Use of sodium hypochlorite in peritoneal dialysis: the genesis of the 'Y' set and beyond.
The 'Y' set introduced in the clinical practice in the early 80s with the aim of reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis, successfully revolutioned the philosophy of the connection system catheter-container of dialysate, which was the main way of bacterial contamination of the peritoneal cavity. In fact, while the previous connection systems had focused the attention on the reduction of the possible contaminating acts, the 'Y' system, taking into account the fact that soon or later a failure could occur even with the most skilled and compliant patient, introduced the possibility to kill the bacteria with a disinfectant and to remove it and the killed bacteria together with the bacteria eventually still surviving, by flushing the contaminated area. This goal was achieved thanks to a 'Y' shaped connector, having a third way connected to the discharge bag/container, besides the two connected to the new bag and to the catheter. From the 'Y' set have originated all the currently used continuous ambulatory peritoneal dialysis connection systems, where the 'Y' is mounted on the bag side (double-bag systems). However in these systems the disinfectant is no longer used, due to the fear of possible untoward effects on the peritoneal membrane. The groundlessness of this position and the possible further advantages of the use of a disinfectant in combination with the 'Y' are discussed and new 'Y' systems preventing every possibility of accidental entry of disinfectant into the peritoneal cavity are presented.
Buoncristiani
Umberto
U
Santa Maria della Misericordia Hospital, Perugia, Italy.
Buoncristiani
Emanuela
E
Bianchi
Paolo
P
D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000382:microbiology; D004202:Disinfectants / Q000494:pharmacology*; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D009017:Morbidity; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012973:Sodium Hypochlorite / Q000494:pharmacology*; D013525:Surgical Instruments; D014511:Uremia / Q000453:epidemiology / Q000628:therapy
D004202:Disinfectants; D012973:Sodium Hypochlorite