Foamings at drain site

[Lynda Smith]

Hi everyone, I wanted to ask if anyone could help me in trying to determine the cause of the foaming and frothing we have been and are continuing to experience at two of our relatively new clinics that have been open for a matter of months. Despite looking in to this with various collegues involved in the building and construction of the clinics in regards to drains and configuration, together with various other colleagues, I'm still struggling to know the exact cause of this phenomenon and therefore know how to resolve this particular problem.  

I would be most grateful of any thoughts from those of you who like me who have worked in the specialist area of nephrology for many years and although as a nurse, I have never seen or had any previous experience of this. I therefore wondered if there is anyone who could help in any way who may have seen this before.

Many thanks

Lynda Smith              

[Chris Pearson]

Hi Lynda,
Are you using any disinfectant chemicals during the heat disinfect cycle or disinfecting the drain line direct ?
If it wasn't present straight away when you opened the units there is a possibility that you have a complex biofilm building up in the open part of the drain, if so this is easily resolved,do you not have your own technicians .
BR
Chris

[Ian Wilde]

Hi Lynda,

We have similar issues at our sites too - although not quite the meringue that you have!

Is it always on a particular panel, particular patient?

One of our medics thought that it may be protein in the waste being whipped up like beating an egg?

[Lynda Smith]

Hi Chris,
Thank you for your reply - we use Clean Cart A weekly and Clean Cart C at the end of each day as well as a heat disinfectant in between times. We don't currently do anything specifically with the drains. It's difficult to know exactly when the foamings first started, I noticed it after about three months as I was down there undertaking Clinical Audits.

We don't have our own technicians, we buy the technical services in from our dialysis machine manufacturer.  

Thanks again, best regards

Lynda    

[Lynda Smith]

Hi Ian,

Thanks for your reply. yes the foaming has been particularly bad and has led to some overspill of foam and damaged the water media panel. This hasn't been associated with only one patient, it has included each and every patient in both clinics.

Protein in the effluent is a good theory as when people have proteinuira or protein in their urine, you see foaming and if it's coming out at pressure which it is it would cause foaming.

We have looked at the drains and the diametre and had extensions of wider tubing on the drains to see if it made a difference. Although it reduced the foaming lsightly, it was still very apparent.

Best regards

Lynda        

[Chris Pearson]

Hi Lynda,
It may be that the weekly sanitisation(A) and daily hot citric rinse(C) on their own without more aggressive "sterilants" isn't enough to knock back any colonisation in the drain collection section of the wall panels as the temperature in there will be quite low,is the collection area under the drain fluid entrance hole accessible to inspect and if necessary thoroughly manually disinfect ?

The only other example of foaming I have ever seen was in Stoke decades ago which turned out to be due to a new supplier of concentrate from Ireland and when they returned to their normal UK supplier it resolved the problem but not sure what the actual specific problem was.
Regards,
Chris

[Chris Eaton]

Another possibility with you saying these are newish instalations, is that of inadequate drain ventilation, this would cause minor air locks in the drain and possibly cause the problem you're experiencing. Think something similar happened here at Preston in the dim and distant past . I understand that additional air vents on the drain run alleviated the problem...

[Chris Pearson]

Did you manage to resolve it Lynda ?

[Chris Pearson]

I'm very disapointed to find that my that my latest completely innocuous remark has been deleted given that the OP hasn't even had the decency to respond to all the posters who took the trouble to try and help resolve the issue.
Am I the only one who would have been interested to know what the problem actually was and how it was resolved ?

[Ian Wilde]

Hi Chris,

I too am curious about the results of Lynda's problem as we suffer from it too but just seem to put up with it.

Lynda may not have had chance to reply due to reasons that may be unknown to us (ill health for example - hopefully not!)

You could always direct message her if you really want to which will drop her an email if Lynda hasn't had chance to return to the website for whatever reason.

Ian

[Chris Pearson]

Hi Ian

I understand that but still think that given the tiny number of respondents on the ART forum unless a post is any way offensive which mine was not they shouldn't be censored it will clearly put others off posting in future it certainly has me.

Best regards,

Chris Pearson

Director Sales and Marketing

Health Tec Medical Ltd

Unit 11,Hathersage Park

Heather Lane,Hathersage

S32 1DP,England

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On 7 Oct 2015, at 08:54, Ian Wilde [via ART Forum] <[hidden email]> wrote:

Hi Chris,

I too am curious about the results of Lynda's problem as we suffer from it too but just seem to put up with it.

Lynda may not have had chance to reply due to reasons that may be unknown to us (ill health for example - hopefully not!)

You could always direct message her if you really want to which will drop her an email if Lynda hasn't had chance to return to the website for whatever reason.

Ian

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NAML

[Ian Wilde]

Given your experience and knowledge in the field I hope the forum hasn't lost your input for future posts.

[Chris Pearson]

Had a look in a similar set up yesterday to check in a new unit due to open as I'd had an idea.
We always used to remove both of the valves in the drain hansen connectors in order both to reduce resistance and also so there wasn't residual drain fluid sealed in to grow bugs which could grow back up the drain line when stored.
Could it be that these male and female valves could cause the froth in the dialysate drain fluid,might be worth an experiment ?

[Ian Wilde]

I'd say there's nothing to lose from trying it Chris.

[Chris Bates]

Hi,
Most of our drain connections are open tubes which hook into the media panels and dribble into the drain hole. We get the foam quite a lot so I don't think the valves will affect this. I think it is just a property of dialysis waste when it is dropping from a height. It may be that some patients produce frothier waste than others too.
Chris

[Chris Pearson]

Hi Chris

Interesting that for some reason it seems to be quite widespread

Best regards,

Chris Pearson

Director Sales and Marketing

Health Tec Medical Ltd

Unit 11,Hathersage Park

Heather Lane,Hathersage

S32 1DP,England

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Office (Direct Line): [phone]

Fax: [phone]

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The information transmitted in this message is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material.  Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited.  If you receive this message in error, please contact the sender and delete the material from any computer.

 

On 30 Nov 2015, at 11:10, Chris Bates [via ART Forum] <[hidden email]> wrote:

Hi,
Most of our drain connections are open tubes which hook into the media panels and dribble into the drain hole. We get the foam quite a lot so I don't think the valves will affect this. I think it is just a property of dialysis waste when it is dropping from a height. It may be that some patients produce frothier waste than others too.
Chris

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[Chris Pearson]

Having had a few discussions with a couple of customers last week I think this fairly widespread problem may be being caused by using 5L vented bleach cans sat on the back of machines for extended periods with what could effectively be water in the can rather than bleach with apparently no testing to see if there is any chlorine in the machine during a clean cycle only that there isn't any residual post rinse.
BR
Chris

[Chris Bates]

Hi Chris,
I don't think this explains it.
We have never used bleach cleans at any of our locations and we still get the problem
Regards
Chris

[Chris Pearson]

Hi Chris,
Doesn't that actually reinforce the theory that it may be being caused by the lack of bleach cleaning post dialyser which is causing a build up of organic matter in the machine and drain lines ?
BR
Chris

[Chris Bates]

Err possibly, now I've read your post properly !