Optimization of the YSet with Disinfectant

In order to overcome the first limitation, i.e to completely eliminate every possibility of failure we proposed a new system called 'Double Y [31, 32] and

Fig. 6. 'Double Y' CAPD connection system with disinfectant. On the left side, the first 'Y' mounted on the distal end of the new dialysate bag, with the still intact breakable-membrane and the lateral way to be used for the injection of disinfectant at the beginning (soon after the connection with the catheter, being the clamp on this still closed) and at the end of the exchange (after the refilling of the abdomen and the closure of the clamp on the catheter and before its de-connection and closure with the cap). On the right side, the second 'Y' mounted on the catheter, with the lateral way to be connected with the drainage bag, which will collect not only the spent dialysate, but also the redundant disinfectant during the injections and the disinfectant washed away with the flush of fresh solution and with the spent dialysate.

Fig. 6. 'Double Y' CAPD connection system with disinfectant. On the left side, the first 'Y' mounted on the distal end of the new dialysate bag, with the still intact breakable-membrane and the lateral way to be used for the injection of disinfectant at the beginning (soon after the connection with the catheter, being the clamp on this still closed) and at the end of the exchange (after the refilling of the abdomen and the closure of the clamp on the catheter and before its de-connection and closure with the cap). On the right side, the second 'Y' mounted on the catheter, with the lateral way to be connected with the drainage bag, which will collect not only the spent dialysate, but also the redundant disinfectant during the injections and the disinfectant washed away with the flush of fresh solution and with the spent dialysate.

consisting of two connectors, each with three ways, and mounted respectively one on the catheter (as the original Y) and the other on the distal end of the down-flow tube of the bag (fig. 6). Through the lateral way of the 'Y' on the catheter can be injected with a syringe fresh and surely effective disinfectant, which can be drained into the collecting bag through the lateral way on the distal end of the new bag. With this procedure, at the beginning of the new exchange, all the inner surface of the connection, not only on the catheter but also on the bag side, is washed with a sufficient quantity of disinfectant, ensuring an efficient disinfection even against heavy contaminations, as it was clearly proved by our in vitro experiments [31]. Through the same way, at the end of the exchange, the 'Y' on the catheter could be refilled with fresh disinfectant, ensuring also an efficient antimicrobial defense during the interval.

Afterwards, in order to overcome the second limitation, i.e. to avoid every possibility of injection of disinfectant into the abdominal cavity, we proposed [33] a new device which, thanks to a special slider, closes automatically the catheter line when the disinfectant is allowed to flow through the connection toward the discharge bag (figs. 7, 8). Furthermore, in order to overcome the

Fig. 7. 'Double Y' CAPD connection system with automatic prevention of accidental intraperitoneal injection of disinfectant. First injection of disinfectant at the beginning of the exchange, to disinfect the system after the connection bag-catheter: the slider in position 1 closes the way to the peritoneal cavity and opens the one to the drainage bag (still empty).

Fig. 7. 'Double Y' CAPD connection system with automatic prevention of accidental intraperitoneal injection of disinfectant. First injection of disinfectant at the beginning of the exchange, to disinfect the system after the connection bag-catheter: the slider in position 1 closes the way to the peritoneal cavity and opens the one to the drainage bag (still empty).

operational difficulties which a minority of patients could encounter in spite of the simplicity of the system, a small, portable, electromechanical device [34] was set up, which performs automatically the various operations performed by the patient in the manual version.

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