Y Connectors In CAPD Patients: Do Subtle Important Modifications Have Potential Role In Reducing Contamination And Rate Of Infective Peritonitis?

Abstract

Continuous Ambulatory Peritoneal Dialysis (CAPD) involves transfer of dialysate into and out of peritoneal cavity several times a day with the help of a permanent catheter and connection system. Connection and disconnections during the exchange lead to entry of various organisms into peritoneal cavity and therefore intraluminal infections account for approxintately one-third to one-half of all episodes of peritonitis. It is essential that innovations in technology of peritoneal dialysis delivery system should aim at protecting critical areas of the connectors from accidental contamination and incorporating effective bacterial flushing techniques. Thus the design of the connectors and )(junction is extremely critical in influencing efficiency of any delivery system. V junction plays a critical role in fluid flow path, especially in terms of convective bacterial removal. Central junction of symmetric V set can induce nonlinear turbulent flow and obstruct the flushing process leading to fibrin blockage. Hence, a variation of Y system, known as asymmetric Y set, was developed with an idea to reduce contamination and rate of peritonitis. Asymmetric Y set essentially has straight transparent line to drain the bag combined with short distance between the Y set and patient line. Various single center and small multicentric studies using twin bag with asymmetric V and advanced connectors have shown significant improvement in peritonitis rates. Further, it is essential to assess these innovations by large well-designed RCTs for their usefulness, cost advantage and impact on quality of life.