Questions About PD
We thank you for your interesting question. A very similar question was posted to the ISPD website in November 2019. At that time, from an informal poll of international members of the Nursing Committee of ISPD, we found that practices do vary considerably among different countries. We checked a couple of days ago again with the same nurses and practices in the different countries have not changed. In general, in the United States, it is common practice to change the transfer set of a patient on PD with suspected peritonitis – the set is changed after the collection of the PD effluent sample, but before the administration of antibiotics. The rationale being to prevent any micro-organisms residing in the transfer set (e.g. in a biofilm) from re-infecting the patient. We are not aware of any research evidence for this practice. Two small, single-centre studies, both conducted multiple years ago, showed that changing the transfer set did not reduce the incidence of relapsing peritonitis compared to not changing the transfer set (1,2). Note: The ISPD definition of relapsing peritonitis is: An episode that occurs within 4 weeks of completion of therapy of a prior episode with the same organism or one sterile episode (3).
We found that practices in other countries vary. In Brazil, for example, the transfer set is changed only after relapsing peritonitis – 4 weeks after antibiotics have been completed. The rationale here again is that it could be microorganisms in the intraluminal biofilm in the transfer set causing the relapsing peritonitis. Once more, we are not aware of research evidence supporting this practice. In Japan and Canada, the practice varies from one PD center to another, some centers changing the transfer set routinely for a patient with suspected peritonitis, while other centers do not. In general, in the U.K., Australia and New Zealand it is not standard practice to change the transfer set for a patient with suspected peritonitis, unless an obvious contaminating event has occurred. Clearly, this topic is an area that would benefit very much from further research.
1.Wong FS, Chau SK, Chow NY, Ho JC, Cheng YL, Yu AW. Effect of Changing Transfer Set on Relapse of Bacterial Peritonitis. Hong Kong Journal of Nephrology. 2004 Oct 1;6(2):87-91. Abstract available at: https://www.sciencedirect.com/science/article/pii/S1561541309601642
2.Richmond DJ, Giminez LF, Reft C. Follow-up study to assess line changes with peritonitis. Adv Perit Dial. 1990;6:148-9.Abstract available at: https://www.ncbi.nlm.nih.gov/pubmed/1982796
3.Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International. 2016 Sep 1;36(5):481-508. Available at: https://journals.sagepub.com/doi/pdf/10.3747/pdi.2016.00078