Questions About PD
Thank you for your interesting question. Although the ISPD’s most recent peritonitis recommendations mention briefly the procedure for adding IP antibiotics, I found guidelines from the Centers for Disease Control (CDC) and the Institute for Safe Medicine Practices (ISMP) give further guidance on this topic (1,2,3).
Taken together these guidelines recommend use of aseptic technique, which includes hand hygiene prior to and after preparation and administration of the medication. Further recommendations to reduce microbial contamination include use of single-use packages of 70% alcohol, iodophor (e.g. Betadine) or chlorhexidine in alcohol using friction to disinfect the port of the IV (in our case, the PD solution bag). According to the CDC, there is not enough evidence to recommend one antiseptic over the others, as well, in general, antiseptics should be allowed to dry for maximal effect (2).
Of note, the “pop-off” vial caps from manufacturers are considered dust covers. Thus, the diaphragm of the medication vial must always be disinfected with a separate antiseptic swab (using friction) and allowed to dry for at least 10 seconds prior to using (3).
- Li PK-T, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD Peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International 2016; 36:481–508.
- Centers for Disease Control. Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for the Prevention of Intravascular Catheter-Related Infections. 2011. Available at http://www.cdc.gov/hai/pdfs/bsi-guidelines-2011.pdf
- Institute for Safe Medicine Practices (ISMP). Safe Practice Guidelines for Adult IV Push Medications. ISMP 2015. Available at http://www.ismp.org/Tools/guidelines/IVSummitPush/IVPushMedGuidelines.pdf
A very interesting question. A recent study Disinfection of the peritoneal dialysis bag medication port: Comparison of disinfectant agent and disinfection time by Conti et al., published online on Nephrology July 2017 (doi:10.1111/nep.13101) has shown that the Medication Port should be scrubbed with 2% chlorhexidine for at least 5 seconds; if alcohol 70% is used the length of friction should not be inferior to 10 s.