JP2000084070A - Peritoneal dialysis device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a peritoneal dialysis device capable of ensuring freedom from the application of excessive pressure to a patient's abdominal cavity, reducing the pressure fluctuation range of pulsating current stimulating his/her abdominal cavity, ensuring a small size and generating a small amount of noises. SOLUTION: Dialysing fluid of at least two different compositions is supplied to a mixing vessel 2 from a plurality of dialysing fluid vessels 1a, 1b, 1c, 1d and 2 and heated. Then, heated dialysing fluid is transferred to an abdominal cavity A and used dialysing fluid is then discharged. The supply of the dialysing fluid to a mixing vessel 3, the transfer thereof to the abdominal cavity A and the discharge of the used dialysing fluid are performed on the operation of a single reversible pump 6. When the internal pressure of the abdominal cavity A exceeds a preset level, the pressure control valve 11 of a bypass circuit 10 installed in parallel with the pump 6 opens, thereby bypassing a part of the dialysing fluid transferred to the abdominal cavity A.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

TECHNICAL FIELD The present invention relates to a peritoneal dialysis device. More specifically, the present invention relates to a peritoneal dialysis device that does not apply excessive pressure to the abdominal cavity, has a constant discharge pressure, and does not substantially generate a pulsating flow.

[0002]

2. Description of the Related Art Artificial dialysis therapy and peritoneal dialysis therapy have been conventionally used for treating patients with renal failure. Artificial dialysis therapy usually requires hospital visits about three times a week, forcing the patient to be restrained in time, greatly hindering the patient's rehabilitation. On the other hand, peritoneal dialysis therapy is a method of performing dialysis using the patient's peritoneum, and the treatment requires replacement of the dialysate four times a day. In recent years, it has been attracting attention because it is possible.

In peritoneal dialysis, CAPD (Continu-ous Ambulatory Perfusion) in which patients themselves exchange dialysate during the day is used.
APD (Automated Peritoneal) that automatically exchanges dialysate using itoneal Dialysis and an automatic peritoneal dialysis machine
Dialysis). CAPD requires complicated operations such as connecting bags and switching valves since the patient himself exchanges dialysate. On the other hand, APD can save the trouble of dialysate exchange work and can reduce the risk of peritonitis caused by bacterial contamination because the number of times of connection with the patient's peritoneal catheter is smaller than that of CAPD. Among the APDs, the dialysate is changed during bedtime at night, but the dialysate is not changed during the daytime, and the CCPD remains in the reservoir.
(Continuous Cyclic Peritoneal Dialysis), and NPD that changes dialysate while sleeping at night and does not store during the day
(Nightly Peritoneal Dialysis) is suitable for rehabilitation because no dialysate exchange is required during the day.

[0004] In the case of an automatic peritoneal dialysis device used for APD, conventionally, a drop type using a head pressure is used for injecting dialysate into a patient's peritoneal cavity and draining dialysate from the patient's peritoneal cavity. However, in the case of the head type, it is necessary to secure a head, so that the size of the apparatus is increased, and the use of a bed is forced to secure a head for drainage. In order to solve such disadvantages, in recent years, a method using a roller pump for injecting dialysate into a patient's peritoneal cavity and discharging dialysate from the patient's peritoneal cavity has been adopted. However, there is a drawback that the dialysate is forcibly supplied even when the peritoneal catheter is closed, and as a result, there is a possibility that the internal pressure of the circuit rapidly increases and the circuit is damaged. In addition, when a dialysate is drained from the peritoneal cavity, if a roller pump is used, even if the dialysate does not remain in the peritoneal cavity, it may be forcibly sucked even if there is no remaining dialysate, and an excessive negative pressure may be applied to the patient's abdominal cavity. Was.

Therefore, as a method for solving this problem,
A method of controlling the pump based on the pressure in the abdominal cavity detected by the pressure detecting means has been proposed (Japanese Utility Model 3-403).
03 publication). This method has the advantage of high safety because the dialysate is transferred while monitoring the intraperitoneal pressure of the patient.However, since the roller pump is used, a pulsating flow is generated, which stimulates the abdominal cavity of the patient. And the position of the peritoneal catheter may be shifted during the dialysis treatment.

On the other hand, as a method which does not require the securing of a head, conventionally, a dialysate bag is housed in a closed rigid container,
A method of transferring a dialysate by pressurizing and depressurizing the atmosphere of a dialysate bag, and a method of transferring a dialysate by alternately pressurizing and depressurizing a pair of chambers each having a soft membrane are known. However, in the former method, it is necessary to supply a single amount of the intraperitoneal fluid to the abdominal cavity at a time or to drain the fluid from the abdominal cavity at one time. There is a disadvantage that the size of the sealed rigid container for accommodating the bag for use becomes large and the device becomes large.
In the latter method, when switching between pressurizing and depressurizing the chamber, it is necessary to switch the valve in conjunction therewith, and there is a disadvantage that noise is generated at that time.

[0007]

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and does not apply excessive pressure to a patient's abdominal cavity. An object of the present invention is to provide a peritoneal dialysis device that can be reduced in size and that is small and generates less noise.

[0008]

SUMMARY OF THE INVENTION The present invention has been made in order to solve the above-mentioned problems, and as a result of diligent studies, a circuit for bypassing a dialysate transferred into a peritoneal cavity in parallel with a pump has been provided so that the pressure in the peritoneal cavity can be controlled. The present invention has been completed by conceiving that the dialysate may be bypassed by the bypass circuit when the pressure exceeds the pressure. That is, the present invention supplies at least two dialysates having different compositions from a plurality of dialysate containers to a mixing vessel, mixes and heats the same, and then transfers the heated dialysate into the abdominal cavity to use the dialysate. In a peritoneal dialysis device configured to drain the dialysate, the supply of the dialysate to the mixing container and transfer to the peritoneal cavity, and the drainage of the used dialysate is performed by one forward / reverse roller pump. A peritoneal dialysis device wherein a part of the dialysate transferred into the peritoneal cavity is bypassed when the internal pressure of the peritoneal cavity exceeds a predetermined pressure by a bypass circuit provided in parallel with the roller pump. Here, it is preferable to provide a pressure control valve that opens when the pressure in the abdominal cavity exceeds a predetermined pressure in the bypass circuit.
Further, the peritoneal dialysis device may be provided with a dialysate heating means for heating the dialysate in the mixing container. In order to prevent excessive pressure from being applied to the abdominal cavity when draining the used dialysate in the abdominal cavity, a circuit for detecting the internal pressure of the abdominal cavity is provided in a circuit from the bypass circuit to the abdominal cavity. You may make it operate a pump based on it.

[0009]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Next, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a system diagram showing one embodiment of the present invention, and FIG. 2 is an explanatory diagram showing an example of the pressure control valve shown in FIG. As shown in FIG. 1, the peritoneal dialysis apparatus of the present invention supplies at least two dialysates having different compositions from a plurality of dialysate containers 1a, 1b, 1c, 1d, 2 to a mixing container 2 to mix and heat. After that, the heated dialysate is transferred into the peritoneal cavity A, and the used dialysate is drained. The supply of the dialysate to the mixing vessel 3 and the transfer into the peritoneal cavity A and the used dialysate are used. The drainage of the dialysate is performed by one forward / reverse pump 6. When the internal pressure of the abdominal cavity A exceeds a predetermined pressure, a bypass circuit 10 provided in parallel with the pump 6
Is opened, and a part of the dialysate transferred into the peritoneal cavity A is bypassed.

A plurality of dialysate containers 1a, 1b, 1c, 1
At least one of d and 2 contains a dialysate having a different composition, and in FIG. 1, the composition of the dialysate container 2 is different from the compositions of the other dialysate containers 1a, 1b, 1c and 1d. The first circuit 7 has connection ends 71, 72, 7 for connecting the plurality of dialysate containers in parallel on the upstream side and the downstream side, respectively.
3, 74, 75 and connection end 76 for connection to mixing vessel 3
The dialysate containers 1 a, 1 b, 1 c, and 1 d containing dialysates having the same composition are opened and closed by an on-off valve 76, and the dialysate container 2 is opened and closed by an on-off valve 77. The mixing container 3 is opened and closed by an on-off valve 79. A forward / reverse pump 6 is provided downstream of the on-off valves 76, 77, and supplies dialysate from the dialysate containers 1a, 1b, 1c, 1d, 2 to the mixing container 3 and the mixing container 3 from the abdominal cavity A The pump 6 transfers the used dialysate from the peritoneal cavity A to the drainage container 4.

The dialysate in the dialysate containers 1a, 1b, 1c and 1d is supplied to the mixing container 3 by the pump 6 through the first circuit 7 and the connection end 76 (at this time, the on-off valves are 77 and 7).
9 open and 78, 81, 92 close). The weight of the dialysate supplied to the mixing container 3 is accurately measured by the measuring means 12, and when the weight reaches a predetermined weight, the supply is stopped, and then the dialysate is supplied from the dialysate container 2. (At this time, the on-off valve is closed at 77 and opened at 78)
The supply is stopped when the specified weight is reached. The weighing means 12 is preferably provided with a heating means 15,
The temperature of the dialysate in the mixing vessel 3 to be heated is controlled almost exactly by the temperature sensor 16. As the heating means 15, a heating element that contacts and heats the mixing vessel, for example, a panel heater, is suitably employed, but any method can be used as long as heating is possible. The heating of the dialysate does not necessarily need to be performed in the mixing vessel 3, and may be continuously heated in a pipe shape, for example, when the liquid is injected into the abdominal cavity A of the patient. As the temperature sensor 16, a thermistor, a thermocouple, or the like is suitably used. The mixing of the dialysates having different compositions supplied to the mixing container 3 proceeds during the heating.

The dialysate heated to an appropriate temperature (usually 35 to 37 ° C.) is pumped from the mixing vessel 3 to the third circuit 9 (having a connection end 91 with the peritoneal catheter 5) and the peritoneal catheter 5 by the pump 6. And is injected into the abdominal cavity A (at this time, the on-off valve 78 is closed and the 92 is opened). The bypass circuit 10 is provided in parallel with the pump 6 interposed in the first circuit 7, and is provided with a pressure control valve 11 that opens when the internal pressure of the abdominal cavity A exceeds a predetermined pressure. Since the internal pressure of the peritoneal cavity A is equal to the pressure of the dialysate in the circuit from the bypass circuit 10 to the peritoneal cavity A, when the dialysate pressure in the circuit during this period exceeds a predetermined pressure, the pressure control valve 11 is opened. A part of the dialysate transferred to the abdominal catheter 5 is bypassed from the downstream side of the pump 6 to the upstream side. Therefore, since the internal pressure of the abdominal cavity A is maintained at a predetermined value or less, excessive pressure is not applied to the abdominal cavity A. The pressure control valve 11 may be of any type as long as it opens the bypass circuit 10 when the internal pressure of the third circuit 9 exceeds a predetermined value. In this case, for example, the pressure is preferably controlled at a set pressure of 70 mmHg corresponding to a head of 1000 mm. The operation of the pressure control valve 11 may be an ON-OFF operation, but it is preferable that the open circuit area be continuously increased in accordance with the increase in the pressure because smooth pressure control can be performed. The pressure control valve 11 of the present embodiment is of the latter type,
A pressure control valve similar to that disclosed in Japanese Patent Publication No. 6-59306 (see FIG. 2) can be employed. In the pressure control valve 11 of this type, the pressure fluctuation width of the pulsating flow can be minimized by appropriately selecting the set pressure, so that the abdominal cavity A can be prevented from being damaged by the pulsating flow. In FIG. 1, reference numeral 17 denotes an air trap;
Is a pilot circuit. Also, in FIG.
Is a casing, 112 is a clamp, 113 is a receiving member, 1
14 is a spring, 115 is a pressure setting dial, 116
Is a pressure bag.

The spent dialysate in the peritoneal cavity A is passed by the pump 6 through the peritoneal catheter 5, the third circuit 9, the first circuit 7 and the second circuit 8 (having a connection end 79 with the drainage container 4). The liquid is transferred and drained into the drainage container 4 (at this time, the on-off valve 79 is closed and 81 is opened). The weight of the used dialysate discharged into the drainage container 4 is measured by the measuring means 41. The dialysis treatment may be terminated when the weight of the dialysate reaches a predetermined amount, but is usually repeatedly performed within a predetermined weight by a preset number of cycles. Here, in order to prevent excessive pressure from being applied to the peritoneum during drainage,
The first circuit 7 or the third circuit 9 extending from the bypass circuit 10 to the third circuit 9 is provided with a pressure detecting means 14 for detecting an intra-abdominal pressure, and a shade in the abdominal cavity A detected by the pressure detecting means 14 at the time of drainage. When the pressure becomes larger than the preset negative pressure, the pump 6 may be decelerated or stopped based on the pressure signal transmitted to the control unit 13. In this case, for example, minus 40 m corresponding to a head 500 mm
It is preferably controlled at a set negative pressure of mHg.

[0014]

As is apparent from the above description, according to the peritoneal dialysis apparatus of the present invention, when the infusion pressure of the dialysate into the abdominal cavity of the patient exceeds a predetermined pressure, the dialysate is provided in the bypass circuit. Since the pressure control valve is opened and a part of the dialysate is bypassed, it is possible to prevent excessive pressure from being applied to the abdominal cavity of the patient by appropriately setting the pressure, and It is possible to reduce the pressure fluctuation width of the pulse flow that stimulates the abdominal cavity of the patient. 1 pump
Therefore, it is possible to provide a peritoneal dialysis device that is small and generates little noise.

[Brief description of the drawings]

FIG. 1 is a system diagram showing one embodiment of the present invention.

FIG. 2 is an explanatory diagram showing an example of a pressure control valve shown in FIG.

[Explanation of symbols]

 1a, 1b, 1c, 1d Dialysate container 2 Dialysate container 3 Mixing container 4 Drainage container 41 Measuring means 5 Abdominal catheter 6 Pump 7 First circuit 71, 72, 73, 74, 75, 76 Connection end 77, 78, 79 on-off valve 8 second circuit 81 connection end 82 on-off valve 9 third circuit 91 connection end 92 on-off valve 10 bypass circuit 11 pressure control valve 12 metering means 13 controller 14 pressure detection means 15 heating means 16 temperature sensor 17 air trap 18 Pilot circuit A Abdominal cavity

Claims (4)

[Claims] Claims 1. A dialysate having at least two different compositions is supplied from a plurality of dialysate containers to a mixing vessel, mixed and heated, and the heated dialysate is transferred into the peritoneal cavity to use spent dialysate. In a peritoneal dialysis device configured to drain the fluid, the supply of the dialysate to the mixing container and transfer into the peritoneal cavity, and the drainage of the used dialysate are performed by a single reversible roller pump. A peritoneal dialysis device in which a part of the dialysate transferred into the peritoneal cavity is bypassed when the internal pressure of the peritoneal cavity exceeds a predetermined pressure by a bypass circuit provided in parallel with the roller pump. 2. A pressure control valve which opens when the pressure of the dialysate exceeds a predetermined pressure is provided in the bypass circuit.
2. A peritoneal dialysis device according to claim 1. 3. The peritoneal dialysis apparatus according to claim 1, further comprising a dialysate heating means for heating the dialysate in the mixing vessel. 4. The peritoneal dialysis apparatus according to claim 1, wherein a means for detecting the internal pressure of the abdominal cavity is provided in a circuit from the bypass circuit to the abdominal cavity.