Double-bag Systems Research Articles

Double bag or Y-set versus standard transfer systems for continuous ambulatory peritoneal dialysis in end-stage kidney disease.

Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis.This is an update of a review first published in 2000. This systematic review sought to determine if modifications of the transfer set (Y-set or double bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes. We searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. Date of last search: 22 October 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing double bag, Y-set and standard peritoneal dialysis (PD) exchange systems in patients with end-stage kidney disease. Data were abstracted by a single investigator onto a standard form and analysed by Review Manager. Analysis was by a random effects model and results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Twelve eligible trials with a total of 991 randomised patients were identified. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial and the methodological quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) in preventing peritonitis in PD. Disconnect systems should be the preferred exchange systems in CAPD.

Comparison of clinical outcome and ease of handling in two double-bag systems in continuous ambulatory peritoneal dialysis: A prospective, randomized, controlled, multicenter study

Background: We performed a prospective, randomized, controlled, multicenter study on the use of two double-bag disconnect systems: Stay-Safe (SS; Fresenius Deutschland GmbH2) and Ultrabag (UB; Baxter Healthcare, Deerfield, IL) to assess the ease of handling, peritonitis rate, exit-site infection rate, and clinical outcome. Methods: We enrolled 110 new continuous ambulatory peritoneal dialysis (CAPD) patients; 55 patients were randomized to SS treatment, and 55 patients, to UB treatment. Results: Patients using the UB and SS systems were followed up for 946 and 846 patient-months, respectively. There were 21 episodes of peritonitis in 18 patients in the UB group and 23 episodes in 18 patients in the SS group. No significant difference was observed in peritonitis rates between the two systems, which were 45 and 36.8 patient-months per episode for the UB and SS groups, respectively. At 12 months, 82.1% of patients in the UB group and 72.1% in the SS group were free of peritonitis; at 18 months, 71.1% and 62.2% were free of peritonitis for the UB and SS groups, respectively (P = 0.559). Gram-positive organisms accounted for 28.6% of infections in the UB group and 39.1% in the SS group. Exit-site infection rates were one episode per 21 patient-months versus 19.2 patient-months in the UB and SS groups, respectively (P = 0.743). Patients perceived SS as easier to handle in 4 of the 13 steps immediately post-CAPD training. However, there was no significant difference in rankings between the two systems after 1 month of adaptation. Median training periods were 4 and 5 days for the SS and UB groups, respectively (P = 0.640). Conclusion: The two double-bag systems (UB and SS) have similar incidences of peritonitis and exit-site infection. Both systems showed comparably good clinical outcome. The SS system is easier to learn during the initial training period, but the difference is not significant after 1 month's adaptation. © 2002 by the National Kidney Foundation, Inc.

Prevention and management of peritonitis and exit-site infection in patients on continuous ambulatory peritoneal dialysis.

Peritoneal dialysis (PD) is an important and lifesaving form of renal replacement therapy for more than 100 000 patients worldwide. Peritonitis, catheter exitsite, and tunnel infections are serious problems in PD patients. Peritonitis accounts for 15–35% of hospital admissions, is the major cause (40– 45%) of transfer to haemodialysis (technique failure), and finally is associated with mortality (7–10% of deaths) either as a primary or contributing factor w1x. In the early 1980s peritonitis incidence was high, with rates as high as 6.3 episodes per patient year. During the 1980s and early 1990s the peritonitis rate dropped to 1.1–1.3 episodes per patient year. With improvements in connection technology (introduction of Y-set and double-bag systems) the peritonitis rates declined further to around 0.5 episodes per patient year w2x.

Acute cerebellar hemorrhage and CT evidence of tight posterior fossa.

We studied 14 patients with cerebellar hemorrhage and a tight posterior fossa, defined by the following CT criteria: effacement of the basal cisterns and ventricular enlargement consistent with obstructive hydrocephalus. In 10 patients, the fourth ventricle was not seen; in 4, it was enlarged and filled with blood. Six patients died before surgery, and eight were treated surgically. Six patients with cerebellar hemorrhage but no CT evidence of a tight posterior fossa survived without surgery.

Comparison of three methods of maintaining a sterile injectate system during cardiac output determinations

Current technique for determining cardiac output involves multiple manipulations of the injectate system and thereby raises the potential for serious infection. A randomized crossover study was undertaken to compare three methods for determining cardiac outputs, focusing on (1) ability to maintain sterile injectate, (2) operator time, and (3) cost effectiveness. The methods compared were the closed-loop injectate delivery, capped-syringe, and double-bag systems. Forty-five subjects were randomly assigned to one of three methods used, then “crossed over” to an alternate method. This resulted in six different groups: (1) 15 subjects assigned to closed loop first, then crossed over to double bag (eight) or capped syringe (seven), (2) 15 subjects assigned to double bag first, then crossed over to closed loop (seven) or capped syringe (eight), and (3) 15 subjects assigned to capped syringe first, then crossed over to double bag (seven) or closed loop (eight). Quantitative cultures of sample injectates served as indicators of contamination. The Wilcoxon signed rank analysis showed no statistical difference (p > 0.9) in patient or catheter caracteristics between treatment groups. None of 30 cultures from the closed-loop method yielded bacterial growth, compared to 6 of the 30 cultures positive from each of the other methods (p < 0.0001). The closed-loop method also required less operator time and was more cost effective than the two alternate methods examined.