sop hemodialisa - parameter ro dan airbersih

8/10/2019 SOP Hemodialisa - Parameter Ro Dan Airbersih

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Water treatment

UNSUR Filter filter Softener RO

SEDIMEN CARBONAluminium v

Arsenic v

Barium v

Cadmium v

Calcium v v

Chloramines v v

Chlorine v v

Chromium v

Copper v

Fluoride v

Lead v

Magnesium v v

Mercury v

Nitrate v

Potassium v

Selenium v

Silver v

Sodium v

Sulfate v

Zinc v

VIRUS v v

PENCEMARAN v v

ENDOTOXIN v

BACTERIA v

PARTICLES v v

STANDARD AIR Cairan Dialisis

Dapat hidup Endotoxin Dapat hidup EndotoxinEuropean Pharmacopoeia (1997) < 100 < 0.25 IU/ml n.s n.s

German Dialisis standard (1993) < 200 n.s < 2.000 Bebas pyrogen

Japanese society for dialisis (1995) n.s n.s


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Akibat yang terjadi jika Air RO tercemar :

NO Tercemar Keadaan Akut Keadaan kronis

1 Aluminium Neurological symptoms Dialysis dementia, osteomalacia

Aplastic bone disease

Abnormal myocardial function

Anemia

2 Aromatic hydrocarbons ? Carcinogen ?

3 Arsenic ? Contribution to uremic symptoms and

neurological damage discussed4 Barium ? ?

5 Cadmium ? Contribution to Anemia

6 Calsium Hard water syndrom : Weak progressive lethargy , weaknessNausea , Hypertensi , Headache ,

Confusion , Seizures , memory loss,

Judgment defect

7 Chloramines Hemolysis , methemoglobinemia Vomiting, Hypotensi , Lethargy , death

8 Chlorine Oxidative blood damage ? Via generation of chloroform :

Ability to form chloramine Carcinogen ?

9 Copper Hemolysis , fever Metallic taste , gastrointestinal discomfort

refractory hypotensi , liver damage

10 Chromium ? ?11 Fluoride Nausea , vomiting , arrythmias , tetany Osteomalacia, osteoporosis

Hemorragic petechiae , ventilatory effort ,

Cardiac arrest, hypocalsemia , hyperkalemi

Acidosis

12 Formaldehyde Hemolysis ?

13 Iron ? ?

14 Hydrogen Peroxide Hemolysis ?

15 Hypochlorite Hemolysis ?

16 Lead Colic, Obstipation, vomiting, Nervous system disorders , anemia

Nervous system disorders

17 Magnesium Hard water syndrom : Burning skin sensation18 Mercury ? ?

19 Monochloramines Methemoglobinemia ?

20 Nitrate , nitrite Hemolysis , methemoglobinemia ?

21 Nitrosamine ? Carcinogen ?

22 Peracetic Acid Hemolysis ?

23 Pesticides ? Polyneuropathy ?

24 Potasium Hyperkalemia : Bradyarrythmia ?Hypokalemia : Tachyarrythmia

25 Selenium ? ?

26 Silicon ? Contribution to neuropathy

Bone and chest disease , anemia

27 Silver ? ?

28 Sodium Hypernatremia: hypertensi HypertensiSevere : intracellular dehydration Augmented interdialytic weight gain

( nausea , vomiting, disorientasi , coma )

Hyponatremia : Hypotensi

Severe : Water poisoning

( Cerebral edema , hemolysis )

29 Sodium Azide Hypotensi , Blurred vision Neurotoxic

Abdominal pain , headache ( damage in the white and grey matter )

Loss of consciousness

30 Sulfate Nausea , vomiting , arrythmias , tetany ?

31 Zinc Hemolysis Anemia , nausea , fever


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Water Quality in hemodialysis 1998, vol 1


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KUALITAS AIR RO KUALITAS AIR BERSIH

Parameter AAMI European Parameter StandardPharmacopoeia AIR BERSIH

Unsur yang terkandung dalam cairan dialisis Sifat fisik :

Calsium 2 ( 0.1 mEq/l ) 2 Keadaan -

Magnesium 4 ( 0.3 mEq/l ) 2 Bau -

Potasium 8 ( 0.2 mEq/l ) 2 Rasa -

Sodium 70 ( 0.3 mEq/l ) 50 Suhu 0C Udara

Kekeruhan NTU 25Unsur yang mengandung RACUN Warna Pt-Co 50terdapat dalam AIR MINUM

Arsenic 0.005 - Sifat kimia:

Barium 0.01 m - pH 6.5 - 9.0

Cadmium 0.001 - Jumlah zat padat mg/l 1500

Chromium 0.014 - Karbon dioksida bebas -

Lead 0.005 - Alkalinitas

Mercury 0.0002 0.001 a. Phenolpthalin mg / l -

Selenium 0.009 - b. Total mg / l 500

Silver 0.005 - c. Hidroksida mg / l -

d. Karbonat mg / l -Unsur lain yang mengandung RACUN e. Bikarbonat mg / l 500

terdapat dalamDIALISIS Kesadahan mg / l 500Almunium 0.01 0.01 Kalsium mg / l -

Ammonium - 0.2 Magnesium mg / l -

Chloramines 0.1 - Besi 1.0

Free Chlorine 0.5 0.1 Mangan 0.5

Chloride - 50 Almunium -

Copper 0.1 - Nitrit 1.0

Nitrat 10

Angka Permanganat 10

Fluoride 0.2 0.2 Khlorida 600

Nitrate 2 2 Sulfat 400

Sulfate 100 50

Zinc 0.1 0.1

Logam berat - 0.1

Standard AAMI menggunakan nilai maximum

mg / l = ppm

CFU : Colony Forming Units

IU : International Units

Water Quality in hemodialysis, 1998 vol 1

AAMI : Association for the Advancement Of Medical Instrumentation

sop hemodialisa - parameter ro dan airbersih

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