Is there any support for the practice of changing transfer sets upon hospital admission when peritonitis is not suspected? I've seen the practice involving five-minute iodine soak/scrubs and I've also heard about outpatient clinics using CHG in a similar fashion, but is there a specific recommendation for this? Lastly, should the connection of an adaptor (e.g. a Baxter adaptor being added on top of a Fresenius transfer set) be performed the using the same sterile transfer set exchange procedure? Thanks!

There is no established maximum dwell time for intraperitoneal antibiotics; the optimal duration depends critically on the pharmacokinetic and pharmacodynamic properties of the specific antibiotic and should be individualized to the patient’s circumstances. Time-dependent antibiotics (e.g., β-lactams, vancomycin) achieve efficacy based on the duration serum concentrations exceed the MIC, making extended dwells generally acceptable and potentially beneficial. Conversely, concentration-dependent antibiotics (e.g., aminoglycosides, fluoroquinolones) are most effective with peak concentrations relative to MIC, suggesting shorter, more frequent administration may be optimal. Individualizing dwell time requires careful consideration of dialysis modality (CAPD vs. APD), residual kidney function, patient comfort and adherence, dialysis schedule, and systemic absorption risk.