I am looking for information on how long Peritoneal bags are permitted to be kept in a dry warmer? If you can provide a reference also, that would be fantastic. Only data I am finding is "short duration" or "as soon as possible". A specific BUD would be preferred. Thanks in advance!

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Jessica S , Scientist from Saint Vincent Hospital asked
I am looking for information on how long Peritoneal bags are permitted to be kept in a dry warmer? If you can provide a reference also, that would be fantastic. Only data I am finding is "short duration" or "as soon as possible". A specific BUD would be preferred. Thanks in advance!

1 answer

Nurse Canada and Members of the ISPD Nursing Committee February 9, 2024

We thank you for your question. Unfortunately, as far as we are aware, there are no guidelines on the
specific question you ask: “How long are PD solution bags permitted to remain in a dry warmer or
warming cabinet”.
 
Solution bags for CAPD are usually warmed to 37 ⁰C (body temperature) shortly before use for the
comfort of the patient. The province of British Columbia (BC) Renal Agency website has posted
instructions for warming PD solution bags, listing three different methods: a heating/warming cabinet, a
microwave, and a heating pad (1). Cautions are listed for each method. If using the heating/warming
cabinet in a hospital setting, the authors recommend the solution bags should be rotated, so that the
oldest are used first, solution bags should be discarded if they are a brown color indicating
caramelization from glucose degradation products (GDPs), and there should be regular checks of the
internal temperature of the warming cabinet (e.g. by technicians in the hospital/facility biomedical
engineering department) to prevent overheating of the PD solution bags. However, the authors do not
mention how long PD solutions can be kept in a warming cabinet, only recommending that PD solutions
should be used as soon as possible after warming and that the solution bags should feel tepid to touch
at the inner wrist. Similarly, in the chapter on “Peritoneal Dialysis Program Organization and
Management: The Nurse’s Role” the authors discuss methods of warming of dialysis solutions, but do
not mention how long PD solutions can be safely stored in a warming cabinet (2).
 
We would note here, that manufacturers of PD solutions only recommend that dry heat should be used
to warm PD solutions. They do not recommend using a microwave to warm PD fluids (may heat the PD
solution unevenly and create “hotspots”), neither do they recommend immersing the PD solution in
warm water (potential exposure of the PD solution to waterborne organisms). PD solution bags should
always have the expiration date checked before use.
 
This is clearly an area that warrants further research.
 
1.BC Renal. Warming peritoneal dialysis solutions. Available at: http://www.bcrenal.ca/resource-
gallery/Documents/Warming%20Peritoneal%20Dialysis%20Solutions.pdf (updated 2018, accessed Feb
3, 2024).
 
2.Luongo, M., Prowant, B., Burrows, L., Neumann, J., Ponferrada, L. (2023). Peritoneal Dialysis Program
Organization and Management. In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of
Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-62087-5_13

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