MP771IN-HOUSE PREPARATION AND CENTRALISED DISTRIBUTION OF ACID DIALYSIS CONCENTRATE: CONSIDERATION ON A PRATICAL EXPERIENCE

Abstract

INTRODUCTION AND AIMS: Evolution of economy requires paying special attention to the cost and sustainability of the medical treatments, in particular for the chronic therapies.Therefore, it is important to focus the attempts of the caregivers on the activities able to generate the most favourable ratio of cost/benefit.During hemodialysis(HD)treatment,a basic and an acid dialysis concentrate are used.Making them available at the HD machine requires a considerable effort in terms of personnel workload and logistic.While the basic component of the HD fluid is usually provided from a cartridge of dry bicarbonate,the acid concentrate is classically supplied to the machine in liquid form contained in 5-ltr bags(Single Patient Dialysis Delivery,SPDD).However,the acid concentrate can also be made available to the HD machine via a Central Concentrate Delivery System(CCDS). METHOD(S): In our HD Unit(Bassano del Grappa-VI-Italy),we adopted an automated CCDS(Granumix Plus ,Fresenius Medical Care,Bad Homburg DE).This system is based on a fully automatic mixing unit that performs the dilution of a highly concentrated ingredient(Diamix )with HD water, and a storage and distribution unit to store the concentrate and distribute it to the HD machines via a dedicated tubing that runs in parallel to the HD water distribution line[fig.1].We evaluated 1-year impact of the CCDS on safety,environmental impact and cost-efficacy.We used CCDS in 85% of our patients(n.75)and reserved SPDD for patients that require peculiar HD treatments with personalized HD fluid composition(n.10).We recorded all HD-clinical related problems and calculated the amount of bags saved, the amount of saved hours of workload by nurse or HD staff and money saved in a 12 months experience. RESULT(S): No clinical,bath-related problems or adverse reactions has been recorded:inversely we reported a reduction of staff work-load,more space in our storehouse and a big money saved.A total of 11000 treatments/year were performed with CCDS in our center,- saving e 25220 for the avoided disposal of 11470 kg of plastic material and 7150 kg of concentrate residuals.Moreover,the movement/management of 59180 kg ofmaterial has been avoided with a considerable reduction of the operators and caregivers effort.This allowed amore time and focus of the caregivers to the care of patients.[Tab 1] CONCLUSION(S): CDS by Granumix Plus is a safe,"green"and cost-effective solution to simplify the preparation of the acid HD concentrate.CCDS can reduce costs and caregivers workload,storage and transport of the canisters/bags at the point of use,the disposal of empty plastic canisters or bags and the disposal of the possibly remaining part of the acid concentrate.