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Technical Bulletin: Free Chlorine, Combined Chlorine and Total Chlorine in Hemodialysis
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Dan Morris, Ph.D. - 2002
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Purpose of this Bulletin
To define the various forms of chlorine encountered in the treatment of water used for Hemodialysis and report on the AAMI guidance for testing treated water for chlorine and chlorine compounds.
Definition
Chlorine is defined in ANSI/AAMI RD61:2000 as “dissolved molecular chlorine” (1). Combined chlorine is defined as “chlorine that is chemically combined, such as in chloramine compounds” (1). Total chlorine is the sum total of the free and combined forms of chlorine.
Chlorine and chloramine can damage Reverse Osmosis membranes and are harmful to dialysis patients. Carbon absorption media are used to remove chlorine and chlorine compounds (2). Monitoring of the capacity of the carbon adsorption bed is essential and test kits or some means of determining removal capacity of the carbon adsorption bed are recommended (3). According to Guidance Document ANSI/AAMI RD62:2001, a single test for total chlorine may be used (4). When a total chlorine test is done, the maximum allowable concentration is 0.1 mg/L total chlorine (4).
Chlorine and chloramines are present in public water supplies because they are added for disinfection purposes (2). In certain places only chlorine is added to the public water supplies. However, even in these places, chloramines should be tested. This is because chloramines can form naturally from the combination of rotting vegetation and chlorine (2).
The following products are used to test for chlorine:
References:
- ANSI/AAMI RD61:2000, Concentrates for Hemodialysis, in AAMI Standards and Recommended Practices – Dialysis, 2001 Edition, p. 50.
- Rebecca L. Amato, Clinical Symptoms of Inadequately Treated Water, in AAMI Standards and Recommended Practices – Dialysis, 2001 Edition, p. 252.
- ANSI/AAMI RD5:1992, Hemodialysis Systems, Appendix B, in AAMI Standards and Recommended Practices – Dialysis, 2001 Edition, p. 37.
- ANSI/AAMI RD62:2001, Water Treatment Equipment for Hemodialysis Applications, in AAMI Standards and Recommended Practices – Dialysis, 2001 Edition, p. 84.
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