An In-House Solution to Address a National Shortage of Dialysate (Video)

Areas hard-hit by the COVID-19 pandemic may be experiencing a decreased supply of dialysate solution bags, which are used in continuous renal replacement therapy. A low or threatened supply of dialysate may compromise care for patients with kidney disease who rely on dialysis.

Nearly 30 years ago, Cleveland Clinic began producing its own solution in-house using industry-standard technology. Today, Sevag Demirjian, MD, Director of Critical Care Nephrology in the Glickman Urological & Kidney Institute, and his team share step-by-step instructions for the in-house production of ultra-pure continuous hemodialysis fluid in the video featured below. This video was created to offer support and instruction to other healthcare centers that may be interested in producing their own dialysate solution:

A Quality Assurance process is integral in the production of ultrapure continuous hemodialysis solution, as outlined in this video. By way of example, Cleveland Clinic follows the below Quality Assurance protocol:

1. Dedicated one or two machines for production only and do not use for patient care.
2. Regularly disinfect and empty dialysate jug where the linse are placed during set-up.
3. Discard bagged solutions after 5 days.
4. Use bicarbonate solution, lines and filter only for 24 hours.
5. Disinfect machines daily.
6. Do chemical disinfection at least once a week.
7. Increase cycles to 40 minutes.
8. Draw monthly samples from the machines and randomly selected bags and send out for testing to meet Association for the Advancement of Medical Instruments ultrapure standards of 0.1 CFU/mL.

By using the information in this video and/or any other materials made available by Cleveland Clinic related to the dialysate solution, you agree to comply with and be bound by the terms of the Permissive Use Agreement, a copy of which is available here.