Challenges and discussion on the On-line CHDF system with a single-patient dialysis machine

Abstract

The stability of circulation and the recovery of the renal function are the main goals of blood purification in the acute critically ill setting. For this purpose, both the continuity and adjustability regarding the purification of dialysis water are necessary to apply the technique of on-line HDF. In our ICU, the on-line CHDF system consists of a dialysis machine and an RO module, where the system is used either continuously or sometimes is shut down for long periods of time. The water quality is maintained by sterilization of the dialysate lines, the aseptic manipulation of the circuits, and programmed cleaning and rinsing at times when this system is not in use. The deposition of calcium carbonate is a major problem associated with the continuous use of the dialysate machine. We therefore established limits in the running time, and an effective protocol for acid-rinsing using an increased concentration of acetate. We have so far experienced few problems with these protocols, however, further improvements are needed for the continuous use of the dialysis machines. A high degree of adjustability is obtained with the disposable special circuit, while the dialysate and substitute flow is optimized for each individual patient. Moreover, the greatest advantage of this system is the fact that this system can deliver very high doses of dialysate and substitution fluid if necessary, and this system is not associated with any increases in either medical costs or manpower.