorine and chloramines form total chlorine

AAMI

association for the advancement of medical instrumentation, develops voluntary standards for dialysis

frequency of routine total chlorine testing

before the first patient treatment and not to exceed every four hours

SDS consists of

bicarb mix tank, bicarb and acid head tank, acid storage tank, and distribution loops

aluminum and flouride can cause

bone disease

A TDS meter should be ______ weekly

calibrated

chloramines

chlorine + ammonia

carbon tank

contains granular activated carbon which absorbs low molecular weight particles from water, chlorine, chloramines, pesticides, industrial solvents and trace organic substances

sediment filter cartridge

cylindrical cartridge of filter media with a central; drainage core, filter out particles, carbon fines and water softener resin

pheonix meters must be verified ____ with standard solutions and calibrated if they show more than ____ +/- the standard

daily, 0.1

microbial testing

determines if microorganisms (endotoxins and bacteria) are present

filter

devices that remove particles by passing fluid through pores

high chlorination of the water supply testing

done when the city adds extra chlorine in the water supply, due to break in main, flooding or bacterial contamination. GAC testing increased to hourly

total chlorine

free chlorine (hypochlorite ion AKA bleach) + combined chlorine (chloramines) safe level 0.00 to 0.09 ppm

3 characteristics of bacteria and or viruses

gram positive bacteria turn purple when gram stained, can form biofilm slime that protects them from disinfection, microscopic single celled

GAC

granulated activated carbon filters are the primary method to remove total chlorine

SDS may be ____ or _____ fed

gravity or pressure

_____ are used to test water for levels of calcium and magnesium

hardness test strips

product water

has been forced thru an RO membrane

HMIS

hazardous materials identification system, this permanent labeling required on SDS equipment uses colored bars, numbers and symbols to alert staff to chemical hazards

captive air tank, aka expansion or bladder tank

helps maintain minimum system pressure while the booster pump cycles

the ____ should always be set to alert staff on the floor that there is a chance of running out of water

holding tank low level alarm

head tanks

in gravity feed solution delivery systems, concentrates are pumped into this equipment for delivery to patient stations

IFU

instructions for use

water softener works by a process known as

ion exchange

loop pumps are always running to

keep water moving in the loop and minimize bacterial contamination

15 minutes

length of time RO has to be running B4 water samples can be taken for RO water sample and chlorine testing

action level

level at which we must take corrective measures.

TCL-2

log used for breakthrough documentation when total chlorine levels are 0.10 ppm or greater after the first carbon tank

TCL-1

log used for routine daily total chlorine documentation of safe ranges between 0.00 and 0.09 ppm

_____ pumps under the holding tank move water from the tank out to the stations

loop

backwashing

means forcing water backwards thru a filter, removes particles clogging filter

adsorption

means to attract and hold on a surface. the binding of chlorine and chloramine molecules to the granulated activated charcoal

temperature blending valve

mixes hot and cold water to 77 deg F,

routine culture testing should be done monthly prior to ____

monthly disinfection

RO pre filters are changed when

monthly or when delta pressure exceeds 10 psi

the acid feed injection pump uses what kind of acid

muriatic or sulfuric

empty bed contact time (EBCT)

period during which feed water must remain in contact with the charcoal bed in a carbon tank, AAMI standard is 10 minutes total EBCT, fmc 12 minutes

granuflo

powdered acid concentrate, or the liquid acid concentrate after reconstitution

reverse osmosis

pressure is applied to a membrane overcomes the osmotic pressure of the solution, the water then travels across the membrane in reverse of the natural occurrence of osmosis

the over temp alarm is in place to

prevent damage to the RO membranes

_____ diverts the product water to the drain if the water exceeds the TDS alarm limit on the RO

product divert

the water exiting the RO is called

product water

percent rejection

provides an indication of how effective an RO machine is, must be 95% when installed and when membranes are changed, action must be taken when there is a radical change in rate

_____ are used to test for residual chlorine after disinfection

residual chlorine strips

precipitate

solid particles that settle out of a solution and can clog pipes or damage components

SDS

solution delivery system, used to mix and deliver dialysate concentrate solutions to single patient dialysis machines.

the hach meter must be verified daily with a ____

standard spec kit

a TDS meter should be ____ daily

standardized

feed water

tap water before treatment

breakthrough

test results after the first carbon filter that are at or above the action level of 0.10 ppm

low range (LR)

the hach colorimeter should always be set in LR

ion exchange

the process that occurs inside a deionizer for water treatment. unwanted ions are exchanged for hydrogen and hydroxyl ions to create pure water

initial volume

the quantity of treated water in the mix tank prior to adding bicarbonate concentrate powder

total volume

the quantity of treated water plus the NaturaLyte bicarbonate base powder required to produce bicarbonate base concentrate as stated on the label

fill volume

the quantity of treated water plus the number of bags of acid base powder required to produce the total volume of acid base concentrate as stated by the manufacturer

microns

the unit of measurement for filter pores.

chloramine adsorption is affected by ____, ___ and ____

time, pH, temperature

backflow prevention device

to keep water from flowing backwards into incoming water supply, installed at start of system

0.00 to 0.09 ppm

total chlorine levels that are patient safe

_____ are located in the distribution loop after the holding tank to remove bacteria and endotoxins

ultra filters

what generally follows the UV light in the system

ultrafilter to catch killed bacteria

ultrafilter

used to control and remove particulates, bacteria, endotoxins, and other microorganisms

temporary labeling

used to label mix tanks with contents that change, must be conspicuous/noticeable

chemical feed system

used to lower feed water pH in RO systems, acid injection corrects alkalinity or pH >8.0.

hydrometer

used to measure specific gravity of an acid concentrate after mixing, must be +/- 2% of expected range

bicarbonate mixer

used to mix bicarbonate concentrate solutions for jugs

water softener

used to reduce the concentration of calcium and magnesium that form scale

hach pocket colorimeter

used to test for total chlorine

spec check color standard kit

used to validate hach colorimeter daily

phoenix meter

used to verify dialysate conductivity

reject water

waste stream sent to drain along with the solutes removed during dialysis

direct feed

water system design in a facility that does not have a holding tank

indirect feed

water system design in a facility that has a holding tank

membrane filters

water treatment cartridges containing thin membranes with pores of a specified size. remove small particles and some solutes

valve panel

where bicarb concentrate, acid concentrate and RO water are centrally delivered for use by HD machines