Acid concentrates leftovers ...

silvia corti's picture

Hi everybody,

please forgive my not-perfect English, I try to do my best. I am Italian and work in a hemodialysis ward since 10 years. My never-solved problem is what the hell to do with Acid Concentrates (with or without acetic acid) leftovers. It's been discussed in my ward, there was a time when we just used to pour it into the sink, but some collegues moaned about the smell and eventual side effects for health.  And now the hospital obliges us to put the bag with the leftovers and the used bicarbonate cartridges in a special bin which goes directly to the incineration ... isn't it crazy to burn a liquid thing??? Is there any kind of official study/documents/reccomendations in Your wards that allow and demonstrate the safety of pouring the concentrates down the sink?

I'll be thankfull for all your support and suggestions ... I read your posts and find this site very interesting!

Silvia

Comments

Perhaps ask on one of the

James Warham's picture

Perhaps ask on one of the larger forums.
As a home heamodialysis patient, unless dialysate runs out in a session there is a little left that is poured down the toilet.

The outer solid container is recycled.



Or perhaps a larger quanity for a short session of treatment.

I suppose a hospital equivalent would be to take the liquids to the sluice to be disposed of.

In the UK there is generally a 'dry' bicat/bibag system for treatment which is drained and then binned so there is little fluid residue.

Hope you find some answers.

James

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thanks James!

silvia corti's picture

thanks James!

may I ask you: which kind of machine do you use for the home treatment? it makes a big difference talking about my question ... if you use Nexstage system, there is not an acid concentrate, while if you use a "normal" machine that needs a water treatment (osmosis unit), then you surely use an acid concentrate ...

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I'm using a Fresenius 5008s,

James Warham's picture

I'm using a Fresenius 5008s, which is one of 2 machines offered by my hospital,  Shrewsbury. The second is the NXstage.

 I previously lived in London and dialysed with a Gambro AK series which again used a acetate.  

 

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thanks! I know perfectly both

silvia corti's picture

thanks! I know perfectly both Fresenius 5008 and Nexstage. We used to have an AK 200 Gambro in the past in my ward. And what again do you do with the acid leftovers of Fresenius 5008? Down the sink? And what with the Bibag bicarbonate leftovers? thank you again!!!

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Acid leftovers

Chris Stait's picture

Hi James and Silvia ,  am now a transplant but had used the Integra machine at home , and rinsed all the leftovers away to a home klargester and that was never upset by the acid!!

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sorry (and thanks!): what's a

silvia corti's picture

sorry (and thanks!): what's a klargester???

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Acid leftovers

Chris Stait's picture

A klargester is septic tank where our sewage goes ( we live in the countryside and not on main sewers  ) it enables anerobic decay and is "biologically active" but it withstood the discharge of acids post dialysis when washed down with water!!.. So the idea of burning it is absolutely crazy.. any town sized sewage works would not notice it at all  !!

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forgive me again and tell me

silvia corti's picture

forgive me again and tell me if I understood: this klargester collects all your sewage AND the acid concentrate leftovers like a normal sewer (in a bigger city) would do. do you still have contacts with the hospoital where you did your dialysis in the past? could you ask them how they treat the acid leftovers in the hospital setting? I think it's crazy to burn that kind of waste, but that's the procedure our hospital has set. I am trying to prove that there are no risk in pouring the concentrates in the sink ... but it's hard!

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acid/ bibag

Ben Wilson's picture

We use a combination of Artis, AK and 5008 machines on our unit. The residual acid from the cannisters is poured away down the sluice and the bibag/ bicarts are drained by the machine and added to the clinical waste. For our HHD patients we encourage them to use up all of the acid over a couple of sessions rather than throw it away unnecessarily- the bibags are just single use however

Hope this helps

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thanks!!!

silvia corti's picture

thanks for your help, I've got some question for you:

- have you got an official procedure/guideline in your ward that describes your practice about waste management as you explained? who pours the acid concentrates down the sluice (nurses, assistants ...)?

- for Artis you use Softpac acid concentrate, don't you? and  Dialyfree for 5008? and again Softpac for AK?

- the re-use of bags for more than 1 treatment is interesting, but there's a clear sign on the bag that doesn't permit it, even though it's something so clever! If you ignore it, why don't use more than ones the bibags/bicarts too?

- if I understood: you throw the used bibag/bicarts on the clinical waste. Why??? It's not something infectious. Why don't you put it into the urban waste?

Thanks again and forgive my not-perfect English!

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I'll try and address the

Ben Wilson's picture

I'll try and address the questions one by one

We don't have anything official about the disposal written down. The nurses or the clincal support workers will tip the acid down the sluice (whoever strips the machine)

We use Fresenius 6 litre acid bottles (A325, A331, A224 & A325) for all our machines. For the bicarb we use 'BiBag' for 5008 and 'BiCart' for AK 200/ Artis

In centre we do not re-use either Acid or Bicarbonate- they are single patient use strictly and the remainder of any acid- no matter how little has been used- will be discarded in sluice if a patient has used the machine. For home HD patients we ask them to re-use their acids as most patients do 2-3 hours 5-6 days a week so it saves massive wastage. They do not re-use their BiBags they are purely single use only

You are correct the BiBags don't need clinical waste but the unit is cramped and we have limited space for bins so we have clinical waste and recylcing bins only at present as we have very little 'urban waste' that needs processing and it was a case of choosing the least-worst option. As and when the unit is relocated we will re-visit our waste management.

Cheers Ben

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