Kashiwagi Tetsuya, Iino Yasuhiko, Miyahara Hideyasu, Katayama Yasuo
Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School.
J Nippon Med Sch. 2010 Apr;77(2):86-92. doi: 10.1272/jnms.77.86.
In peritoneal dialysis (PD) the dialysate is introduced into the peritoneal cavity, and the peritoneal membrane is used as the dialysis membrane. In PD, patients exchange the dialysate by themselves through the connection tube attached to the indwelling catheter that is inserted into the peritoneal cavity. Microbes may enter the peritoneal cavity during dialysate exchange, and, therefore, peritonitis is a potential complication of PD. To prevent microbial contamination, the connection tube tip is generally sealed with a protection cap containing povidone-iodine (PVP-I) during the dwelling time. This cap is designed to make direct contact with the tube tip so that microbes attached during dialysate exchange are killed by the next dialysate exchange. However, if excess PVP-I flows into the peritoneal cavity and is absorbed into the body, the complications, including thyroid dysfunction, peritoneal inflammation, and fibrous thickening, can develop. Therefore, in this study, a new manual connection system (Zero System, JMS Co., Ltd., Hiroshima, Japan) for continuous ambulatory peritoneal dialysis was investigated to confirm that the PVP-I solution within the protection cap of the new system would not flow into the fluid passing through the tube. An experiment was also performed to confirm that the microbes on the connector tip become completely nonviable after attachment of the cap for 3 hours. The cap is fitted with a sponge containing a 10% PVP-I solution, the same as for the conventional cap system. However, the system is designed to achieve disinfection without contact, unlike with the conventional system, in which disinfection is achieved by direct contact of the PVP-I-containing sponge with the open end of the attached connector. The test results demonstrated that adequate disinfection with this system can be achieved by the next exchange, while avoiding entry of PVP-I into the peritoneal cavity from the cap. The results suggest that the use of this connection system can avoid adverse reactions arising from the absorption of PVP-I and prevent the onset of peritonitis caused by microbial invasion of the peritoneal cavity.
在腹膜透析（PD）中，透析液被引入腹腔，腹膜用作透析膜。在腹膜透析中，患者通过连接到插入腹腔的留置导管的连接管自行更换透析液。在透析液更换过程中，微生物可能进入腹腔，因此，腹膜炎是腹膜透析的一种潜在并发症。为防止微生物污染，在留置期间，连接管尖端通常用含有聚维酮碘（PVP-I）的保护帽密封。该保护帽设计为与管尖端直接接触，以便在透析液更换过程中附着的微生物在下一次透析液更换时被杀死。然而，如果过量的PVP-I流入腹腔并被身体吸收，可能会引发包括甲状腺功能障碍、腹膜炎症和纤维增厚在内的并发症。因此，在本研究中，对一种用于持续非卧床腹膜透析的新型手动连接系统（Zero System，日本广岛JMS有限公司）进行了研究，以确认新系统保护帽内的PVP-I溶液不会流入通过管道的液体中。还进行了一项实验，以确认在盖上保护帽3小时后，连接器尖端上的微生物会完全失去活性。该保护帽装有一块含有10% PVP-I溶液的海绵，与传统帽系统相同。然而，与传统系统不同，该系统设计为无需接触即可实现消毒，传统系统是通过含PVP-I的海绵与连接的连接器开口端直接接触来实现消毒的。测试结果表明，该系统在下一次更换时可实现充分消毒，同时避免PVP-I从保护帽进入腹腔。结果表明，使用这种连接系统可以避免因PVP-I吸收引起的不良反应，并防止因微生物侵入腹腔而导致腹膜炎的发生。
