DE2149040A1 - Process and device for peritoneal dialysis in a constant flow - Google Patents

Description

e · Facility for peritoneal dialysis in a constant stream.

For this registration, the priority is derived from the corresponding U.S. application Serial Uo. 77 240 of October 1, 1970 taken.

The invention relates generally to apparatus for the treatment of chronic kine disease, and more particularly on a Verfahran and a device for peritoneal Dialysis.

The dialysis procedure has proven to be an effective tool proven to treat chronic kidney disease. Two types of dialysis are currently used, viz Hemodialysis and peritoneal dialysis. Hemodialysis draws blood from an artery or vein, into one dialyzed and artificial urine outside the body then returned into a vein, generally through cannulas on an arm or leg of the patient. Pur this guy dialysis are permanent connections to the main blood vessels necessary, by means of which the apparatus is connected, and also the blood must be in an external prosthesis

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■ be treated.

In the second type of dialysis, namely peritoneal dialysis, the blood is not immediately put into a prosthesis In this procedure, dialysis fluid is treated either through a puncture in the abdominal wall or inserted into the abdominal cavity by means of a permanently attached percutaneous tube. The dialysate remains for a certain period of time (20 minutes A to an hour) within the cavity and then becomes removed again. While the liquid is inside the cavity, it takes in urea and others metabolic breakdowns from the bloodstream Diffusion through the blood vessel walls within the abdominal cavity on. This dialysis procedure does not require any treatment of the blood or any intervention in the blood circulation. on the other hand, however, the abdominal wall must be penetrated. With both dialysis methods, however, the blood flow must directly or indirectly in chemical equilibrium with a very large amount of dialysate.

In addition to the degradation substances absorbed by the dialysate, certain quantities of proteins and inorganic substances are produced Components that pass through the hemodialysis membrane or the Blood vessel walls can diffuse through it, in the dialysate fluid solved and thus lost. The systematic replacement capacity for these substances can or can may also not be able to measure the physiological values

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to be observed. When exhaustion of certain substances Occurring due to chronic dialysis that is carried out over long periods of time, occur in many cases characteristic pathological symptoms. The depletion of important trace components is proportional to the total amount the dialysate used,

Another serious difficulty with both types of dialysis is the risk of infection during hemodialysis at the points of the cannulas on the arteries and yenas or with peritoneal dialysis at the temporary or permanent penetration points of the abdominal wall given is. The large amounts of dialysate used for treatment must be used during manufacture and during are kept sterile throughout the diffusion process, to avoid infection of the bloodstream or the peritoneal cavity (abdominal cavity).

Because of this, the hospital staff or the patient himself must be extensive and involved Carry out cleaning-sterilization measures, if they connect the cannulas or percutaneous inflow and outflow pipes to the dialysis device. Every Failure to do this can lead to serious infection.

The facilities required for both types of dialysis require a lot of space and are very expensive, which is primarily due to the large amount of dialysate fluid

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and the treatment of the blood is due. Both types of procedure require the patient to go to the facility and is practically immobile for the duration of the dialysis procedure. The complexity and the dialysis procedures used today and the high risks associated with the facilities used have led to the treatment in the at the most irregular intervals and generally about two to three times a week. In the The time span between the treatments decreases Concentration of metabolic breakdown substances in the patient's bloodstream increases steadily and reaches levels that are normally Discomfort and in many babble an exhaustion of the patient before the next dialysis treatment cause.

The unpleasant side effects and the patient's inability to work and move before and during the In many cases, treatment prevents the patient from and can lead a normal, productive life also result in serious psychological problems.

The invention is therefore based on the object · θ ■ to create a facility for peritoneal dialysis in a constant stream of regeneration through which several disadvantages of the procedures and facilities currently in use will be eliminated, with only one small amount of dialysate fluid with low and constant

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temp throughput through the peritoneal cavity (abdominal cavity) is circulated through inflow and outflow pipelines passed through the abdominal wall that was used The fluid that remains in the abdomen is regenerated Fluid reduced to a minimum and thus the abdominal cavity not with a large amount of fluid is stretched so that there is no discomfort due to the fluid remaining within the cavity adjusts. The dialysis is said to have steady throughput rates take place and be designed for almost continuous operation, with the concentration of urea and other metabolic breakdowns that would otherwise occur Formation in the bloodstream is prevented and occurring suddenly with current dialysis procedures Changes in the degradation concentration are prevented. The inflow and outflow pipes passed through the abdominal wall should be permanently attached and designed in such a way that tissue readily adheres to the surfaces the piping grows and forms a living seal that prevents bacterial infection will.

For this purpose a device is used for peritoneal

Dialysis proposed in constant flow, the invention

.BH £ i in C / ie <belly / iahte- etnführhfire lines. Namtich, according to is characterized in thatV'an inflow line and an outflow line _# -i »die. e for introducing dialysate fluid into the abdominal

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cave or to drain the same from the abdominal cavity, and a device for supplying the dialysate fluid to the inflow line, one for training purposes a device serving for a flow of dialysate fluid through the abdominal cavity and a device for removing the dialysate fluid from the drain line serving device are provided. The inflow and outflow lines have one Surface that allows tissue to grow and adhere to the pipe surfaces. The abdominal cavity, the inflow and outflow lines and the regeneration device form a closed system, in which the fluid is continuously regenerated and circulated in a constant flow through the abdominal cavity.

The invention is described below using an exemplary embodiment explained in more detail.

Pig. 1 is a schematic diagram of the regenerative peritoneal dialysis device according to the invention, which is connected to an abdominal cavity and this liquid supplies.

Fig. 2 is a section of the abdominal wall on a larger scale and shows the skin, the subcutaneous Tissue and the peritoneum in connection with a pipe created by tissue growth is anchored in the stream wall.

Fig. 3 shows a section on an even larger scale the pipeline shown in Fig. 2

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with the microwells on the surface, into which the tissue grows. Fig. 4 shows in detail the flow control and Regeneration device.

In accordance with one feature of the invention, two are substantially identical, permanently attached percutaneous tubes 11 and 12 through the abdominal wall used. The pipeline 12 is shown in Fig. 2 on a larger scale. The pipeline can be made of silicone rubber and has a large number of irregular micro-depressions on its outer wall surface 15, which allow the subcutaneous tissue to grow around the outer walls in such a way that this firmly connects to the outer walls, i.e. is anchored to them. Thus are the peritoneal transit points completely closed by the tissue that has grown into the microwells and feeds on neighboring cells will.

The pipes preferably have a very small diameter, for example 1 to 3 mm, and are very flexible formed what due to the very low throughput according to another feature of the Invention in constant flow dialysis is possible. Because of these two characteristics, it becomes permanent Fixing the pipes in the abdominal wall is made much easier. The pipes 11 and 12 each have

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a section 1b "or 17, which is located within the abdominal cavity .proceeds. The other end of the pipe 12 is connected to a device that serves to remove the fluid from the abdominal cavity. To that end is the pipe 12 is connected by a pipe 18 to the pump 19, which supplies liquid from the upper part of the The abdominal cavity is withdrawn and supplied via the pipeline 21 to a regeneration or new formation device 22, which the dialysate is rebuilt, which then mediates the pump 19 is in turn supplied to the abdominal cavity. The liquid passes through the pipeline 25 into the pipeline 11 and through, this into the lower section of the abdominal cavity by means of the pipeline 16. As can thus be seen, it is a closed system in which the dialysate fluid circulates and regenerates will.

The fluid leaking from the abdominal cavity gets there via the line 18 to the liquid pump 19, which consists of a cup-shaped container 26 with a cap 27, which is connected to the container section 26 in some manner such as by means of screws. A piston 28 has two spaced apart openings with one-way valves 31, thus within of the container 26 are located. The piston 28 is urged by two springs 32 in one direction, which on the one hand on the piston 28 and on the other hand on the bottom wall

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of the container 26 ″ and serve to urge the piston in a direction in which liquid is sucked from the abdominal cavity into the chamber 33. The chamber 55 is delimited by the walls of the cup-shaped container 2b and the flexible membrane 54, which is attached to the piston at one end by means of a ring 56 and ^{is clamped at the other end between the cap 2r} / and the side walls of the container 26. Therefore, when the springs 32 urge the piston 28 in one direction, liquid is in the Chamber 33 is sucked in. At the same time, the in the upper chamber 39, which is formed by the other side of the piston, the flexible sealing membrane 54 and a second sealing membrane 4o, is pressed through the pipeline 21 into the regeneration device upper pump wall formed in connection with the flexible sealing membrane 4o, which at one end by means of a ring 41 on the upper wall, and is attached to the piston rod by means of a second ring 42.

The regeneration or formation device can correspond to one of two general versions. In the case of the first type of embodiment shown in FIGS. 1 and 4, the liquid flowing through the pipeline 21 is through a urea separation column 46, an activated carbon column 47, a transparent pipe section 48 which is irradiated from an ultraviolet light source 49, a

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Conventional flow regulators 5o serving for throughput regulation and finally carried out by a filter 51. The amount released by the regeneration device regenerated liquid reaches the inflow line 11 via the pipe 23. The throughput through the gate direction is controlled by means of the flow regulator 5o.

When the piston 28 is at its top dead center position has reached, the chamber 33 is filled with liquid and accordingly the chamber 39 is essentially empty. When the piston is then pushed down, the liquid from the lower chamber 33 passes through the valves 31 in the upper chamber 39. As soon as the piston reaches its lower has reached the plumb point, it is released so that the Springs 32 push the piston upwards again, sucking liquid into the chamber 33 and removing liquid from the Chamber 39 can push out.

Although rolling ¹¹ membranes or membrane seals are in the embodiment shown here, "represented and are preferred because at these minimal leakage flow results, and the piston position and the piston speed can be reliably detected and has the friction very low values, can of course also other seals such as O-ring seals etc. In any case, the pump is completely encapsulated and therefore remains sterile.

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The urea separation column contains a material which absorbs urea or converts it enzymatically to ammonia, such as with enzyme, urease, and then the ammonia is absorbed. Such columns are known per se.

Activated carbonic acid can be used to absorb creatinine, uric acid and other toxic substances will. The ultraviolet sterilizer is used to sterilize the dialysate and to prevent the growth of bacteria. The filter may vary depending on the effectiveness of the ultraviolet sterilizer and the method of sterilization be of such a nature that it allows bacteria to pass through or to hold them back. Of course the filter is designed in such a way that it holds back larger particles so that they cannot get into the abdominal cavity, in which Otherwise they cause tissue irritation ~ or become in could fix this. The filter, the flow regulator, the sterilizer, a transparent window and the regeneration columns form a self-contained unit that can optionally also include the pump and easily can be exchanged. Due to the fact that a very small amount of dialysate is used, which is in the order of magnitude of one liter or less, and because this amount of dialysate is continuously regenerated, is a steady current possible, with a continuous dialysis process can be carried out if necessary. The establishment

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is relatively small due to the small volume of the dialysate used, so that the device can be designed to be portable and can be worn by the patient on the hip. Thus, a patient can who has such a facility with him, will be fully rehabilitated. He is able to do his normal Carry out chores while dialysis is taking place. The procedure is getting very close to that physiological procedures performed by the kidneys.

In a second embodiment of the regeneration or new formation device, which is not shown in the drawing shown, but used in the field of dialysis is, essentially all of the substances removed from the abdominal cavity become nonselective from the dialysate fluid removed. The components removed during dialysis which it is desirable to replace, such as glucose, Sodium, calcium and potassium ions are then released from a source external to the regeneration device introduced into the inflow line. Such a device can be of electronic design, such as, for example by S.B. Tuwiner, "Research, Design and Development of an Improved Water Reclamation System for Manned Space Vehicles "(" Investigations into and development of an improved water recovery system for manned space vehicles "), (April 1% 6), Report No. NASA CR66325 described-

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"is ben, or of the ion exchange type, for example according to R.D. Fall et al., "Feasibility of Microcapsule System for Artifical Kidney Applications "(" Possibility to implement a microcapsule system for artificial Kidney Applications ") Annual Report of the Battelle Memorial Institute (December 1968).

A simplified method of delivering dialysate fluid into the abdominal cavity and removing the fluid this of course renders a regeneration device superfluous. In such a procedure the dialysate fluid together with that used during dialysis removed desirable ingredients from an exterior Freshly supplied source. The fluid drained from the abdominal cavity is in this case a waste container or fed to a cesspool.

In summary, it can therefore be stated that the this compared to known methods is much more advantageous Method enabling features in the use of permanently implanted tubing through which Fluid can be introduced into the abdominal cavity or removed from it, by means of the regeneration device which one and the same fluid after excretion of the degradation substances taken up in the abdominal cavity can be recirculated, the simple sterilization device and the pumping device, through which the liquid passes through the regenerated soldering device

is pumped back into the abdominal cavity.

The use of small, circulated amounts of liquid brings additional benefits. Many of them are called hemodialysis or peritoneal dialysis with large volumes of fluids Any abnormal lifting effects arising are avoided as the liquid with all of those components can be saturated, which when using large amounts of dialysate normally in insufficient amounts in the bloodstream. Because of the low throughput are also effective ultraviolet sterilization and ultrafiltration possible.

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Claims (2)

21 490AQ Claim e (11) and a drain line (12) j4aa · the G o It is used to introduce di al ys at liquid in the abdominal cavity "or to drain the liquid from the abdominal cavity, as well as one to supply the Device (23) serving liquid to the inflow line, one for forming a dialysate liquid flow through, the abdominal cavity serving device (19) and one for removing the dialysate fluid from the drainage line (12) serving device (18) provided s ind. · 2. Device according to claim. 1, characterized, that the device used to form the liquid flow consists of an encapsulated pump (19). 3. Device according to claim 1, characterized in that that the devices used for supplying and removing the liquid comprise a flow regulator (5o). 4. Device according to claim 1, characterized in that that the device serving for supplying the liquid is from a source supplying dialysate liquid, and the device used to drain the liquid consists of a cesspool. 4t changed according to input
Received on . ^ LdiL ^ Lj 2 09815/1128 ^l j. Device according to Claim 1, characterized in that the supply and discharge devices have means (4b-49, b1) which serve to regenerate the dialysate fluid and are connected to the inflow and outflow lines (11, 12) by pipelines (23, 21). b. Device according to claim 3, characterized in that that the regeneration device (22) is one for separation νότα uric acid and creatinine serving column (4Y). ?. Device according to Claim t>, characterized in that a device (49) is provided for irradiating the circulated liquid with ultraviolet radiation. b. Device according to claim 5, characterized in that that the regeneration device has a filter (51), to which the liquid dispensed by the irradiation device can be fed. 9. Device according to claim. 5 _5, characterized in that the ^w device forms a closed system. 2 0 9815/1128 BATH ORIGINAL