Peritonitis prevented in continuous ambulatory peritoneal dialysis by using the Hong Kong connection.

Abstract

Based on the hypothesis that air contamination is an important cause of peritonitis in continuous ambulatory peritoneal dialysis, a simple and cheap connection system was developed whereby a clear polyethylene bag containing an antiseptic gauze was used as a sterilising chamber, effectively enclosing the connection procedure. Seven modifications to the connection technique were introduced over 32 months in 28 patients during 27-9 patient years of experience. The overall rate of peritonitis was 0-6 episode/patient year, but after a final modification at the beginning of the third year the rate fell to 0-17, without a single case of peritonitis occurring attributable to a connection failure in 11-5 patient years.These findings show that in patients receiving continuous ambulatory peritoneal dialysis peritonitis may be prevented by enclosing the connection process and sterilising the introduced air and tubing ends.

CAPD Peritonitis: A Critical Appraisal of Prophylactic Strategies

“…CCPD appears to be equivalent to standard CAPD (25). The use of antiseptics (27,28) and heat (26) at the connection between extension tubing and dialysate bag appears to dramatically reduce peritonitis rates. Whether these results are due to the technique used or are produced by the biases inherent in this study design cannot be determined.…”

“…The publications addressing this issue used many strategies. These included the sterile connection device (1 5 , 16), an ultraviolet germicidal system (1 7), the Oreopoulos-Zellerman (0-Z) connector (1 8), the Peridex filter (19), the Beta Cap technique (20), prophylactic antibiotics (2 1, 22), the re-usable Y connector disinfectant set (23,24), continuous cyclic peritoneal dialysis (25), the Flame-Lock connecting device (26), antiseptic soaks of the connection device (27,28), the 0 set (29-33) and a single use Y connector set (32,34,35).…”

“…The interventions evaluated using this design were the Beta-Cap technique (20), continuous cyclic peritoneal dialysis (25), heat (26), Povidone-iodine (Betadine) soaks of the connector and catheter (27), chlorhexidine connector soaks (28), the 0 set (3 1-33) and the single-use Y set (32-35) ( Table 3).…”

“…In Table 3, the peritonitis rates are expressed as patient-months follow-up per episode of peritonitis. The control group rates used have been from previous experience in the center reporting the new intervention (20,27,31), the United States CAPD Registry (25,32), other reports (26,28,33) and from concurrent controls in the center reporting the new intervention (34,35). With the exception of CCPD (25), the peritonitis rates for the new interventions were much lower than for the control group reported.…”

CAPD Disconnect Systems

“…The Hong Kong connection [6], although using simple equipment, appears complex in practice and also carries the risk of introduc tion of antiseptic into the peritoneal cavity known to be a potential cause of sclerosing peritonitis [7], Using direct heat in the Flame-Lock system [8] produced a peritoni tis rate of 1 episode per 16.7 patient months, but caramélisation of dextrose may occur along with heat damage to the plastic tubing. Despite the increased complexity of these systems, peritonitis rates have not been con sistently reported as being better than around 1 episode every 24 patient months.…”