Authors (including presenting author) :
Ho KM (1), Chan YH (1), Chak WL (1), Sung KMD(1), Ng GWY(2), Cheung VKL(2), So SS(2), Chung TCT(2), Tang KL (3), Tsang YN (3)
Affiliation :
(1) Renal Unit, Department of Medicine, Queen Elizabeth Hospital (2) Multi-Disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital (3) Department of Occupational Therapy, Queen Elizabeth Hospital
Introduction :
Touch contamination during bag exchange in Continuous Ambulatory Peritoneal Dialysis (CAPD) is a common cause of peritonitis, especially for renal failure patients with fair eye-hand coordination plus and minus poor vision who fail to do the aseptic technique in connecting tubing [1,2]. ‘Helping Hands’ is a device designed with distinctive features including tunnel for catheter fixation and parallel point-to-point movement with embedded magnets. The use of this device might enable those CAPD patients with poor vision and/ or eye-hand coordination to perform bag exchange procedure safely and independently.
Objectives :
To examine whether ‘Helping Hands’ device could reduce the risk of CAPD related peritonitis by allowing CAPD users to work through a safer connection process without direct touch on tubing during bag exchange procedure.
Methodology :
This is a randomized, paralleled, controlled trial in public hospital setting. The Renal Unit, Department of Medicine together with the Multi-disciplinary Simulation and Skill Centre (MDSSC) designed, prototyped, and fabricated a CAPD device named “Helping Hands” using 3D-printing technology. All new CAPD patients using Ultra-bag Peritoneal Dialysis (PD) system and attaining “high to moderate readiness” in assessment were invited to participate. Consented participants were randomly assigned to either intervention group (Training + “Helping Hands” provided for CAPD bag exchange) or control group (Training + CAPD bag exchange without “Helping Hands”) using computer-generated numbers.
Result & Outcome :
From December 2020 to December 2022, 26 patients were recruited. Thirteen (50%) and thirteen (50%) were assigned to intervention group and control group respectively. With a total duration of 327 patient-month, peritonitis rate of intervention group was significantly lower than that of control group, 0.14 versus 0.56 per patient-year (p< .01). The peritonitis rate in the intervention group was also lower than the overall peritonitis rate in QEH within the same study period, which was 0.27 per patient-year. Investigation report found that the episodes of peritonitis identified in intervention group were due to patients not clamping the transfer set before disconnection in performing bag exchange as opposed to device safety issues. Conclusion: The use of ‘Helping Hands’ device is safe and can significantly reduce the risk of CAPD-related peritonitis by no direct touching on tubing during bag exchange procedures. The distinctive features of “Helping Hands” might enable those PD patients with poor vision and/ or eye-hand coordination to perform bag exchange procedure safely and independently.
