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Chapter 13.7 : Culture and Endotoxin Assay of Hemodialysis Fluids
Patients undergoing hemodialysis are at risk for the development of endotoxin-mediated pyrogenic reactions, gram-negative bacteremia with sepsis, and chronic inflammatory response syndrome. These events may be related to excessive levels of gram-negative bacillary contamination of the water and dialysate used for hemodialysis applications. This cause-and- effect relationship has led to the establishment of microbiological guidelines pertaining to the allowable levels of contamination in both the dialysate bath and dialysis water. These recommendations include frequency of monitoring and a list of methods considered acceptable for the performance of quantitative testing. Endotoxin testing is discussed in the appendixes at the end of this procedure because it is not routinely done in the clinical setting and is performed usually by renal reference laboratories.