The changing of the titanium adaptor should always be performed with strict aseptic technique. However, since the titanium adaptor can be difficult to remove, it is always a concern that the PD nurse could accidentally contaminate the distal end of the PD catheter or the new titanium connector, thus putting the PD patient at risk for peritonitis from touch contamination.
In general, unless the titanium adaptor for some reason is obviously soiled, we would not recommend changing the adaptor routinely with each episode of peritonitis.