Therapy Modality: Continuous Ambulatory Peritoneal Dialysis (CAPD)

1
Therapy ModalityContinuous Ambulatory
Peritoneal Dialysis (CAPD)

• Renal Division
• Baxter Healthcare

2
CAPD - basic prescription

• Manual therapy
• Prescription volumes standardised
• 1,500ml, 2000ml, 2500ml, 3000ml solution
  bags
• 6-8 hour dwell period each night (depends on type
  of membrane)
• 4-5 day exchanges (with optional night dwell),
• 7 days a week
• 3-5 hr dwell per day exchange

3
CAPD Exchange Procedure

• 1. Fill phase
• (lt10 Minutes)

4
CAPD Exchange Procedure

• 2. Dwell phase
• (4-8 hours)
• 3. Drain phase
• (lt20 minutes)

5
CAPD
CAPD
Continuous Therapy
Volume
Benefits
Limitations
24
0
Time

• Optimum dialysis for low permeability
• Can be performed anywhere

• High transporters will have poor UF
• 4 x exchanges per day
• IP pressure with large volumes

Ambulatory Anywhere 4 - 5 Exchanges Long Dwells
6
Procedural Modifications- increasing UF
1
2
3
7
Procedural Modification - fill volume
8
Procedural Modification- no. of exchanges
9
PD Technique Survival
Kawaguchi PDI 199919 (supp 2)S327
Years

10
PD Technique Survival
Kawaguchi PDI 199919 (supp 2)S327

• Reasons for withdrawal
• - Loss of UF
• - Inadequate dialysis
• - Peritonitis
• - Patient choice/psychological (burn-out)

11
CAPD Outcome - Japan
Kawaguchi PDI 199919 (suppl 3)S9

• 235 patients analysed between 1980 - 1997
• Average survival was 5.8 years
• 142 patients changed dialysis therapy
• Causes - loss of UF (23)
• - inadequate dialysis (16)
• - peritonitis (14)
• Peritonitis rate was very good
• - 1 episode/54 patient months

12
Causes of Technique Failure in Long-term PD

14
5
36
20
25
13
CAPD Systems
AIM Safety, Simplicity, Comfort Convenience

• Requirements
• Minimise risk of touch contamination
• Maximise Flush efficiency
• Inactivate organisms at patient connector if
  touch contamination occurred.
• Proven and reliable connectology
• Increased inactivation of organisms at the
  patient connection if a touch contamination
  occurs
• Easy to learn and use system for all patients

14
Improvements in PD Connectology
Gokal R., Nolph K. Textbook of PD 1-15, 1994.
1977-80 Data Nolph Sorkin, U. Missions1980-87
Data CAPD Registry, USA1987-90 Data Anecodotal
reports, Europe/USA
Infections (Per Patient Months)
1979 Monthly Tubing Change Titanium
Adapter 1980 New Spike CAPD Set
1985 Extended Life Transfer Set, BDP
1986 UVXD

1986 APD-PAC X
1987 Y Set

1988 TwinBag - Europe

1989 UV-Flash, Pac Xtra

1990 PD Ultra Bag

1995
Homechoice

2000 Homechoice PRO





15
Peritonitis Y-set Systems
Holly AJKD 1994
gt Peritonitis rates have improved over the
years Straight line Y-set Staph
epid. 0.34 0.17 Staph aureus 0.15
0.13 Gram -ve 0.12 0.10 Fungal
0.02 0.01
Peritonitis rate episodes/pt month
disconnect
O-set
titaneum
Plastic bags
Glass bottles
16
Sources of Contamination
Routes of entry
17
Safety Reduced risk of organisms entering the
PD system if touch contamination occurs
Kubey W., et al., Blood Purification 2000, 19(1).
Twinbag connectology allows significantly
(plt0.0001) fewer bacteria to be transferred into
the fluid path. A recessed luer is of
particular importance.
Non-Recessed luer
Recessed luer

18
CAPD Connectology Reduced risk
Kubey W., et al., Blood Purification 2000, 19(1).
The short distance between the Y-Junction and the
patient connection ensures effective removal of
bacterial contamination from the patient line
should connection failure occur.