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Comparison of two non-disconnect CAPD delivery systems
L J Hall1, R A Kinney, T E Taber
1Dialysis Institute of Indiana, Indianapolis.
Abstract:
Intraluminal transmission of bacteria remains a significant factor in the morbidity and procedural success of CAPD. A worsening rate of peritonitis in a longstanding CAPD program (first patients 1978) led to a search for a system which might allow a lesser rate of peritonitis. Simplicity in the procedure was a requirement. For this reason disconnect systems were not considered. The Travenol spike system was prospectively compared with Delmed leur lock in terms of rate of peritonitis and difficulty in training. The former had been used by the center since inception of the CAPD program. 28 patients new to CAPD were alternately assigned to each system without other bias, including diagnosis, age, sex, or race. The study, while ongoing, was analyzed at 12 months. 66 patient months were involved with each system. The peritonitis rates were: 2.2 episodes: patient year with the Travenol; 0.9 episode:patient year for the Delmed systems. The Delmed system appears to provide a lower rate of peritonitis. In addition, less manual dexterity, steadiness, and hand eye coordination are necessary.
Insights
The Delmed leur lock system significantly reduced peritonitis rates in continuous ambulatory peritoneal dialysis (CAPD) patients compared to the Travenol spike system. This new system requires less manual dexterity, improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Disease
Background:
- Peritonitis is a major complication in continuous ambulatory peritoneal dialysis (CAPD), impacting patient morbidity and treatment success.
- A rise in peritonitis rates within a long-standing CAPD program necessitated the exploration of alternative connection systems.
- System simplicity was a key requirement, excluding disconnect systems.
Purpose of the Study:
- To prospectively compare the Travenol spike system with the Delmed leur lock system.
- To evaluate the rates of peritonitis and training difficulty associated with each system.
Main Methods:
- A prospective comparative study involving 28 new CAPD patients.
- Patients were alternately assigned to either the Travenol spike or Delmed leur lock system.
- Analysis was conducted at 12 months, involving 66 patient-months for each system.
Main Results:
- The Delmed leur lock system demonstrated a lower peritonitis rate of 0.9 episodes per patient-year.
- The Travenol spike system had a peritonitis rate of 2.2 episodes per patient-year.
- The Delmed system requires less manual dexterity, steadiness, and hand-eye coordination for use.
Conclusions:
- The Delmed leur lock system is associated with a significantly lower rate of peritonitis in CAPD.
- The Delmed system offers a simpler procedure, potentially improving patient adherence and outcomes.