Department of Nephrology, Hochtaunuskliniken, Zeppelinstrasse 20, 61352, Bad Homburg, Germany.
Department of Internal Medicine, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Saar, Germany.
Sci Rep. 2021 May 13;11(1):10212. doi: 10.1038/s41598-021-89643-0.
Peritonitis is a common complication of peritoneal dialysis (PD). Our root cause analysis allowed to attribute some cases to leakage of the PD catheter. Accordingly, a clinically based stress test study on potential material damage issues of PD catheters was performed, focusing on material damage caused by cleaning, de- and attachment procedures during dialysate changes and on the individual storage methods of PD catheters between dialysate changes. PD catheters were exposed to both chemical stress by repeating dialysate-flow and physical stress simulating de- and connecting, fixation, pressure, flexing, folding etc.-simulating standard clinical daily routine of 8-10 years PD catheter usage. Potentially by normal usage caused damages should be then detected by intraluminal pressure, light- and electron microscopy. The multi-step visual control showed no obvious damages on PD catheters nor any leakage or barrier indulgence. Our tests simulating daily routine usage of PD catheters for several years could not detect any material defects under chemical or physical stress. Hence, we presume that most PD catheter damages, as identified cause for peritonitis in some of our patients, may be due to accidental, unnoticed external damage (e.g. through scissors, while changing dressings) or neglecting PD catheter handling specifications.
腹膜炎是腹膜透析 (PD) 的常见并发症。我们的根本原因分析将一些病例归因于 PD 导管泄漏。因此，针对 PD 导管的潜在材料损坏问题进行了一项基于临床的压力测试研究，重点关注透析液更换过程中清洗、拆卸和连接程序引起的材料损坏，以及透析液更换之间 PD 导管的个体储存方法。PD 导管通过重复透析液流动和物理应力（模拟拆卸和连接、固定、压力、弯曲、折叠等）来暴露于化学应力和物理应力下，模拟 PD 导管正常使用 8-10 年的标准临床日常操作。潜在的正常使用引起的损坏应通过管腔压力、光学和电子显微镜检测。多步骤目视检查显示 PD 导管没有明显损坏，也没有泄漏或阻隔。我们模拟 PD 导管日常使用数年的测试在化学或物理应力下均未发现任何材料缺陷。因此，我们推测大多数 PD 导管损坏，正如我们一些患者腹膜炎的原因，可能是由于意外的、未注意到的外部损坏（例如，在更换敷料时被剪刀碰到）或忽略 PD 导管处理规范。
