Total chlorine levels in dialysis water are tested before each patient shift or every four hours.

• A. Only during abnormal readings
• B. Once per week
• C. During patient shift changes only
• D. Before each patient shift or every four hours

Answer: (D)

Total chlorine testing is about keeping the dialysate safe for patients by ensuring the disinfection and dechlorination steps are working properly. Chlorine residuals, including chloramines, can irritate vessels and airways or cause adverse reactions during dialysis, so checking the total chlorine level confirms the water is within safe limits before it reaches a patient. The best practice is to test before each patient shift or at least every four hours, whichever comes first, so any drift or rise is detected promptly and corrective action can be taken without delaying treatment. Testing only when readings are abnormal would miss gradual increases, testing only once per week is far too infrequent, and testing only during shift changes could miss mid-shift changes. This frequency protects patients by ensuring consistently safe water.