The Free Radical Elimination From Peracetic Acid in Reused Dialyzer By Ascorbic Acid
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Abstract
Peracetic acid sterilant for dialyzer reprocessing is a practical approach in patient receiving Hemodialysis. However, the substances may persist in the dialysis membrane despite the reused dialyzer undergoing a standard rinse procedure. The free radical-related diseases may occur for patients. Our objectives were to determine the in vitro residual levels of peracetic acid and their by-products hydrogen peroxide liberated from dialysis membranes after reprocessing process and explore the optimal dose of ascorbic acid in role of free-radical degradation. A dialyzer reuses (N=40) under the criteria in a maximum number of reuses were divided in control group (N=15) and five subgroups of sample with ascorbic acid injection in ranging from 3.9 - 500 mg (N=25). The complete dialyzer reprocessing with peracetic acid was rinsed by normal saline solution coupled with ultrafiltration on the hemodialysis machine to remove all traces of disinfectant. After termination of saline and dialysis fluid flows, amount of disinfectant was quantified by inspecting with peracetic acid and hydrogen peroxide test strip at selected time points (2 - 180 min). The control group found amounts of peracetic acid and hydrogen peroxide both in blood and dialysate compartments, which had significantly increased hydrogen peroxide values in a time dependent manner. In contrast, increased levels of ascorbic acid in sample group produced a concentration-dependent decrease in hydrogen peroxide production. Specifically, ascorbic acid 125 mg dramatically destroyed both residues until the residuals residing in both compartments has been cleared (P<0.001). The clinical practice guideline of reused dialyzer by 125 mg ascorbic acid upon dialyzer rinsing procedure may give rise to improve the quality of medical expertise for saving patient’s life.
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