Disinfection of Disposable Dialysis Tubing

The rate of continuous cycler PD use in the hospital setting is increasing. Using a cycler frees up the nurse's time. Instead of performing 4-8 manual exchanges per day, the nurse can put up enough dialysate for a day with one connection to initiate the cycle and one disconnection to terminate the cycle. Infection rate decreases due to fewer connect/disconnect procedures where touch contamination is possible. The patient can be disconnected for procedures and then reconnected to the same line. Despite these advantages, there is increased cost of continuous cycler PD. The costs are related to the cycler, cycler tubing sets, cycler drain line/bag and dialysate solutions. The patient must be able to disconnect and reconnect to the cycler either in between or during PD treatments as needed either in dwell or at the end of drain. Thus the concept of disinfection of disposable dialysis tubes for multiple use [19].

Multiple use of tubing sets and drain lines were performed with Pac-X/Pac-Xtra Cycler (Baxter Healthcare, McGaw Park, Ill., USA) in the hospital and home setting [19, 20] and HomeChoice Automated PD System (Baxter Healthcare, McGaw Park, Ill., USA) in the hospital setting [21]. Each set from Pac-X/Pac-Xtra cycler was used for 2-3 treatments, each of 16-24 h duration. Drain line extension set connected with the drain line of the tubing set was used for 7 days. Five-liter dialysate bags were used. Fluid was either set initially or added as clinically indicated. Betacaps or minicaps were used to keep the tubing set sterile. Each disposable tubing set from HomeChoice Automated PD system was used for 2-7 treatments, each of 16-24 h duration. Povidone-iodine 10% was infused in the drain line.

Patients prefer to use PD supplies multiple times because of convenience and decreased set-up time. Staff prefer to use PD supplies multiple times because of cost, convenience and decreased set-up time. There was no significant increase incident of peritonitis compared to single use [19-21]. Wadhwa [21] showed that multi-use resulted in a 78% reduction in tubing sets, reducing the disposable supplies and cost, and a substantial saving in nursing time.

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