Bacteriological Studies of the Modified Kiil Dialyser

Jones, D. M.; Tobin, Barbara M.; Harlow, Georgina; Ralston, A. J.

doi:10.1136/bmj.3.5715.135

Cited by 22 publications

(6 citation statements)

References 6 publications

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“…In this respect we would disagree with Fregerslev (7) who suggested all fluids including hemotrate be sterilized. Rather, we agree with Jones et al (10) and suggest that the levels of bacterial contamination be maintained at a low level, preferably less than 1,000/ml. Requirements for sterile source water or dialysate fluid would be most unrealistic since no manufacturer can currently meet that specification.…”

Section: Discussionsupporting

confidence: 92%

Factors That Influence Microbial Contamination of Fluids Associated with Hemodialysis Machines

Favero¹,

Carson²,

Bond³

et al. 1974

Applied Microbiology

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Studies were conducted on the microbiological quality of fluids associated with different types of dialysis systems located in six dialysis centers and 14 homes. Included were (i) single-pass systems employing either parallel flow (Kiil or Gambro) or capillary cartridge dialyzers and (ii) recirculating single-pass and batch recirculating systems using coil dialyzers. Microbiological assays were performed on the water used to prepare dialysis fluid, the concentrated dialysate, and either pre-and postdialyzer dialysate (single-pass systems) or the dialysate contained in storage reservoirs and recirculating cannisters (recirculating systems). The levels of microbial contamination consisting of gram-negative bacteria were directly related to the type of dialysis system, method of water treatment, distribution system, and in some instances, the type of dialyzer. Recirculating single-pass and batch recirculating systems consistently contained significantly higher levels of contamination than single-pass systems. These results were directly related to the design of recirculating systems which permits carbonand nitrogen-containing waste products dialyzed from the patient to accumulate, be used as nutrients by microorganisms, and subsequently allow for 2to 4-log increases in contamination levels during a dialysis treatment. In contrast, levels of contamination in single-pass machines were related more to the quality of the water used to prepare dialysis fluid and the adequacy of cleaning and disinfection procedures than to the design of the system.

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Section: Discussionsupporting

confidence: 92%

Factors That Influence Microbial Contamination of Fluids Associated with Hemodialysis Machines

Favero¹,

Carson²,

Bond³

et al. 1974

Applied Microbiology

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show abstract

“…Further evidence against the role of live bacteria in producing dialysis reactions is shown by the lack of correlation with positive blood cultures. Jones et al (1970) suggested that dialysis reactions are produced by the entry into the blood of bacteria from the dialysate compartment and demonstrated the persistence of bacteria in Kiil boards exposed to 2% formaldehyde. The incidence of reactions in our patients did not correlate with the presence of bacteria in samples of priming saline taken from the blood compartment of the dialysers.…”

Section: Discussionmentioning

confidence: 99%

Pyrexial Reactions during Haemodialysis

Robinson¹,

Rosen²

1971

BMJ

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SummaryThe characteristics, circumstances, and treatment of 450 pyrexial reactions occurring in 468 patient-months over a period of two and a half years, using a warm single-pass Kiil system, were studied. There is a wide variation in severity of symptoms and morbidity. The incidence of pyrexial reactions has an epidemic pattern within the hospital unit. Patients on dialysis at home have reactions much less often than patients in hospital.Blood cultures taken from patients during each of the 450 reactions showed a growth on 38 occasions, but this was not significantly different from the incidence of positive cultures taken simultaneously from control patients during haemodialysis. Reactions were not correlated with bacterial growth from the blood compartment of the kidney before dialysis. There was no difference in incidence of reactions when using different types of equipment which were either a central tank distribution system with bedside monitors or chemically-or heat-sterilized individual proportioning pump systems. Reactions were also noted with the disposable coil kidney and recirculating single-pass (R.S.P.) system, but presented different features from those of the Kiil kidney.The incidence of reactions was not related to the albuminoid nitrogen content of the water supply. Reactions were not abolished by deionization of the tap-water.

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“…Despite the introduction of sterile, disposable dialysers clinical reactions caused by bacterial contamination of the dialysate are still in evidence. The frequency has been reported to be about 10% (14) and a good correlation has been found between the degree of contamination and the severity of the reactions (6,7, 9,10,12).…”

Section: Discussionmentioning

confidence: 97%

Bacteriological and Clinical Evaluation of Different Dialysate Delivery Systems

Dawids

Vejlşgaard

1976

Journal of Internal Medicine

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In the period 1-74 four different dialysate delivery systems have been used in our department. 1 ) Central mixing of dialysate using tap water and a dialysate delivery line with "dead ends" resulting in stagnant dialysate. 2) Central mixing of dialysate with cold distilled water, otherwise equal to system 1. 3) Local mixing of dialysate with cold distilled water, delivered through a line with "dead ends" resulting in stagnant water. 4) Local mixing of dialysate with distilled water, cooled to 25°C just prior to use, reduced "dead ends" and monitored constant overflow to drain through the water supply line. The bacterial contamination of the four systems was examined and related to the clinical occurrence of pyrogenic and other reactions. An improvement was noted with the change from central to local mixing of dialysate (system 3) but complete sterility and virtual freedom from clinical reactions were first obtained in system 4. It is concluded that the use of sterile or near sterile dialysate is recommendable.

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Bacteriological Studies of the Modified Kiil Dialyser

Cited by 22 publications

References 6 publications

Factors That Influence Microbial Contamination of Fluids Associated with Hemodialysis Machines

Factors That Influence Microbial Contamination of Fluids Associated with Hemodialysis Machines

Pyrexial Reactions during Haemodialysis

Bacteriological and Clinical Evaluation of Different Dialysate Delivery Systems

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