WO2018041622A1

WO2018041622A1 - Blood treatment device and method for operating a blood treatment device

Info

Publication number: WO2018041622A1
Application number: PCT/EP2017/070634
Authority: WO
Inventors: Manfred Weis; Arne Peters; Christoph Wiktor; Stefan Kreber; Gerhard Mager
Original assignee: Fresenius Medical Care Deutschland Gmbh
Priority date: 2016-08-27
Filing date: 2017-08-14
Publication date: 2018-03-08
Also published as: CN109641096A; DE102016010434A1; CN109641096B

Abstract

The invention relates to a blood treatment device with an extracorporeal blood circuit I and a liquid system II which is separated from the extracorporeal blood circuit by a semipermeable membrane 11 of a filter 10 that has a first filter chamber 12 and a second filter chamber 13. The first filter chamber is part of the extracorporeal blood circuit, and the second filter chamber is part of the liquid system. The liquid system comprises a device for balancing fresh and used treatment liquid. The invention additionally relates to a method for operating such a blood treatment device. The blood treatment device according to the invention has a volumetric balancing system with a balancing chamber 1; 20; 50. The balancing chamber 1; 20; 50 according to the invention is characterized in that the first balancing chamber half 4 and the second balancing chamber half 5 of the balancing chamber 1 are separated by a membrane 3 which is a semipermeable membrane such that a material exchange between the first and second chamber halves is possible via the semipermeable membrane. Thus, the balancing chamber can also function as a filter.

Description

Blood treatment device and method for operating a

Blood treatment device

The invention relates to a blood treatment device with an extracorporeal blood circulation and a fluid system which is separated from the extracorporeal blood circulation by a semipermeable membrane of a filter having a first filter chamber and a second filter chamber, wherein the first filter chamber is part of

Extracorporal blood circulation and the second filter chamber is part of the fluid system and the fluid system comprises means for balancing fresh and used treatment liquid. Moreover, the invention relates to a method for operating such a blood treatment device.

For the removal of urinary substances and for the removal of fluids in chronic renal failure, various methods are used for apparative blood purification or blood treatment. In hemodialysis (HD) the diffusive predominates

Transport of matter, while in hemofiltration (HF) a convective mass transfer via the semipermeable membrane of a filter takes place. A combination of both methods is hemodiafiltration (HDF).

Because of the large replacement quantities, the above method requires the need for accurate balancing of the fresh supplied to the filter

Dialysis fluid and the used dialysis fluid discharged from the filter, taking into account the amount of fluid removed from the patient via the membrane of the filter over the entire treatment time. The patient through

Ultrafiltration withdrawn amount of liquid can be supplied to the patient with controlled dehydration as a substituent partially or completely. The supply of substituate in the extracorporeal blood circulation upstream of the dialyzer is referred to as pre-dilution and the supply of substituate downstream of the dialyzer is referred to as post-dilution. Both methods can also be combined with each other. The accuracy of the accounting is very high demands. This presupposes that with the balancing systems an exact balancing of fresh and used dialysis fluid is possible.

The prior art includes balancing systems that have balancing chambers which are divided by a flexible membrane into two balancing chamber halves.

DE-A-28 38 414 describes a dialysis machine with a balancing system, which has two balancing chambers whose balancing chamber halves are alternately filled with fresh dialysis fluid with rejection of used dialysis fluid from the other chamber half. The part of the fluid circuit enclosed between the balancing system and the dialyzer therefore behaves like a closed system whose volume is constant. Via an ultrafiltration pump, liquid can be withdrawn from the closed system. The membrane of the known balancing chambers is not permeable to the substances contained in the dialysate, so that a mass transfer can not take place.

Balancing systems are also known which have only one balance chamber which is not subdivided by a membrane into two chamber halves. In these

Balancing chambers displaced in the chamber spent dialysate is displaced by inflowing dialysate.

In addition to the accurate accounting of fresh and spent dialysate and the creation of a secure barrier between the extracorporeal blood circulation and the machine part of the blood treatment device is important. In addition, a compact structure of the blood treatment device is desired.

The invention has for its object to provide a blood treatment device with improved balancing and a method for operating a

Indicate a blood treatment device that allows for improved accounting. The solution of these objects is achieved according to the invention with the features of

independent claims. The dependent claims relate to advantageous

Embodiments of the invention.

The blood treatment device according to the invention has a volumetric balancing system with a balancing chamber. The balancing chamber according to the invention is characterized in that the first balancing chamber half and the second balancing chamber half of the balancing chamber are separated by a membrane, which is a semi-permeable membrane, so that a mass transfer between the first and second chamber halves is possible via the semipermeable membrane. Consequently, the balance chamber can also act as a filter.

The balancing chamber according to the invention can in different ways in the

Liquid system of a blood treatment device are involved. The

Balance chamber can be used in different blood treatment methods, for example, in a hemodialysis or hemofiltration or a

Hemodialysis and haemofiltration (hemodiafiltration) blood treatment.

The treatment liquid can in a known manner by means of pumps in

Promoted liquid lines and the liquid lines can by means of

Shut-off valves are shut off. The liquid lines can be arranged such that the treatment liquid, in particular dialysate, along the

semipermeable membrane through which a chamber half, along the membrane through the other half of the chamber or through the membrane flows from one to the other half of the chamber. In this case, the liquid flow can be interrupted in the other chamber halves.

In a liquid flow from one to the other half of the chamber substances with a low permeability, such as urea or beta2 microglobulin, are retained, while higher permeability materials, such as water, can pass through the semipermeable membrane. Consequently, during the Balance to retain or concentrate certain substances in one of the two chamber halves.

The fluid system may be connected to an inlet and / or outlet of the first

Balancing half include connected fluid lines and / or connected to an inlet and / or outlet of the second balancing chamber half fluid lines. The control of the pumps and the shut-off can be done with a control unit. The operation of the blood treatment device can take place in successive working cycles, which can each comprise two work cycles. The work cycles may include other work cycles.

In a first embodiment, the control unit for controlling the pumps and shut-off valves is configured such that flows in a first cycle of a cycle of successive cycles, treatment liquid, in particular dialysate, via the semipermeable membrane of the balance chamber from the first balance chamber half in the second balancing chamber half, and in a second work cycle

successive working cycles, treatment liquid through the first

Balance chamber half flows.

In the first working cycle of the first embodiment, treatment liquid, in particular dialysate, from the second filter chamber of the filter, which is part of the

Fluid system is, in the first balance half of the balance and the second

Balance chamber half flow into the second filter chamber, so that treatment liquid circulates in the fluid system (hemodialysis). Flows through it

Treatment liquid, the semipermeable membrane of the balance chamber. Alternatively, in the first cycle via the semipermeable membrane of the filter

extracorporeal blood circulation fluid can be withdrawn. This liquid can from the second filter chamber in the first balance half of the balance and from the second

Balancing chamber half to a connection of a leading to the first filter chamber blood supply line (predilution) and / or outgoing from the first filter chamber discharge line (postdilution) flow (hemofiltration). In the second working stroke of the first embodiment, an exchange of fresh and used treatment liquid can take place. The fresh dialysate may be provided in a dialysate source and directed to a drain. The first

Balance chamber half incoming fresh dialysate displaces the dialysate located in the first and second balancing chamber half, which can flow into the drain. The volume of dialysate relevant for balancing is determined by the volume of dialysate

Balance chamber half determined.

The timing can also be effected as a function of the substance concentration, flow rate, pressure, etc., wherein these quantities can be measured with suitable sensors in the liquid system.

An alternative embodiment provides that the control unit for controlling the pumps and shut-off devices is configured such that in a first cycle of a cycle of successive working cycles treatment liquid flows through the semi-permeable membrane of the balancing chamber from the first balancing chamber half into the second balancing chamber half, and in a second Working cycle of

successive working cycles treatment liquid through the semipermeable membrane of the balance chamber from the second half of the balance chamber into the first

Balance chamber half flows.

In the first working cycle of the alternative embodiment, treatment liquid, again from the second filter chamber of the filter which is part of the fluid system, can flow into the first balance half and out of the second balance chamber half into the second filtration chamber so that dialysate circulates in the fluid system (hemodialysis). In this case, treatment liquid flows through the semipermeable membrane of the balance chamber again. Alternatively, liquid can be withdrawn from the extracorporeal blood circulation in the first working cycle via the semipermeable membrane of the filter. The liquid can flow from the second filter chamber into the first balance half of the balance and out of the second balance chamber half to a connection of a blood supply line (predilution) leading to the first filter chamber and / or a discharge line (postdilution) leaving the first filter chamber (hemofiltration). In the second working cycle of the alternative embodiment, an exchange of fresh and used treatment liquid can take place. The second

Balancing chamber half fresh dialysate displaces the dialysate located in the first and second balancing chamber, which can flow into the drain.

It is also possible that hemodialysis and hemofiltration are combined.

The blood treatment device according to the invention can also have a

Have the ultrafiltration device with the liquid system or via the semipermeable membrane of the filter the extracorporeal blood circulation liquid can be withdrawn. Such ultrafiltration devices belong to the state of the art.

The blood treatment device according to the invention and the method according to the invention allow both the use of a filter as balance chamber both balancing and a material separation. With the balance chamber according to the invention, an additional barrier can be created. In addition, a concentration or concentration of certain substances in one of the balance chamber halves is possible. The entire blood treatment device can have a compact construction with the balancing chamber according to the invention.

In the following, several embodiments of the invention will be explained in more detail with reference to the drawings.

Show it:

1A, the balance chamber of the blood treatment device according to the invention in a simplified schematic representation, 1B is a simplified schematic representation of a formed as a hollow fiber filter 1 balance chamber,

Fig. 2A shows a first switching state of the balance chamber in a power stroke of a

Duty cycle,

Fig. 2B shows a second switching state of the balance chamber in a power stroke of a

Duty cycle,

2C shows a third switching state of the balancing chamber in a working cycle of a

Duty cycle,

FIG. 2D shows a fourth switching state of the balancing chamber in a working cycle of a

Duty cycle,

2E shows a fifth switching state of the balancing chamber in a working cycle of a

Duty cycle,

2F shows a sixth switching state of the balancing chamber in a working cycle of a

Duty cycle,

Fig. 3 shows a first embodiment of the invention

Blood treatment s device,

Fig. 4 shows a second embodiment of the invention

Blood treatment s device,

Fig. 5 shows a third embodiment of the invention

Blood treatment device and

Fig. 6 shows a fourth embodiment of the invention

Blood treatment device. Fig. 1A shows a balance chamber 1 in a simplified schematic representation. The balancing chamber 1 has a rigid housing 2, which is divided into a first balancing chamber half 4 and a second balancing chamber half 5 by a semi-permeable membrane 3, which is a rigid diaphragm. The semipermeable membrane 3 is impermeable to low permeability materials, such as urea or beta 2 microglobulin, and permeable to high permeability materials, such as water. In a symmetrical division of the balance chamber 1, both chamber halves have the same volume. Alternatively, an asymmetric division into chamber halves with different volumes is possible.

The first balancing chamber half 4 has an inlet 4A and an outlet 4B and the second balancing chamber half 5 has an inlet 5A and an outlet 5B. At the inlets and outlets, liquid lines, for example hose lines, can be connected. The supply or discharge of liquid into and out of the chamber halves can be interrupted by means of shut-off devices 6 which are only shown as a hint. Arrows indicate the flow direction in and out of the chamber halves.

Fig. 1B shows an embodiment of a balance chamber 1, which is designed as a hollow fiber filter. The low permeability fabrics are bright dots and the high permeability fabrics are dark dots. The outlet 4B of the first chamber half and the inlet 5A of the second chamber half are closed, while the inlet of the first balancing chamber half 4A and the outlet 5B of the second balancing chamber half are open. For example, if the fabric is high

Permeability to water and the low permeability material is urea, the high permeability water flows through the semipermeable membrane formed by the hollow fiber bundle from the first balancing chamber half to the second

Balancing chamber half. It can be seen that the semipermeable membrane retains the low permeability materials, such as urea.

Hereinafter, the various switching states of the balance chamber of Fig. 1A will be described with reference to Figs. 2A to 2F. The individual switching states are designated in the figures with clock A to clock F. The bars can be single

Work cycles of a duty cycle, where multiple cycles can follow each other. In one work cycle, the workstakes can follow each other in different orders. Transient conditions may be provided between the cycles, for example, a state in which only one inlet or outlet is open or all inlets or outlets are closed.

2A shows a switching state in which the inlet 4A of the first balancing chamber half 4 and the outlet 5B of the second balancing chamber half 5 are open and the outlet 4B of the first balancing chamber half 4 and the inlet 5A of the second balancing chamber half 5 are closed. The substances with a high permeability flow through the

Balance chamber 1, wherein the substances with a low permeability of the

retained semipermeable membrane (clock A). The volume of the liquid flowing into the first balancing chamber half 4 displaces the same volume of the liquid in the balancing chamber 1.

FIG. 2B shows a switching state in which the inlet 4A and the outlet 4B of the first balancing chamber half 4 are opened and the inlet 5A and the outlet 5B of the second balancing chamber half 5 are closed. The liquid flows through the first

Balancing half 4, with substances with a high permeability in the second

Balance chamber half 5 can get (clock B).

2C shows a switching state in which the inlet 4A of the first balancing chamber half 4 and the outlet 5B of the second balancing chamber half 5 are closed and the outlet 4B of the first balancing chamber half 4 and the inlet 5A of the second balancing chamber half 5 are opened. The high permeability materials flow through the balancing chamber 1, with the low permeability substances being retained by the semipermeable membrane 3 (clock C).

FIG. 2D shows a switching state in which the inlet 4A and the outlet 4B of the first balancing chamber half 4 are closed and the inlet 5A and the outlet 5B of the second balancing chamber half 5 are opened. The liquid flows through the second Balance chamber half 5, with substances with a high permeability in the first

Balance chamber half 4 can pass (clock B).

Figures 2E and 2F show the switching states of Figures 2A and 2B, respectively, wherein a liquid is supplied to the inlet with both a low permeability material and a high permeability material (Figure 2E) and a liquid having a high permeability fabric at the inlet is supplied (Fig. 2F). It turns out that the low-permeability substance is retained by the semipermeable membrane 3 and does not enter the second balancing chamber half 5.

Fig. 3 shows a simplified schematic representation of an inventive

Blood treatment device having the balance chamber according to the invention. The blood treatment apparatus in the present embodiment is one

Hemodialysis device.

The Hämodialy sevorrichtung has a filter 10 (dialyzer), which passes through a semi-permeable membrane 11 into a first filter chamber 12 and a second filter chamber

13 is divided. At the inlet 12A of the first filter chamber 12 is a blood supply line

14 and to the outlet 12B of the first filter chamber 12, a Blutabführleitung 15 is connected. The blood of the patient is conveyed in the extracorporeal blood circulation I with a blood pump 16 which is provided in the blood supply line 14.

The liquid system II has the balancing chamber 17 described with reference to FIGS. 1A and 1B and FIGS. 2A to 2F, which is subdivided by a semipermeable membrane 18 into a first balancing chamber half 19 and a second balancing chamber half 20. The first balancing chamber half 19 has an inlet 19A and an outlet 19B, while the second balancing chamber half 20 has only one outlet 20B.

In addition, the liquid system II has a dialysate source 21 for fresh dialysate, which via a first liquid line 22 to the inlet 19A of the first

Balancing chamber half 19 is connected. The dialysate is conveyed into the first balancing chamber half 19 with a first pump 23, which is provided in the first liquid line 22. Upstream of the first pump, a first obturator 24, for example an electromagnetically actuated hose clamp, is provided in the first fluid line 22.

The outlet 13B of the second filter chamber 13 is connected to the first liquid line 22 via a second liquid line 25. The connection point 26 of the second liquid line 25 to the first liquid line 22 is between the first obturator 24 and the first pump 23. The second liquid line 25 may also be connected downstream of the pump to the first liquid line or to the inlet of the first balance chamber half. In the second liquid line 25, a second obturator 27 is provided.

The outlet 19B of the first balancing chamber half 19 is connected via a third fluid line 28 to a drain 29, so that used dialysate can flow off. In the third liquid line 28, a third obturator 30 is provided.

The outlet 20B of the second balancing chamber half 20 is over a fourth

Liquid line 31, in which a fourth obturator 32 is provided, connected to the inlet 13 A of the second filter chamber 13. In the fourth liquid line 31, a second pump 33 is provided which promotes dialysate from the second balancing chamber half 20 into the second filter chamber 13.

The blood treatment device may also have an ultrafiltration device which has an ultrafiltration pump 34 which extracts ultrafiltrate from the liquid system II. The ultrafiltration pump 34 is in a fifth fluid line 35

provided, which is connected to the second liquid line 25.

In addition, the blood treatment device has a central control unit 36, via control lines not shown with the first and second pump 23, 33 and the ultrafiltration pump 34 in the fluid system II and the blood pump 16 in the extracorporeal blood circulation I and the shut-off valves 24, 27, 30, 32nd in the Liquid system I is connected so that the flow rates of the pump can be adjusted and the shut-off valves can be actuated. The control unit 36 may comprise a general processor, a digital signal processor (DSP) for continuous processing of digital signals, a microprocessor, an application specific integrated circuit (ASIC), a logic element integrated circuit (FPGA), or other integrated circuits (IC) or hardware devices. Have components to perform the individual process steps. A data processing program (software) can be run on the hardware components to carry out the method steps. It is also possible a plurality or combination of the various components.

The control unit 36 is configured such that the subsequent work cycles are carried out in successive work cycles.

The successive working cycles each comprise two work cycles. In a first operating cycle, the control unit 36 controls the shut-off devices in such a way that the first and third obturators 24, 30 are closed and the second and fourth obturators 27, 32 are open. Consequently, the balance chamber is operated in the switching state of the take C (Fig. 2C). In a second power stroke, the control unit controls the

Shut-off in such a way that the first and third shut-off device 24, 30 is opened and the second and fourth obturator 27, 32 are closed. Consequently, the balance chamber is operated in the switching state of the take D (FIG. 2D). Then follows the second cycle, etc.

In the first working cycle dialysate flows from the second filter chamber 13 into the first balancing chamber half 19, from the first balancing chamber half through the semipermeable membrane 18 into the second balancing chamber half 20, from the second balancing chamber half into the second filtering chamber 13 (dialysate chamber) and out of the second filter chamber 13 Substances with a low permeability in the dialysate, such as urea, are retained by the semipermeable membrane 18, so that these substances are concentrated in the first balance chamber half. The dialysate is conveyed by the first and second pumps 23, 33. In the second working cycle, dialysate flows from the dialysate source 21 into the first

Balance chamber half 19 and from the first balance chamber half in the sequence 29, so that used dialysate can flow. The dialysate is pumped by the first pump.

The clock C is used to exchange liquid in the dialyzer, wherein blood and dialysate flow in DC. However, the flow of blood and dialysate can also be carried out in countercurrent with an appropriate configuration. The clock D is used to exchange liquid in the balance chamber with filter function. An advantage of using the balancing chamber with filter function in this application is that in the

Fluid system is given an additional barrier to the patient.

Fig. 4 shows an embodiment in which the blood treatment device is a hemofiltration device. The hemofiltration device has a filter 10, which is subdivided by a semipermeable membrane 11 into a first filter chamber 12 and a second filter chamber 13. To the inlet 12A of the first filter chamber 12 is a blood supply line 14 and to the outlet 12B of the first filter chamber 12 is a

Blood discharge line 15 connected. The blood of the patient is conveyed in the extracorporeal blood circulation I with a blood pump 16 which is provided in the blood supply line 14.

The fluid system II has the balancing chamber 17 described with reference to FIGS. 1A and 1B and FIGS. 2A to 2F. The first balancing chamber half 19 has an inlet 19A and an outlet 19B, while the second balancing chamber 19

Balance chamber half 20 has only one outlet 20B.

In addition, the fluid system II has a dialysate source 21 for fresh dialysate, which is connected via a first fluid line 37 to a branch 38, which leads to the inlet 19A of the first balancing chamber half 19. The dialysate can be conveyed from the dialysate source 21 into the first balancing chamber half 19 with a first pump 39, which is provided in the first fluid line 37. Upstream of the first pump 39, a first obturator 40, for example an electromagnetically actuated hose clamp, is provided in the first fluid line 37. The outlet 13B of the second filter chamber 13 is connected via a second liquid line 41 to the branch 38 leading to the inlet 19A of the first

Balancing chamber half 19 leads. In the second liquid line 41, a second pump 42 is provided. Downstream of the second pump 42, a second shut-off device 43 is provided in the second liquid line 41.

The outlet 19B of the first balancing chamber half 19 is connected to the outlet 29 via a third fluid line 44. In the third liquid line 44 is third

Shut-off valve 45 is provided.

From the outlet 20B of the second balancing chamber half 20 is a fourth

Liquid line 46 from, in which a fourth obturator 47 is provided. The fourth fluid conduit 46 branches into first and second portions 46A, 46B, with the first portion 46A leading to a port of the blood supply conduit 14 upstream of the filter 12 and the second portion 46B leading to a port of the blood discharge conduit 15 downstream of the filter such that substituate the extracorporeal blood circulation upstream of the filter (predilution) or downstream of the filter (postdilution) can be supplied. In each of the first and second sections of the fourth fluid line 46, a further obturator 48A, 48B is provided, so that it is possible to switch between a predilution and / or postdilution.

The blood treatment device may also have an ultrafiltration device having an ultrafiltration pump 34, which withdraws ultrafiltrate from the fluid system I. The ultrafiltration pump 34 is provided in a fifth liquid line 35 which is connected to the second liquid line 41.

The control unit 36 is configured in the hemofiltration device such that the subsequent work cycles are carried out in successive working cycles.

The successive working cycles each comprise two work cycles. In a first operating cycle, the control unit 36 controls the shut-off devices such that the second and fourth obturator 43, 47 open and the first and third obturator 40, 45 are closed. Consequently, the balance chamber is operated in the switching state of the clock E in a horizontally mirrored representation (Fig. 2E). In a second power stroke, the control unit controls the shut-off devices such that the second and fourth

Shut-off 43, 47 closed and the first and third obturator 40, 45 are open. Consequently, the balance chamber is operated in the switching state of the take F in a horizontally mirrored representation (FIG. 2F). Then follows the second cycle, etc.

In the first working cycle, liquid flows from the second filter chamber 13 into the first balancing chamber half 19, from the first balancing chamber half through the semi-permeable membrane 18 into the second balancing chamber half 20 and out of the second

Balance chamber half in the blood supply line 14 and / or blood discharge line 15. The liquid is withdrawn with the second pump 42 from the second filter chamber 13. Substances having a low permeability are retained by the semipermeable membrane 18, so that these substances can not enter the extracorporeal blood circulation I and are concentrated in the first balancing chamber half 19.

In the second working cycle, dialysate flows from the dialysate source 21 into the first

Balance chamber half 19 and from the first balance chamber half in the sequence 29, so that the used dialysate can flow.

Hemofiltration takes place in the cycle E and in the cycle F an exchange of liquid takes place in the balancing chamber with filter function. An advantage of using the balance chamber with filter function in this application is that the substituate is given a barrier to the patient.

Fig. 5 shows another embodiment in which the blood treatment device is a hemodialysis device. The hemodialysis apparatus has a filter 10 (dialyzer), which is subdivided by a semi-permeable membrane 11 into a first filter chamber 12 and a second filter chamber 13. To the inlet 12A of the first

Filter chamber 12 is a blood supply line 14 and to the outlet 12B of the first

Filter chamber 12 is connected to a Blutabführleitung 15. The patient's blood will promoted in extracorporeal blood circulation I with a blood pump 16, which in the

Blood supply line 14 is provided.

The fluid system II has the balancing chamber 50 described with reference to FIGS. 1A and 1B and FIGS. 2A to 2F, which is divided by a semipermeable membrane 51 into a first balancing chamber half 52 and second balancing chamber half 53. The first balance chamber half 52 has an inlet 52A and an outlet 52B, and the second balance chamber half 53 has an inlet 53A and an outlet 53B.

The outlet 13B of the second filter chamber 13 is connected via a first fluid line 54 to the inlet 52A of the first balancing chamber half 52. In the first

Liquid line 54, a first pump 55 is provided. Downstream of the first pump 55, a first obturator 56 is provided in the first fluid line 54.

From the outlet 52B of the first balance chamber half 52, a second leads

Liquid line 57, in which a second obturator 58 is provided, to a drain 29th

In addition, the fluid system I has a dialysate source 21 for fresh dialysate, which via a third fluid line 59 with the inlet 53 A of the second

Balance chamber half 53 is connected. The dialysate can be in the second

Balancing half with a second pump 60 promoted in the third

Liquid line 59 is provided. Downstream of the second pump 60, a third obturator 61, for example an electromagnetically actuated hose clamp, is provided in the third fluid line 59.

The outlet 53B of the second balance chamber half 53 is over a fourth

Liquid line 62, in which a fourth obturator 63 is provided, connected to the inlet 13 A of the second filter chamber 13. The blood treatment device may also have an ultrafiltration device having an ultrafiltration pump 34, which withdraws ultrafiltrate from the fluid system I. The ultrafiltration pump 34 is in a fifth fluid line 35

provided, which is connected to the first liquid line 54 upstream of the first pump 55.

The control unit 36 is configured in this embodiment of the Hamödialysevorrichtung such that in successive working cycles, the subsequent work cycles are performed.

The successive working cycles each comprise two work cycles. In a first operating cycle, the control unit 36 controls the shut-off devices in such a way that the first and fourth obturators 56, 63 are opened and the second and third obturators 58, 61 are closed. Consequently, the balance chamber 50 is operated in the switching state of the take A (Fig. 2A). In a second power stroke, the control unit controls the

Shut-off devices such that the first and fourth obturator 56, 63 closed and the second and third obturator 58, 61 are open. Consequently, the balance chamber is operated in the switching state of the take C (Fig. 2C). This is followed by the second one

Work cycle etc.

In the first working cycle dialysate flows out of the second filter chamber 13

(Dialysatkammer) in the first balance chamber half 52, from the first half balance chamber through the semi-permeable membrane 51 in the second balance chamber half 53, from the second balance chamber half in the second filter chamber 13 (dialysate) and from the second filter chamber 13 back into the first balance chamber half. The dialysate is conveyed by the first pump 55. Low permeability substances are retained by the semipermeable membrane, so that these substances in the first

Balance chamber half be concentrated.

In the second power stroke dialysate flows from the Dialy satquelle 21 in the second balancing chamber half 53 and from the second balancing chamber half in the sequence 29, so that the used dialysate can drain off. The dialysate is conveyed by the second pump 60.

The clock A serves for the circulation of dialysate through the second filter chamber

(Dialysate chamber), wherein blood and dialysate flow in countercurrent. Alternatively, the flow of blood and dialysate can also take place in a corresponding configuration in direct current. The clock C is used to exchange liquid in the

Balance chamber with filter function. An advantage of using the balance chamber with filter function in this application is that a mixing of fresh dialysate is avoided with used dialysate.

Fig. 6 shows another embodiment in which the blood treatment device is a hemofiltration device. The hemofiltration device has a filter 10, which is subdivided by a semipermeable membrane 11 into a first filter chamber 12 and a second filter chamber 13. To the inlet 12A of the first filter chamber 12 is a blood supply line 14 and to the outlet 12B of the first filter chamber 12, a Blutabführleitung 15 is connected. The blood of the patient is conveyed in the extracorporeal blood circulation I with a blood pump 16 which is provided in the blood supply line 14.

The fluid system I comprises the balancing chamber 50 described with reference to FIGS. 1A and 1B and FIGS. 2A to 2F, which is divided by a semipermeable membrane 51 into a first balancing chamber half 52 and second balancing chamber half 53. The first balance chamber half 52 has an inlet 52A and an outlet 52B, and the second balance chamber half 53 has an inlet 53A and an outlet 53B.

The second filter chamber 13 has no inlet in the hemofiltration device but only one outlet 13B. The outlet 13B of the second filter chamber 13 is connected via a first fluid line 54 to the inlet 52A of the first balancing chamber half 52. In the first liquid line 54, a first pump 55 is provided. Downstream of the first pump 55 is in the first liquid line 54 a first

Shut-off 56 provided.

From the outlet 52B of the first balance chamber half 52, a second leads

Liquid line 57, in which a second obturator 58 is provided, to a drain 29th

Balance chamber half 53 is connected. The dialysate can be in the second

Balancing chamber half 53 are conveyed with a second pump 60 which is provided in the third fluid line 59. Downstream of the second pump 60 is provided in the third liquid line 59 in third obturator 61, for example, an electromagnetically actuated hose clamp.

From the outlet 53A of the second balancing chamber half is a fourth

Liquid line 70 from, in which a fourth obturator 71 is provided. The fourth fluid conduit 70 branches downstream of the fourth obturator 71 into first and second portions 70A, 70B, the first portion 70A leading to a connection of the blood supply line 14 upstream of the filter 10 and the second portion 70B to a connection of the blood discharge line 15 downstream of the filter 10, so that substituate may be delivered to the extracorporeal blood circuit upstream of the filter (predilution) or downstream of the filter (postdilution). In each of the first and second sections of the fourth fluid line 70, a further shut-off device 71A, 71B is provided, so that it is possible to switch between predilution and / or post-dilution. The substituate is conveyed with a third pump 73 (Substituatpumpe), in the fourth

Liquid line 70 is provided downstream of the third obturator 71.

The blood treatment device may also have an ultrafiltration device having an ultrafiltration pump 34, which withdraws ultrafiltrate from the fluid system I. The ultrafiltration pump 34 is in a fifth fluid line 35 provided, which is connected to the first liquid line 54 upstream of the first pump 55.

The successive working cycles each comprise two work cycles. In a first operating cycle, the control unit 36 controls the shut-off devices in such a way that the first and fourth obturators 56, 71 are opened and the second and third obturators 58, 61 are closed. Consequently, the balance chamber is operated in the switching state of the take A (FIG. 2A). In a second power stroke, the control unit 36 controls the

Shut-off devices such that the first and fourth obturator 56, 71 closed and the second and third obturator 58, 61 are open. Consequently, the balance chamber is operated in the switching state of the take C (Fig. 2C). Then follows the second cycle, etc.

In the first working cycle, liquid is withdrawn from the second filter chamber 12 with the first pump 55. The liquid flows into the first balancing chamber half 52, from the first balancing chamber half through the semipermeable membrane 51 into the second balancing chamber half 53 and from the second balancing chamber half to the blood feed and discharge duct 14, 15. Low permeability substances are produced by the semipermeable membrane 51, so that these substances can not enter the extracorporeal blood circulation I and are concentrated in the first balance chamber half 52.

In the second power stroke dialysate flows from the Dialy satquelle 21 in the second balancing chamber half 53 and from the first balancing chamber half 52 in the drain 29, so that the used dialysate can flow. The dialysate is conveyed by the second pump 60. In the cycle A hemofiltration takes place and in the cycle C there is an exchange of liquid in the balancing chamber with filter function. An advantage of using the balance chamber with filter function is in this application is that a

Mixing of substituate and filtered liquid is avoided.

Claims

Claims:

A blood treatment device with an extracorporeal blood circulation (I) and a fluid system (II) which is separated from the extracorporeal blood circulation by a semipermeable membrane (11) of a filter (10) having a first

Filter chamber (12) and a second filter chamber (13), wherein the first filter chamber part of the extracorporeal blood circulation and the second filter chamber is part of the fluid system and the fluid system comprises means for balancing fresh and used treatment liquid, characterized in that the means for Balancing of fresh and used treatment liquid as a balance chamber (1; 17, 50) is formed, which has a semi-permeable membrane (3; 18, 51), the balance chamber into a first balance chamber half (4; 19, 52) and a second balance chamber half (5, 20, 53).

2. A blood treatment device according to claim 1, characterized in that the liquid system (I) leading to an inlet of the first balancing chamber half (19) liquid line (22, 37) and one of an outlet of the first balancing chamber half outgoing liquid line (28, 44) and a comprising a liquid line (31, 46) emerging from an outlet of the second balancing chamber half (20), wherein in the liquid system are pumps (23, 33, 39) for conveying the treatment liquid and shut-off elements (24, 27, 30, 32, 40, 43, 45 , 47) are provided for shutting off the liquid lines, that a control unit (36) is provided for controlling the pumps and shut-off devices, which is configured such that in a first working cycle of a working cycle of successive

Working cycles treatment liquid via the semipermeable membrane (18) of the balance chamber (17) from the first balance chamber half (19) in the second

Balance chamber half (20) flows, and in a second operating cycle of successive working cycles, treatment liquid flows through the first balancing chamber half (19) (FIGS. 3, 4).

3. A blood treatment device according to claim 2, characterized in that the blood treatment device comprises a dialysate source (21) for fresh dialysate and a used dialysate outlet (29) leading to the inlet of the first balancing chamber half (19)

Liquid line (22) to the dialysate source (21) and from the outlet of the first balancing chamber half (19) outgoing liquid line (28) are connected to the outlet (29), the outgoing from the outlet of the second balancing chamber half (20)

Liquid line (31) leads to an inlet of the second filter chamber (13) and from an outlet of the second filter chamber (13), a liquid line (25) going off to the leading to the inlet of the first balance chamber half (19) liquid line (22) or the Inlet of the first balance chamber half leads, wherein for operating the blood treatment device as a hemodialysis a control unit (36) for driving the pumps and shut-off valves is configured such that in a first working cycle of a cycle of successive

Duty cycles,

Treatment liquid from the second balancing chamber half (20) in the second filter chamber (13) and from the second filter chamber in the first

Balancing chamber half (19) flows, so that treatment liquid on the semipermeable membrane (18) of the balance chamber (17) of the first

Balancing half flows in the second balancing chamber half, and in a second power stroke of successive working cycles

Treatment liquid from the dialysate source (21) through the first

Balancing chamber half (19) to the outlet (29) flows (Figure 3).

4. Blood treatment device according to claim 2, characterized in that

the blood treatment device has a fresh dialysate dialysate source (21) and a spent dialysate outlet (29) leading to the inlet of the first balance chamber half (19)

Liquid line (37) to the dialysate source (21) and from the outlet of the first balancing chamber half (19) outgoing liquid line (44) are connected to the outlet (29), the outgoing from the outlet of the second balancing chamber half (20)

Liquid line (46) to a leading to the first filter chamber (12) blood supply line (14) and / or outgoing from the first filter chamber Blutabführleitung (15) of the extracorporeal blood circulation (I), and from an outlet of the second filter chamber (13) a liquid line (41) which leads to the liquid line (37) leading to the inlet of the first balancing chamber half or the inlet of the first balancing chamber half (19), wherein for operation of the blood treatment device as haemofiltration device the control unit (36) controls the pumps and shut-off devices in such a way is configured that in a first cycle of a work cycle of successive

Working cycles, treatment liquid from the second balancing chamber half (20) to the leading to the first filter chamber blood supply line (14) and / or first filter chamber outgoing Blutabführleitung (15) flows, so that

Treatment liquid via the semipermeable membrane (18) of the balance chamber from the first balance chamber half (19) into the second balance chamber half (20) flows, and in a second work cycle of successive cycles, treatment liquid from the dialysate source (21) through the first

Balancing chamber half (19) to the outlet (29) flows (Figure 4).

A blood treatment device according to claim 1, characterized in that the fluid system (I) comprises a liquid conduit (54) leading to an inlet of the first balancing chamber half (52) and one of an outlet of the first

Balancing chamber half-outgoing liquid line (57) and one to an inlet of the second balancing chamber half (53) leading liquid line (59) and one outgoing from an outlet of the second balancing chamber half

In the liquid system (I), there are provided pumps (55, 60, 73) for conveying the treatment liquid and shut-off devices (56, 58, 61, 63, 71) for shutting off the liquid lines, that a control unit (36) is provided for driving the pumps and shut-off devices, which is configured such that in a first operating cycle of a working cycle of successive

Duty cycles,

Treatment liquid flows via the semi-permeable membrane (51) of the balancing chamber (50) from the first balancing chamber half (52) into the second balancing chamber half (53) and, in a second working cycle of successive working cycles, treating liquid via the semipermeable membrane (51) of the balancing chamber (50). from the second balancing chamber half (53) into the first balancing chamber half (52) flows (Fig.3, Fig. 4).

A blood treatment device according to claim 5, characterized in that the blood treatment device comprises a dialysate source (21) for fresh dialysate and a spent dialysate outlet (29) leading to the inlet of the second balance chamber half (53)

Liquid line (59) to the dialysate source (21) and the outgoing from the outlet of the first balancing chamber half (52) liquid line (57) are connected to the outlet (29), the outgoing from the outlet of the second balancing chamber half (32)

Liquid line (62) leads to an inlet of the second filter chamber (13) and from an outlet of the second filter chamber (13) a liquid line (54) goes off, leading to an inlet of the first balance chamber half (52), wherein the operation of the blood treatment device as a hemodialysis device the control unit (36) is configured to control the pumps and shut-off devices such that in a first working cycle of a working cycle of successive

Duty cycles,

Treatment liquid from the second balancing chamber half (53) in the second filter chamber (13) and from the second filter chamber in the first

Balancing chamber half (52) flows, so that treatment liquid via the semipermeable membrane (51) of the balance chamber (50) of the first

Balancing chamber half (52) flows into the second balancing chamber half (53), and in a second working cycle of successive working cycles, Treatment liquid flows from the dialysate source (21) into the second balance chamber half (53) and from the first balance chamber half to the drain (29), so that treatment liquid via the semipermeable membrane (51) of the balance chamber (50) from the second balance chamber half (53) in the first balance chamber half (52) flows (FIG. 5).

7. Blood treatment device according to claim 5, characterized in that

the blood treatment device comprises a fresh dialysate dialysate source (21) and a spent dialysate outlet (29) leading to the inlet of the second balance chamber half (53)

Liquid line (59) to the dialysate source (21) and the outgoing from the outlet of the first balancing chamber half (52) liquid line (57) are connected to the outlet (29), the outgoing from the outlet of the second balancing chamber half (53)

Liquid line (70) leading to the first filter chamber (12)

Blood supply line (14) and / or outgoing from the first filter chamber

Blood discharge line (15) of the extracorporeal blood circuit (I) and from an outlet of the second filter chamber (12) a liquid line (54) goes off, leading to an inlet of the first balance chamber half (52), wherein for operating the blood treatment device as Hämofiltrationsvornchtung the control unit (36) is configured to drive the pumps and shut-off devices such that in a first work cycle of a cycle of successive

Duty cycles,

Treatment liquid from the first balance chamber half (52) to the leading to the first filter chamber blood supply line (14) and / or to the first of Filter chamber outgoing Blutabführleitung (15) flows, so that treatment liquid flows through the semi-permeable membrane (51) of the balance chamber (50) from the first balancing chamber half (52) in the second balancing chamber half (53), and in a second working cycle of successive working cycles, treatment liquid the dialysate source (21) in the second

Balancing chamber half (53) and from the second balancing chamber half to the outlet (29) flows, so that treatment liquid flows through the semi-permeable membrane (51) of the balance chamber (50) from the second balancing chamber half (53) in the first balancing chamber half (52) (Fig. 6).

8. Blood treatment device according to one of claims 1 to 7, characterized

characterized in that an ultrafiltration device for removing liquid from the liquid system is provided.

9. A method of operating a blood treatment device with a

extracorporeal blood circulation and a fluid system separated from the extracorporeal blood circuit by a semipermeable membrane of a filter having a first filter chamber and a second filter chamber, wherein the first filter chamber is part of the extracorporeal blood circuit and the second filter chamber is part of the fluid system and the fluid system Device for balancing fresh and used

Treatment liquid comprises, characterized in that for balancing fresh and used treatment liquid, a balance chamber is used which has a semi-permeable membrane which divides the balance chamber into a first balance chamber half and a second balance chamber half.

10. The method according to claim 9, characterized in that in a first working cycle of a working cycle of successive

Working cycles through the semipermeable membrane of the treatment liquid Balancing chamber flows from the first balancing chamber half in the second balancing chamber half, and in a second operating cycle of successive working cycles, treatment liquid flows through the first balancing chamber half (Fig.3, Fig. 4).

11. The method according to claim 10, characterized in that for the operation of

Blood treatment device as a hemodialysis device in a first working cycle of a working cycle of successive

Duty cycles,

Treatment liquid from the second balancing chamber half in the second

Filter chamber and flows from the second filter chamber into the first balancing chamber half, so that treatment liquid on the semipermeable membrane of the balancing chamber from the first balancing chamber half in the second

Balancing chamber half flows, and in a second operating cycle of successive working cycles, treatment liquid flows from the dialysate source through the first balancing chamber half to the drain (FIG. 3).

12. The method according to claim 10, characterized in that for the operation of

Blood treatment device as hemofiltration device in a first working cycle of a working cycle of successive

Duty cycles,

Treatment liquid from the second balancing chamber half flows to the blood supply line leading to the first filter chamber and / or the blood discharge line of the extracorporeal blood circuit leaving the first filter chamber, so that the treatment liquid flows via the semipermeable membrane of the balancing chamber flows from the first balancing chamber half into the second balancing chamber half, and in a second working cycle of successive working cycles, treatment liquid flows from the dialysate source through the first balancing chamber half to the drain (FIG. 4).

13. The method according to claim 9, characterized in that in a first working cycle of a working cycle of successive

Duty cycles,

Treatment liquid flows via the semipermeable membrane of the balancing chamber from the first balancing chamber half into the second balancing chamber half, and in a second working cycle of successive working cycles,

Treatment liquid flows through the semi-permeable membrane of the balancing chamber from the second balancing chamber half in the first balancing chamber half (Fig. 5, Fig. 6).

14. The method according to claim 13, characterized in that for the operation of

Duty cycles,

Treatment liquid from the second balancing chamber half in the second

Filter chamber and from the second filter chamber flows into the first balance chamber half, so that the dialysate flows through the semipermeable membrane of the balance chamber from the first balancing chamber half in the second balancing chamber half, and in a second cycle of successive cycles, treatment liquid from the dialysate source in the second balancing chamber half and acv us the first balance chamber half flows to the drain, so that the dialysate flows through the semipermeable membrane of the balancing chamber from the second balancing chamber half in the first balancing chamber half (Figure 5).

15. The method according to claim 13, characterized in that for the operation of the blood treatment device as hemofiltration device in a first working cycle of a working cycle of successive working cycles,

Treatment liquid from the second balancing chamber half to the leading to the first filter chamber blood supply line and / or to the first of

Filter chamber outgoing Blutabführleitung the extracorporeal blood circuit flows, so that the dialysate flows through the semipermeable membrane of the balancing chamber from the first balancing chamber half in the second balancing chamber half, and in a second working cycle of successive working cycles,

Treatment liquid flows from the dialysate source in the second balancing chamber half and from the first balancing chamber half to the drain, so that

Treatment liquid flows through the semipermeable membrane of the balance chamber from the second balancing chamber half in the first balancing chamber half (Figure 6).