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Dialysis Machine Review

Cairns Regional Council Plumbing Inspectors were asked by the Queensland Health,
    Cairns, Building Engineering and Maintenance Services (BEMS), Plumbers to review
    the plumbing requirements for the installation of Dialysis Machines into private
This review was instigated due to a new type of machine, the new, NxStage, System
    One, now being installed in addition to the previous system.
The new system is more portable allowing the Client to move more freely around the
    home and allows them to travel with minimal disruption, thus improving their quality of

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                       OLDER STYLE OF MACHINE
                       Requires permanent plumbing

                       NEW MACHINE
                       No permanent plumbing
                          connections required

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New machine in portable setup

                                            •   Allows for travel
                                            •   Dialysate mixture can be pre-
                                                ordered to arrive into the next
                                                town in travel itinerary (no
                                                dependency on water supply)
                                            •   Increased quality of life for client

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Old Machine – Water & Wastewater Connection

                                        •   Twin Cartridge Filter
                                        •   Twin Carbon Filter
                                        •   Permanent connection to water
                                        •   Dual Check Valve required – AS
                                            3500 Pt 1 – Table F1
                                        •   Water supply must be on whilst
                                            treatment is in progress
                                        •   Machine makes up Dialysate
                                            during treatment.
                                        •   Waste is permanently connected
                                            via tundish – Sanitary Plumbing
                                        •   Around 600 litres per treatment

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New Machine – Water Connection

                                       •   Integral Cartridge Filter supplied
                                           as part of unit – only filtration
                                       •   Line strainer & Dual Check Valve
                                           supplied & fitted by BEMS
                                       •   Dual Check Valve required – AS
                                           3500 Pt 1 – Table F1
                                       •   Machine makes up Dialysate into
                                           60 litre bags. Water supply is then
                                           disconnected. – machine now able
                                           to be moved around the house
                                           independent from water supply for
                                           3 treatments

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New Machine – Waste Connection

                                    •   The wastewater from these machines
                                        is clear, however, preferred point of
                                        discharge is not to waste fixtures.
                                    •   The waste is a low velocity pumped
                                    •   This trial the waste is discharged to a
                                        WC. No sanitary plumbing work
                                    •   BEMS have devised an adaptor that
                                        discharges over the WC
                                    •   This method was adopted to suite all
                                        applications – Some clients look after
                                        the equipment better than others
                                    •   A non-return similar to a waterless trap
                                        is installed in case of surcharge of the
                                        pan (in lieu of an air gap)
                                    •   These machines only discharge 20
                                        litres per treatment

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New Machine – Waste Connection

                                The new machines are cleaned
                                   manually by using a syringe.
                                By using this method there is no risk
                                   of any backflow contamination of
                                   the water supply as there is no
                                   direct connection to the water
                                Queensland Health provide extensive
                                   training to their client prior to
                                   installation of the unit into the
                                   client’s home.
                                This ensure that any health issues
                                   about infection etc are minimised.

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All Machines – Water Quality

•   Queensland Health test samples of the water supply from each individual
    dwellings prior to commissioning of the unit to ensure the water quality is
    suitable for dialysis treatment.
•   If a client moves to a different premises, the water from the new dwelling is
    tested as above.
•   This means that despite the entire new unit is reasonably easy to transport,
    Queensland Health does not condone connecting the unit to any water
    supply other than a trusted site.
•   As previously mentioned, when the new units are used for travel, the Client
    arranges for pick up of the Dialysate mixture from Qld Health Centres along
    their travel route.

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All Machines – Legislation – Australian Standards

ISSUE                  LEGISLATION    SECTION          COMMENT

Backflow Prevention    AS/NZ 3500.1   Table F1         Dual Check Valve fitted

Line Strainer          AS/NZ 3500.1   12.3 (a)         Line strainer fitted

Water Quality          AS/NZ 3500.1   12.2 – Note 1.   Qld Health tests water supply to all new installs.
                                                       Portable Units use Dialysate pre-prepared by Qld Health

Utility Operator       AS/NZ 3500.1   12.2 – Note 2.   Qld Health notifies Cairns Water Operations upon installation
      Notification                                          of all units
                                                       There is no need to notify other Utility Operators when
                                                            travelling with Portable Units as water supply is not
                                                       The risks involved with unplanned shut downs of the water
                                                            supply is minimised with the new machines, as the
                                                            Dialysate is pre-made for 3 treatments.

Meter Identification   AS/NZ 3500.1   12.5             Qld Health Plumbers to spray meter Blue

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All Machines – Legislation – Plumbing & Drainage Act

ISSUE                  LEGISLATION   SECTION          COMMENT

Water Supply &         P&D Act       119              All permanent connections to the water supply and
Sanitary Plumbing                                     sanitary plumbing & drainage must be performed by a
Installation                                          licensed plumber. (Max penalty 165 Penalty Units -
Approvals – Old        P&D Act       81               Due to the extent of the permanent connections to the
Machines (new                                         water supply and sewer, a Form 1 for Compliance
installs)                                             Assessment of the work will be required
Approvals – New type   P&D Act       Various          As a control valve is the only plumbing work involved
machines                                              and is often teed off existing fixture service pipes and no
                                                      connection required to the sanitary drain, it would be
                                                      unreasonable to request a form 1 & fees.
                                                      Due to the minor nature of the work, CRC will accept a
                                                      Form 4. This will notify the Council of the work

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All units to be supplied with a permanent connection to water supply with a
    control valve inline strainer and dual check valve.
Wastes from the new installations of the Old Machines to discharge to a
    trapped tundish directly connected to drain or a stack (not to Floor Waste
Wastes from the New Machines to discharge over a WC Pan via the adaptor
    developed by BEMS. The performance of this adaptor is to be monitored by
    BEMS and any modifications to be assessed by the Plumbing Inspectors.
Queensland Health continue to provide training for their clients on these
    machines prior to installation in their homes

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Photo Gallery

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Photo Gallery

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Photo Gallery

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