RO System Distribution Loop

Indirect Feed vs Direct Feed

Fresenius Medical Care South Asia Pacific

Rubin Frost
Regional Director
Technical Services & Water Solutions

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 1
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 2
 Distribution Loop

Definition & Configuration

Flow velocity > 0.45 m/sec
• Definition
– The distribution loop is the physical
means for the delivery of purified
water from the purification
equipment to the dialysis equipment

• Configuration

– Direct feed
• Purified water is delivered from RO
Unit to HD equipment
• Required flow velocity >0.45 m/sec

– Indirect feed
• Purified water is delivered from RO
Unit to a storage tank and from Flow velocity> 0.90 m/sec
storage tank to HD equipment
• Required flow velocity >0.90 m/sec

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Distribution Loop

Choice for system configuration depends on:

• Purity of water required

– Must not degrade water quality achieved during purification processes
• Amount of water required
– Delivers purified water at appropriate pressures and flow rates
– Dependent on number of machines
• Choice of material depends on:
– Cost
– Availability
– Inertness to chemicals
– Lifespan of material

• Materials not to be used include:

– Brass, Copper, Aluminum and Zinc

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 Distribution Loop

Acceptable Materials
Inertness
No. of Risk of Resistance Life
Material Description Cost Installation Availability to
fittings stagnation to heat span
chemicals

PVC Polyvinyl 5 – 10
Low Medium High High Easy Yes No
Type 1 chloride years

Acrylonitrile
Medium 10
ABS butadiene Medium High High Medium Yes No
years
styrene

Polypropylene 10
PP-R High Medium High High Difficult Yes Yes
Random years

25
SS Stainless Steel High Difficult Low Low Difficult Yes Yes
years

Cross-linked 15 – 20
PEX Low Easy Low Low Easy Yes Yes
Polyethylene years

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 Distribution Loop
Design suggestions Comments
• Reduce elbows and fittings • ABS, PP-R, and PVC require
during installation many fittings, increasing the
risk of bacterial contamination
• Only install machine connections • Each connection is a risk for
that are required stagnations

• Fresenius Medical Care • PEX is flexible – meaning less

recommends opaque PEX fittings required and can be
(RAUPEX) installed quickly

• Min. 6 monthly chemical • More frequent disinfection is

disinfection recommended

• Weekly heat disinfection is • Heat disinfection is a preventive

recommended if system is measure
capable

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 Distribution Loop - Disinfection

Chemical Disinfection Heat Disinfection (>85°C)

• Reactive measure • Proactive measure

• Frequency: 6 monthly • Frequency: weekly

• Eliminates existing bacteria • Prevents bacteria growth

• High risk if biofilm • Low risk of biofilm

• Chemical is not environmental friendly • Environmental friendly

• High risk to operator • Low risk to operator

• Manual process, requires manpower • Automated process

• Longer process as chemicals need to • Shorter process – only cool down

flush out required

• Lower initial cost • Higher initial cost

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 7
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

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 Pro’s & Con’s of Indirect Feed

Pro’s Con’s
• Smaller Reverse Osmosis (RO) • Dialysis Water no longer purified
Systems could be used, avoiding • Disinfection and maintenance is
peak load periods more difficult and often impossible
• Water saving, as RO stops when • Higher power consumption due an
Tank is FULL -> no Reject to drain extra pump

• Dialysis Water buffer if: • Poor tank designs may lead to:
– Stagnation
– Raw water supply is unreliable – Contamination (inadequate air
– RO System is unreliable filter)
– Biofilm
• Longer Distribution Loop can be
• No patient protection if Dialysis
installed
Water out of specification (no
• RO System can be located on direction to drain)
different floors (more than 1) • Higher risk of Bacterial
contamination

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 9
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

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 Storage Tank Requirements

Spray Ball mechanism

to eliminate stagnation
& ensure complete Sealed Lid with
disinfection of tank adequate air vent

Automatic disinfection Sealed Overflow in

program case of malfunction

UV Disinfection Lamp,
Properly sized lamp replaced every
Bacterial filter on year
water outlet.
Small undersize filter
housing and filters
suffer from pressure
loss and bypass issues

Please note: Conical or bowl shape

Filters do not prevent
endotoxins from Drainage from lowest
entering the system, point
UV radiation is
required

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 Storage Tank - Pitfals

Experience for the Field

• Storage Tank does not conform with
ISO26722
• Poor design & installation of Storage Tank
• Very difficult to disinfect Tank connection
pipe This pipe was
• Inappropriate filter used or not replaced originally see
regularly through!

Please note: If UV monitor is used, it needs to be a This filter was

calibrated ultraviolet intensity meter, the minimum installed in a
dose of radiant energy should be at least 16 mW Purified Water
sec/cm2 Storage Tank and
Easier and more economical is to replace the lamp this water was
as per the manufacturers guidelines (12 monthly) send to HD
machine!

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 12
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

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 Pro’s & Con’s of Direct Feed

Pro’s Con’s
• Patient Safety as Dialysis Water is • RO System must be sized to fulfil
constantly monitored & sent to max. demand
drain if unsuitable
• Continues purification of unused • Higher water consumption due to
Dialysis Water continues reject to drain (not with
• Reduced risk of bacterial MX Eco)
contamination • If RO System is unreliable, all
• Easy to disinfect as Loop & RO are dialysis stops as there is no buffer
disinfected together
of purified water
• Faster flush out of chemicals
– Tank Buffer only lasts for ~1 hour
• Additional protection against
bacterial contamination if RO is • Distribution loop length limitation
equipped with UV sterilizer • RO System must be located on the
• No need for an extra recirculation same floor (+ 1) as the dialysis
pump unit

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 14
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 15
Distribution Loop Examples

Direct Feed (PEX)

Dialysis Unit information:
Dialysis Water PEX (SDR 7.4) Velocity Pressure Drop per
• Number of HD Machines = 16 Flow Rate Diameter mm Metres/sec 100 m (Straight)
• Number of Reuse Device =2
5 20 (14.5) 0.50 0.3 bar
Dialysis Water required:
HD Machines * max dialysis flow + 5 25 (18.2) 0.32 0.1 bar
Reuse Device * max flow rate 10 20 (14.5) 1.01 1.01 bar

= 16*0.5+2*2 = 12 L/min 10 25 (18.2) 0.64 0.34 bar

15 20 (14.5) 1.51 2.08 bar

Required RO is MX Eco 3 with 15 L/min
15 25 (18.2) 0.96 0.70 bar
Choice of distribution Loop (PEX)
20 20 (14.5) 2.01 3.49 bar
• Direct feed must be >0.45 m/sec 20 25 (18.2) 1.28 1.16 bar

• Choice of pipe size = 20 mm PEX tubing absolute roughness = 0.007 mm

For other material:

- Velocity may be lower
- Pressure drop may be higher

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Distribution Loop Examples

Direct Feed (PEX) – 100 m

• P1 – Before RO Membrane
– Feed Pressure = 8 bar
• P2 – Reject Line
– Reject pressure = 7 bar
• P3 – After RO Membrane
– Loop pressure = 4 bar
– HD machines =0
– Dialysis water flow = 15 L/min
– Velocity = 1.51 m/s
• P4 – After 30 m of Loop
– Loop pressure = 3.37 bar
– HD machines = 4
– Dialysis water flow = 13 L/min
– Velocity = 1.31 m/s
• P5 – After 50 m of Loop
– Loop pressure = 3.05 bar
– HD machines = 8
– Dialysis water flow = 11 L/min
– Velocity = 1.11 m/s
• P6 – After 70 m of Loop
– Loop pressure = 2.81 bar
– HD machines = 12
– Dialysis water flow = 9 L/min
– Velocity = 0.91 m/s
• P7 – End of Loop
– Loop pressure = 2.64 bar
– HD machines = 16
Reuse machine =2
–
– Dialysis water flow = 3 L/min
Applied pressure (P1) as per
Velocity = 0.3 m/s
–
manufacturer’s recommendations
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Distribution Loop Examples

Direct Feed (PEX) – 250 m

• P1 – Before RO Membrane
– Feed Pressure = 8 bar
• P2 – Reject Line
– Reject pressure = 7 bar
• P3 – After RO Membrane
– Loop pressure = 4 bar
– HD machines =0
– Dialysis water flow = 15 L/min
– Velocity = 1.51 m/s
• P4 – After 75 m of Loop
– Loop pressure = 2.44 bar
– HD machines = 4
– Dialysis water flow = 13 L/min
– Velocity = 1.31 m/s
• P5 – After 125 m of Loop
– Loop pressure = 1.63 bar
– HD machines = 8
– Dialysis water flow = 11 L/min
– Velocity = 1.11 m/s
• P6 – After 175 m of Loop
– Loop pressure = 1.03 bar
– HD machines = 12
– Dialysis water flow = 9 L/min
– Velocity = 0.91 m/s
• P7 – End of Loop
– Loop pressure = 0.61 bar
– HD machines = 16
– Reuse machine =2
– Dialysis water flow = 3 L/min
– Velocity = 0.3 m/s

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 18
Distribution Loop Examples

Indirect Feed (PEX)

Dialysis Unit information:
Dialysis Water PEX (SDR 7.4) Velocity Pressure Drop per
• Number of HD Machines = 16 Flow Rate Diameter mm Metres/sec 100 m (Straight)
• Number of Reuse Device =2
10 20 (14.5) 1.01 1.01 bar
Booster Pump CM3-5:
10 25 (18.2) 0.64 0.34 bar
Flow rate @ 4.0 bar ~ 23 L/min 15 20 (14.5) 1.51 2.08 bar

Dialysis Water consumption = 12 L/min 15 25 (18.2) 0.96 0.70 bar

20 20 (14.5) 2.01 3.49 bar

Choice of distribution Loop (PEX)
20 25 (18.2) 1.28 1.16 bar
• Direct feed must be >0.90 m/sec
30 20 (14.5) 3.03 7.27 bar

30 25 (18.2 1.92 2.41 bar

• Choice of pipe size = 25 mm

In Indirect Feed; flow rate & pressure PEX tubing absolute roughness = 0.007 mm
are controlled by the booster pump!
For other material:
- Velocity may be lower
- Pressure drop may be higher

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Distribution Loop Examples

Indirect Feed (PEX) – 250 m

• Booster Pump CM3-5
– Feed Pressure = 4 bar
– Dialysis water flow ~ 23 L/min
• P3 – Start of Loop
– Loop pressure = 4 bar
– HD machines =0
– Dialysis water flow = 23 L/min
– Velocity = 1.47 m/s
• P4 – After 75 m of Loop
– Loop pressure = 2.88 bar
– HD machines = 4
– Dialysis water flow = 21 L/min
– Velocity = 1.35 m/s
• P5 – After 125 m of Loop
– Loop pressure = 2.24 bar
– HD machines = 8
– Dialysis water flow = 19 L/min
– Velocity = 1.22 m/s
• P6 – After 175 m of Loop
– Loop pressure = 1.71 bar
– HD machines = 12
– Dialysis water flow = 17 L/min
– Velocity = 1.09 m/s
• P7 – End of Loop
– Loop pressure = 1.35 bar
–
–
HD machines
Reuse machine
= 16
=2
With Indirect Feed, flow rate and pressure are
–
–
Dialysis water flow
Velocity
= 11 L/min
= 0.7 m/s
controlled by the booster pump!
In some installations we mix pipe size to ensure
sufficient velocity at the end of the loop!
Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 20
Distribution Loop Examples

Mixed Loop
• Direct feed to HD Machine
– Reduced risk of bacterial
contamination
– Continues purification of
dialysis water
– Ease of disinfection
– Ro Sized to fulfil HD Machine
water requirements

• Indirect feed to ADR

– Peak consumption covered by
storage tank
– Operation id independent of
direct feed
– Ease of disinfection and
maintenance

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 21
Agenda

A Distribution Loop

B Pro’s & Con’s of Indirect Feed

C Storage Tank Requirements

D Pro’s & Con’s of Direct Feed

E Distribution Loop Examples

F Summary

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 22
 Summary

Distribution Loop - What is the right configuration?

• Direct Feed is recommended, however, choice depends on:
• Location & local requirements

• Loop length

• Peak consumption

• Indirect Feed has a higher risk of bacterial contamination though:

• Non-compliant Storage Tanks

• Ineffective disinfection

• Economy through Indirect Feed

• Only true for less advanced RO Systems

• Fresenius Medical Care MX Eco system, with dynamic Recovery

• Water consumption does NOT increase in Direct Feed

• Energy consumption is similar in both configurations

• MX Eco can achieve Recovery of up to 90%

• Specific configuration (Direct/Indirect) shall not be directed, as it

depends on local factors

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 23
Thank you for your kind attention

Fresenius Medical Care South Asia Pacific

Rubin Frost
Regional Director
Technical Services & Water Solutions

Direct vs Indirect Feed of Dialysis Water, Rubin Frost © Copyright 25/02/2014 Page 24