CA1110551A

CA1110551A - Negative pressure valving system and transmembrane pressure alarm system

Info

Publication number: CA1110551A
Application number: CA313,089A
Authority: CA
Inventors: Jan Soderstrom
Original assignee: Baxter Travenol Laboratories Inc
Current assignee: Baxter International Inc
Priority date: 1977-10-12
Filing date: 1978-10-11
Publication date: 1981-10-13
Also published as: DE2844105A1; GB2005561B; GB2035130A; ES474147A1; JPS54117196A; BE871129A; GB2005561A; FR2405734A1; GB2035130B; NL7809853A

Abstract

ABSTRACT OF THE DISCLOSURE
There is disclosed herein a negative pressure dialysis machine which includes a negative pressure valv-ing system and transmembrane pressure alarm system.
An electromagnetically controlled flapper valve is disclosed herein for use as a negative pressure control valve. The flapper valve permits accurate control of negative pressure and changes in negative pressure to be affected rapidly.
Transmembrane pressure alarm systems are provided which detect the difference in pressure between the blood and dialysate in the dialyzer and activate alarms and pre-vent dialysis (a) if the dialysate pressure exceeds the blood pressure and/or (b) if a blood pressure signal is not received which would permit actual transmembrane pressure to increase beyond a predetermined limit.

Description

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ACKGRO~D OF THE INVENTION

The invention relates to dialysis machines, and more particularly, to a negative pxessure valve system and to alarm systems ~or use in such machines.
In dialysis, a patient's blood and dialysate flow through a dialyzer which includes a semlpermeable membrane for separating the blood and the dialysate.
Impurities and water from the blood cross the membrane and enter the dialysate for disposal. The terms dialysate, dialysis solution and dialyzing ~luid as may be used here-inafter are intended to be synonomous.
In some dialyzers the dialysate is drawn through the dialyzer under a negative pressure (i.e., below atmo-spheric pressure). Such systems normally include a nega-tive pressure pump positioned downstream of the dialyzer for drawing the dialysate through the dialyzer and a negative pressure valve positioned upstream of the dialyzer.
The negative pressure in the dialyzer is controlled by adjustment of the negative pressure control valve. Although these systems are commonly referred to as negative pressure systems, there are certain conditions under which positive dialysate pressures may be generated. U.S. Patent 3,878,095 discloses one such negative pressure system.
In some machines electromechanically operated needle valves have been used as the negative pressure con-trol valve. Such valves have an operating characteristic such that as the valve moves from the open position toward the closed position, the change in pressure is relatively `~ -2-.

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small and linear. However as the valve is about to close, the pressure becomes increasingly negative at a very rapid rate until the valve closes. In other words, as the valve closes, there are very great changes in pressure. This steep change in pressure makes it difficult to accurately control and maintain the negative pressure at highly nega-tive levels (e.g., -400 to -500 mm Hg). This is particularly true in an electromechanical system wherein gear tolerances and changes in temperature also affect the control and positioning of the needle valve and thus the negative pressure.
Furthermore, the electromechanical system includes a constant speed DC motor to operate the valve. Therefore, since the valve characteristics are relatively linear, the time necessary to induce large changes in negative pressure may be relatively long. For example, the change rrom -200 mm H~ to 0 mm Hg may take on the order of two minutes.
It is the-efore desirable to provide a more accurately controllable and responsive negative pressure valve system.
In dialysis the pressure differential across the semipermeable membrane (i.e., the difference in pressure between the blood and the dialysate) is important. This differenti21 may be referred to as the transmembrane pres-sure. However, in the event that the dialysate pressure exceeds the blood pressure, impurities in the dialysate could undesirably pass through the membrane and into the blood.

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It is desirable, therefore, that dialysis be prevented in the event that the dialysate pressure exceeds the blood pressure.
During dialysis, water is removed ~rom the blood by a process known as ultrafiltration. The quantity of water removed is directly related to the transmembrane pressure. It is desirable to control the amount of water removed since removal of too much water during dialysis may result in undesirable side effects.
Therefore, it is desirable to maintain control over the difference between the dialysate pressure and blood pressure so as to control ultrafiltration.
Some prior art dialysis machines have included txansmembrane pressure monitors, which merely measured and displayed the transmembrane pressure. In another machine, provisions were made for alarms in the event the transmembrane pressure exceeded a predetermined value.
The alarms included a tolerance or alarm window of, for example, 50 mm Hg above or below the predetermined value.
Therefore, in the event that the transmembrane pressure was zero, it is possible tha with those tolerances dialysate pressure could increase beyond the blood pressure level, thereby permitting undesirable transfer from the dialysate to the blood.
It is therefore desirable to provide an alarm system for preventln~ dialysis if the dialysate pressure exceeds the blood pressure.
In order to maintain a set or predetermined trans-membrane pressure, both the dialysate pressure and the blood pressuremust be monitored. In the event that the blood pressure signal is not received by -the -trans-membrane pressure control system, it is possible that the actual transmembrane pressure could undesirably e~ceed the set or prede~ermined pressure without providin~ any indi-cation or alarm as to that acutal increase.
It is therefore desirable to provide a system whereby the actual transmembrane pressure is maintained at a set or predetermined level, and in the event of signal failure from the venous pressure transducer, appropriate alarms and shut-off mechanisms are activated.

SUMMARY OF THE INVENTION

According to the invention there is provided a dialysismachine for use with a negative pressure dialyzer which includes a negative pressure control valve positioned upstream of a dialyzer, a negative pressure sensing means operatively associ-ated with said valve means positioned downstream thereof, and a negative pressure pump for drawing dialysate through said valve means and said dialyzer. The negative pressure valve means comprises electromagnetically controllable flapper valve means for accurately controlling negative pressure, said valve means being effective to minimize the time in which said machine responds to changes in negative pressure.
The negative pressure control system of this dialysis machine provides for very accurate and very responsive control of the negative pressure. The electromagnetically controlled flapper valve has to permit very rapid response times in terms of the stabilization of the negative pressure in the system.

This rapid response time (on the order of 30 seconds~ has been found to be very desriable from physiologoical, safety and/or convenience points of view.

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The -transmembrane pressure alarm systems disclosed herein prevent the dialysate pressure from exceedi.ng the blood pressure. Another feature of the transmembrane alarm system ls that the transmembrane pressure will be maintained at a set or predetermined level during operation of the machine, and in the event that no venous pressure signal is received or the venous pressure becomes negative below a predetermined level, the system will alarm and prevent further dialysis.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGURE 1 is a flow diagram depicting the fluid flow path within the dialysis machine;
FIGURE 2 is a broken away and sectional view showing the details of the negative pressure control flapper valve;
FIGURE 3 is a front view of a transmembrane/
dialysate pressure module; and FIGURE 4 is a block-type diagram showing the transmembrane alarm systems.

DESCRIPTION OF THE P~EFERRED El~BODIMENT
.

I. In General Referring now to Figure 1, the di.alysis machine is shown in block diagram form.
Incoming water flows to the holding tank 10.
From the holding tank the water flows through a heat exchanger 12, a first temperature sensor 14, through an 55~
electric heater 16, and to a second tempera-ture sensor 18.
The heated water then flows from the second temperature sensor 18 ~o a degassing section 20, which includes a restriction and degassing pump. Degassed water then flows to a holding tank 22, which is connected at its upper end to a pressure relief valve 24 and through a return line 26 to the input tank 10. Degassed water flows from the holding tank 22 through a flow detector 28 and to a dialy-sate mixing chamber 30. Dialysate concentrate flows to the mixing chamber 30 from a concentrate pump 32 and mixes with the degassed water. The amount of concentrate deli-vered to the mixing chamber by the pump 32 is controlled by a conductivity detector 34 that is positioned immediately downstream of the mixing chamber 30.
The dialysate which has been prepared then flows via line 36 to the negative pressure or dialysate pressure control valve 38, through line 39 and to a ne~ative pressure or dialysate pressure transducer 40. The transducer 40 and negative pressure valve 38 are connected through a feedback loop 42 for controlling the valve 38 and the negative pressure.
The dialysate then flows from the transducer 40 to a junction 44, at which point the flow lines divide into two branches. One branch is a dialyzer bypass line 46 which includes a bypass control valve 48. The other branch includes a dialyzer inlet line 50, having an inlet control valve 52 positioned therein. A negative-pressure-type dialyzer 54 is positioned downstream of the valve 52, and the downstream end of the dialyzer connects to the 5~
outlet line 56, outlet control valve 58 and to the junction 60.
A negative pressure pump 62 is positioned down-stream of the junction 60 for drawing dialysate through the system and part~ularly through the negative pressure valve 38 and khe dialyzer 54. Used or spent dial~sate flows from negative pressure pump 62 to the drain 64.
The dialyzer 54 includes a semipermeable mem-brane, shown illustratively as 54a, which separates the dialysate from the blood side of the dialyzer. A patient's blood enters the dialyzer via the arterial line 66 and exits the dialyzer via the venous line 68. A pressure transducer 70 is positioned in the venous line 68 to detect the blood pressure at that point.
The mean transmembrane pressure within the dia-lyzer is approximated by measuring the difference between the pressure measured by the venous pressure transducer 70 and that measured by the negative pressure transducer 40. Both the venous pressure transducer 70 and the nega-tive pressure transducer 40 are connected to the transmem-brane/dialysate pressure module 200.

II. The Negative Pressure Control_System Referring now to Figure 2, there is shown an electromagnetically operated flapper type negative pres-sure valve assembly 38, to which the input line 36 and the output line 39 are connected. ~lectromagnetically-operated flapper valves are sold by Hydraulic Servo System ~8--5~
Corp~, 5800 Transit Road, Depew, New York 14042. ~Model 58 valve when modified, has been found to be generally suitable for a negative pressure control valve in a dialysis machine.) The valve assembly 38 includes a magnet frame 100 within which is posltioned a magnet coil 102. An elon-gated rod or armature 104 is provided and its upper section is positioned in the coil. The armature is connected to a flat leaf spring-like member 106 which permits the armature to pivot and which is ad~usted to bias the arma-ture to a first position.
A flow housing 110 is secured to the bottom of the magnetic frame, the spring-like member 106 is secured to the housing, and the O-ring 112 seals the armature 104 to the housing. The housing 110 includes: a central bore 114; an inlet bore 116 and an outlet bore 118, which are axially aligned; and a flow orifice or nozzle 120 which is positioned at the outlet end of the inlet bore 116. The inlet bore is connected to the line 36 and the outlet bore 118 is connected to the line 39.
The armature 104 includes an elongated lower section 104a which is positioned within the central bore 114. The lower end of the armature includes flat land portion 104_ which faces the orifice 120 and is constructed to seat thereagainst. The positioning of the land 104b relative to the nozzle 120 establishes the pressure drop or negative pressure across the negative pressure valve.
The level of negative pressure is related to the distance between the land 104b and the orifice 120. In other words, s~
the closer the land is to the orifice, the more negative the pressure, and the further the land is from the orifice, the less negative the pressure. In this application the lower section 104a has a length greater than the length of the upper section so as to permit control of the positioning of the land and operation of the system under dialysate positive pressure. The length of the lower section in this valve is several times greater than khe length of the lower section in the standard model 58 r and under the same system constraints positive dialysate pressures could not be ob-tained with the standard model 58. It has been found that the valve disclosed herein has-an operating characterlstic which is substantially linear.
The position of the armature relative to the orifice is controlled by controlling the current flow through the magnetic coil. The armature is biased by the spring-like member 106 to a first position, such that when there is no current flow, the valve is in an open position, away from the orifice, and there is a very small pressure drop across the valve.
The magnetic coil 102 is operatively associated with the transducer 40 through a buffered operational amplifier. It will be appreciated that the long length of the lower section (i.e., the distance between the pivot 106 and the land 104) pe~mits of very carefully controlled incremental changes in the distance between the orifice and the land. Therefore, positioning of the land 104b relative to the orifice 120 can be controlled by very small .

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changes in the current flow to the magnetic coil 102.
This is -true throughout substantially the entire operating range of the valve.
~ s the current flow through the coil increases, the upper section of the armature is pulled against biasing spring, and the land section 104b is moved toward the orifice 120, which increases the negative pressure. It has been Eound that negative pressure increases substan-tially linearly wi-th increasing current flow through the coil. Thus the positioning of the land and the negative pres-sure can be controlled very accurately, even at highly negative values, such as -400 or -500 mm Hg.
Furthermore, since the only moving part in the system is the armature and the operating characteristics are substantially linear, the response time to change the negative pressure at the valve is very small. The time required for the entire system to adjust to changes in the negative pressure and stabilize are related to system constraints. In this system, the response time to change from -200 mm Hg to 0 mm Hg is on the order of 30 seconds.
Different systems may respond in longer or shorter times depending upon system constraints.
Flapper valve assemblies, such as 38, are believed to be readily interchangeable between dialysis machines so as to avoid problems in calibration and standardizing equipment when replacing the valve assem-blies.

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III. Transmembrane Pressure Controls The dialysis machine as used herein can be referred to as a proportional dialysate delivery system as sold by Baxter Travenol Laboratories, Inc., under the name Propor-tionin~ Dialyzin~ Fluid Delivery System (5M 1352 - 5M 1355).
These machines are in modular form whereby various functions can occur within the movable and serviceable modules.
Figure 3 shows the front panel of a transmembrane/dialysate pressure module 200. The panel shows a negative pressure gauge 201 which provides for negative pressure readings of zero (0) to -500 mm Hg. A slide control 202 is provided for setting transmembrane pressure, as will be described hereinafter.
This module can be operated either in a dialysate pressure mode or a transmembrane pressure mode. Indicator light 204 will be lit when the machine is in the dialysate pressure mode, and light 206 will be lit when the machine is operated in the transmembrane pressure mode. Switch 208 permits selection of operation in either the trans-membrane pressure or dialysate pressure mode. During set-up and initial operation of the machine, the module is operated in the dialysate pressure mode. Once stabilized, the module may be switched to the transmembrane pressure mode.
~he transmembrane pressure in the dialyzer is approximated by measuring the difference between the pres-sure indicated by the venous pressure transducer ~0 and the negative pressure transducer 40. For example, if the s~
venous pressure is +50 and -the negative pressure is -200, the transme~brane pressure is 250.
The operator can select a desired transmembrane pressure by use of the slide control 202. For example, the transmembrane pressure can be set at 300 and this pressure will be maintained automatically through the opera-tion of the negative pressure control valve 38 as the venous pressure varies. Use of the flapper valve 38 thus is very advantageous in that the negative pressure changes can quickly follow or "track" changes in the venous blood pres-sure.

III. A. Zero Transmembrane Pressure Alarm ~ondition There are circumstances in which the operator desires that the transmembrane pressure be zero (i.e., no pressure differential across the membrane). However, the dialysate pressure should never exceed the blood pres-sure since undesirable impurities may then pass through the semipermeable membrane and into the blood.
Under normal operating circumstances, an "alarm window" of +50 mm Hg is provided. For example, at 200 mm Hg, alarms would be activated if the transmembrane pressure is not within the pressure of 150-250 mm Hg.
However, with any such alarm window, at a transmembrane pressure of 0 mm Hg, it is possible that the pressure on the dialysate side of the membrane could undesirably exceed the venous blood pressure.

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As described hereinaft~r, means are provided for preventing dialysate pressure from exceeding the blood pressure and appropriate alarms are activated.
In the event that the dialysate pressure exceeds the venous pressure, further dialysis is prevented by opening bypass valve 48 and closing the clialysis inlet and outlet valves 52 and 58. Thls effectively isolates the dialyzer and prevents ~he undesirable situation in which the dialysate pressure can increase above the blood pressure. Further-more, audible and visible alarms are also activat~d.
Referring now to Figure 4, the dialysate flows through negative pressure transducer 40. Negative pres-sure transducer 40 includes an operational ampllfier that develops a vol-tage which varies in accordance with the pres-sure on the transducer. When the pressure on the transducer 40 is negative in nature, a positive voltage is developed at the output of transducer 40; when the pressure on trans-ducer 40 is positive, negative voltage is developed at the output o transducer 40. In the preferred embodiment, the signal developed at the output of negative pressure transducer 40 will be +1.6 volts at -100 mm Hg. At 0 mm Hg, the outputof pressure transducer 40 will be 0 volts, and at ~100 mm Hg, the output will be -1.6 volts. This voltage is coupled from transducer 40 to one input 300 of an adder circuit 302 in pressure module 200.
Venous pressure transducer 70 includes an opera-tional amplifier circuit that develops a voltage which varies in accordance with the venous pressure at the trans-ducer. In the preferred ernbodiment, the output of pressure transducer 70 will vary over a range of -2 volts at 0 mm H

to -8 volts at 300 mm Hg. This output signal is coupled from pres-sure transducer 70 to an amplifier/inverter 304 in pressure module 200. Amplifier/inverter 304 provides a scaling factor adjustment to its output signal in addi-tion to an inversion. Consequently, at the output of amplifier/invertex 304, the voltage will vary from 0 volts at 0 mm Hg to +~.8 volts at 300 mm Hg. The signal developed by amplifier/inverter 304 is coupled to a second input 306 of adder circuit 302.
Adder circuit 302 adds the signals coupled to inputs 300 and 306 and develops an output signal correspond ing to the sum of the signals at inputs 300 and 306. For example, i the dialysate pressure is -100 mm Hg, the voltage coupled to input 300 will be +1.6 volts. If the venous pressure is also 100 mm Hg, +1.6 volts will be coupled to input 306. The output of adder circuit 302 would then be 3.2 volts. The output of adder circuit 302 is coupled to an amplifier 308 where it is amplified and coupled to a comparator 310.
Comparator 310 compares the signal coupled from the amplifier 308 to a reference voltage. If the signal from amplifier 308 exceeds the reference voltage, comparator 310 will develop an output signal which is coupled to the alarm circuit 312 actuating audible and visible alarms.
Alarm circuit 312 is also coupled to valves ~8, 52 and 58 in order to open valve 48 and close valves 52 and 58.
In the preferred embodiment, should the dialysate pressure become positive rather than negative, the voltage SS~
-developed at the output of transducer 40 will become posi-tive. If, for example, the dialysate pressure becomes +100 mm Hg, the voltage at input 300 will be -1.6 volts.
The blood pressure as sensed by transducer 70 remains at 100 mm Hg so that the dialysate pressure and blood pressure are identical. In this circumstance, the output of ampli-fier/inverter 304 will develop a voltage of ~1.6 volts which is coupled to input 306 of adder circuit 302. Adder cir-cuit 302 will add the voltages developed at the two inputs and will develop an output voltage of 0 volts. The 0 volt signalldeveloped by adder circuit 302 is coupled to ampli-fier 308 and from amplifier 308 to comparator 310. A 0 volt signal, indicating identity of pressure between pres-sure transducer 70 and pressure transducer 40, and any more positive signal, indicating a greater pressure at transducer 40 than at transducer 70,will actuate comparator 310 to develop an output signal and actuate the alarms in alarm circuit 312. Alarm circuit 312 will open valve 48 and close valves 52 and 58, thus bypassing the dialyzer 54.

III. B. Alarm Conditions for Loss of Venous Blood Pressure Signal This alarm condition is intended to prevent the transmembrane pressure from increasing beyond a set limit.
The venous pressure transducer 70 provides information to the pressure module for comparison with the signal ~rom the negative pressure transducer 40 SG as to maintain the appropriate transmembrane pressure.

, -16-It is possible ~hat signals ~rom the venous pres-sure transducer may not be received in the transmembrane pressure module, for example if there are faulty connections between the various modules of the machine. In this parti-cular machine, if no signal is received, the machines assumes a venous pressure of -100 mm Hg. When operatlng properly and if the venous pressure signal is ~200 and the desired transmembrane pressure is set at 300, then the dialysate pressure would be controlled to -100. However, if no signal is received, the machine would assume a venous pressure of -100 (even though the actual pressure was ~200). Based on the -100 indication, the transmembrane pressure module operates the negative pressure controls to permit the negative pressure to reach -400. Therefore, the actual transmembrane pressure would be 600 (i.e., the actual venous pressure of +200 less the actual dialysate pessure of -400). However, the displayed transmembrane pressure would be only 300 and no alarm would have been activated.
As described hereinafter, there is provided electronic circuitry for (1) preventing further dialysis by bypassing and isolating the 2ialyzer through the valves 48, 52 and 58, and (2) activating audible and visual alarms when no signal from the venous pressure transducer is applied to the pressure module.
As previously noted, venous pressure transducer 70 includes an operational amplifier circuit that develops a voltage which varies in accordance with the venous pres-sure at the transducer. Further, at the output of amplifier/

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inverter 304, the voltage will vary from 0 volts for 0 mm Hg to +4.8 volts for 300 mm Hg.
Resistor 320 is shown in Figure 4 as being coupled between a reference potential and amplifier/inverter 304.
Resis~or 320 in the preferred embodiment is coupled to a positive voltage potential and has a value of appro~imately 200K ohms. This resistor is generally termed in the art as a "pull-down" resistor.
The output of amplifier/inverter 304, in addition to going to adder circuit 302, also is coupled to the input of a comparator circuit 322. A reference voltage also is coupled to comparator 322. If the signal coupled to compara-tor 322 exceeds the reference voltage, comparator 322 will develop a comparison signal that is coupled to an alarm circuit 324. The comparison signal will actuate the audi~
ble and visual alarms contained in alarm circuit 324.
Alarm circuit 324 also will open valve 48 and will close valves 52 and 58, thus bypassing membrane 54.
Should venous pressure transducer 70 be inadver-tently disconnected from amplifier/inverter 304, or should the coupling therebetween be inadvertently broken, the input voltage coupled to amplifier/inverter 304 will be 0 volts. With an open connection at the input of amplifier/
inverter 304, pull-down resistor 320 will cause the input to become positive. In the preferred embodiment, this will become positive with the voltage of approximately +0.5 volts, corresponding to a blood pressure more negative than -100 mm Hg. The output of amplifier/inverter 304 will -18~

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now become negative ra-ther than its normal positive condi-tion. The +0.5 volts coupled to the input of amplifier/
inverter 304 will cause the amplifier to develop -1.8 volts approximately at its output. This -1.8 volt signal is coupled to comparator 322 causing comparator 322 to develop a comparison signal that is coupled to alarm circuit 324.
In the event that there is no open connection and the venous signal is less -than O volts (i.e., -100 mm Hg), the alarms will still be actuated. As previously noted, alarm circuit 324 will actuate its audible and visual alarms, open valve 48 and close valves 52 and 58, thus preventing excessive transmembrane pressure.
It will be appreciated that numerous changes and modifications can be made in the embodiment disclosed herein without departing from the spirit and scope of this invention.

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Claims

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

Claim 1. A dialysis machine for use with a negative pressure dialyzer which includes a negative pres-sure control valve positioned upstream of a dialyzer, a negative pressure sensing means operatively associated with said valve means positioned downstream thereof, and a negative pressure pump for drawing dialysate through said valve means and said dialyzer, wherein the improvement comprises said negative pressure valve means, comprising electromagnetically controllable flapper valve means for accurately controlling negative pressure, said valve means being effective to minimize the time in which said machine responds to changes in negative pressure.
Claim 2. A dialysis machine as in Claim 1, wherein said flapper valve means includes, a body having electromagnet means at one end, flow housing means at the other end, and a central bore there-through, elongated armature means having an upper and a lower section pivotally secured to said housing so that said upper section is surrounded by said magnet and said lower section extends into said flow housing, and said flow housing including dialysate inlet and outlet bores which are substantially axially aligned, said bores having inner ends which are spaced from each other, and said armature including land means in said lower section at the lower end thereof, said land means being positioned between the inner ends of said bores and movable toward and away from the inner end of said inlet bore, so as to controllably vary the negative pressure, in relation to the current flow through said magnet.
Claim 3. A dialysis apparatus as in Claim 2, wherein there is further provided spring biasing means cooperatively associated with said armature for maintain-ing said armature in a first open position when there is no current flow through the magnet.
Claim 4. A dialysis apparatus as in Claim 3, wherein there is further provided nozzle means at the inner end of said inlet bore, said nozzle arranged for cooperation with said land portion on said armature.
Claim 5. A dialysis machine as in Claim 1, wherein flapper valve means includes a body having electromagnet means at one end, flow housing means at the other end,and a central bore therethrough, elongated armature means having an upper and a lower section pivotally secured to said housing so that said upper section is surrounded by said magnet and said lower sec-tion extends into said flow housing, with said lower section being of a length substantially greater than the length of said upper section so as to permit for accurate control of the positioning of said lower section.