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Keith Osborne
Keith Osborne

Buy Dialysis Tubing

Peritoneal dialysis (PD) access is important for patients undergoing PD. However, one of the potential complications of peritoneal dialysis access is damage to the dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients. Much of the damage caused by pets has been attributable to cat biting or scratching, whereas the present case is an extremely rare case of dialysis tubing damage caused by a pet cockatoo.

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This is a rare case report of PD tubing damage caused by a cockatoo kept at home. It may be necessary to pay sufficient attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos.

Peritoneal dialysis (PD) access is important for patients undergoing PD, just as vascular access is important for hemodialysis patients. However, one of the potential complications of peritoneal dialysis access is damage to the PD equipment including dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. Damage to the dialysis tubing is usually discovered by dialysate leakage, but dialysis tubing damage has also been revealed after examining the cause of peritonitis. As such, while many of the damages brought about by pets have been attributable to cat biting [1,2,3,4,5,6,7,8,9,10, 13, 14, 16,17,18], our present case was an extremely rare case of dialysis tubing damage caused by a pet cockatoo.

Damage to PD equipment can often occur due to human error. However, PD equipment damage caused by pets in PD patients has recently been occasionally reported, with an increase in the number of families keeping pets [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. As described above, the causative pet was a cat in almost all cases, other than two cases caused by a hamster [11, 12], and one case caused by a cockatoo [15] (Table 1). To our knowledge, this is the second case report of PD tubing damage by a bird.

The PD equipment damaged by pets was dialysis tubing in most reported cases. One case each of PD catheter damage and PD solution bag damage has also been reported (Table 1). The type of PD in patients whose equipment was damaged was continuous cycler peritoneal dialysis in many cases (Table 1), suggesting that animals frequently bit or scratched the equipment which remained unnoticed by the patient, i.e., during sleep. Damage to PD tubing by pets does not completely tear the tube (Table 1), but results in a pinhole-shaped damage that may go unnoticed until leakage of PD solution is confirmed, and discovery may be delayed when the leakage is minor. In our case, the cockatoo completely cut the dialysis tubing with its beak in front of the patient during CAPD operation. Thus, the patient noticed the damage immediately and visited our hospital. Early treatment including antibiotic administration may have prevented peritonitis.

Very little epidemiological data are available on pet-related peritonitis in peritoneal dialysis. Incidences of 0.54% in all PD peritonitis cases in a report on a French-speaking registry for peritoneal dialysis (RDPLF) and of 0.03% in all cases of PD peritonitis in a single-center study have been reported [19]. In general, PD equipment damage can be a cause of PD peritonitis, but bacteria not observed in normal peritonitis are often detected in PD peritonitis caused by pets (Table 1), due to differences in bacterial flora between pets and humans [19,20,21]. In cats and dogs, Pasteurella species, which are indigenous bacteria in the oral cavity, are problematic as causative bacteria of peritonitis [19, 21]. As shown in Table 1, the culture results were Pasteurella species in most previous reports with a cat. Chlamydia psittaci infection is a well-known Cockatoo-associated infection [22], and generally, birds may cause fungal infection because many fungi are found on the feathers and skin of healthy birds [20]. Among these, Cryptococcus neoformans is well-known and causes pulmonary and skin cryptococcosis [20, 23]. Fungal infection of PD patients caused by birds has rarely been reported, but an outbreak of Candida parasilosis-induced fungal peritonitis that was considered to have been caused by pigeon guano has been described [24]. Mucormycosis peritonitis that was likely to have been caused by a cockatoo has also been reported in a case involving biting of PD tubing by a cockatoo [15], similarly to our case. Our patient received preventive drug administration of levofloxacin because the presence or absence of infection was unclear at the time of arrival and this drug is effective for both Chlamydia psittaci and contaminating bacteria.

In conclusion, this is the first case report of PD tubing damage without peritonitis caused by a cockatoo kept at home. However, only cases in which peritonitis develops tend to be reported. Thus, there actually may be more cases of PD equipment damage by pets. Therefore, it may be necessary to pay attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos, that have powerful beaks and are playful because of their high intelligence.

After a few hours, the solution and the wastes are drained out of your belly into the empty bag. You can throw away the used solution in a toilet or tub. Then, you start over with a fresh bag of dialysis solution. When the solution is fresh, it absorbs wastes quickly. As time passes, filtering slows. For this reason, you need to repeat the process of emptying the used solution and refilling your belly with fresh solution four to six times every day. This process is called an exchange.

You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up at night to do an exchange.

With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night. In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine. People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD.

If you choose automated peritoneal dialysis, you also need to learn how to do exchanges by hand in case of a power failure or if you need an exchange during the day in addition to nighttime automated peritoneal dialysis.

Your health care team will provide everything you need to begin peritoneal dialysis and help you arrange to have supplies such as dialysis solution and surgical masks delivered to your home, usually once a month. Careful hand washing before and wearing a surgical mask over your nose and mouth while you connect your catheter to the transfer set can help prevent infection.

A transfer set is tubing that you use to connect your catheter to the bag of dialysis solution. When you first get your catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection. A connector under the cap will attach to any type of transfer set.

You may need to limit some physical activities when your belly is full of dialysis solution. You may still be active and play sports, but you should discuss your activities with your health care team.

One of the most serious problems related to peritoneal dialysis is infection. You can get an infection of the skin around your catheter exit site or you can develop peritonitis, an infection in the fluid in your belly. Bacteria can enter your body through your catheter as you connect or disconnect it from the bags.

Peritoneal dialysis increases your risk for a hernia for a couple of reasons. First, you have an opening in your muscle for your catheter. Second, the weight of the dialysis solution within your belly puts pressure on your muscle. Hernias can occur near your belly button, near the exit site, or in your groin. If you have a swelling or new lump in your groin or belly, talk with your health care professional.

With automated peritoneal dialysis, you may absorb too much solution during the daytime exchange, which has a long dwell time. You may need an extra exchange in the midafternoon to keep your body from absorbing too much solution and to remove more wastes and extra fluid from your body.

Dialysis, in the most general sense, is the process by which molecules filter out of one solution, by diffusing through a membrane, into a more dilute solution. Outside of hemodialysis, which removes waste from blood, scientists use dialysis to purify drugs, remove residue from chemical solutions, and isolate molecules for medical diagnosis, typically by allowing the materials to pass through a porous membrane.

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