EP2203110A1 - Medical system having consumables monitoring - Google Patents
Medical system having consumables monitoringInfo
- Publication number
- EP2203110A1 EP2203110A1 EP08843148A EP08843148A EP2203110A1 EP 2203110 A1 EP2203110 A1 EP 2203110A1 EP 08843148 A EP08843148 A EP 08843148A EP 08843148 A EP08843148 A EP 08843148A EP 2203110 A1 EP2203110 A1 EP 2203110A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- invasive
- information
- unit
- control unit
- central control
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150015—Source of blood
- A61B5/150022—Source of blood for capillary blood or interstitial fluid
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- A—HUMAN NECESSITIES
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150206—Construction or design features not otherwise provided for; manufacturing or production; packages; sterilisation of piercing element, piercing device or sampling device
- A61B5/150305—Packages specially adapted for piercing devices or blood sampling devices
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150358—Strips for collecting blood, e.g. absorbent
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150381—Design of piercing elements
- A61B5/150412—Pointed piercing elements, e.g. needles, lancets for piercing the skin
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- A—HUMAN NECESSITIES
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150381—Design of piercing elements
- A61B5/150503—Single-ended needles
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150763—Details with identification means
- A61B5/150786—Optical identification systems, e.g. bar codes, colour codes
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- A—HUMAN NECESSITIES
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- A61B5/150763—Details with identification means
- A61B5/150793—Electrical or magnetic identification means
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- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150847—Communication to or from blood sampling device
- A61B5/15087—Communication to or from blood sampling device short range, e.g. between console and disposable
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- A—HUMAN NECESSITIES
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/151—Devices specially adapted for taking samples of capillary blood, e.g. by lancets, needles or blades
- A61B5/15101—Details
- A61B5/15103—Piercing procedure
- A61B5/15107—Piercing being assisted by a triggering mechanism
- A61B5/15113—Manually triggered, i.e. the triggering requires a deliberate action by the user such as pressing a drive button
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- A61B5/15—Devices for taking samples of blood
- A61B5/151—Devices specially adapted for taking samples of capillary blood, e.g. by lancets, needles or blades
- A61B5/15101—Details
- A61B5/15115—Driving means for propelling the piercing element to pierce the skin, e.g. comprising mechanisms based on shape memory alloys, magnetism, solenoids, piezoelectric effect, biased elements, resilient elements, vacuum or compressed fluids
- A61B5/15117—Driving means for propelling the piercing element to pierce the skin, e.g. comprising mechanisms based on shape memory alloys, magnetism, solenoids, piezoelectric effect, biased elements, resilient elements, vacuum or compressed fluids comprising biased elements, resilient elements or a spring, e.g. a helical spring, leaf spring, or elastic strap
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- A61B5/15—Devices for taking samples of blood
- A61B5/151—Devices specially adapted for taking samples of capillary blood, e.g. by lancets, needles or blades
- A61B5/15146—Devices loaded with multiple lancets simultaneously, e.g. for serial firing without reloading, for example by use of stocking means.
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- A61B5/15—Devices for taking samples of blood
- A61B5/151—Devices specially adapted for taking samples of capillary blood, e.g. by lancets, needles or blades
- A61B5/15146—Devices loaded with multiple lancets simultaneously, e.g. for serial firing without reloading, for example by use of stocking means.
- A61B5/15148—Constructional features of stocking means, e.g. strip, roll, disc, cartridge, belt or tube
- A61B5/15149—Arrangement of piercing elements relative to each other
- A61B5/15151—Each piercing element being stocked in a separate isolated compartment
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- A—HUMAN NECESSITIES
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/151—Devices specially adapted for taking samples of capillary blood, e.g. by lancets, needles or blades
- A61B5/15146—Devices loaded with multiple lancets simultaneously, e.g. for serial firing without reloading, for example by use of stocking means.
- A61B5/15148—Constructional features of stocking means, e.g. strip, roll, disc, cartridge, belt or tube
- A61B5/15157—Geometry of stocking means or arrangement of piercing elements therein
- A61B5/15159—Piercing elements stocked in or on a disc
- A61B5/15163—Characterized by propelling the piercing element in an axial direction relative to the disc
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/157—Devices characterised by integrated means for measuring characteristics of blood
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/94—Identification means for patients or instruments, e.g. tags coded with symbols, e.g. text
- A61B90/96—Identification means for patients or instruments, e.g. tags coded with symbols, e.g. text using barcodes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
- A61B2017/00482—Coupling with a code
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/08—Sensors provided with means for identification, e.g. barcodes or memory chips
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150175—Adjustment of penetration depth
Definitions
- the invention relates to a medical system comprising a central control unit and an invasive unit with at least one invasive consumable. Furthermore, the invention relates to a method for monitoring a medical system. Such medical systems and methods for monitoring the medical systems are used in particular in the field of medical diagnostics and medical therapy, for example as part of a homecare program for diabetic patients or in the context of hospital diagnostics or therapeutics in hospitals and nursing homes. Other applications are possible.
- the concentrations of different analytes in the patient's body fluids must be monitored regularly. For example, monitoring blood glucose levels for diabetics is an essential part of the daily routine. As a rule, the blood glucose concentration must be determined quickly and reliably several times a day in order to be able to take appropriate medical measures if necessary.
- a corresponding medication In addition to diagnostics, a corresponding medication also plays a decisive role. For example, in order to compensate for fluctuations in the blood glucose concentration, a diabetic must make an insulin medication adapted to the measured blood glucose concentrations. In order to limit the daily routine of the patients, especially the diabetics, no more than necessary, are used for both the diagnosis and for the medication often appropriate mobile devices that should be easy to transport and handle, so that the measurement or the medication For example, at work, on the road or in the leisure can be done.
- lancing devices can also be reversibly mechanically connected to a measuring device used for determining the analyte concentration, as described, for example, in EP 1 032 307 B1. Despite this mechanical coupling, the lancing device and the measuring device are, however, still independently functioning units and together form a medical system.
- the lancets are usually disposable products, which include, for example, a sharply ground metal pin and a molded plastic holder, which connect to the lancing device.
- lancets are possible, for example, lancets in the form of sharp edges or mandrels, which are moved accordingly by the lancing device.
- lancets can easily be counterfeited or imitated.
- counterfeit lancets or other consumables can create significant health hazards and injuries when used. This applies in particular to invasive consumables, ie consumables which are set up to intervene (such as lancets) in a body tissue of a patient.
- Another disadvantage of such counterfeit consumables is that due to inadequate fits, some of the peripherals used devices can be damaged.
- counterfeit consumables and counterfeiting cause the affected companies considerable economic damage and, in case of malfunctions, reputational damage.
- the lancets or other types of consumables may be arranged in a magazine so that the user does not have to change the lancet before each use of a lancing device, but only exchanges the magazine at longer intervals when all the lancets contained therein have been used up.
- a lancing device with a lancet magazine is the lancing device "Accu-Chek Multiclix" from Roche Diagnostics GmbH.
- Lancets, lancet magazines and lancing devices are generally purely mechanical parts without electrical or analytical functions.
- consumables may also be affected which have an analytical function (for example test elements or subcutaneous sensors), consumables for the medication (for example cannulas, catheters or the like) or other types of consumables.
- consumables in general are often referred to as "disposables" in diagnostics.
- RFID labels high-frequency labels
- the RFID technology as an example of electronic identifiers includes the contactless identification by means of radio waves.
- the information of such an RFID tag which is also referred to as an RFID label and which contains an electronic chip, are usually transmitted wirelessly via radio with different frequencies to a reader, which can then display and / or store the information.
- RFID tags that can store electronically readable information are generally available in numerous designs.
- RFIDs are also known, which are based on organic electronics (for example, semiconducting or conductive polymers).
- inexpensive, printed designs of electronic identifiers are known.
- the information is encrypted, for example, in an electrically conductive barcode and can be read without contact via numerous antennas in a reader.
- An example of such a design is disclosed in WO 2004/088037 Al.
- a medical system generally consists of a plurality of individual components, which, even if these components can be partially integrated into a common housing or mechanically connected to one another, usually perform their functions independently of one another.
- An example is the aforementioned lancing aids, which almost always have purely mechanical functionality and which are functionally not interacting with a measuring device, which in turn is used for measuring an analyte concentration in a blood sample generated by the lancing device.
- a user would thus, in order to detect counterfeit consumables, also have to carry with him a separate reading device in the above-mentioned methods for identifying these consumables, which can read out the identifiers.
- this is hardly possible in many cases for reasons of space and also represents an increased cost.
- peripheral devices such as purely mechanical lancing devices
- purely mechanically operating peripheral devices generally have no display capability for displaying the information of the identifiers of the consumables.
- the Users are not provided with information about these consumables, such as lancets.
- a peripheral device such as a lancing device
- both devices are typically functional decoupled from each other, so that the user still has no way, as usual, lack of clear identification of consumables counterfeits reliably detect.
- EP 1 043 037 A2 describes an injection device with a pen containing a syringe to be pressed out.
- the dosage when squeezing the syringe is adjusted with a Dosiermengen- setting.
- an external display device is provided, which can be attached to the pen. Via contacts and mating contacts, information about the dosing quantity is transmitted to the display unit and displayed on a large-format display.
- the pen is also proposed to use the pen with a coding recognizable by the display device in the form of elevations or depressions. so that the display device always knows which Pen or Pentyp it works with.
- EP 1 043 037 A2 is very specifically tailored to a specific unit and thus inflexible with respect to changing combinations of the individual components.
- a direct mechanical coupling must be made, and when using a pen not recognizable by the display device, the system is not functional.
- EP 1 352 611 describes a measuring unit with a container for test elements, which can be provided with an information chip in order to transmit to a measuring device of the unit information about the number and calibration data of test strips.
- necessary information is passed on to the measuring device via the RFID tag, which would otherwise have to be transferred to the measuring device, for example via a so-called ROM key or other information sources, or manually in order to enable an evaluation of the test strips.
- the RFID tag in the dispenser as described in US 2006/0182656 and EP 1 352 611, is merely a variant of known methods and apparatus for providing the meter with information needed for measurement without the need for meaningful measurement or evaluation of the measurement would be difficult or impossible.
- RFID technology is used to transfer information between parts of a measurement unit.
- US 2004/0138688 describes the identification of a lancet in which the identification is in the form of a barcode.
- this barcode has no electronic information and can not be identified by a device that does not make direct visual contact with the consumable.
- US 2007/0232879 A1 describes devices and methods for determining an analyte concentration.
- a mounting unit which serves to attach a transdermal sensor.
- this mounting unit comprises an electronic unit which, inter alia, comprises an RFID identifier for identifying the sensor. Signals from this RFID identifier can be picked up by a receiver unit.
- US 2002/0004403 A1 describes a unit comprising a biological head (BIH) with sensors for monitoring physiological parameters and a control module (Communication and Control Module, CCM), which activates and reads the measuring head.
- BIH biological head
- CCM Communication and Control Module
- several sensors can be provided.
- BIH and CCM can be wireless data transmission.
- an identification management is proposed in which, for example, the exchange of information about the sensor type plays a role.
- WO 2006/065754 A2 describes a sensor dispenser which is set up to determine an analyte concentration in a body fluid.
- a cartridge with test strips is accommodated in a cap of the instrument, whereby calibration information can be transferred from the cartridge to the instrument.
- the instrument comprises a lancet device.
- the object of the present invention is therefore to provide a medical system and a method for monitoring a medical system, which avoid the disadvantages of known medical systems and methods for monitoring such systems.
- the medical system and method should enable a user to independently, easily, reliably and quickly identify counterfeit consumables.
- One idea of the present invention is to combine components which hitherto functioned largely independently of one another to form a medical system in which a central control unit is provided which can centrally assume the abovementioned tasks of identifying consumables.
- a central control unit already present in the overall system measuring device, which has its own “intelligence" (for example in the context of a microcontroller) and which is thus suitable to monitor independently acting peripheral devices such as lancing devices .
- a medical system which comprises a central control unit and at least one invasive unit.
- the medical system can be set up, for example, to take on one or more therapeutic tasks and / or diagnostic tasks and / or tasks of sample collection.
- the medical system can be a medical system which can be used for monitoring and treating diabetic patients, in particular in the so-called home care sector.
- the medical system is thus composed of several components which comprise at least the central control unit and at least one invasive unit. These components can be functionally independent of each other, can be handled decentralized independently of each other, but can also be completely or partially mechanically combined, for example via a common housing, via connecting elements or the like.
- the central control unit is set up to display at least one diagnostic measured value by means of a display element.
- This diagnostic measured value can be determined, for example, by the central control unit itself, but can also be input externally into the central control unit.
- the central control unit thus serves as an interface between a patient and the medical system. It is particularly preferred if a measuring device is used as the central control unit, which is already present in a medical system (for example, a medical system for diagnosing and / or treating a diabetic patient).
- the central control unit may have at least one measuring function for determining a diagnostic measured value, for example an optical and / or electrochemical measuring function for determining a blood glucose value, a lactate value, a cholesterol value or another analyte concentration in a sample of a body fluid.
- the central control unit may have, for example, one or more test elements, for example test strips.
- this central control unit comprises a data processing electronics, such as one or more micro-controllers, by means of which the display of the diagnostic measurement value is supported and by means of which data processing functions can also be exercised.
- the central measuring unit has at least one optical and / or electrochemical measuring unit which is set up to determine a concentration of an analyte, in particular a metabolite, in a body fluid by means of at least one test element. Furthermore, without restricting the conversion According to the invention, it is assumed that the central control unit comprises a blood glucose meter which can determine a blood glucose concentration by means of a test strip or test strip with a corresponding test element and an optical and / or electrochemical measuring unit and this blood glucose concentration by means of, for example designed as a display, display element can transmit to a patient.
- a defined central control unit for which, as described above, preferably an existing anyway in a medical system unit with its own “intelligence", ie, for example, with at least one microcontroller or other unit with options for performing arithmetic operations, is used, which includes medical system continues to have at least one invasive unit .
- This at least one invasive unit is functionally independent of the central control unit.Functionally independent means that the respective function of control unit and invasive unit can be exercised independently of the presence of the other unit In other words, the central control unit and the invasive unit should be autonomous, that is, functionally independent of one another.For the definition of the system concept, reference may also be made to the description of FIG n.
- the invasive unit comprises at least one invasive consumable.
- the invasive entity as a whole and / or the invasive consumable are designed to invasively engage a patient's tissue.
- intervention may mean a perforation of the tissue, for example a perforation of a skin area to obtain a sample of a body fluid, and / or a temporary or permanent implantation of the invasive consumable means, such as the introduction of a cannula or a subcutaneous sensor in a body tissue.
- the invasive unit may generally include a peripheral device that interacts with the invasive consumable.
- the peripheral device and the invasive consumable may then together form the invasive unit.
- Under a peripheral device is generally understood to mean a device which is functionally independent of the central control unit and which is arranged to (for example, autonomously) to ensure the function of the invasive unit.
- a peripheral device is generally understood to mean a device which is functionally independent of the central control unit and which is arranged to (for example, autonomously) to ensure the function of the invasive unit.
- the invasive unit may preferably have a sample collection function, which can be realized, for example, by a lancet.
- the invasive unit may have, for example, a peripheral device configured as a lancing device, wherein the lancing device is configured to perforate a skin area of a patient by means of a consumable designed as a lancet.
- the invasive unit may further comprise, for example, a medication function, in particular a dosing function.
- This medication function can be realized in various ways.
- the invasive unit may have a peripheral device in the form of a medication pen.
- Most common embodiments of such medication sticks are insulin pens.
- such medication sticks are configured to inject a patient with a dose of a medicament by means of a disposable dispenser configured as a cannula.
- this dose may be preset and administration of the dose may be by manual actuation of the medication pen, such as depressing a punch.
- the medication function can also be designed automated, for example by means of a peripheral device designed as a medication pump.
- a peripheral device designed as a medication pump.
- Most common embodiments of such medication pumps are insulin pumps that automatically automate a patient, for example, over a predefined period of time, delivering a set dose of insulin.
- the medication pump is designed to inject a dose of a medicament by means of a consumable designed as a catheter.
- the invasive consumable in this case usually includes a tube and a cannula, which can be exchanged and disposed of as a unit or separately.
- the invasive unit may further comprise an analytical and / or diagnostic function.
- the invasive unit may comprise a peripheral device configured as a measuring unit, wherein the measuring unit is configured to deliver a concentration of an analyte, in particular a metabolite, in a body fluid by means of a consumable comprising a subcutaneous sensor inserted in a body tissue of a patient determine.
- the consumable may include, for example, in addition to a replaceable subcutaneous sensor leads, implantation aids or the like. It should be noted that the measured value supplied by this measuring unit is preferably independent of the one described above Measurement function of the central control unit.
- the measurement unit may be configured to continuously measure over one or more days in the body tissue of the patient, whereas the central control unit is arranged for point measurements.
- the central control unit with its measuring function can be used to carry out a calibration measurement of the measured values supplied by a subcutaneous sensor.
- the central control unit and the invasive unit are preferably designed to be completely functionally independent, i. independently of each other perform their respective functions, even if these units may be mechanically interconnected, for example. It is particularly preferred if the invasive unit is as simple as possible, i. For example, it does not have its own intelligence or electronics.
- the invasive unit can comprise purely mechanical functions (such as, for example, a purely mechanically functioning piercing aid), which, however, can also be designed, for example, as electromechanical functions.
- the lancing device can also be electrically driven, and / or the medication function can be configured by a pump or a differently designed actuator.
- this invasive consumable is a particularly critical point of the medical system because, due to the invasive properties of the consumable, it comes into direct contact with open body tissue of a patient.
- sterilization problems are particularly critical for this consumable, which can occur, for example, when such consumables are used inadmissible often.
- Another problem is the already mentioned counterfeiting problem, since, for example, improperly packaged, improperly stored or improperly manufactured consumables can also lead to damage to the patient, with sometimes serious consequences for the health of the patient.
- a third problem is the interaction between the invasive consumable and the rest of the invasive device, such as the peripheral device.
- counterfeiting or improper manufacture of the consumable may, as described above, result in damage to the invasive unit or other types of malfunction.
- the invasive unit with at least one non-contact readable electronic identifier.
- the central control unit can be designed with a corresponding interface for reading out the electronic identifier, for example an interface which is set up for transmitting and / or receiving electromagnetic waves, preferably in the high-frequency range.
- the medical system according to the present invention differs fundamentally from systems in which electronic identifiers are used to establish the operational readiness of the system.
- US 2006/0182656 A1 in which, when inserting a test strip from a test strip dispenser, batch information of the test strip is transmitted to a measuring device, without which the measuring device could not perform its function, in the present case the invasive unit and the central one work Control unit independently.
- the central control unit merely assumes the additional task of reading out the at least one piece of information and, as explained in more detail below, making it available for further uses.
- the idea of the present invention also differs, for example, from EP 1 352 611 A1.
- the advantage of the embodiment of the medical system according to the invention is that now information about the at least one inserted invasive unit is centrally available in an independent control unit.
- the transmission of this at least one information takes place without requiring contact between the central control unit and the invasive unit.
- the consumables are thus provided for devices which are independently operable by the central control unit and which, for example, no own electronic AusleseAL for contain electronic information of the identifiers.
- the central control unit which, for example, no own electronic Ausleseloid for contain electronic information of the identifiers.
- the invasive units themselves, or the peripheral devices can be kept technically simple and preferably without own electronics or microcontroller for calculation.
- information about the invasive units or the invasive consumables are still centrally available in the central control unit.
- the central control unit can be set up to transmit an acoustic indication and / or an optical indication and / or a haptic indication, in particular a vibration, to the user in accordance with the information read.
- the user may be provided with information about whether a consumable is inserted in the invasive unit, whether it is correctly positioned and / or oriented, and even a positioning aid can be provided. This is of great advantage, for example, in patients with visual impairments, which is common in diabetic patients.
- the information which can be read electronically without contact, may include, for example, at least one of the following information:
- the invasive unit can additionally have at least one peripheral device which cooperates with the invasive consumable.
- invasive consumables can also be combined in the invasive unit, for example in a consumables magazine.
- a "consumable magazine” is to be understood as meaning all common types of containers which comprise more than one invasive consumable.
- drum magazines, bar magazines, series magazines, zigzag magazines, tape cassettes or the like can be mentioned here.
- An invasive unit may also include various types of invasive consumables, for example, various types of lancets, or may include invasive and non-invasive consumables, such as lancets and simple test elements.
- the at least one electronic identifier can, for example, be connected to the at least one invasive consumable, or, alternatively or additionally, can also be connected to the peripheral device.
- the invasive consumable may comprise, for example, at least one first non-contact readable electronic identifier for storing at least one first information
- the peripheral device may comprise at least one second non-contact readable electronic identifier for storing at least one second information.
- the reliability can be increased by the fact that the first information and the second information are read out at the same time or with a time delay from the central control unit.
- the central control unit can accordingly be set up to read out the at least one first information and the at least one second information. For example, both information can be compared with desired information (for example, a first desired information and a second desired information).
- the information can be stored for later evaluation, for which purpose the central control unit can provide a volatile and / or non-volatile data memory and / or a database.
- the at least one piece of information can continue to be evaluated in a fault diagnosis, for example in the context of a customer complaint.
- WEI terhin the at least one information can be provided to a user, for example via the display element described above.
- This at least one display element may comprise, for example, one or more displays, for example matrix displays, or segmented displays and / or also simpler display elements. For example, simple symbols or luminous fields or luminous points can be included.
- a warning can be output to a user and / or warning information can be stored in a data memory.
- a "flag" can be set if an unsuitable, ie, for example, unauthorized, faulty or counterfeit consumable is used. This flag can be read out accordingly later.
- at least one device function of the central control unit can also be actively blocked so that, for example, a faulty function of the entire medical system is prevented.
- the invasive consumable of the invasive unit can also be determined when the invasive consumable of the invasive unit was last changed. Accordingly, for example, warnings may be issued when the last change is more than a predetermined period of time, and / or changes in the consumable may be initiated in some other way, and / or in turn active system functions may be disabled. Furthermore, based on the at least one information, for example, a manufacturer of the invasive unit and / or the invasive consumable can be determined. This manufacturer information can, for example, be output again or can be stored in turn for later evaluation.
- this information can also be used, for example, for an anti-counterfeiting device, in particular for the protection against the use of counterfeit invasive consumables, such as, for example, lancets, test strips or the like.
- counterfeiting can not only cause economic damage, but can also affect the functionality of the entire medical system, which can have fatal consequences for a user and patient.
- counterfeiting can not only cause economic damage, but can also affect the functionality of the entire medical system, which can have fatal consequences for a user and patient.
- the central control unit preferably includes an interface for exchanging the information with the identifier. In general, however, several such interfaces are required, since not only with the at least one Identif ⁇ kator is communicated, but for example, with external data processing equipment.
- the central control unit preferably comprises at least one first interface for exchanging data with an external data processing device, and furthermore at least one second interface for exchanging the one information described above with the at least one identifier.
- the central control unit accordingly preferably additionally comprises the at least one second interface, which is an interface for contactless electronic data exchange with the at least one identifier, which is naturally adapted to the design of the at least one identifier.
- this identifier is a purely passive identifier, which does not include its own power supply.
- This can be realized, for example, by using an electronic bar code, as described, for example, in WO 2004/088037 A1.
- electronic barcode barcode strips are applied as electrically conductive strips and can be read without contact via antennas in a reader.
- RFID chips usually have no own power supply and draw their energy from the received electromagnetic radiation.
- variable identifier can also be used, that is to say an identifier in which the written information can be changed from the outside. This can be done, for example, with an electronic barcode by acting on the barcode itself, for example by destroying individual strips of the barcode.
- RFID chips radio frequency identifiers
- RFID chips radio frequency identifiers
- high-frequency identif ⁇ katoren which may be configured, for example, with a silicon chip and an antenna and / or an organic electronic circuit, for example, by a corresponding write operation by irradiation of an electromagnetic field information can be selectively written.
- the radiated from outside energy is used to turn the ange- demanded to broadcast information via one or more antennas.
- Such high-frequency chips are known from various fields of technology.
- the at least one identifier can be designed such that it also includes information about a position and / or orientation of the invasive consumable within the invasive unit, for example within the peripheral device.
- the medical system should again be a medical system, which is preferably self-contained in that it serves to monitor and / or diagnose and / or treat one or more closed clinical pictures, such as, for example, the care of diabetes. patients.
- this medical system can be a medical system according to one of the above-described embodiments, so that with regard to preferred exemplary embodiments and definitions of system components, reference may be made, for example, to the above description.
- the medical system comprises a central control unit, which is set up to display at least one diagnostic measured value by means of at least one display element, and at least one invasive unit with at least one invasive consumable, which can intervene invasively in a tissue of a patient.
- the invasive unit in turn comprises at least one non-contact readable electronic identifier for storing at least one piece of information.
- the method is set up such that the central control unit reads out the at least one piece of information of the electronic identifier.
- the method in its preferred embodiment relates in particular to how the at least one piece of information of the at least one identifier is evaluated.
- the various options that can also be used in combination are described, with the emphasis on the evaluation in each case.
- the evaluated information can also be stored in one or more data stores and / or databases are stored.
- these can be transmitted to a user, for example optically and / or acoustically and / or haptically, and / or can be transmitted to an external computer (for example a doctor computer or a company computer of the manufacturer in case of a defect diagnosis or misdiagnosis) or can be transferred to others Be further utilized.
- the central control unit can be determined by the central control unit on the basis of the information as to whether the invasive consumable has previously been used in the medical system, for example in combination with a measuring device.
- This information may be used multiple times, for example, to provide product information or usage information to a patient upon first use. Alternatively or additionally, for example, a multiple use can be avoided to avoid sterility problems.
- the central control unit determines whether a expiration date of the invasive unit and / or of the invasive consumable has expired. In response to this determination, for example, a warning can again be output to a user, or an action can be triggered in this case as well as in other cases, such as, for example, the blocking of a system function of the medical system.
- the information may also be stored in one or more data memories, for example volatile or non-volatile data memories, of the central control unit for later evaluation. This information is later available, for example, for further evaluation, presentation, error diagnosis or as additional information for a medical diagnosis. The information can be evaluated in particular in the context of a fault diagnosis and / or a processing of a complaint.
- the method can furthermore be designed such that the central control unit uses the information to determine whether the invasive unit and / or the invasive consumable are suitable for use in the medical system. In this way, it can be detected, for example, whether it is an authorized by the manufacturer of the system or individual system components (such as peripherals) consumables or counterfeiting or counterfeiting.
- This functionality option as described above, not only has significant economic importance for the system manufacturers, but can also significantly add to it to prevent malfunction or damage to the medical device, to prevent false diagnostic results or even to prevent infections or injuries caused by improperly manufactured and / or stored consumables.
- this information can be stored purely passive in the central control unit and / or can be displayed for a patient or a physician and / or can be kept ready for later evaluation, and / or system functions can also be actively blocked, for example. to prevent malfunctions from the outset.
- the method can also be configured in such a way that the central control unit uses the information to determine how many invasive consumables the invasive unit comprises. For example, in this way a total number of lancets in a magazine of the invasive unit can be determined. This can be displayed to a user, for example.
- the number of unused invasive consumables such as the number of unused lancets, can also be determined. This can be done, for example, as described above, by using a variable identifier, wherein, for example, each time an invasive consumable is used, the identifier is changed by the central control unit and / or by the invasive unit itself, for example by a peripheral device.
- a stored in a high-frequency chip information can be changed
- an electronic barcode can be changed mechanically, for example by removing or adding individual bars or differently shaped segments of this barcode.
- the central control unit determines whether the invasive consumable has already been used. If so, a user may be prompted to use a new invasive consumable and / or the invasive unit may be caused to use a new invasive consumable.
- the evaluated information can thus be used purely passively, that is, for example, stored, can be transmitted to a user by means of a corresponding display, or an active system function can be triggered or blocked.
- the identifier is designed such that the information stored in this identifier can be changed, for example by the central control unit and / or a
- Peripheral device information about the identity of the central tax be stored in the Identif ⁇ kator.
- the central control unit for example a measuring device
- a serial number of the central control unit or of the measuring device can be stored in this identifier. If this serial number or otherwise designed information about the identity of the central control unit is then read in by the same central control unit or another central control unit used later on, each of the measuring devices can recognize that this is a used invasive unit or a used one invasive consumable.
- This additional information may for example be stored and / or displayed again and / or certain actions may be triggered, such as a blockage of system functions, unless an authorized by the manufacturer of the medical system consumables was inserted, or the inasive unit previously with another central unit was used.
- a position-sensitive identifier it can also be detected whether the invasive consumable is correctly positioned in the invasive unit.
- a user guidance can take place in that signal tones and / or vibrations of the central control unit are output while the consumable is inserted into a peripheral device.
- These beeps or vibrations may change in volume or frequency, for example, when a visually impaired user inserts the consumable into the peripheral device, so that this process may be assisted in the manner of a tone bearing.
- a confirmation may be displayed that the consumable has been inserted correctly.
- the central control unit determines whether the last change of the invasive consumable took place.
- the date of the last change can for example be stored again for later evaluation and / or can be output to a user.
- the number of uses of the consumables used would also be storable.
- the plunger depth can also be determined by the central control unit on the basis of the information the lancing device is set.
- the identifier is in turn designed as a variable identifier, wherein a change in the puncturing depth comprises a change in the readable information stored in the identifier.
- the puncture depth can for example be displayed, stored or otherwise used.
- the central control unit can be set up to carry out the method in one or more of the illustrated variants.
- the central control unit may comprise one or more microcomputers which support and / or set up, for example, by means of appropriate program-technical devices and / or software, the determination and / or storage and / or evaluation of one of the aforementioned additional information are to perform according to this additional information further actions, such as the above-described blocking of one or more system functions of the medical system.
- the above-described method and the medical system in one of the described embodiments result in particular in the advantages that the patients can exchange the consumables in good time, since they are provided, for example, by the central control unit be reminded of the date of the last change.
- This can be of economic importance, since peripherals and gauges are usually system components that are not sold cost-effectively, whereas the consumables represent the actually economically interesting components.
- the method and the proposed system provide unique selling points against potential competitors.
- the imitation of consumables, especially lancets made much more difficult, since customers can now be able to detect unauthorized consumables independently. As a result, damage to the image, which can occur due to counterfeiting, can be avoided or reduced.
- Consumption change can be remembered. This increases the user-friendliness of the medical system. Furthermore, he can see at a glance, for example in a blood glucose measurement, how many consumables, such as lancets, are still available to him for further measurements. Detecting that authorized or unauthorized consumables are used also provides security for the patient. In addition, the ability to detect whether consumables have been properly inserted into peripherals provides additional operational security. To protect the patient can also be ensured if necessary, for example in a clinic mode, that a consumable - for example, a lancet - can only be used once.
- Figure 1 shows a preferred embodiment of a simple medical system for diabetes control
- Figure 2 is a schematic diagram of an extended medical system with a plurality of invasive units
- Figure 3 shows a possible embodiment of the attachment of an identifier to a consumable
- Figure 4 is an alternative to Figure 3 embodiment of the attachment of an identifier to a consumable
- characters 5A and 5B show a first embodiment of a realization of a position-sensitive identifier
- Figure 6 shows a second embodiment of the realization of a position sensitive Identif ⁇ kators.
- a medical system 110 designates a central control unit 114 and an invasive unit 120, which are preferably functionally independent of each other such that the respective functions of the central control unit 114 and the invasive unit 120 are independent of the presence of the respective other unit 114, 120 is exercisable. That is, both the central control unit 114 has one or more functions that are usable by the user without the presence of the invasive unit 120, and conversely, the function of the invasive unit 120 can be utilized by the user without the central control unit 114 must be present.
- FIG. 1 shows a first, simple exemplary embodiment of a medical system 110. It is a medical system 110 which can be used for diabetes control and which in this embodiment comprises two individual components which can be used in principle independently of one another.
- the medical system 110 first comprises a measuring device 112, which functions as a central control unit 114 in the medical system 110.
- the measuring device 112 is, for example, a blood glucose measuring device which can determine a blood glucose concentration in a blood drop by means of a test element (not shown in FIG. 1) and, for example, an optical and / or electrochemical measuring method.
- the measuring device 112 has operating elements 116 for operating the system functions, via a (not visible in Figure 1) control and evaluation for evaluation of the test strip measurement and a display element 118, which for clarity in Figure 1 to the right of the meter 112 again shown in an enlarged view.
- the meter 112 may include additional components, such as one or more interfaces, a magazine for holding test elements, or the like.
- the medical system 110 comprises an invasive unit 120, which in this exemplary embodiment is designed to perform a sample extraction function for obtaining a liquid sample, in particular a blood drop.
- the function of the invasive unit 120 is independent of the radio of the meter 112, even though these altogether constitute the diabetes control medical system 110.
- the invasive unit 120 comprises a peripheral device 122 in the form of a lancing device 124.
- the lancing device 124 has a spring mechanism arranged in the interior of a housing 126, which can be tensioned via a tensioning button 128 and triggered via a release button 130.
- the invasive unit 120 in this embodiment comprises a plurality of invasive consumables 132, which in this embodiment are configured in the form of lancets 134.
- the lancets 134 are combined in a drum-shaped magazine 136, wherein each of the lancets 134 is arranged in a separate lancet chamber.
- the magazine 136 is inserted into the housing 126 of the lancing device 124, so that a lancet 134 can be used for each lancing operation.
- the illustrated magazine 136 may be a commercially available type Accu-Chek Multicix Safety Drum.
- the magazine 136 is shown once in the non-installed state and once in the state inserted into the lancing aid 124, wherein the process of insertion in FIG. 1 is indicated symbolically by the arrow 138.
- the invasive consumables 132 in the exemplary embodiment illustrated in FIG. 1 are equipped with an identifier 140.
- This Identif ⁇ kator 140 is shown only symbolically in Figure 1 and is symbolized here as an RFID chip.
- This identifier 140 can thus be read out electronically and is able to store at least one piece of information.
- This information can be interrogated or read out electronically by the measuring device 112, which is indicated symbolically in FIG. 1 by the reference numeral 142.
- this electronic information transmission can take place via radio waves, for example radio waves in the megahertz or gigahertz range, as is customary for such identifiers 140.
- a single identifier 140 is attached to the magazine 136.
- the individual lancets 134 and invasive Consumables 132 may each be identified, for example, similar to the lancet marking, which is shown in US 2004/0138688 Al, but with electronically readable Identif ⁇ katoren. Combinations of these embodiments are also conceivable, ie an embodiment in which all invasive consumables 132 are configured with identifiers and in which additionally the magazine 136 has such an identifier 140.
- the lancing device 124 may itself have an identifier 140.
- FIG. 2 symbolically shows an extension of the above-described medical system 110.
- the medical system in turn comprises a central control unit 114 in the form of a measuring device 112.
- the measuring device 112 can be designed, for example, analogously to the description according to FIG. 1, can have a display element 118 and operating element 116 and can be designed, for example, to to determine an analyte concentration, for example a blood glucose concentration, by means of a test strip 144 or by means of a test element (for example a test strip) designed in another way and to display this as a diagnostic measured value on the display element 118.
- FIG. 2 symbolically shows a data processing device 146 which can be used, for example, for the electronic processing of diagnostic measured values and / or for exercising other system functions (such as, for example, the evaluation of the information transmitted by the identifier 140).
- the measuring device 112 has two cutting edges. represent, which are shown only symbolically.
- a first interface 148 is for data exchange with external devices, such as external computers.
- This first interface 148 which may be configured, for example, as an infrared interface, can thus be used, for example, to perform software updates on the measuring device 112 and / or to transfer medical measured data to an external computer (for example a doctor's computer and / or a computer) Patient computer).
- the measuring device 112 has a second interface 150, by means of which information can be requested without contact and electronically, which information is stored in identifiers 140 of the invasive units 120.
- This second interface 150 is preferably a radio interface.
- both interfaces 148, 150 may also be combined into a single interface.
- the central control unit 114 is symbolically represented by the dashed line as a closed unit. This is intended to symbolize that this closed unit can function functionally independently, although this functional unit 114 can also be associated with other components, such as a dispenser box for providing test strips 144 or similar components.
- the medical system 110 comprises four invasive units 120.
- These invasive units 120 are functionally preferably independent of the central control unit 114 and are preferably independent of one another. However, this functional independence, represented by the dashed line 114, does not mean that these components can not be placed in close proximity to the central control unit 114.
- FIG. 1 in which a coupling point 152 can be seen on the measuring device 112, via which the lancing aid 124 can be coupled to a housing 154.
- the central control unit 114 and the invasive unit 120 in the form of lancing device 124 form a mechanically combined system.
- the system functions of the central control unit 114 (measurement and display) and the invasive unit 120 (sample collection) are still clearly separated.
- the invasive units 120 in turn comprise a lancing device 124 as a peripheral device 122, which interacts with invasive consumables 132 in the form of lancets 134.
- the lancing device 124 can be made to a large extent to the figure 1.
- the medical system 110 comprises an invasive unit 120 in the form of a peripheral device 122 designed as an insulin pen 156.
- This insulin pen 156 is shown only symbolically in FIG. 2 and interacts with an invasive consumable 132 in the form of a cannula 158.
- the insulin pen 156 is configured to allow a patient to inject a preset amount of medication for insulin.
- the medical system 110 comprises a peripheral device 122 designed as an insulin pump 160, which cooperates with a consumable 132 in the form of a tube 162 and a cannula 164.
- Tube 162 and cannula 164 are usually designed as a common, disposable unit, which is designated as catheter 165 in FIG.
- the insulin pump 160 thus enables a patient to deliver to a patient via a pump (not shown in FIG. 2) a preselected amount of insulin from a storage vessel by means of operating elements 166 and shown on a display element 168.
- the medical system 110 comprises a peripheral device 122 in the form of a measuring unit 170, which cooperates with a consumable 132 in the form of a hypodermic sensor 172 to ensure continuous monitoring, for example, of a blood glucose value in tissue layers of a patient.
- the invasive units 120 shown in FIG. 2 are merely selected by way of example in accordance with customary components used in diabetes monitoring.
- the medical system 110 may also include other or different types of components.
- both the invasive consumables 132 and the peripheral devices 122 are each configured with electronic identifiers 140.
- the central control unit 114 can thus query information of these electronic identifiers 140.
- Identif ⁇ katoren 140 are mainly very inexpensive and small variants of electronically readable Identif ⁇ katoren into consideration.
- the information of the identifiers 140 should be readable when the invasive units 120 are near the meter 112, for example when the lancing device 124 is coupled to the meter 112.
- An arrangement in spatial proximity for example, at a distance below 50 cm, but is conceivable.
- RFID chips from. Hitachi in Japan into consideration, which silicon chips have dimensions below 0.4 mm edge length including antenna. Typical operating frequencies are 2.45 GHz, memory capacities are 128 bits. Such RFID chips are potentially extremely inexpensive, since they were originally developed for use in banknotes. Furthermore, for example, RFID chips of the type "mic3 ® TAG" come the microsensys GmbH, Germany, considering that edge lengths of about 1.6 mm x 1 mm, working frequencies in the range of 13.56 MHz and memory of 64-bit ROM exhibit. However, other types of RFID chips can be used.
- the stored information is encoded by a printed bar code of conductive ink (the so-called HidE principle).
- HidE principle the so-called HidE principle.
- the size of the information that can be stored essentially depends on the size of the electronic barcode, that is, in particular, also on the size of the consumable 132.
- the identifier 140 may be located on the invasive unit 120 in different ways. Examples of such arrangements or attachments are shown in FIG. 3 and in FIG. Thus, FIG. 3 shows an exemplary embodiment of invasive consumables 132, which in turn are configured in the form of lancets 134. These lancets are, analogously to the exemplary embodiment in FIG. 1, arranged in a drum-shaped magazine 136, the individual lancets 134 being arranged in lancet cavities 174. These lancet cavities 174 are arranged rotationally symmetrically radially outward in the drum magazine 136. In this case, an arrangement is selected in Figure 3, in which a lancet cavity 174 is not filled with a lancet 134. Instead, in this embodiment, an identifier 140 is inserted into the lancet cavity 174.
- FIG. 4 shows a magazine 136 in which an identifier 140 is applied from the outside to the outer wall of the magazine 136.
- the magazine 136 is shown in plan view
- the magazine 136 is shown in a view from the side.
- an RFID chip 178 can be used as the identifier 140
- a conductive barcode 176 (chipless identif ⁇ er) is preferably printed on the side wall of the magazine 136 as an identifier 140, glued on or on others Manner applied.
- Various other configurations of attaching the identifier 140 are possible.
- FIGS. 5 A to 6 Various possibilities are shown in FIGS. 5 A to 6 for reading the identifiers 140 by means of the central control unit 114.
- FIGS. 5 A and 5 B show an exemplary embodiment which corresponds to the medical system 110 according to FIG.
- the lancing aid 124 is coupled to the measuring device 112 in the embodiment shown, and invasive consumables 132 are arranged in the lancing aid 124 with a magazine 136.
- an RFID chip 178 is inserted in the magazine as an identifier 140 in a lancet cavity 174 (not shown).
- the measuring device 112 has a second interface 150 in the form of an antenna 180, via which the information of the RFID chip 178 can be read out.
- this second interface 150 can be designed such that it not only interrogates the signal of the RFID chip 178 itself with respect to its content, but also registers a signal intensity.
- FIG. 5A While the entire medical system 110 is shown symbolically in FIG. 5A, only the case is shown symbolically and greatly simplified in FIG. 5B, in which the magazine 136 rotates relative to the measuring device 112 (which is not shown in FIG. 5B).
- the signal of the identifier 140 (denoted by "read out" 142 in FIG. 5B) becomes weaker.
- This attenuation can be registered by the measuring device 112, so that it is possible to deduce a position of the identifier 140 and thus an angular position of the drum magazine 136.
- it is a position-sensitive identifier 140, which is asymmetrically connected to the consumption element. or their magazine 136 is arranged so that not only the information of the identifier 140 can be read out by means of the measuring device 112, but also from the signal strength or other signal properties on a positioning or orientation of the consumable 132 can be closed.
- FIG. 6 diagrammatically shows another embodiment of a position-sensitive identifier 140.
- the illustrated medical system 110 corresponds, for example, to the medical system 110 according to FIG. 1, so that again reference may be made to the above description.
- the identifier 140 corresponds to the exemplary embodiment according to FIG. 4 and comprises a conductive barcode 176 applied peripherally to the magazine 136.
- the second interface 150 of the measuring device 112 comprises a plurality of individual antennas 180, which overall determine the positioning of the strips or areas of the conductive barcode 176 can determine. For example, similar to plate capacitors, an electric field changes between these antennas 180 and the strips of the conductive bar code 176, which can be used to determine the positioning of the magazine drum 136. If the magazine 136 is rotated (reference numeral 182 in FIG. 6), the signal at this second interface 150 changes, from which again the orientation of the consumable 132 can be deduced.
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Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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EP08843148A EP2203110A1 (en) | 2007-10-24 | 2008-10-23 | Medical system having consumables monitoring |
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EP07119134A EP2052678A1 (en) | 2007-10-24 | 2007-10-24 | Medical system with monitoring of consumables |
PCT/EP2008/064380 WO2009053437A1 (en) | 2007-10-24 | 2008-10-23 | Medical system having consumables monitoring |
EP08843148A EP2203110A1 (en) | 2007-10-24 | 2008-10-23 | Medical system having consumables monitoring |
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EP2203110A1 true EP2203110A1 (en) | 2010-07-07 |
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EP07119134A Ceased EP2052678A1 (en) | 2007-10-24 | 2007-10-24 | Medical system with monitoring of consumables |
EP08843148A Withdrawn EP2203110A1 (en) | 2007-10-24 | 2008-10-23 | Medical system having consumables monitoring |
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EP07119134A Ceased EP2052678A1 (en) | 2007-10-24 | 2007-10-24 | Medical system with monitoring of consumables |
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EP (2) | EP2052678A1 (en) |
CN (1) | CN101969834B (en) |
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WO (1) | WO2009053437A1 (en) |
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HK1154194A1 (en) | 2012-04-13 |
CN101969834A (en) | 2011-02-09 |
WO2009053437A1 (en) | 2009-04-30 |
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