Total Water

Dialysis Water Treatment Technologies

Each Total Water 510(k) dialysis water system is custom engineered for the current and future needs of our customers. Total Water's individual tank regeneration process is designed to provide our customers medical grade traceability with each deionizer. Put our knowledge and products to work for you.

Total Water can design and install a system utilizing existing and emerging technologies to give you the water quality to meet your standards.

• Carbon Filtration
• Reverse Osmosis
• Ultrafiltration
• Deionized Water Systems
• Ultraviolet TOC Reduction
• Ultraviolet Disinfection Systems

Single Patient (Acute) Treatments

• Portable Exchange Deionizers
• Portable Reverse Osmosis Units

Solution Delivery Equipment

• Acetate Central Feed
• Bicarbonate Central Feed

Why do we need purified water for dialysis?

Because the patient's blood and dialysate are separated only by a thin semi-permeable membrane, the quality of dialysis water and the dialysate is very important. The average person drinks approximately 14 liters of water a week. On average, dialysis patients are subjected to 360 liters of water per week.

What is dialysate?

Dialysate is a mixture of purified water, acetate and bicarbonate. The dialysate is approximately 95% purified water.

What is Hemodialysis?

During hemodialysis, blood from the dialysis patient flows through one compartment of an artificial kidney (dialyser), while an isotonic salt solution (dialysate) flows in a countercurrent manner through another compartment. A thin semi-permeable membrane separates the two compartments, allowing metabolic waste products in the patient's blood to diffuse across the membrane into the dialysate and to be discarded with the dialysate to drain.

What does 510(k) mean?

Any manufacturer that wants to market a new medical device or obtain premarket clearance of a substantial equivalent device must submit a 510(K) premarket notification to the FDA (Food and Drug Administration). Total Water Treatment Systems 510(K) number is K002045.

Typical Dialysis Water System Requirements

Backflow Prevention

Backflow prevention is incorporated to insure the integrity of a potable water system. In the event a treated water system reverses flow, the backflow preventer will divert the treated water to drain insuring the integrity of the potable water feed. Backflow prevention should be installed to meet state and local requirements.

Temperature Mixing Valve

A temperature mixing valve mixes the cold and hot incoming water feed to approximately 77 degrees F. Advantage - A reverse osmosis membrane is most efficient with a 77 degree F water feed. Disadvantage - Loss of cold or hot water supply pressure will cause the mixing valve to shut off its outlet and consequently shut down the dialysis water purification system.

Water Softener

Water softening, with the use of ion exchange, removes positively charged ions (calcium, magnesium, and heavy metals) from the incoming water supply. The positively charged ions are replaced with sodium ions. The main function of a water softener in a dialysis water purification system is to protect and extend the life of the reverse osmosis membranes. The two styles of water softeners normally used in a dialysis water purification system are: single and duplex softeners.

Carbon Filtration

Carbon filtration is used to remove chlorine, chloramines, and low molecular weight organics through the process of adsorption. Adsorption is the process by which a vapor, dissolved material or very small particle adheres to the surface of a solid. Carbon filtration capacity is commonly sized for the empty bed contact time (EBCT) required to remove chlorine and chloramines from the supply water. AAMI standards for EBCT is 6 minutes for chlorine and 10 minutes for chloramines removal. Carbon beds should be installed in a worker-polisher configuration with test ports installed at the output of both carbon beds. AAMI recommends a test for free and total chlorine is conducted prior to every patient shift.

Reverse Osmosis

A reverse osmosis unit used for dialysis should be equipped with the following:

• 5-micron prefiltration
• Pressure readings
• Flow readings
• Temperature monitor
• Conductivity water quality monitor equipped with visual and audible alarms

Distribution System

The distribution system is the piping and valves used to convey the purified water from the water treatment area to the individual dialysis station. Distribution piping is installed in a direct feed or indirect feed style. A direct feed system utilizes the reverse osmosis pump to supply the distribution piping with purified water. An indirect feed system utilizes a storage tank and distribution pump to supply the distribution piping with purified water. Materials that have been used for dialysis water distribution systems include polyvinyl chloride (PVC), natural (non-pigmented) polypropylene, stainless steel and glass. PVC is usually the material of choice for dialysis water distribution systems.

Storage Tank

A storage tank should be made of an inert material and opaque in color. It should be of a sealed-top/coned-bottom design. The tank should also have a hydrophobic vent filter to control airborne bacteria from entering the tank.

Deionization

Deionization is normally utilized in a dialysis water purification system for the following reasons:

• To provide the best quality water for dialysis
• Emergency bypass in the event of RO failure
• Bacteria control when cation and anion resins are separated
• To polish the reverse osmosis water
• To polish the distribution loop return water before it goes out to the dialysis stations

Ultraviolet Disinfection

UV disinfection is utilized in a dialysis water purification system for bacteria control. Final filtration should be utilized at the output of the UV disinfection unit.

Final Filtration

Final Filtration of 0.05-micron or smaller is recommended for bacteria and endotoxin control. The final filter or ultrafilter should be the last component the purified wate passes through before going out to the dialysis stations.

Remote Alarms

The water purification system should be connected to a remote alarm located adjacent to the clinic nurses station. The remote alarm should alarm both audible and visually. The remote alarm should be customized to the water purification system.

System Monitoring

The dialysis system monitoring should include a daily check-off sheet, chlorine and chloramines testing, bacteria testing, and endotoxin testing.

System Sanitization

Sanitization should be based on bacteria testing and a preventative maintenance schedule. The most common system sanitization chemicals are chlorine and Renalin.

Free Water Analysis and Consultation

Total Water's certified water experts can assist you with your water treatment needs. We can answer any questions, concerns, provide different options, quotes, service info or anything else you might need. Just tell us a little about yourself to request a consultation.