透析器复用经验交流.pptVIP

透析器复用经验交流 Dialyser reuse 提要Contents Ⅰ 透析器复用Reason, disputes, methods of reuse 复用的原因和争议及现状 复用的方法 Ⅱ部分B.Braun客户使用、复用Diacap Polysulfone的经验experience of our customer Ⅲ复用中的可能问题Potential problems 透析器复用 1 复用的原因和争议及现状Reason, disputes a.复用的支持和反对意见Pros and cons b.复用现状What’s on 2 复用的方法Methods a.自动复用Automatic b.手工复用Manual c.两者的比较Comparison 1.复用的原因和争议及现状 Reason, disputes a 复用的支持意见pros 降低使用成本，减轻病人经济负担economical consideration CéTS, 1991 改善生物相容性，减少相应的免疫反应increase biocompatibility Daugirdas and Ing,1988; Hakim and Lowrie, 1980 减少透析器首次使用综合症reduce 1st use syndrome Bok et al, 1980 有利于环保environmental friendly a 可能的不利因素cons 透析器的性能受到的可能影响possible influence of the dialyser Gotch , 1986; Cheung, 1999; Pizziconi, 1990 消毒不严格带来的可能后果malpractice of disinfection 残余消毒剂带来的不利影响adverse reaction of disinfectant 血液交叉感染/对滤器处理人员的危险cross infection National Kidney Foundation report on dialyzer reuse. Task Force on Reuse of Dialyzers, Council on Dialysis, National Kidney Foundation. Am J Kidney Dis. 1997 美国肾病基金会报告 The National Kidney Foundation takes no position for or against dialyzer reuse. The principal reason for the practice of reuse is economical. 经济原因决定复用 In view of the uncertainties related to the safety and biological impact of reuse procedures, the task force recommends that a full discussion of the issue of reuse and its potential beneficial and detrimental effects be undertaken with each patient. 复用的考虑应个体化 Dialyzers should not be reprocessed from patients who have tested positive for hepatitis B surface antigen. HBV阳性不应复用 Given the significant fall in dialyzer efficiency for urea removal that can occur after repeated uses of a dialyzer, dialysis prescriptions in units practicing reuse should be designed to deliver a Kt/V or URR value that exceeds the dose used for patients treated with single-use dialyzers to make allowance for any possible reuse-induced reduction in dialyzer efficienc