WO1999062573A1 - Ultraviolet transmitter for haemodialysis - Google Patents

Ultraviolet transmitter for haemodialysis Download PDF

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Publication number
WO1999062573A1
WO1999062573A1 PCT/EP1999/003446 EP9903446W WO9962573A1 WO 1999062573 A1 WO1999062573 A1 WO 1999062573A1 EP 9903446 W EP9903446 W EP 9903446W WO 9962573 A1 WO9962573 A1 WO 9962573A1
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Prior art keywords
dialysate
burner
dialysis
free
housing
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PCT/EP1999/003446
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German (de)
French (fr)
Inventor
Klaus Büttner
Original Assignee
Buettner Klaus
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Publication date
Application filed by Buettner Klaus filed Critical Buettner Klaus
Priority to EP99955226A priority Critical patent/EP1001819A1/en
Publication of WO1999062573A1 publication Critical patent/WO1999062573A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
    • A61M1/168—Sterilisation or cleaning before or after use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
    • A61M1/1654—Dialysates therefor
    • A61M1/1656—Apparatus for preparing dialysates
    • A61M1/1674—Apparatus for preparing dialysates using UV radiation sources for sterilising the dialysate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
    • A61M1/168—Sterilisation or cleaning before or after use
    • A61M1/1682—Sterilisation or cleaning before or after use both machine and membrane module, i.e. also the module blood side
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3681—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits by irradiation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/05—General characteristics of the apparatus combined with other kinds of therapy
    • A61M2205/051—General characteristics of the apparatus combined with other kinds of therapy with radiation therapy
    • A61M2205/053—General characteristics of the apparatus combined with other kinds of therapy with radiation therapy ultraviolet

Definitions

  • the invention relates to a UV lamp for treating liquids which are connected with the hemodialysis treatment of patients, comprising a housing in which the UV burner is arranged.
  • liquids can be sterilized or disinfected by means of UV light irradiation.
  • a dialysis machine is known (DE 196 40 840 AI), in which the disinfectant used for disinfection is sterilized with the aid of UV radiation.
  • UV burners are also used to irradiate the osmosis water treated by reverse osmosis before the dialysate is processed.
  • An additional UV burner can also be used in such a system to irradiate the dialysate (DD 284 603 B5).
  • pathogens for example, can be “killed”, that they can nevertheless get into the patient's bloodstream and can carry out a wide variety of reactions there.
  • pathogens for example, can be “killed”, that they can nevertheless get into the patient's bloodstream and can carry out a wide variety of reactions there.
  • These can be allergic reactions, for example fever reactions could be attributed to the fact that such pathogens do not lead to an outbreak, for example, but can trigger reactions in the body that are very unpleasant for the treated patient.
  • the dialysate should not contain any impurities, an "ultra-pure" dialysate is expected.
  • Renal insufficiency patients are detoxified three times a week with the help of an artificial kidney. This detoxification is reduced to the principle that patient blood is passed in countercurrent to a suitable water circuit within an extracorporeal blood circuit. Water and blood are separated from each other by a semipermeable membrane, the dialysis membrane. The transfer of the urinary substances from the patient's blood to the dialysate (“wash water”) takes place by diffusion, osmosis and ultrafiltration.
  • the possibility of treating liquid flows within a hemodialysis system is to be created within one housing with the aid of one radiator or more.
  • the UV lamp according to the invention can be a mobile device, with a plurality of liquid lines with inlet and outlet being present, so that those liquid flows can be treated that occur anywhere in a hemodialysis system. Treatment is then to be understood as an action which not only kills germs, bacteria and pathogens but also changes them so that no more reactions occur in the body of the patient being treated. This is accomplished according to the invention by assigning the corresponding liquid lines to the vicinity of the burner, so that, for example, bacteria are not only killed in the conventional sense, but can also be broken down into particles which are no longer perceived as foreign bodies in the blood of the patient being treated , so that the typical body defense reactions do not occur. It is particularly important in connection with the online hemodialysis method that the bypass dialysate can be passed through one of the liquid lines.
  • dialysate used can also be brought into the form of clean waste water. It no longer needs to be collected and disposed of separately, but can be discharged via the usual sewage system.
  • the present invention has the effect that the well-being of the patient is significantly improved.
  • disinfection processes with disinfectants could be dispensed with, so that no rinsing and disinfection phases are required. Even residues of the disinfectant can no longer arise.
  • Tap water is demineralized using reverse osmosis. The permeate is formed.
  • the demineralized water is fed to the dialysis machine via a hose.
  • the dialysis machine mixes from the permeate and the dialysis concentrate a physical solution, which is compared to the uremic-laden blood Concentration gradient to the substances to be eliminated.
  • the dialysate thus generated is heated to 37 ° C and degassed.
  • the dialysate is now conducted past the dialysis membrane outside the dialysis machine in the extracorporeal circuit. On the other side of the dialysis membrane, the blood to be cleaned is passed in countercurrent.
  • Germs are entered via couplings and also via the permeate. The germs find a good multiplication environment in the dialysate. Because the route of the dialysate in the dialyser is very complex, the mass of germs is deposited in the device and forms the so-called biofilm.
  • the endotoxins represent the problem for the patient. Because of their small size, they are able to pass through the dialysis membrane and thus get into the patient's blood, which could suffer an endotoxin shock. 5. The oxygen transport capacity of the erythrocytes suffers from the influence of dialysis.
  • the leukocytes recognize a foreign body in the dialysis membrane. They lie on the inside of the dialysis membrane.
  • the leukocytes lose their function of capturing endotoxins.
  • the present invention achieves:
  • the UV rays generate oxygen radicals, saturated oxygen and ozone in the dialysate. 0 and 0 3 have a short half-life. It is expected that the O radicals and ozone will come together after a short flow to form saturated oxygen. This means that the dialysate is enriched with saturated oxygen and thus leads the dialysate enriched with free, saturated oxygen to the dialysis membrane. About the Dialysis membrane reaches part of the oxygen in the blood and thus compensates for the oxygen deficiency in the blood that occurs during dialysis, which leads to vitalization of the patient during and after dialysis. This means that the body's own barriers (the leukocytes) are activated to bind endocotoxins. The risk of excessive oxygenation of the blood cannot be overlooked. In this respect, due to the design, care must be taken that the UV burner is not placed too close to the dialysis membrane.
  • Photochemistry actually degrades pollutants in water treatment and does not simply shift them to another matrix like conventional physical techniques such as activated carbon absorbers or filtration.
  • a bypass is removed from the dialysis circuit after the UV burner and this already sterilized dialysate passes through a separate UV burner cell again.
  • the dialysate treated in this way can then be administered to the patient as a substituate. It can then be safely assumed that absolute freedom from sterility, pyrogen and endotoxins has been produced.
  • the substituate bypass can be additionally secured with a pyrogen and endotoxin filter.
  • Fig. 1 of the drawing shows a schematic cross-sectional view through the housing of a device according to the invention.
  • Fig. 2 shows schematically the liquid circuits during dialysis in a device according to the invention.
  • an essentially cylindrical housing is designated, which is equipped with two UV burners 20 and 21. Air inlet and outlet openings are provided at the top and bottom. 30 designates a reflective coating of the inner housing in relation to the burner element 20.
  • the housing 10 can be arranged separately from the dialysis device, but could also be integrated into this as well.
  • liquid lines 11, 12 and 13 which stand for the individual liquid flows in a hemodialysis system. These can be straight runs 12 and 13. It can also be a serpentine arrangement, as is shown schematically in the circuit 11.
  • the liquid flowing through the circuit 11 is treated very intensively by the burner 21 arranged on the inside, but is also acted upon from the outside by the burner 20, so that the desired effect is achieved, namely that the emerging liquid is free of foreign particles that are in the human body could trigger any reaction.
  • the raw or osmosis water 30 reaches the first UV burner for the osmosis water via a reverse osmosis, this is designated in the figure with 1 HE.
  • the osmosis water therefore enters the dialysis machine and thus reaches the actual dialysate circuit 31.
  • the dialysate circuit contains the second and third burner (2nd unit and 3rd unit) as well as the dialyzer D.
  • the blood circuit has been designated 33 and closes over the patient and the dialyzer.
  • the fourth burner (4th U) is located in the substituate circuit 32.

Abstract

The invention relates to a device for treating liquids linked to haemodialysis of patients. The inventive device has a housing (10) with a UV burner (20, 21). A plurality of liquid conduits (11, 12, 13) that are made from a material that is permeable to ultraviolet radiation are grouped together with external connections for the supply and removal of liquids around the burner(s) (20, 21), whereby the liquid flowing therethrough is immediatedly disinfected and made free of endotoxin and pyrogen. The conduits (11, 12, 13) are crossflown by osmotic water, permeate, treated dialysate, used dialysate prior to disposal (waste water), and optionally bypass dialysate in the online haemodialysis method.

Description

UV-Strahler für die Haemodialyse UV lamp for hemodialysis
Die Erfindung bezieht sich auf einen UV-Strahler, um Flüssigkeiten zu behandeln, die im Zusammenhang mit der Haemo-Dialyse- behandlung von Patienten stehen, aufweisend ein Gehäuse, in dem der UV-Brenner angeordnet ist.The invention relates to a UV lamp for treating liquids which are connected with the hemodialysis treatment of patients, comprising a housing in which the UV burner is arranged.
Es ist bekannt, dass Flüssigkeiten vermittels von UV-Licht- Bestrahlung entkeimt bzw. desinfiziert werden können. So ist eine Dialysemaschine bekannt (DE 196 40 840 AI) , bei welcher das zur Desinfektion verwendete Desinfektionsmittel mit Hilfe von UV-Strahlung entkeimt wird.It is known that liquids can be sterilized or disinfected by means of UV light irradiation. A dialysis machine is known (DE 196 40 840 AI), in which the disinfectant used for disinfection is sterilized with the aid of UV radiation.
Im Zusammenhang mit der Haemodialyse werden auch UV-Brenner eingesetzt, um das durch Umkehrosmose aufbereitete Osmosewasser vor der Aufbereitung des Dialysats zu bestrahlen. Auch kann an einer solchen Anlage ein zusätzlicher UV-Brenner eingesetzt werden, um das Dialysat zu bestrahlen (DD 284 603 B5) .In connection with hemodialysis, UV burners are also used to irradiate the osmosis water treated by reverse osmosis before the dialysate is processed. An additional UV burner can also be used in such a system to irradiate the dialysate (DD 284 603 B5).
In der Praxis hat sich gezeigt, dass diese Maßnahmen unzureichend sind und dass sich durchaus retrograde Verkeimungen in der Anlage bilden können.In practice, it has been shown that these measures are inadequate and that retrograde contamination can develop in the system.
Weiterhin ist bei bekannten Anlagen zur Haemodialyse kritisch, selbst wenn diese mit Filtern und/oder UV-Brennern arbeiten, dass beispielsweise Krankheitserreger zwar „abgetötet" werden können, dass sie dennoch in den Blutkreislauf des Patienten gelangen können und dort die verschiedensten Reaktionen ausüben können. Es kann sich hierbei um allergische Reaktionen handeln, es kann sich beispielsweise um Fieberreaktionen handeln. Dies könnte darauf zurückgeführt werden, dass derartige Krankheitserreger beispielsweise nicht zum Ausbruch führen, wohl aber Reaktionen im Körper auslösen können, die für den behandelten Patienten sehr misslich sind.Furthermore, it is critical in known systems for hemodialysis, even if they work with filters and / or UV burners, that pathogens, for example, can be “killed”, that they can nevertheless get into the patient's bloodstream and can carry out a wide variety of reactions there. These can be allergic reactions, for example fever reactions could be attributed to the fact that such pathogens do not lead to an outbreak, for example, but can trigger reactions in the body that are very unpleasant for the treated patient.
Folgende Forderungen werden an die Dialyse gestellt:The following demands are placed on dialysis:
1. Es sollen während und nach der Dialyse Vitalitätseinbrüche bei den Patienten verhindert werden.1. Vitality drops in the patients should be prevented during and after dialysis.
2. Das Dialysat sollte keine Verunreinigungen enthalten, ein "ultrareines" Dialysat wird erwartet.2. The dialysate should not contain any impurities, an "ultra-pure" dialysate is expected.
3. Die derzeit verwendeten Filter sind teuer und belasten die Dialysebehandlung um zusätzliche DM 15,--.3. The filters currently used are expensive and add an additional DM 15 to the dialysis treatment.
Niereninsuffiziente Patienten werden dreimal pro Woche mit Hilfe einer künstlichen Niere entgiftet. Auf das Prinzip reduziert erfolgt diese Entgiftung dadurch, dass Patientenblut innerhalb eines extrakorporalen Blutkreislaufes an einem geeigneten Wasserkreislauf im Gegenstrom vorbeigeführt wird. Wasser und Blut sind durch eine semipermeable Membran, der Dialysemembran, voreinander getrennt. Der Übergang der harnpflichtigen Substanzen aus dem Blut des Patienten in das Dialysat ( "Waschwasser" ) erfolgt durch Diffusion, Osmose und Ultrafiltration.Renal insufficiency patients are detoxified three times a week with the help of an artificial kidney. This detoxification is reduced to the principle that patient blood is passed in countercurrent to a suitable water circuit within an extracorporeal blood circuit. Water and blood are separated from each other by a semipermeable membrane, the dialysis membrane. The transfer of the urinary substances from the patient's blood to the dialysate ("wash water") takes place by diffusion, osmosis and ultrafiltration.
Je mehr Flüsigkeit dem Patienten entzogen wird, desto besser ist erfahrungsgemäß die Entgiftung. Das gilt insbesondere für den Bereich der Mittelmoleküle (Referenzbeispiel Vitamin B 12) , die seit ca. 25 Jahren im Gespräch, aber immer noch nicht definiert sind. Daraus entwickelte sich die Therapielinie Haemodifiltration. Dabei werden dem Patienten bis zum 60 1 bis 80 1 Flüssigkeit abgepresst. Damit das überhaupt möglich wird, wird dem Patienten ein Substituat zugeführt . Dieses Substituat ist sterile und pyrogenfreie physiologische Kochsalzlösung, die teuer ist. Um diese Therapieform weiterführen zu können, benutzt man daher das vom Dialysegerät hergestellte Dialysat als Substituat. Das ist aber weder steril noch pyrogenfrei und auch nicht frei von Endotoxinen. Zur Sicherstellung der Sterilität, Pyrogen- und Endotoxinfreiheit wurden entsprechende Filter entwickelt. Diese Form der Dialysebehandlung wird als ONLINEDIALYSE bezeichnet.Experience has shown that the more fluid is withdrawn from the patient, the better the detoxification. This applies in particular to the area of middle molecules (reference example vitamin B 12), which have been under discussion for about 25 years but are still not defined. The haemodifiltration therapy line developed from this. The patient is pressed up to 60 1 to 80 1 of liquid. To make this possible at all, the patient is given a substituate. This substituate is sterile and pyrogen-free physiological saline, which is expensive. In order to be able to continue this form of therapy, the dialysate produced by the dialysis machine is therefore used as a substituate. However, this is neither sterile nor pyrogen-free and also not free of endotoxins. Appropriate filters have been developed to ensure sterility, freedom from pyrogens and endotoxins. This form of dialysis treatment is called ONLINEDIALYSE.
Bei der vorliegenden Erfindung soll mit Hilfe eines Strahlers oder mehrerer innerhalb eines Gehäuses die Möglichkeit geschaffen werden, Flüssigkeitsströmungen innerhalb einer Haemo- Dialyseanlage zu behandeln.In the present invention, the possibility of treating liquid flows within a hemodialysis system is to be created within one housing with the aid of one radiator or more.
Realisiert wird dies durch die im Kennzeichen des Anspruchs angegebenen Merkmale.This is realized by the features specified in the characterizing part of the claim.
Bei dem UV-Strahler gemäß der Erfindung kann es sich um eine mobile Einrichtung handeln, wobei eine Mehrzahl von Flüssigkeitsleitungen mit Zulauf und Ablauf vorhanden sind, so dass diejenigen Flüssigkeitsströmungen behandelt werden können, die irgendwo in einer Haemo-Dialyseanlage auftreten. Unter Behandeln soll dann eine Einwirkung verstanden werden, die dazu führt, dass Keime, Bakterien und Krankheitserreger nicht nur abgetötet werden sondern sich auch so verändert werden, dass keine Reaktionen im Körper des behandelten Patienten mehr auftreten. Bewerkstelligt wird dies nach der Erfindung durch die Zuordnung der entsprechenden Flüssigkeitsleitungen zur Nähe des Brenners, so dass beispielsweise Bakterien nicht nur im herkömmlichen Sinne abgetötet werden, sondern auch zu solchen Teilchen zerkleinert werden können, die im Blut des behandelten Patienten nicht mehr als Fremdkörper wahrgenommen werden, so dass die typischen Körper-abwehrreaktionen nicht auftreten. Besonders bedeutsam ist im Zusammenhang mit den Online-Haemo- Dialyse-Verfahren, dass das Bypass-Dialysat durch eine der Flüssigkeitsleitungen hindurchgeleitet werden kann.The UV lamp according to the invention can be a mobile device, with a plurality of liquid lines with inlet and outlet being present, so that those liquid flows can be treated that occur anywhere in a hemodialysis system. Treatment is then to be understood as an action which not only kills germs, bacteria and pathogens but also changes them so that no more reactions occur in the body of the patient being treated. This is accomplished according to the invention by assigning the corresponding liquid lines to the vicinity of the burner, so that, for example, bacteria are not only killed in the conventional sense, but can also be broken down into particles which are no longer perceived as foreign bodies in the blood of the patient being treated , so that the typical body defense reactions do not occur. It is particularly important in connection with the online hemodialysis method that the bypass dialysate can be passed through one of the liquid lines.
Schließlich kann mit Hilfe der durch das Gehäuse des Brenners hindurchströmenden Leitungen auch das benützte Dialysat in die Form von sauberem Abwasser gebracht werden. Es braucht also nicht mehr aufgefangen und separat entsorgt zu werden, sondern es kann über die übliche Abwasserleitung abgegeben werden.Finally, with the help of the lines flowing through the housing of the burner, the dialysate used can also be brought into the form of clean waste water. It no longer needs to be collected and disposed of separately, but can be discharged via the usual sewage system.
Die vorliegende Erfindung führt dazu, dass sich das Wohlbefinden der Patienten deutlich verbessert. Es könnte beispielsweise auf Desinfektionsvorgänge mit Desinfektionsmitteln verzichtet werden, so dass keine Freispülphasen und Desinfektionsphasen mehr erforderlich sind. Auch Rückstände des Desinfektionsmittels können also nicht mehr anfallen.The present invention has the effect that the well-being of the patient is significantly improved. For example, disinfection processes with disinfectants could be dispensed with, so that no rinsing and disinfection phases are required. Even residues of the disinfectant can no longer arise.
Weiterhin stellen Leckagen im Wärmetauscher der Dialyseanlage keine Gefahr mehr durch Verkeimungen dar, es können Heizkosten eingespart werden. Schließlich kann auch auf sog. Sterilfilter verzichtet werden, die im Betrieb von Haemo-Dialyse-Anlagen einen erheblichen Kostenfaktor darstellen.Furthermore, leaks in the heat exchanger of the dialysis system no longer pose a risk from germs, and heating costs can be saved. Finally, so-called sterile filters can also be dispensed with, which represent a considerable cost factor in the operation of Haemo dialysis systems.
Für die vorliegende Erfindung sind folgende Merkmale wesentlich:The following features are essential for the present invention:
1. Leitungswasser wird mit Hilfe der Umkehrosmose entmineralisiert . Es entsteht das Permeat .1. Tap water is demineralized using reverse osmosis. The permeate is formed.
2. Das entmineralisierte Wasser wird über einen Schlauch dem Dialysegerät zugeführt .2. The demineralized water is fed to the dialysis machine via a hose.
3. Das Dialysegerät mischt aus dem Permeat und dem Dialysekonzentrat eine physilogische Lösung, die gegenüber dem urämisch beladenen Blut ein Konzentrationsgefälle zu den zu eliminierenden Substanzen hat.3. The dialysis machine mixes from the permeate and the dialysis concentrate a physical solution, which is compared to the uremic-laden blood Concentration gradient to the substances to be eliminated.
4. Das so erzeugte Dialysat wird auf 37°C erwärmt und entgast.4. The dialysate thus generated is heated to 37 ° C and degassed.
5. Das Dialysat wird nunmehr außerhalb des Dialysegerätes im extrakorporalen Kreislauf an der Dialysemembran vorbeigeleitet. Auf der anderen Seite der Dialysemembran wird das zu reinigende Blut im Gegenstrom vorbeigeleitet .5. The dialysate is now conducted past the dialysis membrane outside the dialysis machine in the extracorporeal circuit. On the other side of the dialysis membrane, the blood to be cleaned is passed in countercurrent.
Im Inneren eines bekannten Dialysegerätes könnten folgende Effekte auftreten:The following effects could occur inside a known dialysis machine:
1. Es werden Keime über Kupplungen und auch über das Permeat eingetragen. Die Keime finden im Dialysat ein gutes Vermehrungsmillieu. Weil die Streckenführung des Dialysates im Dialysgerät sehr komplex ist, lagert sich die Masser der Keime im Gerät ab und bildet den sog. Biofilm.1. Germs are entered via couplings and also via the permeate. The germs find a good multiplication environment in the dialysate. Because the route of the dialysate in the dialyser is very complex, the mass of germs is deposited in the device and forms the so-called biofilm.
2. Der Biofilm ist mit der üblichen Desinfektion nicht zu entfernen.2. The biofilm cannot be removed with the usual disinfection.
3. Teile des Biofilms (Endotoxine) lösen sich aber während der Dialyse und werden mit dem Dialysatfluss an die Membram geführt .3. Parts of the biofilm (endotoxins) dissolve during dialysis and are brought to the membrane with the dialysate flow.
4. Die Endotoxine stellen das Problem für den Patienten dar. Auf Grund ihrer geringen Größe sind sie in der Lage, die Dialysemembran zu passieren und gelangen so in das Blut des Patienten, der einen Endotoxinschock erleiden könnte. 5. Die Sauerstofftransportfähigkeit der Erythrozyten leidet unter dem Einfluss der Dialyse.4. The endotoxins represent the problem for the patient. Because of their small size, they are able to pass through the dialysis membrane and thus get into the patient's blood, which could suffer an endotoxin shock. 5. The oxygen transport capacity of the erythrocytes suffers from the influence of dialysis.
6. Die Leukozyten erkennen in der Dialysemembran einen Fremdkörper Sie legen sich an die Innenseite der Dialysemembran an.6. The leukocytes recognize a foreign body in the dialysis membrane. They lie on the inside of the dialysis membrane.
7. Von der Blutseite werden die Leukozyten wegen der eingeschränkten Sauerstofftransportfähigkeit der Erythrozyten nur ungenügend mit Sauerstoff versorgt,7. Because of the restricted oxygen transport capacity of the erythrocytes, the leukocytes are only insufficiently supplied with oxygen from the blood side,
8. von dem Membranseite her überhaupt nicht. Freier Sauerstoff ist wegen der Entgasung des Dialysates nicht vorhanden.8. Not at all from the membrane side. Free oxygen is not available due to the degassing of the dialysate.
9. Das führt dazu, dass die Leukozyten ihre Funktion, Endotoxine einzufangen, stark einbüßen.9. As a result, the leukocytes lose their function of capturing endotoxins.
Mit der vorliegenden Erfindung wird im Vergleich hierzu erreicht :In comparison, the present invention achieves:
Zetrümmerung von Pyrogenen und Endotoxinen zu biologisch unwirksamen Fragmenten. Der theoretische Ansatz zur Endotoxin- reduktion ist die Wechselwirkung der Wellenlänge des UV-Lichtes mit den Endotoxinen.Crushing pyrogens and endotoxins into biologically ineffective fragments. The theoretical approach to endotoxin reduction is the interaction of the wavelength of UV light with the endotoxins.
Erzeugung von freiem Sauerstoff im Dialysat. Durch die UV- Strahlen werden Sauerstoffradikale, gesättigter Sauerstoff und Ozon im Dialysat erzeugt. 0 und 03 haben einge geringe Halbwertszeit. Es ist zu erwarten, dass die O-Radikale und Ozon sich nach einer kurzen Fließstrecke zu gesättigtem Sauerstoff zusammenfinden. D.h. das Dialysat wird mit gesättigtem Sauerstoff angereichert und führt das so mit freiem, gesättigtem Sauerstoff angereicherte Dialysat zur Dialysemembran. Über die Dialysemembran erreicht ein Teil des Sauerstoffs das Blut und kompensiert so die während der Dialyse auftretende Sauerstoff- Unterversorgung des Blutes, was zur Vitalisierung des Patienten während und nach der Dialyse führt. D.h. es werden die körpereigenen Barrieren (die Leukozyten) aktiviert, Endoztoxine zu binden. Die Gefahr der zu starken Oxigenierung des Blutes ist dabei aber nicht zu übersehen. Insofern muss hier konstruktionsbedingt darauf geachtet werden, dass der UV-Brenner nicht zu nahe an der Dialysemembran plaziert wird.Generation of free oxygen in the dialysate. The UV rays generate oxygen radicals, saturated oxygen and ozone in the dialysate. 0 and 0 3 have a short half-life. It is expected that the O radicals and ozone will come together after a short flow to form saturated oxygen. This means that the dialysate is enriched with saturated oxygen and thus leads the dialysate enriched with free, saturated oxygen to the dialysis membrane. About the Dialysis membrane reaches part of the oxygen in the blood and thus compensates for the oxygen deficiency in the blood that occurs during dialysis, which leads to vitalization of the patient during and after dialysis. This means that the body's own barriers (the leukocytes) are activated to bind endocotoxins. The risk of excessive oxygenation of the blood cannot be overlooked. In this respect, due to the design, care must be taken that the UV burner is not placed too close to the dialysis membrane.
Abbau organischer Verbindungen, die sich im Grundwasser angereichert haben.Breakdown of organic compounds that have accumulated in the groundwater.
Durch Photochemie werden bei der Wasseraufbereitung Schadstoffe tatsächlich abgebaut und nicht wie bei herkömmlichen physikalischen Techniken wie Aktivkohleabsorber oder Filtration lediglich in eine andere Matrix verlagert.Photochemistry actually degrades pollutants in water treatment and does not simply shift them to another matrix like conventional physical techniques such as activated carbon absorbers or filtration.
Onlinedialyse-Verfahren.Online dialysis procedure.
Aus dem Dialysekreislauf nach dem UV-Brenner wird ein Bypass abgenommen und dieses bereits sterilisierte Dialysat passiert noch einmal eine separate UV-Brennerzelle. Das so behandelte Dialysat kann danach als Substituat dem Patienten verabreicht werden. Es ist dann sicher davon auszugehen, dass dann absolute Sterilität-, Pyrogen- und Endotoxinfreiheit hergestellt worden ist. Hilfsweise kann der Substituat-Bypass noch mit einem Pyrogen- und Endotoxinfilter zusätzlich gesichert werden.A bypass is removed from the dialysis circuit after the UV burner and this already sterilized dialysate passes through a separate UV burner cell again. The dialysate treated in this way can then be administered to the patient as a substituate. It can then be safely assumed that absolute freedom from sterility, pyrogen and endotoxins has been produced. Alternatively, the substituate bypass can be additionally secured with a pyrogen and endotoxin filter.
Die Erfindung wird nachstehend anhand der Zeichnung beispielsweise erläutert.The invention is explained below with reference to the drawing, for example.
Fig. 1 der Zeichnung zeigt eine schematische Querschnittsansicht durch das Gehäuse einer Vorrichtung gemäß der Erfindung. Fig. 2 zeigt schematisch die Flüssigkeits-Kreisläufe bei der Dialyse in einer Vorrichtung gemäß der Erfindung.Fig. 1 of the drawing shows a schematic cross-sectional view through the housing of a device according to the invention. Fig. 2 shows schematically the liquid circuits during dialysis in a device according to the invention.
Mit 10 ist ein im wesentlichen zylinderförmiges Gehäuse bezeichnet, welches mit zwei UV-Brennern 20 und 21 bestückt ist. Oben und unten sind Lufteintritts- und Austrittsöffnungen vorgesehen. Mit 30 ist eine reflektierende Beschichtung des Innengehäuses in Bezug auf das Brennerelement 20 bezeichnet. Das Gehäuse 10 kann separat von der Dialyseeinrichtung angeordnet werden, könnte aber auch ebenso gut in diese integriert sein.With 10 an essentially cylindrical housing is designated, which is equipped with two UV burners 20 and 21. Air inlet and outlet openings are provided at the top and bottom. 30 designates a reflective coating of the inner housing in relation to the burner element 20. The housing 10 can be arranged separately from the dialysis device, but could also be integrated into this as well.
In der Zeichnung sind drei Flüssigkeitsleitungen 11, 12 und 13 gezeigt, die für die einzelnen Flüssigkeitsströme in einer Haemo-Dialyse-Anlage stehen. Es kann sich hierbei um geradlinige Durchläufe 12 und 13 handeln. Es kann sich auch um eine schlangenförmige Anordnung handeln, wie dies schematisch bei dem Kreislauf 11 gezeigt ist. Die durch den Kreislauf 11 strömende Flüssigkeit wird sehr intensiv von dem innen angeordneten Brenner 21 behandelt, aber auch von außen her vom Brenner 20 beaufschlagt, so dass die gewünschte Wirkung erzielt wird, nämlich dass die austretende Flüssigkeit frei von Fremdpartikeln ist, die im menschlichen Körper irgendeine Reaktion auslösen könnten.In the drawing, three liquid lines 11, 12 and 13 are shown, which stand for the individual liquid flows in a hemodialysis system. These can be straight runs 12 and 13. It can also be a serpentine arrangement, as is shown schematically in the circuit 11. The liquid flowing through the circuit 11 is treated very intensively by the burner 21 arranged on the inside, but is also acted upon from the outside by the burner 20, so that the desired effect is achieved, namely that the emerging liquid is free of foreign particles that are in the human body could trigger any reaction.
Die Fig. 2 zeigt die eigentlichen Flüssigkeitsströme in einer Vorrichtung gemäß der Erfindung.2 shows the actual liquid flows in a device according to the invention.
Das Roh- oder Osmosewasser 30 gelangt über eine Umkehrosmose zum ersten UV-Brenner für das Osmosewasser, dieser ist in der Figur mit l.HE bezeichnet. Von daher gelangt das Osmosewasser in das Dialysegerät und erreicht damit den eigentlichen Dialysat- kreislauf 31. Im Dialysatkreislauf befindet sich der zweite und der dritte Brenner (2. HE und 3.HE) sowie der Dialysator D. Der Blutkreislauf ist mit 33 bezeichnet worden und schließt sich über den Patienten und den Dialysator. Im Substituatkreislauf 32 befindet sich der vierte Brenner (4.HE) . The raw or osmosis water 30 reaches the first UV burner for the osmosis water via a reverse osmosis, this is designated in the figure with 1 HE. The osmosis water therefore enters the dialysis machine and thus reaches the actual dialysate circuit 31. The dialysate circuit contains the second and third burner (2nd unit and 3rd unit) as well as the dialyzer D. The blood circuit has been designated 33 and closes over the patient and the dialyzer. The fourth burner (4th U) is located in the substituate circuit 32.

Claims

PatentanspruchClaim
Vorrichtung zur Behandlung von Flüssigkeiten, die im Zusammenhang mit der Haemo-Dialyse-Behandlung von Patienten stehen, aufweisend ein Gehäuse, in dem ein UV-Brenner angeordnet ist, dadurch gekennzeichnet, dass eine Mehrzahl von durch das GehäuseDevice for the treatment of liquids which are associated with the hemodialysis treatment of patients, comprising a housing in which a UV burner is arranged, characterized in that a plurality of through the housing
(10) hindurchgehenden Flüssigkeitsleitungen (11, 12, 13) aus UV- strahlungsdurchlässigem Material mit äußeren Anschlüssen für die Zufuhr und die Abnahme von Flüssigkeiten um den oder die Brenner(10) continuous liquid lines (11, 12, 13) made of UV-radiation-permeable material with external connections for the supply and removal of liquids around the burner or burners
(20, 11) so gruppiert sind, dass die hindurchgeströmte Flüssigkeit sowohl desinfiziert, endotoxinfrei, pyrogenfrei als auch frei von Teilchen gemacht wird, auf die der menschliche Organismus ansprechen könnte, und die Leitungen (11, 12, 13) für sich sowohl vom Osmosewasser, Permeat, vom aufbereiteten Dialysat als auch vom benutzten Dialysat vor der Entsorgung(20, 11) are grouped in such a way that the liquid which has passed through them is made both disinfected, endotoxin-free, pyrogen-free and free of particles to which the human organism could respond, and the lines (11, 12, 13) themselves of both osmosis water , Permeate, from the processed dialysate and the dialysate used before disposal
(Abwasser) und gegebenenfalls vom Bypass-Dialysat im Online- Haemodialyse-Verfahren durchströmt sind. (Wastewater) and possibly bypass dialysate in the online hemodialysis process.
PCT/EP1999/003446 1998-06-04 1999-05-20 Ultraviolet transmitter for haemodialysis WO1999062573A1 (en)

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EP99955226A EP1001819A1 (en) 1998-06-04 1999-05-20 Ultraviolet transmitter for haemodialysis

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DE29809867U DE29809867U1 (en) 1998-06-04 1998-06-04 UV lamp for hemodialysis
DE29809867.9 1998-06-04

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