JP5699008B2 - Blood purification equipment - Google Patents

Description

  The present invention relates to a blood purification apparatus for performing blood purification treatment with a blood purifier connected to a blood circuit.

  Recently, in a dialysis machine as a blood purification apparatus, there is a technique for performing priming, blood return and replacement (emergency replacement) using dialysate for supplying to a dialyzer during dialysis treatment (particularly, on-line HDF or on-line HF). Has been proposed. For example, Patent Document 1 discloses a replacement fluid in which one end is connected to a sampling port formed in a predetermined part of the dialysate introduction line and the other end is connected to a blood circuit (arterial blood circuit or venous blood circuit). A dialysis apparatus including a line and a replacement fluid pump disposed in the replacement fluid line is disclosed. In order to perform priming, blood return or replacement fluid (emergency replacement fluid) with such a dialysis device, the dialysate introduction line dialysate is supplied to the blood circuit (arterial blood circuit or venous blood circuit) by driving the replacement fluid pump. It can be supplied.

  By the way, the dialyzer as a blood purifier includes a so-called laminated type in addition to the one using a hollow fiber. As disclosed in, for example, Patent Document 2, this multi-layered dialyzer has a blood purification membrane for blood purification and a blood flow path through which blood flows and the dialysate through the blood purification membrane. A dialysis fluid channel that circulates is formed, and the blood channel can be expanded or contracted according to the fluid pressure of the fluid flowing in the blood channel. If such a laminated blood purification means (dialyzer) is used, the blood flow path expands and contracts according to the fluid pressure, so that it is difficult to lower the patient's blood pressure during treatment.

JP 2004-313522 A JP 2010-273893 A

However, the conventional blood purification apparatus has the following problems when the laminated dialyzer is used as a blood purification device.
Since the laminated dialyzer is normally in a state in which the blood flow path is contracted, when performing priming, the dialysate flow path is depressurized by driving a dewatering pump, for example, to the blood flow path. It is necessary to expand the blood flow path with a negative pressure in the dialysate flow path to allow the priming liquid to flow well. However, if the priming fluid is circulated in the blood flow channel while making the inside of the dialysis fluid flow negative, the priming fluid in the flow process is filtered (positive filtered) to the dialysate flow channel side through the blood purification membrane. There is a problem that.

  However, if the priming solution is filtered (positive filtration) to the dialysate flow path side, the pressure in the blood circuit (in the closed circuit formed by the arterial blood circuit and the venous blood circuit during priming) will decrease. There is a risk that the blood flow path of the laminated dialyzer will be blocked. Thus, if the blood flow path of the laminated dialyzer is blocked during priming, the flow of the priming solution is hindered, and there is a problem that it is difficult to perform priming well. Such a problem also occurs in a case where priming is performed using a dialysis device (blood purification device) as described above and a physiological saline solution is primed as a priming solution.

  The present invention has been made in view of such circumstances, and when priming a blood circuit to which a stacked blood purifier is connected, the blood flow path of the stacked blood purifier is blocked. An object of the present invention is to provide a blood purification apparatus that can prevent the priming liquid and ensure good circulation of the priming liquid.

The invention described in claim 1 includes a plurality of blood purification membranes for performing blood purification, and a blood passage through which blood flows and a dialysate passage through which dialysate flows through the blood purification membrane. And a laminated blood purifier in which the blood flow path can be expanded or contracted according to the fluid pressure of the fluid flowing in the blood flow path, and a proximal end is connected to the blood purifier, An arterial blood circuit provided with a blood pump, a venous blood circuit whose proximal end is connected to the blood purifier, a dialysate introduction line for introducing dialysate into the blood purifier, and the blood purification A blood purification apparatus comprising a dialysate discharge line for discharging dialysate from the blood vessel, wherein one end is connected to the dialysate introduction line or the priming solution storage bag and the other end is connected to the arterial blood circuit or Connect to venous blood circuit Is a priming line capable of supplying the priming solution within the arterial blood circuit or the venous blood circuit, and a liquid pressure detecting means capable of detecting the hydraulic pressure of the arterial blood circuit or the venous the blood circuit, the artery When priming in a state where the tip of the side blood circuit and the tip of the venous blood circuit are connected, the dialysate channel is reduced with respect to the blood channel by reducing the pressure in the dialysate channel in the blood purifier The blood flow channel is expanded with a negative pressure inside, and the priming fluid in the arterial blood circuit and the venous blood circuit is allowed to flow while maintaining the expanded state of the blood flow channel, and control means, under the condition that the detected hydraulic pressure in the hydraulic pressure detecting means becomes below a predetermined value, a predetermined amount of the priming liquid to the arterial blood circuit or the venous blood circuit , By the row Ukoto refilling step of refilling supply feed to through the priming line, characterized in that it can prevent clogging of the blood flow path of the laminated type blood purifier.

  According to a second aspect of the present invention, in the blood purification apparatus according to the first aspect, the control means introduces a priming solution into the arterial blood circuit and the venous blood circuit while the priming line is open during priming. And a cleaning and replacing step of replacing the air with the air, and a bubble removing step of removing bubbles by flowing the priming liquid in the arterial blood circuit and the venous blood circuit while the priming line is closed. And during the bubble removal step, by depressurizing the dialysate flow path in the blood purifier to expand the blood flow path with a negative pressure in the dialysate flow path relative to the blood flow path, The priming liquid in the arterial blood circuit and the venous blood circuit is caused to flow while maintaining the expanded state of the blood flow path.

  According to a third aspect of the present invention, in the blood purification apparatus according to the second aspect, the control means causes the blood pump to reversely drive during the bubble removal step so that the bubbles in the blood purification device are moved to the vein side. It transfers to the blood circuit side.

  The invention according to claim 4 is the blood purification apparatus according to any one of claims 1 to 3, wherein one end of the priming line is connected to a sampling port formed at a predetermined portion of the dialysate introduction line. And the other end of the artery-side blood circuit is connected to a tip of the artery-side blood circuit and the blood pump, and the dialysate in the dialysate-introducing line is connected to the blood pump through the priming line. In the arterial blood circuit, and the control means, during priming, causes the arterial blood circuit, the venous blood circuit, and the blood flow path to be supplied by the dialysate supplying means during priming. Is filled with dialysate as a priming solution.

  According to a fifth aspect of the present invention, in the blood purification apparatus according to the fourth aspect, the dialysate supply means is disposed across the dialysate introduction line and the dialysate discharge line, and the dialysate is supplied to the blood purifier. And the control means bypasses the dialysate discharge side of the dual pump during the replenishment step to bring the dialysate to the discharge side. It is characterized by circulating.

  The invention according to claim 6 is the blood purification apparatus according to any one of claims 1 to 5, further comprising a venous pressure sensor in the middle of the venous blood circuit, It consists of a venous pressure sensor.

  According to the first to third aspects of the present invention, when priming is performed in a state where the tip of the arterial blood circuit and the tip of the venous blood circuit are connected, the fluid pressure detected by the fluid pressure detecting means becomes a predetermined value or less. If the blood circuit to which the laminated blood purifier is connected is primed, a replenishing step of supplying and replenishing a predetermined amount of the priming liquid via the priming line can be performed. It is possible to prevent clogging of the blood flow path of the purifier and to ensure good circulation of the priming liquid.

  According to the invention of claim 4, the control means fills the arterial blood circuit, the venous blood circuit and the blood flow passage with the dialysate as the priming liquid by the dialysate supply means at the time of priming. Can be easily performed, and when priming a blood circuit to which a stacked blood purifier is connected, the blood flow path of the stacked blood purifier is prevented from being blocked. Can do.

  According to the invention of claim 5, the dialysate supply means comprises a dual pump, and the control means bypasses the dialysate discharge side of the dual pump and circulates the dialysate on the discharge side during the replenishment step. Therefore, the dual pump used at the time of blood purification treatment can be used as the dialysate supply means.

  According to the sixth aspect of the present invention, the venous pressure sensor is provided in the middle of the venous blood circuit, and the fluid pressure detecting means includes the venous pressure sensor. It can be used as pressure detection means.

The schematic diagram which shows the hemodialysis apparatus (blood purification apparatus) which concerns on 1st Embodiment of this invention. Schematic diagram showing the state of blood circuit priming (washing and replacing step) in the hemodialysis device Schematic diagram showing the state during priming of the blood circuit (bubble removal process) in the hemodialysis device Schematic diagram showing the state of blood circuit priming (replenishment process) in the hemodialysis device Overall schematic diagram showing stacked blood purification means (dialyzer) in the hemodialysis machine It is a schematic diagram which shows the filter membrane in the blood purification means (dialyzer) of the same laminated type, Comprising: (a) When a liquid distribute | circulates by a normal hydraulic pressure, (b) When a liquid distribute | circulates by a high hydraulic pressure, (c ) Diagram showing the case where liquid flows at low hydraulic pressure Flow chart showing control contents by control means in the hemodialysis apparatus The schematic diagram which shows the hemodialysis apparatus (blood purification apparatus) which concerns on 2nd Embodiment of this invention. Schematic diagram showing the state of blood circuit priming (washing and replacing step) in the hemodialysis device Schematic diagram showing the state during priming of the blood circuit (bubble removal process) in the hemodialysis device Schematic diagram showing the state of blood circuit priming (replenishment process) in the hemodialysis device

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.
The blood purification apparatus according to the first embodiment is applied to a hemodialysis apparatus. As shown in FIG. 1, an arterial blood circuit 2 and a venous blood circuit 3 are added to a laminated dialyzer 1 as a blood purification apparatus. Connected to the blood circuit, the dialyzer main body B having the dialysate introduction line L1 and the dialysate discharge line L2, the dual pump 7 as the dialysate supply means, the replacement fluid line L8a and the priming line L8b Mainly composed of a line L8, a fluid pressure measuring means 12 for measuring the fluid pressure of the dialysate in the dialysate discharge line L2, a control means 16, and a venous pressure sensor 17 as a fluid pressure detecting means. Yes.

  The laminated dialyzer 1 includes a blood purification membrane for blood purification, and a blood flow channel through which blood flows and a dialysate flow channel through which dialysate flows are formed through the blood purification membrane. The blood channel can be expanded or contracted according to the fluid pressure of the fluid flowing in the channel. Specifically, as shown in FIG. 5, the laminated dialyzer 1 is formed with a plurality of fixing plates C in a housing F, and a sheet-like blood purification membrane D (filtration membrane) between the fixing plates C. ) Between the blood purification membrane D and a dialysate passage β through which the dialysate flows between the blood purification membrane D and the fixed plate C. It is.

  Thus, the laminated dialyzer 1 has a plurality of laminated sheet-like blood purification membranes D (filtration membranes), and a liquid (priming solution or When blood or the like is circulated (see FIG. 6A), when liquid is circulated at a high hydraulic pressure (see FIG. 6B), and when liquid is circulated at a low hydraulic pressure (FIG. 6C). And the flow path volume between the blood purification membranes D is different. If such a laminated dialyzer 1 is used, the blood flow path α expands and contracts in accordance with the fluid pressure, so that it is difficult to lower the patient's blood pressure during treatment.

  In addition, the laminated dialyzer 1 is provided with a blood introduction port 1a for introducing blood and a blood lead-out port 1b for leading the introduced blood in the housing F, and a dialysate introduction port 1c for introducing a dialysate, A dialysate discharge port 1d for discharging the introduced dialysate is formed, the blood circuit (arterial blood circuit 2 and venous blood circuit 3), dialysate introduction line L1 and dialysate discharge line in the dialyzer body B L2 is connected to each. However, the blood can be purified by bringing the dialysate into contact with the blood introduced from the blood introduction port 1a via the blood purification membrane D.

  The arterial blood circuit 2 is mainly composed of a flexible tube, one end of which is connected to the blood inlet 1a of the laminated dialyzer 1 and blood collected from the blood vessel of the patient is placed in the blood flow path α of the laminated dialyzer 1. It is a guide. A connector a to which an arterial puncture needle (not shown) can be attached is formed at the other end of the arterial blood circuit 2, and an arterial air trap chamber 5 for defoaming is connected in the middle. A blood pump 4 is provided. The blood pump 4 is a squeezing type pump (with a structure in which a flexible tube is squeezed to rotate the blood from the arterial puncture needle side toward the blood inlet 1a of the laminated dialyzer 1 when rotated forward). It is.

  Similar to the arterial blood circuit 2, the venous blood circuit 3 is mainly composed of a flexible tube, and one end of the venous blood circuit 3 is connected to the blood outlet 1b of the laminated dialyzer 1 to derive blood that has passed through the blood flow path α. It is something to be made. At the other end of the venous blood circuit 3, a connector b to which a venous puncture needle (not shown) can be attached is formed, and a venous air trap chamber 6 for defoaming is connected midway. . That is, the patient's blood collected by the arterial puncture needle reaches the laminated dialyzer 1 via the arterial blood circuit 2, and after blood purification, flows through the venous blood circuit 3, and the venous puncture needle. It is configured to return to the patient's body through the external circulation.

  In addition, a bubble detector A capable of detecting bubbles in the flow path is disposed in the vicinity of the distal end of the venous blood circuit 3 (in the present embodiment, the connection site of the electromagnetic valve V11). With this bubble detector A, it is possible to detect bubbles in blood circulating outside the body during blood purification treatment. The bubble detector A according to the present embodiment is disposed at the connection site of the electromagnetic valve V11, but the connection between the distal end of the venous blood circuit 3 and the venous air trap chamber 6 in the venous blood circuit 3. You may make it arrange | position in any site | part between the site | parts (specifically site | part in which the overflow line L10 in the venous blood circuit 3 was formed).

  An electromagnetic valve V10 is connected to the distal side of the arterial blood circuit 2 (between the connector a and the blood pump 4 and in the vicinity of the connector a), and the distal side of the venous blood circuit 3 (connector b and A solenoid valve V11 is connected to the vein-side air trap chamber 6 and in the vicinity of the connector b). An overflow line L10 that can discharge liquid or gas to the outside is extended from the upper part of the venous air trap chamber 6 formed in the middle of the venous blood circuit 3, and in the middle of the overflow line L10. Is connected to a solenoid valve V8. Further, a venous pressure sensor 17 as a fluid pressure detecting means is disposed at the upper part of the venous air trap chamber 6, and by measuring the pressure on the air layer side of the venous air trap chamber 6, The fluid pressure in the blood circuit 3 (the pressure of the fluid (blood or priming fluid) flowing in the vein-side blood circuit 3) (the venous pressure measured during blood purification treatment) can be detected.

  Before the dialysis treatment, as shown in FIG. 1, by connecting the connector a and the connector b, the tip of the arterial blood circuit 2 and the tip of the venous blood circuit 3 are connected to each other. A closed circuit on the blood circuit side can be formed by the side blood circuit 2 and the vein side blood circuit 3 (including the blood flow path α in the laminated dialyzer 1). Then, by supplying dialysate into the closed circuit via the connection line L8 (specifically, the priming line L8b), the blood circuit (the arterial blood circuit 2 and the venous blood circuit 3) and the connection line are supplied. Priming work is possible by filling L8 with dialysate. In the priming process, as will be described later, the dialysate can overflow from the overflow line L10 to clean the inside of the closed circuit on the blood circuit side.

  End portions of the dialysate introduction line L1 and the dialysate discharge line L2 are connected to the dialysate introduction port 1c and the dialysate discharge port 1d of the dialyzer 1, respectively, and the laminated dialyzer is connected via the dialysate introduction line L1. 1 is configured such that the dialysate introduced into 1 can pass through the dialysate flow path β and be discharged from the dialysate discharge line L2. In addition, a dual pump 7 for introducing the dialysate into the laminated dialyzer 1 through the dialysate introduction line L1 and discharging the dialysate from the laminated dialyzer 1 is disposed in the dialyzer body B.

  The dialyzer main body B has a dialysate introduction line L1 and a dialysate discharge line L2, and has a dual pump 7, bypass lines L3 to L6, and electromagnetic valves V1 to V7. Among these, the duplex pump 7 is disposed across the dialysate introduction line L1 and the dialysate discharge line L2, and introduces dialysate prepared to a predetermined concentration into the laminated dialyzer 1 and dialyzes from the laminated dialyzer 1. The subsequent dialysate is discharged. The dual pump 7 according to the present embodiment constitutes a dialysate supply means used in a bubble removing process described later.

  An electromagnetic valve V1 is connected to the middle of the dialysate introduction line L1 (on the downstream side of the connecting portion with the connection line L8 in the dialysate introduction line L1 (stacked dialyzer 1 side)), and the dialysate discharge line L2 An electromagnetic valve V2 is connected midway (upstream from the connecting portion of the dialysate discharge line L2 with the bypass line L3 (on the laminated dialyzer 1 side)). In addition, filtration filters 8 and 9 are connected between the dual pump 7 and the solenoid valve V1 in the dialysate introduction line L1.

  The filtration filters 8 and 9 are for filtering and purifying the dialysate flowing through the dialysate introduction line L1, and the filtration filters 8 and 9 bypass the dialysate discharge line L2 to guide the dialysate. Bypass lines L3 and L4 are connected to each other. Solenoid valves V3 and V4 are connected to the bypass lines L3 and L4, respectively. Note that an electromagnetic valve V6 and an atmospheric introduction line L7 are connected between the filtration filter 8 and the filtration filter 9 in the dialysate introduction line L1, and an electromagnetic valve V12 is connected to the atmospheric introduction line L7. .

  On the other hand, a fluid pressure measuring means 12 capable of measuring the fluid pressure of the dialysate is connected between the connecting portion with the bypass line L3 and the connecting portion with the bypass line L4 in the dialysate discharge line L2. Further, bypass lines L5 and L6 that bypass the dual pump 7 are connected to the dialysate discharge line L2, respectively, in order to remove water from the patient's blood flowing in the laminated dialyzer 1 to the bypass line L5. The dewatering pump 10 is disposed, and an electromagnetic valve V5 capable of opening and closing the flow path is connected to the bypass line L6.

  Further, on the upstream side of the dual pump 7 in the dialysate discharge line L <b> 2 (between the connecting portion with the bypass line L <b> 5 and the dual pump 7), a pump 14 for adjusting the fluid pressure on the drain side in the dual pump 7. Is arranged. Further, a chamber 15 is connected to the upstream side (between the pump 14 and the duplex pump 7) of the dialysate discharge line L2 (between the pump 14 and the duplex pump 7), and the chamber 15 is connected to the atmosphere open line via a check valve or the like. L9 is connected, and an electromagnetic valve V7 is connected to the atmosphere release line L9.

  Here, the solenoid valves V1 to V12 constitute an on-off valve that can open and close the dialysate or blood flow path. In the present embodiment, the solenoid valves V1 to V12 are optionally selected in the priming process. By opening and closing the switch, a desired flow path can be formed. Specifically, at the start of priming (at the time of a washing and replacing process described later), as shown in FIG. 2, the solenoid valves V5 and V6 on the dialyzer body B side and the solenoid valves V8 to V11 on the blood circuit side are opened. In addition, by closing the other solenoid valves (solenoid valves V1 to V4, V7, V12), the dialysate in the dialysate introduction line L1 can be supplied to the arterial blood circuit 2. it can.

  One end of the connection line L8 is connected to the sampling port 11 formed at a predetermined portion of the dialysate introduction line L1 (in this embodiment, the tip of the branch line L1a branched from the dialysate introduction line L1). The end is connected to the arterial blood circuit 2 (or may be the venous blood circuit 3), and the dialysate from the dialysate introduction line L1 is supplied to the arterial blood circuit 2 (or venous blood circuit 3). It consists of a flow channel to obtain.

  In the middle of the connection line L8 according to the present embodiment, the replacement fluid pump 13 is disposed and the distal end of the connection line L8 is connected to the upper portion of the artery side air trap chamber 5, and the distal end of the connection line L8 is connected to the artery side blood circuit 2. A priming line L8b connected between the solenoid valve V10 and the blood pump 4 (if it is between the tip of the arterial blood circuit 2 and the blood pump 4) and connected to the tip of the solenoid valve V9; It consists of a flow path with This connection line L8 is discarded together with the arterial blood circuit 2 and the venous blood circuit 3 after the completion of one blood purification treatment, and like the arterial blood circuit 2 and the venous blood circuit 3, For example, it consists of a flexible tube. In the present embodiment, the replacement fluid line L8a and the priming line L8b are flow paths branched in the middle of one connection line L8. However, separate replacement fluid lines and priming lines composed of separate flow paths may be used. Good.

  The replacement fluid pump 13 is disposed in the middle of the replacement fluid line L8a in the connection line L8, and can supply the dialysate from the dialysate introduction line L1 to the blood circuit (arterial blood circuit 2 or venous blood circuit 3). . Like the blood pump 4, the replacement fluid pump 13 is a squeezing type pump (with a configuration in which the dialysis fluid can flow by squeezing a flexible tube constituting the replacement fluid line L 8 a when driven).

  However, at the time of priming, the dialysate can be supplied to the arterial blood circuit 2 via the priming line L8b, and the replacement fluid pump 13 is driven during the blood purification treatment, so that the replacement fluid line L8a is used. A dialysate can be supplied into the arterial blood circuit 2 to perform a replacement fluid during blood purification treatment. The replacement fluid line L8a of the connection line L8 according to the present embodiment is connected to the upper portion of the artery side air trap chamber 5, but is between the blood pump 4 and the laminated dialyzer 1 in the artery side blood circuit 2. It may be connected to any position.

  The priming line L8b is composed of a flow path in which an actuator or the like such as the replacement fluid pump 13 is not provided, and an electromagnetic valve V9 serving as an opening / closing means in the vicinity of the connection with the arterial blood circuit 2 (or venous blood circuit 3). When the electromagnetic valve V9 is opened, the dialysate introduction line L1 and the arterial blood circuit 2 are in communication with each other. The tip of the priming line L8b may be connected to any position in the artery side blood circuit 2 between the tip of the artery side blood circuit 2 and the blood pump 4.

  The control means 16 is composed of, for example, a microcomputer capable of performing control related to opening / closing of arbitrary electromagnetic valves V1 to V12, and driving or stopping of optional actuators such as the dual pump 7 (dialysate supply means), blood pump 4 and replacement fluid pump 13. Is. In particular, the control means 16 according to this embodiment depressurizes the dialysate flow path β in the laminated dialyzer 1 when priming is performed with the tip of the arterial blood circuit 2 and the tip of the venous blood circuit 3 connected. As a result, the blood flow path α is expanded with the inside of the dialysate flow path β being a negative pressure with respect to the blood flow path α, and the arterial blood circuit 2 and veins are maintained while maintaining the expanded state of the blood flow path α. The priming liquid in the side blood circuit 3 is made to flow.

  More specifically, at the time of priming, the control means 16 introduces a priming solution (dialysate) into the arterial blood circuit 2 and the venous blood circuit 3 while the priming line L8b is open, and is used to replace air. A replacement step (see FIG. 2) and a bubble removal step (FIG. 3) in which the priming fluid (dialysate) in the arterial blood circuit 2 and the venous blood circuit 3 flows while the priming line L8b is closed. In the bubble removing step, the dialysate flow path β in the laminated dialyzer 1 is depressurized to reduce the pressure in the dialysate flow path β relative to the blood flow path α. The blood channel α is expanded, and the priming solution (dialysate) in the arterial blood circuit 2 and the venous blood circuit 3 is allowed to flow while maintaining the expanded state of the blood channel α. It is.

  At the time of the washing and replacing step, the priming line L8b is opened by opening the electromagnetic valve V9 (blood pump 4 is stopped), and the overflow line is opened by opening the electromagnetic valve V8. L10 is in an open state, and the bubbles transferred from the laminated dialyzer 1 to the venous blood circuit 3 are discharged from the overflow line L10 to the outside.

  Here, the control means 16 according to the present embodiment sets the priming line L8b on the condition that the hydraulic pressure detected by the venous pressure sensor 17 (hydraulic pressure detection means) becomes a predetermined value or less, particularly in the bubble removal process. A replenishment step (see FIG. 4) for supplying and replenishing a predetermined amount of the priming solution to the blood circuit (a closed circuit composed of the arterial blood circuit 2 and the venous blood circuit 3) can be performed. . During the replenishment step, the control means 16 opens the solenoid valve V5 to bypass the dialysate discharge side of the duplex pump 7 by the bypass line L6 and circulate the dialysate on the discharge side.

Hereinafter, the control content of the control means 16 according to the present embodiment will be described based on the flowchart of FIG. 7 and FIGS.
First, at the time of priming before dialysis treatment, as shown in FIG. 2, by connecting the connector a and the connector b, the tip of the arterial blood circuit 2 and the tip of the venous blood circuit 3 are connected. A closed circuit on the blood circuit side is formed by the arterial blood circuit 2 and the venous blood circuit 3 (including the blood flow path α in the laminated dialyzer 1). Then, the solenoid valves V5 and V6 on the dialyzer body B side and the solenoid valves V8 to V11 on the blood circuit side are opened, and the other solenoid valves (solenoid valves V1 to V4, V7 and V12) are closed. Then, the cleaning replacement step S1 is performed.

  The washing and replacing step S1 is a step of introducing dialysate (priming solution) into the arterial blood circuit 2 and the venous blood circuit 3 while replacing the air with the priming line L8b open. By driving the dual pump 7 (dialysate supply means), the dialysate (priming solution) of the dialysate introduction line L1 is supplied to the blood circuit side (arterial blood circuit 2) via the priming line L8b. This is a step of opening the solenoid valve V8 and discharging the dialysate as the priming solution from the overflow line L10. In this washing and replacement step S1, since the blood pump 4 is stopped by the control of the control means 16, the dialysate flowing through the priming line L8b flows toward the opposite side of the blood pump 4, and the venous air trap It overflows from the overflow line L10 through the chamber 6.

  Thereby, from the connection part with the priming line L8b in the arterial blood circuit 2, the distal end part of the arterial blood circuit 2 (formation part of the connector a), and the distal end part of the venous blood circuit 3 in the venous blood circuit 3 The flow path from (the formation part of the connector b) to the venous air trap chamber 6 is replaced with air from the dialysis fluid (priming fluid). At the time of the washing and replacement step S1, the electromagnetic valve V5 is opened by the control of the control means 16, and the dialysate discharge side in the dual pump 7 is bypassed and the dialysate is circulated on the discharge side. Thus, since the dialysate on the dialysate discharge side of the dual pump 7 is merely circulated in the bypass line L6, the water removal pump 10 may be driven or stopped.

  After the washing and replacement step S1 as described above is completed, as shown in FIG. 3, the electromagnetic valves V1, V2, V6 on the dialyzer body B side and the electromagnetic valves V10, V11 on the blood circuit side are opened, The other solenoid valves (solenoid valves V3 to V5, V7 to V9, V12) are closed, and the bubble removal step (S2 to S5) is performed. This bubble removal step (S2 to S5) is a step for removing bubbles by flowing the dialysate (priming solution) in the arterial blood circuit 2 and the venous blood circuit 3 while the priming line L8b is closed. is there.

  More specifically, when the bubble removal process is started, the control valves 16 control the electromagnetic valves V8 and V9 to be closed, the blood pump 4 is driven in reverse, and the arterial blood circuit 2 and veins are driven. The dialysate (priming solution) in the side blood circuit 3 is circulated by flowing in the direction of the arrow in FIG. 3 (S2). At this time, since the electromagnetic valve V5 is closed by the control of the control means 16, the dialysate in the dialysate discharge line L2 flows in the discharge direction (downstream side).

  Furthermore, in the bubble removal step, the water removal pump 10 is driven while the electromagnetic valve V5 is closed under the control of the control means 16. Thus, by depressurizing the dialysate flow path β in the laminated dialyzer 1, the blood flow path α is expanded with the negative pressure in the dialysate flow path β relative to the blood flow path α, and the blood flow The priming fluid in the arterial blood circuit 2 and the venous blood circuit 3 can flow while maintaining the expanded state of the path α.

  However, in the bubble removal step, it is determined whether or not bubbles are detected by the bubble detector A (S3). If bubbles are detected, the process returns to the cleaning and replacement step S1, and the priming line L8b and the overflow line L10 are turned on. The dialysate (priming solution) is introduced from the priming line L8b into the arterial blood circuit 2 and the venous blood circuit 3 while being in the open state, and the introduced dialysate is overflowed from the overflow line L10 together with air bubbles and discharged.

  Thereafter, the process proceeds to the bubble removal process again, and it is determined whether or not there is a bubble detected by the bubble detector A (S3). If no bubble is detected, the process proceeds to S4, and it is determined whether or not the state where the bubble is not detected continues for a predetermined time (whether the predetermined time has elapsed). If the predetermined time has not elapsed, the process proceeds to S5. Then, it is determined whether or not the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) (that is, the fluid pressure in the venous blood circuit 3) has become a predetermined value or less.

  If it is determined in S5 that the hydraulic pressure detected by the venous pressure sensor 17 (hydraulic pressure detecting means) is not lower than the predetermined value, the process returns to S3 and whether or not the bubble detector A detects the bubble. Is determined. Thus, in the bubble removal process, the determination process of S3 to S5 is repeatedly performed. On the other hand, when it is determined in S5 that the hydraulic pressure detected by the venous pressure sensor 17 (hydraulic pressure detecting means) has become a predetermined value or less, the process proceeds to the replenishment step S6.

  In the replenishment step S6, a predetermined amount of priming fluid is supplied to the blood circuit (arterial blood) via the priming line L8b on condition that the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) has become a predetermined value or less. Circuit 2 and venous blood circuit 3) and replenishing, as shown in FIG. 4, solenoid valves V2, V5, V6 on the dialyzer body B side and solenoid valves V9 to V11 on the blood circuit side are provided. In this step, each of the solenoid valves is opened and the other solenoid valves (solenoid valves V1, V3, V4, V7, V8, and V12) are closed.

  That is, in the replenishment step S6, while maintaining the drive of the duplex pump 7 and the reverse drive of the blood pump 4, the solenoid valve V5 is opened, so that a predetermined amount of priming liquid is supplied via the priming line L8b. It can be supplied to (the arterial blood circuit 2 and the venous blood circuit 3). By opening the electromagnetic valve V5, the dialysate on the dialysate discharge side of the duplex pump 7 is merely circulated in the bypass line L6, so that the water removal pump 10 stops even if it is driven. It may be. Thereby, the negative pressure state in the blood circuit (arterial blood circuit 2 and venous blood circuit 3) can be eliminated, and the blood flow path α of the laminated dialyzer 1 can be prevented from being blocked. it can. The control means 16 opens the solenoid valve V5 during the replenishment step S6, thereby bypassing the dialysate discharge side of the duplex pump 7 by the bypass line L6 and circulating the dialysate on the discharge side. Yes.

  When the replenishment step S6 ends, the process returns to S2 again and the bubble removal steps (S2 to S5) are performed. On the other hand, if it is determined in S4 of the bubble removal process that the state in which the bubble detector A has not detected the bubble has continued for a predetermined time (the predetermined time has elapsed), a series of priming is completed, and the next step such as the blood purification treatment process is performed. It will move to a process. In the bubble removal step, detection of bubbles by the bubble detector A and detection of fluid pressure by the venous pressure sensor 17 (fluid pressure detecting means) are continuously performed.

  According to the above embodiment, when priming is performed in a state where the distal end of the arterial blood circuit 2 and the distal end of the venous blood circuit 3 are connected, the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) is predetermined. Since the replenishment step S6 for supplying and replenishing a predetermined amount of priming fluid (dialysis fluid) via the priming line L8b can be performed on condition that the value is less than or equal to the value, the blood circuit (artery When priming the side blood circuit 2 and the venous side blood circuit 3), it is possible to prevent the blood flow path α of the laminated dialyzer 1 from being blocked and to ensure good circulation of the priming solution (dialysis solution). Can do.

  Further, the control means 16 fills the arterial blood circuit 2, the venous blood circuit 3 and the blood flow path α with dialysate as the priming liquid by the dual pump 7 (dialyte supply means) during priming. It is possible to easily perform priming automation, and when priming a blood circuit (arterial blood circuit 2 and venous blood circuit 3) to which the laminated dialyzer 1 is connected, the blood flow path of the laminated dialyzer 1 It is possible to prevent α from being blocked.

  Further, the dialysate supply means is composed of the dual pump 7, and the control means 16 bypasses the dialysate discharge side in the dual pump 7 and circulates the dialysate on the discharge side during the replenishment step S6. A dual pump used at the time of blood purification treatment can be used as a dialysate supply means. Furthermore, since the venous pressure sensor 17 is provided in the middle of the venous blood circuit 3 (specifically, the venous air trap chamber 6), and the fluid pressure detecting means includes the venous pressure sensor 17, the blood purification treatment is performed. The vein pressure sensor 17 that is sometimes used can be used as a fluid pressure detecting means. In addition, since the control means 16 transfers the air bubbles in the laminated type dialyzer 1 to the venous blood circuit 3 side by rotating the blood pump 4 in the reverse direction during the air bubble removing process, the air bubbles can be removed more smoothly. Can do.

Next, a second embodiment according to the present invention will be described.
As in the first embodiment, the blood purification apparatus according to the second embodiment is applied to a hemodialysis apparatus. As shown in FIG. 8, an arterial blood circuit is added to the laminated dialyzer 1 as a blood purification apparatus. 2 and a blood circuit to which the venous blood circuit 3 is connected, a dialyzer body B having a dialysate introduction line L1 and a dialysate discharge line L2, a dual pump 7 as a dialysate supply means, and a physiological saline ( A priming line L11 for supplying the priming fluid) to the arterial blood circuit 2, a fluid pressure measuring means 12 for measuring the fluid pressure of the dialysate in the dialysate discharge line L2, and a control means 16. It is configured. In addition, the same code | symbol is attached | subjected to the component similar to 1st Embodiment, and those detailed description is abbreviate | omitted.

  The priming line L11 has a base end connected to a storage bag 18 containing a predetermined amount of physiological saline as a priming solution, and a tip connected to the blood pump 4 and the connector a (or electromagnetic valve V10) in the arterial blood circuit 2. The physiological saline chamber 19 and the electromagnetic valve V13 are connected on the way. However, the storage bag 18 is disposed at a position higher than the arterial blood circuit 2 and the venous blood circuit 3, and when the electromagnetic valve V13 is opened, the storage bag 18 is placed in the storage bag 18 by its own weight due to the height difference. A physiological saline solution (priming solution) is supplied to the arterial blood circuit 2.

Hereinafter, the control content of the control means 16 according to the present embodiment will be described based on the flowchart of FIG. 7 and FIGS. 9 to 11.
First, before dialysis treatment (before priming), as shown in FIG. 9, by connecting the connector a and the connector b, the tip of the arterial blood circuit 2 and the tip of the venous blood circuit 3 are connected, The arterial blood circuit 2 and venous blood circuit 3 (including the blood flow path α in the dialyzer 1) form a closed circuit on the blood circuit side, and electromagnetic valves V8, V10, V11, V13 on the blood circuit side. The cleaning and replacing step S1 is performed by opening each of these. In this washing and replacement step S1, since the operation on the dialyzer body B side does not contribute to the priming action, the solenoid valve or actuator on the dialyzer body B side is in any state (however, the dialysate flow of the laminated dialyzer 1) It may be in a state where no negative pressure is generated in the road).

  The washing and replacing step S1 is a step of introducing physiological saline (priming solution) into the arterial blood circuit 2 and the venous blood circuit 3 and replacing it with air while the priming line L11 is opened. Is performed by opening the electromagnetic valve V10 to supply the physiological saline solution (priming solution) in the storage bag 18 to the blood circuit side (arterial blood circuit 2) by its own weight. In this step, the physiological saline solution as the priming solution is discharged from the overflow line L10 with V8 open. In this washing and replacement step S1, since the blood pump 4 is stopped under the control of the control means 16, the physiological saline that has flowed through the priming line L11 flows toward the opposite side of the blood pump 4, and the venous air It overflows from the overflow line L10 through the trap chamber 6.

  Thereby, from the connection part with the priming line L11 in the arterial blood circuit 2, the distal part of the arterial blood circuit 2 (formation part of the connector a) and the distal part of the venous blood circuit 3 in the venous blood circuit 3 The inside of the flow path from the (connector b forming portion) to the vein-side air trap chamber 6 is replaced with physiological saline (priming solution) from the air. After the washing and replacement step S1 is completed, as shown in FIG. 10, the electromagnetic valves V1, V2, V6 on the dialyzer body B side and the electromagnetic valves V10, V11 on the blood circuit side are opened, The solenoid valves (solenoid valves V3 to V5, V7, V8, V12, and V13) are closed, and the bubble removing step (S2 to S5) is performed. This bubble removing step (S2 to S5) is a step for removing bubbles by causing the physiological saline (priming solution) in the arterial blood circuit 2 and the venous blood circuit 3 to flow while the priming line L11 is closed. It is.

  More specifically, when the bubble removing step is started, the control valves 16 control the electromagnetic valves V8 and V13 to be closed, the blood pump 4 is driven in reverse, and the arterial blood circuit 2 and veins are driven. The physiological saline solution (priming solution) in the side blood circuit 3 is circulated by flowing in the direction of the arrow in FIG. 10 (S2). At this time, since the electromagnetic valve V5 is closed by the control of the control means 16, the dialysate in the dialysate discharge line L2 flows in the discharge direction (downstream side).

  Furthermore, in the bubble removal step, the water removal pump 10 is driven while the electromagnetic valve V5 is closed under the control of the control means 16. Thus, by depressurizing the dialysate flow path β in the laminated dialyzer 1, the blood flow path α is expanded with the negative pressure in the dialysate flow path β relative to the blood flow path α, and the blood flow The priming fluid in the arterial blood circuit 2 and the venous blood circuit 3 can flow while maintaining the expanded state of the path α.

  However, in the bubble removal step, it is determined whether or not bubbles are detected by the bubble detector A (S3). If bubbles are detected, the process returns to the cleaning and replacement step S1, and the priming line L11 and the overflow line L10 are turned on. A physiological saline solution (priming solution) is introduced from the priming line L11 into the arterial blood circuit 2 and the venous blood circuit 3 while being in an open state, and the introduced physiological saline is overflowed from the overflow line L10 together with air bubbles and discharged. To do.

  Thereafter, the process proceeds to the bubble removal process again, and it is determined whether or not there is a bubble detected by the bubble detector A (S3). If no bubble is detected, the process proceeds to S4, and it is determined whether or not the state where the bubble is not detected continues for a predetermined time (whether the predetermined time has elapsed). If the predetermined time has not elapsed, the process proceeds to S5. Then, it is determined whether or not the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) (that is, the fluid pressure in the venous blood circuit 3) has become a predetermined value or less.

  If it is determined in S5 that the hydraulic pressure detected by the venous pressure sensor 17 (hydraulic pressure detecting means) is not lower than the predetermined value, the process returns to S3 and whether or not the bubble detector A detects the bubble. Is determined. Thus, in the bubble removal process, the determination process of S3 to S5 is repeatedly performed. On the other hand, when it is determined in S5 that the hydraulic pressure detected by the venous pressure sensor 17 (hydraulic pressure detecting means) has become a predetermined value or less, the process proceeds to the replenishment step S6.

  In the replenishment step S6, a predetermined amount of priming fluid is supplied to the blood circuit (arterial blood) via the priming line L11 on condition that the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) has become a predetermined value or less. The circuit 2 and the venous blood circuit 3) are supplied and replenished. As shown in FIG. 11, the solenoid valves V10, V11 and V13 on the blood circuit side are opened, and the solenoid valve V8 is closed. It is a process performed as a state. In this washing and replacement step S1, since the operation on the dialyzer body B side does not contribute to the priming action, the solenoid valve or actuator on the dialyzer body B side is in any state (however, the dialysate flow of the laminated dialyzer 1) It may be in a state where no negative pressure is generated in the road).

  That is, in the replenishment step S6, the solenoid valve V13 is opened and the priming line L11 is opened, so that a predetermined amount of priming fluid is supplied to the blood circuit (arterial blood circuit 2 and venous blood via the priming line L8b. It can be supplied to the circuit 3). Thereby, the negative pressure state in the blood circuit (arterial blood circuit 2 and venous blood circuit 3) can be eliminated, and the blood flow path α of the laminated dialyzer 1 is prevented from being blocked. Can do. In addition, the control means 16 which concerns on this embodiment has stopped the compound pump 7 and the water removal pump 10 at the replenishment process S6.

  When the replenishment step S6 ends, the process returns to S2 again and the bubble removal steps (S2 to S5) are performed. On the other hand, if it is determined in S4 of the bubble removal process that the state in which the bubble detector A has not detected the bubble has continued for a predetermined time (the predetermined time has elapsed), a series of priming is completed, and the next step such as the blood purification treatment process is performed. It will move to a process. In the bubble removal step, detection of bubbles by the bubble detector A and detection of fluid pressure by the venous pressure sensor 17 (fluid pressure detecting means) are continuously performed.

  According to the above embodiment, when priming is performed in a state where the distal end of the arterial blood circuit 2 and the distal end of the venous blood circuit 3 are connected, the fluid pressure detected by the venous pressure sensor 17 (fluid pressure detecting means) is predetermined. Since a replenishment step S6 for supplying and replenishing a predetermined amount of a priming solution (physiological saline solution) via the priming line L11 on condition that the value is less than or equal to the value can be performed, the blood circuit to which the laminated dialyzer 1 is connected ( When priming the arterial blood circuit 2 and the venous blood circuit 3), the blood flow path α of the laminated dialyzer 1 is prevented from being blocked to ensure a good flow of the priming liquid (dialysis liquid). be able to.

  In addition, a venous pressure sensor 17 is provided in the middle of the venous blood circuit 3 (specifically, the venous air trap chamber 6), and the fluid pressure detecting means includes the venous pressure sensor 17. The used venous pressure sensor 17 can be used as a fluid pressure detecting means. In addition, since the control means 16 transfers the air bubbles in the laminated type dialyzer 1 to the venous blood circuit 3 side by rotating the blood pump 4 in the reverse direction during the air bubble removing process, the air bubbles can be removed more smoothly. Can do.

  In the first embodiment and the second embodiment, when priming is performed, the dialysate channel (dialysate pipe) in the dialyzer body B and the dialysate channel β of the laminated dialyzer 1 are previously set. Although it is preferable to fill the dialysate, the above-described series of operations can be performed without filling.

  Although the present embodiment has been described above, the present invention is not limited to these embodiments. For example, a priming solution used for priming may be a liquid other than a dialysis solution or a physiological saline solution. . In addition, the fluid pressure detecting means capable of detecting the fluid pressure in the artery side blood circuit 2 or the vein side blood circuit 3 is replaced with a vein pressure sensor as in this embodiment, for example, the artery side blood circuit 2 (arterial side). Other sensors may be provided in the upper portion of the air trap chamber 5 or the like. The overflow line 10 extends from the upper part of the venous air trap line 6 in the venous blood circuit 3, but extends from other parts in the venous blood circuit 3 to allow liquid or gas to flow outside. It is good also as what can be discharged.

When priming with the tip of the arterial blood circuit and the tip of the venous blood circuit connected, the dialysate flow is reduced with respect to the blood channel by reducing the pressure in the dialysate channel in the stacked blood purifier. Control means for expanding the blood flow path with a negative pressure in the passage and flowing the priming fluid in the arterial blood circuit and the venous blood circuit while maintaining the expanded state of the blood flow path. is a condition that the hydraulic pressure detected by the hydraulic pressure detecting means becomes a predetermined value or less, the priming liquid of a predetermined amount of arterial blood circuit or the venous blood circuit, provided feeding and through the priming line supplemental step of replenishing the row Ukoto, if stacked blood purification apparatus capable of preventing the clogging of the blood flow path of the blood purifier of, can be applied to such as those other functions are added Te .

1 ... Laminated dialyzer (blood purifier)
DESCRIPTION OF SYMBOLS 2 ... Arterial side blood circuit 3 ... Vein side blood circuit 4 ... Blood pump 5 ... Arterial side air trap chamber 6 ... Vein side air trap chamber 7 ... Duplex pump 8, 9 ... Filtration filter 10 ... Dewatering pump 11 ... Collection port 12 ... Fluid pressure measuring means 13 ... Fluid replacement pump 14 ... Pump 15 ... Chamber 16 ... Control means 17 ... Vein pressure sensor (fluid pressure detecting means)
A ... Bubble detector L1 ... Dialysate introduction line L2 ... Dialysate discharge line L8 ... Connection line L8a ... Replacement fluid line L8b ... Priming line L11 ... Priming line V1-V13 ... Solenoid valve

Claims (6)

A plurality of blood purification membranes for performing blood purification are laminated and a blood channel through which blood flows and a dialysate channel through which dialysate flows are formed through the blood purification membrane, and the blood flow A laminated blood purifier in which the blood flow path can be expanded or contracted according to the fluid pressure of the fluid flowing in the path;
An arterial blood circuit in which a proximal end is connected to the blood purifier and a blood pump is disposed in the middle thereof;
A venous blood circuit having a proximal end connected to the blood purifier;
A dialysate introduction line for introducing dialysate into the blood purifier,
A dialysate discharge line for discharging dialysate from the blood purifier,
A blood purification apparatus comprising:
One end is connected to the dialysate introduction line or the priming solution storage bag, the other end is connected to the arterial blood circuit or the venous blood circuit, and the priming solution is inserted into the arterial blood circuit or the venous blood circuit. A priming line that can supply
Fluid pressure detecting means capable of detecting fluid pressure in the arterial blood circuit or venous blood circuit;
When priming with the tip of the arterial blood circuit and the tip of the venous blood circuit connected, the dialysate is depressurized in the dialysate channel in the blood purifier to the blood channel. A control means for expanding the blood flow path as a negative pressure in the flow path, and causing the priming fluid in the arterial blood circuit and the venous blood circuit to flow while maintaining the expanded state of the blood flow path;
And the control means supplies a predetermined amount of priming fluid into the arterial blood circuit or the venous blood circuit on the condition that the hydraulic pressure detected by the hydraulic pressure detection means has become a predetermined value or less. , by the row Ukoto refilling step of refilling supply feed to through the priming line, a blood purification apparatus, characterized in that it can prevent clogging of the blood flow path of the laminated type blood purifier.   The control means, at the time of priming, introduces a priming solution into the arterial blood circuit and the venous blood circuit while replacing the priming line, and replaces it with air, and closes the priming line. While the arterial blood circuit and the venous blood circuit are allowed to flow to remove bubbles by flowing the priming fluid in the arterial blood circuit and the venous blood circuit, and during the bubble removing process, the dialysate flow path in the blood purifier By depressurizing the inside of the blood flow path, the blood flow path is expanded with a negative pressure in the dialysate flow path, and the arterial blood circuit and veins are maintained while maintaining the expanded state of the blood flow path. The blood purification apparatus according to claim 1, wherein the priming liquid in the side blood circuit is caused to flow.   3. The blood purification according to claim 2, wherein the control means transfers the bubbles in the blood purifier to the venous blood circuit side by rotating the blood pump in the reverse direction during the bubble removing step. apparatus.   One end of the priming line is connected to a sampling port formed in a predetermined part of the dialysate introduction line, and the other end is between the tip of the arterial blood circuit in the arterial blood circuit and the blood pump. And a dialysate supply means capable of supplying dialysate from the dialysate introduction line to the arterial blood circuit via the priming line, and the control means The dialysis fluid supply means fills the arterial blood circuit, the venous blood circuit, and the blood flow path with a dialysis fluid as a priming fluid. The blood purification apparatus as described.   The dialysate supply means is disposed across the dialysate introduction line and the dialysate discharge line, and comprises a dual pump for introducing the dialysate into the blood purifier and discharging the dialysate from the blood purifier. 5. The blood purification apparatus according to claim 4, wherein the control means bypasses the dialysate discharge side of the dual pump and circulates the dialysate on the discharge side during the replenishment step.   The blood purification apparatus according to any one of claims 1 to 5, wherein a venous pressure sensor is provided in the middle of the venous blood circuit, and the fluid pressure detecting means includes the venous pressure sensor. .

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