Potential causes of black-stained

peritoneal dialysis tubing: an analysis

from nurse practitioners prospect
INTRODUCTION
Continuous Ambulatory Peritoneal dialysis (CAPD) is the main
method of treatment for Thai End-Stage Renal Disease (ESRD) patients
under the PD First Policy of the Universal Coverage (UC) scheme. More
than 12,000 ESRD patients have registered for PD modality with
participating PD centers under the UC scheme.
In 2008, the Tenckhoff tube and transfer set of a middle-aged male ESRD
patient were found to be stained with black particle during his routine
follow-up CAPD care. More cases were then revealed before a national
survey study reported that the incidence of this contamination was as
high as 57.6 per 1,000 CAPD cases. This contaminant has been
hypothesized to be a potential risk for infection.
Without real understanding of its causal mechanism, preventive measure
is not possible. Initially, iodine-based disinfectant was suspected to be
the cause and attempts had therefore been made but failed to prevent
the contamination. As iodine and silicone are not found in normal
peritoneal dialysate, we believe that the black-stained particle is a
contamination during the process of peritoneal dialysis and transfer set
exchange. This might be caused by clinical care provided, patient clinical
condition and self-care, as well as equipment used. This might explain

why attempts that focus on only one aspect of the etiology failed to
prevent the contamination. The objective is to present an analysis of
nurse practitioners perspective, which is useful for identifying potential
causes of black particles.
OBJECTIVES
For CDHD, CDPD, CDKT, CDOR Nurses:
To Facilitate a seminar that will promote awareness to our conurses and other member of the health care team.
To provide information about the latest trend that will affect
the nursing profession through invited speaker.
To assess the audience/participants comprehension of the
subject matter via evaluation or assessment form at the end of
the seminar.
For the Speaker:
To recognize the importance of delivering the subject matter to
his/her co-nurses and other members of the healthcare team.
To discuss the peritoneal dialysis related complications and
interventions required to maintain functionality and patency
and the overall cost.
To respond to the audiences questions through open forum
after the seminar.
For the Audiences/Participants:
To find out the latest issues / trends about the Nursing
Profession.
To acquire knowledge regarding Peritoneal Dialysis.

 To determine the signs and symptoms that should take into

consideration before initiation of dialysis.
Course Outline:
To assist the nephrologist in making decision regarding optimal
care for this complex group of patients.
To conduct Health Teachings about proper care of the exit site
of the PD patients.
Characteristics associated with the ideal PD exit site, and a
series of imperative factors that emerges.

Dietary Interventions Improve

Hyperphosphatemia Treatment in
Peritoneal Dialysis Patients
INTRODUCTION
Intensive dietary interventions may further decrease serum
phosphate concentrations in peritoneal dialysis (PD) patients compared
with phosphate binder therapy alone, a small study suggests.
For the trial, Jiaqi Qian, MD, of Ren Ji Hospital, in Shanghai, China, and
colleagues tracked serum phosphate levels in 97 PD patients over the
course of a year. All patients took a calcium carbonate phosphate binder;
half also reduced their dietary intake of phosphate under the guidance of
a dietitian and PD nurse.
According to results published online ahead of print in Nutrition,
Metabolism
and
Cardiovascular
Diseases,
serum
phosphate
concentration declined significantly in the dietary intervention group
from 1.98 to 1.65 mmol/L, as intake of dietary phosphate also declined.
Furthermore, fewer patients on a low phosphorus diet needed to use a
phosphate binder while others reduced their dose. By comparison, serum
phosphate concentration remained stable in the control group who took
phosphate binders alone.
The researchers, who observed that limiting dietary phosphate is notably
challenging for patients, analyzed subgroups based on patient
compliance to the interventions: 1 group limited phosphorus-rich foods,
another changed to phosphorus-reducing cooking methods (e.g., boiling,
stewing, and pre-soaking meat for an hour), and yet another group did
both. Family members were asked to support the changes. Dietary
phosphate decreased significantly in all 3 groups, but especially in the

group that altered both their diet and cooking.

The two dietary intervention components in our study, lowering
phosphate rich food or changing cooking method, showed independent
effect on reducing phosphate intake in PD patients, the investigators
wrote. Modifying cooking methods did not decrease serum phosphate
concentration significantly, however. The researchers suggest reducing
phosphate-rich foods may be more important.
To lower their dietary phosphate, patients were asked to reduce
phosphate-rich foods, such as meat and dairy items and foods with a
high phosphate-to-protein ratio, such as soft drinks, fast food, processed
foods, and condiments and other products containing phosphate-salt
additives. Patients completed a 3-day diet diary twice a month and
provided it to the dietitian and PD nurse during their monthly sessions.
Patients recorded the weight of raw foods and how food was cooked. For
processed foods, they also provided the nutrition label. The researchers
used a software program to estimate dietary phosphate and other
nutrients based on the diaries, which they noted may underestimate
phosphate intake by 250 mg/day (compared with chemical analysis).
OBJECTIVES
For CDHD, CDPD, CDKT, CDOR Nurses:
To Facilitate a seminar that will promote awareness to our conurses and other member of the health care team.
To provide information about the latest trend that will affect
the nursing profession through invited speaker.
To assess the audience/participants comprehension of the
subject matter via evaluation or assessment form at the end of
the seminar.
For the Speaker:
To recognize the importance of delivering the subject matter to
his/her co-nurses and other members of the healthcare team.

 To discuss the peritoneal dialysis related complications and

interventions required to maintain functionality and patency
and the overall cost.
To respond to the audiences questions through open forum
after the seminar.
For the Audiences/Participants:
To find out the latest issues / trends about the Nursing
Profession.
To acquire knowledge regarding Peritoneal Dialysis.
To acquire knowledge regarding Dietary Regimens

for

Peritoneal Dialysis Patients.

Course Outline:
To assist the nephrologist in making decision regarding optimal
care for this complex group of patients.
Techniques in cooking to lessen the Phosphorus in foods with
high phosphorus content.