臨牀透析 Vol.35 No.10(5)


特集名 在宅血液透析の勧め―円滑導入のためのノウハウ
題名 水質管理・機器の保守点検
発刊年月 2019年 09月
著者 大濵 和也 埼玉医科大学病院臨床工学部・医療機器安全管理責任者/埼玉医科大学保健医療学部
【 要旨 】 在宅血液透析(HHD)では医療施設で用いている透析装置を家庭へ設置して 治療を行っている.HHDは医療施設以外で施行されるが,装置管理責任は施設側にある.施設は水質管理から装置管理までの系統的管理が必要である.水質は原則,施設と同等の管理が必要であり,化学的汚染物質測定,生物学的汚染測定が必須となる.しかし,調査結果によると水質測定項目や頻度は施設ごとに大きく異なっている.また,機器管理において,日常点検はHHD患者自身が行うため,点検内容の患者教育を行う必要がある.一方,定期点検は機器の定量的な評価が必要で臨床工学技士や装置業者の訪問が必要である.使用環境によりさまざまなトラブルが起こりうるため,点検項目は添付文書の項目に加え,個別の対策が必要になる.
Theme Reconsideration of standard hemodialysis: What is the optimal prescription and management for each patient?
Title Water quality management and inspection of maintenance equipment
Author Kazuya Ohama Faculty of Clinical Engineering, Saitama Medical University Hospital/Medical Equipment Safety Manager, Saitama Medical University Graduate School
[ Summary ] The dialysis device normally used in medical centers and hospitals is installed at a patient's home to perform home hemodialysis (HHD). Although HHD is performed outside the hospital, the responsibility of equipment management rests with the facility associated with performing HHD. Systematic management includes a variety of tasks ranging from water quality to equipment management. Essentially, water quality needs to be managed as well as facilities, and it is necessary to measure the chemical and biological pollution standards. However, our survey results showed that the variables used to evaluate water quality and the frequency significantly differ across facilities. With respect to appropriate equipment management, it is necessary to educate patients regarding the essential components of inspection because patients undergoing HHD perform daily inspection of the equipment. Periodic inspection requires quantitative evaluation of equipment and requires visits by clinical engineers and contractors. Notably, various difficulties/technical issues may occur depending on the usage environment; therefore, inspection of equipment requires individual measures in addition to the measures listed in the document provided with the HHD machine.
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