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A project to develop a transportable dialysis crash cart system. (New Products).

Natural disasters and wars have demonstrated a prevalent need for a portable, resilient, and self-sufficient system able to perform dialysis treatments. Given the limitations and expense of transporting dialysis equipment, it is necessary to develop a standard method to deliver dialysis as part of a humanitarian relief effort. To date there is no such system available. In the past, relief efforts have proved ineffective in delivering dialysis treatments to victims of acute renal failure, particularly in settings outside of a normal hospital environment. This has been due largely to a dependence of dialysis treatments on a pure water supply; however, in a disaster zone, this pure water supply cannot be assumed to exist.

A project to develop a dialysis system that would be transportable, durable, and completely self-sufficient in its ability to produce dialysate from a local water supply was sponsored by the University of California, San Diego (USDC) Medical Center, Dr. Ravindra Mehta, and Dr. Amit Sharma. Dr. Mehta was the originator of the idea. Engineering instructors for the project were Professor Jerry Tustaniwskyj and Professor Nate Delson, USDC Department of Mechanical and Aerospace Engineering.

Statement of Requirements

The dialysis crash cart system must be able to perform dialysis treatment in all types of emergencies and in any type of environment. It must be ready to provide continuous renal replacement therapy (CRRT) to patients of acute renal failure in a disaster or war area. Since this system needs to be entirely independent, with the exception of an available water source and gasoline supply, the crash cart has several key functional requirements that include the ability to:

* be self-sufficient electrically;

* completely purify water;

* produce bags of sterile dialysate fluid;

* contain all medical supplies needed for dialysis treatment; and

* be transportable via air, ground, and sea.


The complete dialysis crash cart system is the main deliverable item of this project. However, within the crash cart system there are several deliverable subcomponents. The assemblage will contain one functional portable dialysis system that includes:

* a water prefiltration system, including a carbon activated filter and pre-filter;

* an electric water heater;

* water pumps, PVC tubing, valves, and fittings fully assembled;

* a reverse osmosis filtration system;

* an endotoxin removal column;

* a DiaPure Dissolution System[R];

* DiaPure concentrate bags;

* saline, calcium chloride, sodium citrate needed as replacement fluids during treatment;

* all other medical disposables;

* the Baxter BM-11[R] dialysis machine; and

* a specially designed cargo container that will house all of the equipment divided into removable stationary sections.


The project had two main objectives. The first goal was to completely integrate various pieces of equipment so that the end product would be filled bags of dialysate base solution suitable for use with patients. The second goal was to design a container that would house all of the equipment and supplies that would be needed for dialysis treatment. This container had to be designed in such a way that all of the dialysate producing equipment would be ready to be operational upon arrival at the location.

The dialysis crash cart will incorporate a water filtration system that will produce medical quality water. This water will be used to produce dialysate from prepackaged bags of dry powder using a dissolution system that will monitor the concentration of the dialysate. The dialysate base solution will then be used for CRRT using a small portable dialysis machine and appropriate pumps. The dialysis crash cart is designed to be self-sufficient in its electrical production; therefore, a generator will provide power for all components. All of these components, their peripherals, and other medical equipment and disposables necessary for the dialysis treatment are in a specially designed, compartmentalized, shock-resistant, waterproof container. Once at the desired location, the dialysis crash cart will be easily and quickly set up, self-sufficient in its water and energy needs, and usable regardless of the environment provided that there is some source of water and gasoline to run the generator. This design will ensure that all of the necessary equipment is available to the medical professionals who are responsible for the health and welfare of patients who have suffered renal failure.


Overall, the dialysis crash cart project was a success. The project goals were met on time and under budget. The water filtration system and the dialysate making system were both integrated and ran properly. A container prototype was also developed that would transport the entire crash cart system as one independent unit with the ability to treat 10 CRRT patients for 1 week (7 days) before extra supplies would be needed. The entire crash cart system is an accomplishment due to the fact that it is a completely self-sufficient dialysis system; no other equipment need be supplied. The only things not included in the system are a water and gasoline supply.

This project was intended to demonstrate the feasibility of the dialysis crash cart. It was in no way intended to be the final prototype or design. That is why once the initial container was built, the design team saw ways to improve the container, and those have been included in the final report. The next step is to find the money to actually build a full-scale container and test the system in a true field environment. The difficulty with the system is that technology changes so fast that the equipment used in this project may be obsolete in 5 years. Therefore, as long as the feasibility of the cart could be established, the final design could be constructed with the appropriate pieces of equipment.

When the final dialysis crash cart is built, it will be an extremely important system that doctors can use in disaster zones. It has been proven that providing quick and effective dialysis treatment to victims can save lives. It is the belief of the design team that the dialysis crash cart will be able to provide that type of treatment in a quick and organized manner, thereby reducing the loss of life that can occur following a disaster.

For more detailed information on the dialysis crash cart, visit prev/spring2000/dalysis/Dialysis%20 Crash%20Cart.htm

Note: Portions of this text were taken from the UCSD web site. The complete address is at the end of this article.
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Publication:Nephrology Nursing Journal
Geographic Code:1USA
Date:Oct 1, 2001
Previous Article:Patient education about self-assessment of need for dialysis and the use of Kayexalate[R]. (Clinical Consult).
Next Article:Disaster Preparedness for Dialysis Facilities. (Disaster Planning).

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