Conclusions

During the last 15 years, the worldwide adoption of the CAPD connection systems derived from the original 'Y' system enabling the 'flushing before filling' (mainly in the form of 'double-bag' systems, where the 'Y' is in the bag

Fig. 8. 'Double Y' CAPD connection system with automatic prevention of accidental intraperitoneal injection of disinfectant. Second injection of disinfectant, at the end of the exchange, to refill the 'Y' on the catheter for the interval phase: the slider again in position 1 closes the way to the peritoneal cavity and opens the one to the drainage bag (already filled with the spent dialysate).

Fig. 8. 'Double Y' CAPD connection system with automatic prevention of accidental intraperitoneal injection of disinfectant. Second injection of disinfectant, at the end of the exchange, to refill the 'Y' on the catheter for the interval phase: the slider again in position 1 closes the way to the peritoneal cavity and opens the one to the drainage bag (already filled with the spent dialysate).

side) has stabilized the peritonitis rate in this type of treatment at levels surely acceptable. However, peritonitis still remains one of the most frequent complications of CAPD and certainly the most serious, both for the clinical consequences (morbidity and mortality) and for the technique survival. Furthermore, the fear for this complication is still the most important obstacle to a wider diffusion of this kind of treatment. The main reason for the persistence of this still relatively high peritonitis rate resides in the fact that in order to simplify the maneuver and, above all, to avoid the hypothetic risk of possible toxic effects of an accidental entry of disinfectant into the peritoneal cavity, the use of this has been abandoned. However, this choice seems at present no longer justified on the basis of the following considerations: (1) we have accumulated a large body of evidence that the disinfectant proposed for this use, Amuchina, has a very low degree of general and local toxicity, at the point that it has been also utilized for peritoneal washing; (2) new systems have been set up, which guarantee an almost absolute certainty of complete disinfection and avoid any possibility of accidental entry of disinfectant in the peritoneal cavity; (3) for the less skilled patients an electromechanical device is now available; (4) the further reduction of the peritonitis rate achievable with this new connection systems utilizing a proper disinfectant could be of great importance, not only under the clinical aspect, but also for a safer and wider diffusion of this kind of treatment, what could have a considerable positive social-economic impact in view of the growing number of uremic patients.

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