JP2000325470A5 - - Google Patents

Description

[0010]
In the hemodialysis apparatus according to the present invention, (1) the dialysate is injected into the blood circuit by reverse filtration through the dialyzer to sufficiently perform automatic cleaning (priming) of the blood circuit (2) the blood pump and the third by synchronizing the feeding means, blood puncture needle arterial and venous, after connecting the arterial and the venous blood circuit simultaneously, the inverse filtering dialysate in the blood circuit and the dialyzer by ultrafiltration (3) Quickly replace any amount of dialysate (by the above-mentioned back filtration) at any speed by operating the third delivery means during hemodialysis, (4) After the end of treatment By interlocking control of the third fluid delivery means and the blood pump, the blood in the arterial side and the venous side blood circuit is returned to the patient's body (by the above-mentioned back filtration) without removing the blood circuit. The purpose is that.

Claims (36)

A hemodialysis apparatus for contacting and purifying blood and dialysate through a semipermeable membrane, comprising a blood circulation system for circulating blood and a dialysis fluid delivery system for pumping dialysate, the blood circulation system comprising The arterial blood circuit for drawing blood from the patient and flowing it into the dialyzer and the venous blood circuit for returning the blood discharged from the dialyzer to the patient, and the dialysate delivery system sends the dialysate to the dialyzer. It has a dialysate supply line to be supplied and a dialysate drain line for draining dialysate that has flowed out from the dialyzer, and can be rotated forward and reverse to at least one of the two blood circuits of the blood circulation system. An overflow line connecting portion having a blood pump and having an overflow line connected to the other blood circuit for overflowing the liquid (outside the circuit), an upstream side circuit of the connecting portion and an opening / closing means for the overflow line The The dialysate supply line and the dialysate drain line respectively have a first fluid delivery means (feed side) and a second fluid delivery means (drain side), and are disposed upstream of the first fluid delivery means. At least one bypass line of the first bypass line connecting the side and the downstream side, or the second bypass line connecting the upstream side and the downstream side of the second liquid transfer means, An automatic hemodialysis apparatus characterized in that a third delivery means for water / replenishment is provided. By linking the blood pump and the third fluid delivery means, and the opening / closing means, a priming step before the start of hemodialysis, a blood removal step from a patient to the blood circulation system at the start of hemodialysis, a blood removal step The start mechanism to shift to the hemodialysis (blood circulation) process, the fluid replacement mechanism that performs replacement fluid to the dialysis blood circuit during the hemodialysis process, and the blood return process to return blood from the blood circulation system to the patient at the end of hemodialysis The hemodialysis apparatus according to claim 1, wherein the process and each mechanism are performed automatically. 3. The hemodialysis apparatus according to claim 2, further comprising control means for interlockingly controlling at least the blood pump, the third fluid delivery means, and the two or more opening / closing means. Blood pump, water removal / replenishment pump (third fluid delivery means), pinch valve as opening / closing means for vein side blood circuit 1 , Pinch valve 2 4. The automatic hemodialysis apparatus according to claim 3, further comprising: a control system for controlling the control means and the control system for communicating the respective components, interlocking them with each other and in accordance with changes in the respective components. The third liquid transfer means is provided in any one of the first bypass line and the second bypass line, and the third liquid transfer means can transfer liquid in both forward and reverse directions. Hemodialysis apparatus as described in. By providing a third fluid delivery means capable of delivering fluid in both forward and reverse directions in any one of the bypass lines, one fluid delivery means is used for both water removal to the blood circulation system and replacement fluid The automatic hemodialysis apparatus according to claim 5. The automatic hemodialysis apparatus according to claim 5, wherein a pump is installed in the first bypass line and the second bypass line. A bypass circuit of a second bypass line is provided between the upstream side and the downstream side of the dialysate delivery pump which is the second delivery means on the dialysate drainage line side, and a bypass circuit of a second bypass line is provided. The automatic hemodialysis apparatus according to any one of claims 1 to 3, which is attached. The hemodialysis apparatus according to any one of claims 1 to 3 , wherein the third fluid delivery means is provided in the first bypass line. The hemodialysis apparatus according to any one of claims 1 to 3, 5 and 9 , wherein air bubble detection means is attached to at least one of the arterial blood circuit and the venous blood circuit. The hemodialysis apparatus according to any one of claims 1 to 3 , 5 and 8 to 10 , wherein a blood pump is attached to the arterial blood circuit. The blood according to any one of claims 1 to 3, 5 , 8 to 11, wherein the arterial blood circuit has a soft segment of a flexible chamber, a heparin injection segment, and the venous blood circuit has a pressure monitoring line. Dialysis device. The automatic hemodialysis apparatus according to claim 1 or 12, wherein the heparin injection segment is joined at a position as close as possible to the connection portion 1 with the arterial puncture needle. The automatic hemodialysis apparatus according to claim 1 or 12, wherein a soft segment is inserted upstream of the blood pump without steps. The hemodialysis apparatus according to any one of claims 1 to 3, 5 , 8 to 12, wherein the amount of liquid fed from the third liquid feeding means is 0 to 500 ml / min. The dialysate is injected into the blood circuit by backfiltration through the dialyzer The automatic hemodialysis apparatus according to any one of claims 1 to 3, wherein the blood circuit is primed. The priming step efficiently cleans the blood circuit and removes air bubbles by providing a chamber connected with the overflow line and opening / closing means such as a pinch valve on the upstream side of the chamber and the overflow line. Automatic hemodialysis apparatus as described in. Connect the hemodialyzer and blood circuit, set the hemodialysis device, short circuit with each end of the blood circuit, and use the dialysate sent from the dialysate production device to fill the water in the hemodialysis device After dialysate replacement, connect the dialysate circuit with the connection point and the hemodialyzer at a fixed point, and start the automatic priming switch and simultaneously make the dialysate circuit connected to the hemodialyzer a closed system. The automatic hemodialysis apparatus according to claim 1 or 16. In the automatic hemodialysis apparatus according to claim 1,
1) Opening / closing means provided upstream of the overflow line after activating the automatic priming 1 (PV1, (Hereinafter also referred to as pinch valve 1), an opening / closing means provided in the overflow line 2 (PV2, Less pinch valve 2 With the water removal / replacement fluid pump operated at an arbitrary speed in the direction of replacement fluid in the state of opening), from the upstream side to the downstream side of the dialysis fluid delivery line 7 The artery of the hemodialyzer by injecting the dialysate into the bloodstream, synchronizing the transfer of the dialysate into the blood circuit by reverse filtration through the hemodialyzer, and operating the blood pump at the same flow rate. Washing the side portion, the entire arterial blood circuit, and the end of the venous blood circuit to the vein chamber at an arbitrary time setting, and draining the washing solution from the overflow line;
2) Rotate the blood pump forward at an arbitrary speed, and use a pinch valve 1 Open the pinch valve 2 Closing the hemodialyzer, circulating the backfiltration dialysate of the blood circuit for an arbitrary time period,
3 3 ▼ Pinch valve 1 And pinch valves 2 Open both, operate the water removal / replenisher pump at an arbitrary flow rate in the fluid replacement direction, and operate the blood pump at an arbitrary flow rate in the forward rotational direction, and reversely inject dialysate through the hemodialyzer. The same amount of circulating fluid is drained from the overflow line while circulating through the hemodialyzer and blood circuit. Process,
4 4 ▼ Pinch valve 1 Open the pinch valve 2 With the priming solution in the hemodialyzer and the blood circuit being circulated in positive rotation with the blood pump closed, and waiting until the next blood removal step;
The automatic hemodialysis apparatus according to claim 1, wherein automatic priming is performed by The automatic hemodialysis apparatus according to claim 19, wherein the flow rate of the water removal / replenishment pump is less than the flow rate of the blood pump in step (3) of the preceding item. By synchronizing the blood pump and the third fluid delivery means, the puncture needle on the artery side and the vein side and the artery side and the vein side blood circuit are connected simultaneously, and then the reverse in the blood circuit and in the dialyzer by water removal. The automatic hemodialysis apparatus according to any one of claims 1 to 3, wherein the filtrate is replaced with blood. The artery side and the vein side are punctured after the automatic priming step, the motion / vein puncture needle and the motion / vein blood circuit are simultaneously connected, and the automatic blood removal / dialysis step is started. Automatic hemodialysis apparatus as described in. The automatic hemodialysis apparatus according to claim 22, wherein the blood removal time is programmed in advance so that the amount of water removed by this step is the same as the amount of filling priming fluid in the hemodialyzer and the arterial blood circuit. Simultaneously with the start of the automatic blood removal / dialysis process, operate the water removal / replenisher pump in the direction of water removal and the blood pump in synchronization in the positive rotation direction, and the pinch valve 1 So that the water removal rate by the water removal / refilling pump and the blood removal rate by the blood pump are the same when discharging the filling priming solution of the hemodialyzer and the arterial side blood circuit from the hemodialyzer by closing the The automatic hemodialysis apparatus according to claim 1, which is set to. The automatic hemodialysis apparatus according to claim 1 or 24, wherein after the blood removal time has expired, the water removal amount (water removal rate), the treatment time, and the blood flow rate input in advance are automatically switched to shift to dialysis treatment. The automatic hemodialysis apparatus according to any of the preceding claims, wherein the third delivery means is activated to rapidly replace the dialysate (by backfiltration). A chamber connected to a blood pump provided in the blood circulation system and an overflow line, a channel opening / closing means provided on the upstream side and downstream side of the chamber, and water removal / replenishment provided in the bypass line of the dialysis fluid delivery system The third fluid delivery means for linking is interlocked, and interlocking control is not limited to only each step or mechanism, and a series of priming step, blood removal step, (hemodialysis) start mechanism, fluid replacement mechanism, blood return step etc. The automatic hemodialysis apparatus according to any one of claims 1 to 3, applied to the entire work flow. The automatic hemodialysis apparatus according to claim 25, wherein switches of the air bubble detector and the syringe pump are automatically operated in synchronization with the transition to dialysis treatment. The automatic hemodialysis apparatus according to any one of claims 1 to 4, wherein a program for operating the fluid replacement switch at an arbitrary blood pressure level is set in conjunction with the automatic blood pressure monitor. Operate the water removal / replacement fluid pump, pump the dialysate downstream from the upstream side of the dialysate delivery line at a preprogrammed speed and time (quantity) and dialyze in reverse filtration through the hemodialyzer The automatic hemodialysis apparatus according to any one of claims 1 to 4, wherein the fluid is injected inside the blood circuit, and after a predetermined time (i.e., a predetermined amount is reached), the water removal / replacement fluid pump is stopped. Blood pump to avoid venous pressure rise by reverse filtration replacement (Pl) 31. The automatic hemodialysis apparatus according to claim 30, wherein the monitoring unit stops the monitoring range of the venous pressure gauge / dialysis fluid pressure alarm as well as stopping. The automatic hemodialysis apparatus according to claim 30, wherein an observation period is provided after completion of the fluid replacement operation, and the blood pump is maintained at a low speed for an arbitrary time. The automatic hemodialysis apparatus according to claim 32, wherein a program for automatically returning the water removal rate to a previous value is set after the observation period. The automatic hemodialysis apparatus according to any one of claims 1 to 4, wherein a program for automatically shifting to an extracorporeal blood circulation step is set at the end of dialysis treatment. At the same time as the above program (blood return) is started, the vein pressure gauge or dialysis fluid pressure gauge alarm is canceled, and after dialysis treatment is completed, the drainage / refill pump is installed in advance in the fluid replacement direction. The reverse pump dialysate is a water removal / replenisher pump when it is operated at a fixed arbitrary speed and when the blood pump is synchronously reversely rotated at an arbitrary preset speed and the dialysate is backfiltered from the hemodialyzer. The blood is distributed to the arterial blood circuit and the venous blood circuit at a rate defined by the fluid replacement speed and the reverse rotation speed of the blood pump, and the blood in the hemodialyzer and each circuit is sequentially transferred through the arterial and venous needles. The automatic hemodialysis apparatus according to any one of claims 1 to 3, which returns blood into the body. After the process of the previous paragraph, stop the blood pump and the water removal / replenisher pump, and use the pinch valve 1 The automatic hemodialysis apparatus according to any one of claims 1 to 3, 34.