MO707: Efficacy and Safety of ‘Helping Hands’: A 3D-Printed Device of Peritoneal Dialysis Adopted in Continuous Ambulatory Peritoneal Dialysis: A Randomized Controlled Trial
Authors: Man Ho Ka , Han Chan Yiu , Leung Chak Wai , Chu Agnes Cheung Sim , Yiu George Ng Wing , Cheung Victor , Sze So Sze , Ting Chung Cheuk , Leung Tang Ka , Ning Tsang Yiu 
Published: May 2022

Abstract

BACKGROUND AND AIMS
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 (Hsieh et al. The negative impact of early peritonitis on continuous ambulatory peritoneal dialysis patients. Perit Dial Int. 2014;34(6):627–35; Woten and Cabrera. Peritonitis: prevention of peritoneal dialysis-induced peritonitis in adults. CINAHL Nursing Guide EBSCO Publishing, 16 November 2018). Those who are unable to execute CAPD by themselves resulted in high restriction in independent living where support from helper or institutional care is required. Up till now, no commercially available CAPD device could be utilized to solve this issue. ‘Helping Hands’ is a device designed with distinctive features including tunnel container for catheter fixation and comfortable handle and clips for parallel point-to-point movement with embedded magnets, and 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. In this study, we hypothesized the use of ‘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 procedures.

METHOD
This is a randomized, paralleled, controlled pilot trial in public hospital setting. An interdisciplinary collaboration workgroup was established at Queen Elizabeth Hospital in May 2019. The Renal Unit of Department of Medicine together with the Multi-disciplinary Simulation and Skill Centre designed, prototyped, and then 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 with occupational therapists were invited to participate in this program. All consented participants were randomly assigned to either intervention group (training + ‘Helping Hands’ provided for CAPD bag exchange) or control group (training alone + CAPD bag exchange without ‘Helping Hands’) using computer-generated numbers.

RESULTS
From December 2020 to November 2021, 17 patients, with their demographic shown in Fig. 1 were recruited into the study. Nine (53%) and eight (47%) were assigned to intervention group and control group, respectively. Within comparable study period (41 patient-month for both groups), peritonitis rate of intervention group was significantly lower than that of control group, 0.29 versus 1.18/patient-year (P &lt; .01). The peritonitis rate in the intervention group was also lower than the overall peritonitis rate in the Queen Elizabeth Hospital within the same study period, which was 0.31/patient-year (4193 patient-month; peritonitis episode = 108). Investigation report found that the episode of peritonitis identified in intervention group was due to patient not clamping the transfer set before disconnection in performing the 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.