Abstract
The main characteristic of CAPD is self-care and home treatment, and it is considered to have various benefits, such as an excellent effect in improving uremic condition and full rehabilitation in comparison with HD. However, this modality is used for those patients who are considered to be at some disadvantage with frequent HD. During the last 5 years at Saiseikai Yahata Hospital, 22 patients, 16 males and 6 females, whose mean age was 53.1 years, were managed on CAPD for more than one year. The reason for selecting CAPD were aged people in 5, pediatric patient in 3, cardiovascular trouble in 4, diabetes in 4, trouble with HD in 3 and better rehabilitation in 3. Of these patients, 16 were still on CAPD, 2 dropped out due to tunnel infection and 4 died due to heart failure (2), peritonitis (1) and emaciation (1) by January 31 1985. These patients had 60 episodes and 70.6 months hospitalization during 548.4 months of observation period, or 1.31 episodes and 47.1 days per patient-year. The causes of hospitalization were peritonitis in 21, inadequate body weight control in 12, exit or tunnel infection in 4, inconvienency of their helper in 8, trouble at the time of dialyzate in or out in 5, re-education in 2, ileus in 1, hernia of the abdominal wall in 1, Adams Stokes syndrome in 1, unknown fever in 1 and emaciation in 1. Twenty-one cases of peritonitis developed in 13 patients and the incidence was one episode for every 26.1 patient-months. sixty-two percent of peritonitis was caused by contamination occuring at the time of bag exchange and 19% was caused by tunnel infection. The former occurred frequently in the 2nd year of CAPD and in the latter cases catheters had to be removed.
In ordes to succeed and develop long-term CAPD, it is important to improve the technology of the connecting systems of the CAPD bag and peritoneal catheter, and to establish on individual CAPD program in each hospital managed by nephrologists and well educated nurses. A CAPD nurse should care for her patient continuously and make an effort to educate and cooperate with other nurses in the ward.
