Document Detail


Dialyzer reuse-Part I: Historical perspective.
MedLine Citation:
PMID:  16423181     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The first apparatus for hemodialysis in animals, made painstakingly by Abel et al. in their laboratory at the beginning of 20th century, was cleaned with acid-pepsin to digest blood, disinfected with thymol, and reused for up to 30 experiments for as long as 8 months. The obvious incentive was saving time. In the early years of hemodialysis in patients, dialyzers and lines were assembled and sterilized immediately before dialysis. Various methods of dry and moist heat sterilization and miscellaneous chemical agents were employed for disinfection. Significant time was required to assemble the dialyzers, so there was an incentive to reuse previously assembled dialyzers to save time, especially for home hemodialysis. Bleach to clean and formaldehyde to disinfect the membranes and lines was used for this purpose. Preassembled dialyzers, commercially introduced in the 1950s, were the most expensive components of hemodialysis systems, therefore reprocessing of these dialyzers was the most effective way to save money. Refrigeration of coil dialyzers with blood, introduced in the mid-1960s, was associated with frequent febrile reactions and was soon abandoned. Preassembled coil and plate dialyzers permitted almost complete return of blood after dialysis and led to the introduction of chemical disinfection for dialyzer reprocessing. A variety of disinfectants have been used. Formaldehyde was the most common disinfectant until the end of the 1970s. Sodium hypochlorite was used to clean the majority of dialyzers and to sterilize dialyzers with polyacrylonitrile membranes. In the early 1980s, peracetic acid and glutaraldehyde started to compete with formaldehyde. By the 1990s, formaldehyde had become less popular than peracetic acid. In the mid-1990s, disinfection and membrane cleaning with acetic acid and heat was introduced. Manual reprocessing was replaced by early reuse machines in the mid-1970s and a more sophisticated second generation of automated hemodialyzer reprocessing machines followed in the late 1970s. Recently disinfection of dialyzers with moist heat has resumed. Saving both time for the patient and money for the provider were the main motivations for designing a new machine for daily home hemodialysis. The machine, developed in the 1990s, cleans and moist-heat disinfects the dialyzer and lines in situ so they do not need to be changed for a month. In contrast, the reuse of dialyzers in home hemodialysis patients treated with other hemodialysis machines has become less popular and is almost extinct.
Authors:
Zbylut J Twardowski
Publication Detail:
Type:  Historical Article; Journal Article    
Journal Detail:
Title:  Seminars in dialysis     Volume:  19     ISSN:  0894-0959     ISO Abbreviation:  Semin Dial     Publication Date:    2006 Jan-Feb
Date Detail:
Created Date:  2006-01-20     Completed Date:  2006-08-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-53     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, University of Missouri, Columbia, Missouri 65203, USA. twardowskiz@health.missouri.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Disinfectants
Equipment Design
Equipment Reuse
Formaldehyde
History, 20th Century
Humans
Renal Dialysis / history*,  instrumentation*
Chemical
Reg. No./Substance:
0/Disinfectants; 50-00-0/Formaldehyde

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Lipid abnormalities associated with end-stage renal disease.
Next Document:  Leptin and renal disease.