JP2006181386A - Automatic peritoneal dialysis apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an automatic peritoneal dialysis apparatus by which the dialysate can be safely and securely infused into and discharged from a patient and a load on the patient can be reduced. <P>SOLUTION: This automatic peritoneal dialysis apparatus includes a cylinder 4 and a piston 5 which reciprocally moves in an axial direction in the cylinder 4 and can suck into the cylinder or deliver, and measures each fluid, as a means to suck or deliver the peritoneal dialysis fluid or the discharged fluid from the abdominal cavity of the patient or to measure the transported quantity by the suction or the delivery, and a flexible bag housed in a hermetically closed container as a means to suck or deliver the peritoneal dialysis fluid or the discharged fluid from the abdominal cavity of the patient or to measure the transported quantity by the suction or the delivery. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to an automatic peritoneal dialysis apparatus that automatically injects a dialysis solution into the abdominal cavity of a patient and discharges it after a predetermined time.

  Peritoneal dialysis has advantages such as low treatment costs and the need for frequent dialysis patients to return to society, and the number of facilities in Japan is gradually increasing. Continuous peritoneal dialysis (hereinafter abbreviated as CAPD) is easy for a patient to exchange dialysate at home and is inexpensive, and many peritoneal dialysis patients employ this method. However, although it is convenient, since the exchange of the bag, the attachment / detachment of the connector, and the opening / closing of the clamp (opening / closing means) are repeated several times a day, the burden on the patient is not small. In addition, some patients are blind and have hand injuries, and they may become contaminated due to misoperation of the patients or cause injection / drainage errors.

  Therefore, a peritoneal dialysis apparatus that automatically performs the above operation has been devised and improved. In a simpler automatic peritoneal dialysis machine, the drop causes the dialysate to be injected into the patient's abdominal cavity and drained from the abdominal cavity. This type has a relatively simple structure and is safe for a living body because it is injected and discharged by gravity. On the other hand, there has been a problem that a head required for performing injection / discharge must be provided, and the posture of the patient at the time of treatment is forced, and the apparatus is enlarged. When a roller pump is used for injecting and discharging fluid from the automatic peritoneal dialysis machine, there is no need to make a drop, but the roller rotates regardless of the amount of fluid to be dispensed and the amount of fluid to be drained. In spite of the small amount of staying liquid, the peritoneum may be damaged by forcible suction.

As described above, the conventional apparatus has merits and demerits, and has the following common disadvantages in addition to the above. First, since the liquid injection amount and the liquid discharge amount are measured as the weight by the load cell, the size is increased and the cost is increased. Secondly, the dialysate bag, the drainage bag, the patient's peritoneal catheter, the heating means and the like are connected by conduits, and each of these conduits is equipped with an opening / closing means. And since one series of one opening / closing means was separately operated with respect to one conduit | pipe, the control apparatus became complicated and became the cause of the cost increase.
JP-A-5-131027

  The problem to be solved by the present invention is firstly to provide an automatic peritoneal dialysis apparatus capable of safely and reliably injecting and discharging a dialysis solution to a patient. That is, there is provided an apparatus that operates in a predetermined order without contamination or erroneous operation, and injects an accurate amount of dialysate and discharges a staying fluid. Secondly, the burden on the patient at the time of treatment is reduced by an automatic peritoneal dialysis device. That is, the present invention provides an apparatus that reduces manual operation during dialysate exchange and does not require forcing the patient's posture during fluid exchange. A third object is to provide a relatively simple and inexpensive automatic peritoneal dialysis apparatus having a structure.

  In order to solve the above-mentioned problems, the present invention provides a cylinder and the inside of the cylinder in the axial direction as means for aspirating or feeding peritoneal dialysate or drainage from the patient's abdominal cavity and measuring the transport amount by the suction or feeding. The present invention provides an automatic peritoneal dialysis apparatus having a piston capable of reciprocally moving and sucking, feeding, and metering each liquid into the cylinder.

  The automatic peritoneal dialysis apparatus of the present invention has a flexible bag or diaphragm (diaphragm) instead of the means as means for sucking, feeding and measuring the peritoneal dialysate and the drainage from the patient's abdominal cavity. A chamber or the like can also be used.

  As the automatic peritoneal dialysis apparatus of the present invention, as a conduit opening / closing device for transporting the peritoneal dialysate constituting the automatic peritoneal dialysis device or the drainage fluid from the patient's abdominal cavity, And the number of the conduits is the same as the number of the conduits, (2) the conduit opening / closing means is mounted on the rotating shaft, and (3) the number of the rotating shafts is the number of the conduit opening / closing means. And (4) a conduit opening / closing device capable of opening an arbitrary number of conduits by rotation of the rotating shaft, in particular, only one conduit can be opened and the remaining conduits can be closed. The thing provided with is preferable.

Hereinafter, an embodiment of the present invention will be described with reference to FIG.
Embodiment 1 of the Invention Embodiment using a cylinder and a piston capable of reciprocating axially in the cylinder and sucking, feeding and metering peritoneal dialysate and drainage from the patient's abdominal cavity into the cylinder 2 is opened, and the dialysate is caused to flow by the piston 5 into a cylinder 4 having a predetermined capacity provided with the piston 5 capable of moving in the axial direction and sucking, discharging and metering peritoneal dialysate (step A). . Next, the conduit 2 is closed, only the second conduit 12 connected to the storage container 13 is opened, the piston 5 is pressed, and the dialysate sucked into the cylinder 4 in the step A is caused to flow out to the storage container 13. This operation is repeated to store a necessary amount of dialysate in the storage container 13 (step B). For example, when a 100 ml cylinder is used, the above operation may be repeated 10 times in order to send 1000 ml.

  In the automatic peritoneal dialysis apparatus of FIG. 1, a plurality of dialysate containers are coupled to the upstream end of the conduit 2, but the amount of dialysate stored in one dialysate container is used as an injection amount. If it is sufficient, for example, if the daily injection amount is about 3000 ml, one dialysis fluid container may be used.

  In the automatic peritoneal dialysis apparatus of FIG. 1, in addition to the above operation, one end of the manifold 11 in which the first dialysate container 1 is connected by the conduit 2 and the manifold 11 in which the storage container 13 is connected by the conduit 12. A second dialysate container 10 is connected to one end of the manifold between one end, and in the same manner as the above operation, only the conduit 9 connected to the second dialysate container 10 is opened and the piston 5 is sucked. Then, predetermined amounts of dialysate having different concentrations can be allowed to flow into the cylinder 4 from the second dialysate container 10. Then, the conduit 9 to which the second dialysate container 10 is connected is closed, only the second conduit 12 connected to the storage container 13 is opened, and sucked into the cylinder 4 as described above, and dialysates having different concentrations. Can flow out into the storage container 13 and the dialysate can flow into the storage container 13. This line connected to the second dialysate container 10 is used to store dialysate having different concentrations when dialysate shortage is recognized when the dialysate from the first dialysate container is stored. The Further, the storage container 13 is preferably provided with a heating means 14 capable of heating the dialysate in the storage container. In addition, the automatic peritoneal dialysis apparatus may need to be heated before injecting the dialysate into the patient, and therefore preferably has a heating means in contact with the storage container.

  In order to inject the dialysate heated in the storage container 13 into the abdominal cavity of the patient 16, only the conduit 12 is opened and a predetermined amount of dialysate is sucked into the cylinder 4. Next, the conduit 12 is closed, and only the third conduit 15 connected to the abdominal cavity of the patient is opened, and the predetermined amount of dialysate sucked by pressing the piston 5 is discharged into the abdominal cavity of the patient 16. The above operation is repeated to inject a necessary amount of dialysate into the abdominal cavity of the patient 16 (step C).

  The liquid retained in the abdominal cavity of the patient 16 is opened only by the same operation as described above, and the liquid (residual liquid) retained in the abdominal cavity of the patient 16 is sucked into the cylinder 4. Next, the conduit 15 is closed, only the conduit 17 connected to the drainage container 18 is opened, and the retained liquid sucked into the cylinder 4 by pressing the piston 5 is discharged into the drainage container 18. The above operation is repeated, and the staying liquid is discharged into the drainage container 18 so that the negative pressure in the abdominal cavity of the patient 16 is not damaged to the living body (step D).

  In order to discharge the staying liquid into the drainage container 18 so that the inside of the abdominal cavity of the patient 16 does not become an extreme negative pressure in the D stage, it is connected to a peritoneal catheter inserted into the abdominal cavity of the patient or an extension tube connected thereto. For example, a conduit that can be blocked by a negative pressure of 110 mmHg or more and can be inflated by a positive pressure of 140 mmHg or more is preferable because pressure can be prevented from being directly applied to the abdominal cavity of the patient and the pressure can be relieved. Therefore, it is preferable that at least a part of the conduit is formed of a flexible thin film. Further, an overload sensor (strain gauge) can be provided at the rear end of the piston 5 to measure the load, and the pressure in the cylinder 4 can be measured.

  In the automatic peritoneal dialysis apparatus of the present invention, only one of the conduits is opened, and as a tube opening / closing means for closing the other conduit, each interlocking cam is operated by rotating the rotating shaft, It is preferable that only one of the pushers can be released from the conduit and the other conduit can be closed depending on the position of the interlocking cam.

  For example, when there are five conduits as shown in FIG. 1, the number of interlocking cams attached to one rotating shaft as shown in FIG. It is preferable to use up to three. The reason is that if there are up to three pipes, and if this pipe is an A pipe, the rotation axis is either forward or negative from the state where the pipe A is open. This is because by rotating, it is easy to close the conduit A and open only one other conduit independently. However, if four or more conduit opening / closing means are provided on one rotating shaft, it is physically difficult to open only one conduit. That is, if it is attempted to open a conduit whose phase of the interlocking cam is shifted by two or more, a state where a conduit whose phase is shifted by one is surely created is not preferable. On the contrary, if one conduit opening / closing means is not attached to one rotating shaft, the number of rotating shafts increases, the apparatus becomes complicated, and the control becomes complicated.

  The five sets of opening / closing means are arranged at the positions of the rotation shafts so that only one of the conduits 2, 9, 12, 15 and 17 can be opened by the rotation of the rotation shaft 25. In the case of the conduit opening / closing means, three sets of the first conduit opening / closing means 19 are mounted with a phase difference of 120 °, and two sets of the conduit opening / closing means 19 of the second rotation shaft are 120 to 180 °. Those mounted with a phase difference of 1 are preferable.

  Further, in FIG. 1, when the second dialysate container is not used and the number of the conduits is four, in FIG. 2, two conduit opening / closing means 19 are mounted on the first rotation shaft, One having two conduit opening / closing means 19 mounted on the second rotating shaft can be mentioned. Also, in this case, two of the conduit opening / closing means 19 are mounted on the first rotating shaft with a phase difference of 120 to 180 °, and two of the conduit opening / closing means 19 are mounted on the second rotating shaft 120-180. Although it is preferable that one of the conduit opening / closing means 19 is attached to one rotating shaft and one of the conduit opening / closing means 19 is attached to the other rotating shaft. good.

  As the conduit opening and closing means for opening and closing the conduit by the rotation of the interlocking cam and the interlocking cam, for example, a mechanism comprising an interlocking cam 26 and a pusher 27 as shown in FIG. FIG. 3A shows a state in which the conduit 28 is opened. FIG. 3B shows the open / close state of the conduit when the interlock cam 26 is rotated by rotating the rotating shaft 25 and the conduit 28 is closed by the pusher 27 and the receiving groove 29. As the receiving groove 29 used when closing the conduit 28, a groove having a recess having the same degree of R as the top corresponding to the top of the pusher 27 as shown in FIG.

  In order to determine the position and / or moving direction of the interlock cam, it is preferable to provide an optical sensor in the vicinity of the interlock cam. With this optical sensor, it is possible to confirm the position of the interlock cam, and to determine the direction in which the interlock cam is rotated in order to move the pusher of the conduit to be clamped next.

  The movement speed of the piston at the time of discharging or injecting liquid from each conduit other than the peritoneal catheter inserted into the abdominal cavity of the patient or a conduit connected to an extension tube connected thereto is determined by inhalation and In order to shorten the discharging time, it is preferable that the moving speed of the piston is higher than that when the liquid in the conduit connected to the peritoneal catheter or the extension tube connected thereto is sent. The movement speed of the piston when draining or injecting fluid from a peritoneal catheter inserted into the abdominal cavity of a patient or a conduit connected to an extension tube connected thereto does not damage the abdominal cavity. It is preferable to be within a predetermined range. For example, the moving speed of the former piston is usually about 400 to 600 ml / min, for example 600 ml / min, whereas the moving speed of the latter piston is about 10 to 300 ml / min, for example 300 ml / min.

  The capacity of the cylinder is usually 30 to 200 ml, preferably 50 to 100 ml. Further, it is preferable that a position detection sensor such as an optical sensor (photo interrupter) or a slider resistor (potentiometer) is provided in the vicinity of the outer cylinder portion of the cylinder. By providing this position detection sensor, it is preferable to detect the suction or discharge amount of dialysate or the drainage fluid from the abdominal cavity of the patient, and automatically control the suction or discharge amount of the liquid based on the detection result. .

  Moreover, it is preferable that the piston portion of the cylinder has a sterile structure. As this aseptic structure, for example, the space between the rear end flange 6 and the piston rear end side flange 7 of the cylinder outer cylinder in FIG. 6 is covered with a flexible bellows-shaped aseptic cover 33, or as shown in FIG. A means for covering the entire cylinder 4 with a stretchable cover, for example, a rubber cover 30, can be mentioned.

  Further, in the automatic peritoneal dialysis apparatus of FIG. 1, a combination of the cylinder 4 and the piston 5 is used to suck and discharge peritoneal dialysate or drainage from the abdominal cavity of the patient 16. For example, two sets may be used as shown in FIG. By using two sets of the cylinder 4 and the piston 5, it is possible to eliminate the waiting time for sucking and discharging the peritoneal dialysate or the drainage from the abdominal cavity of the patient 16, and to reduce the influence of intermittent transport. For example, when one side is sucking, the other side can discharge.

  2. In the case of using a flexible bag, a peritoneal dialysis solution, using a flexible bag 32 of a predetermined capacity housed in a sealed container 31 in FIG. 5 instead of the cylinder 4 and the piston 5 in FIG. Alternatively, drainage from the abdominal cavity of the patient 16 could be aspirated and drained. Since the bag 32 is compressed by pressurizing the inside of the sealed container 31, the peritoneal dialysate in the bag 32 or the drainage from the abdominal cavity of the patient 16 can be sent. Since the negative pressure is applied to the bag 32 by depressurizing the inside, the peritoneal dialysis solution or the drainage fluid from the abdominal cavity of the patient 16 can be sucked into the bag 32.

  For example, only the conduit opening / closing means 1K is opened, the inside of the sealed container 31 is decompressed, and the dialysate is drawn from the dialysate container 1 into the flexible bag. Further, only the conduit opening / closing means 3 </ b> K is opened, the inside of the chamber 31 is pressurized, the liquid in the flexible bag 32 is sent to the storage container 13, and heated by the heating means 14. Further, only the conduit opening / closing means 3K is opened, and the dialysate is drawn into the flexible bag 32 in the same manner as described above. Next, only the conduit opening / closing means 4K is opened, and the dialysate in the flexible bag 32 is sent to the abdominal cavity of the patient 16. The pressurization or depressurization in the chamber 31 can be performed by, for example, injecting or exhausting a gas into the chamber 31.

  As a means for sucking or discharging the dialysate or the drainage fluid from the abdominal cavity of the patient, in addition to the means using the cylinder and the piston or the flexible bag, a flexible diaphragm (diaphragm) is provided for partitioning. It is possible to introduce gas into one of the two chambers (hereinafter referred to as A chamber) and the other chamber (hereinafter referred to as B chamber). The chamber includes a chamber into which dialysate or drainage from the abdominal cavity of the patient can be injected.

  The diaphragm (diaphragm) of the chamber extends and reverses in the direction of the wall surface by introducing gas into the A chamber, and discharges the dialysate stored in the B chamber or the drainage from the patient's abdominal cavity. The gas introduced into the A chamber is discharged, and the A chamber is further depressurized, so that the diaphragm (diaphragm) that has been stretched and reversed in the direction of the wall surface of the B chamber is extended in the direction of the wall surface of the A chamber. Thus, it is possible to introduce dialysate or drainage from the abdominal cavity of the patient into the room B by reversing the rotation.

1. First, since the injection and discharge of liquid is quantitatively performed by the stroke of the cylinder and the piston, injection and discharge can be performed while quantifying dialysate and staying liquid, and excessive injection that becomes a burden on the living body. And an accurate amount of liquid can be transferred while preventing discharge (suction). Therefore, not only is it safe for the living body, but liquid injection and discharge are quantitatively performed by the strokes of the cylinder and the piston, so that liquid can be fed even when there is no drop.

2. Secondly, the automatic peritoneal dialysis machine is set up in advance with the minimum necessary setup, and after that, this machine automatically selects, closes and opens the flow path, and measures liquid, warms, infuses, The device that automatically performs even draining and priming (filling the inside of the conduit with liquid) automatically performs almost all operations associated with liquid exchange, so even patients with limited eyes and hands Relief from accidents caused by contamination and misoperation, reducing the burden of manipulating the procedure.

3. Third, because it is a metering pump, it counts the number of pumps without measuring the weight of the dialysate or the accumulated liquid that has been discharged, and further measures the position of the piston with a position detection sensor. The amount of liquid can be quantified. Therefore, it is not necessary to provide an expensive load cell for weight measurement.

4). Fourthly, when selecting the flow path in the apparatus, the opening and closing means attached to each conduit is opened and closed. By rotating only the rotating shaft, a plurality of interlocking cams and pushers attached to the rotating shaft are used. Can be activated to open and close multiple conduits. Therefore, the device that controls the opening / closing means mounted on the conduit can be made simpler than when the device is individual. As a result, the overall structure of the automatic peritoneal dialysis apparatus becomes relatively simple, and the cost can be reduced.

It is a figure which shows the structure of one Example of the automatic peritoneal dialysis apparatus of this invention. It is a figure which shows one Example of the opening / closing means of the conduit | pipe arrange | positioned to the rotating shaft of the automatic peritoneal dialysis apparatus of this invention. An opening / closing means for a conduit comprising an interlocking cam and a pusher mounted on a rotating shaft, and an open state and a closed state of the conduit by the opening / closing means are shown. (A) The open state of the conduit is shown. (B) The closed state of the conduit is shown. It is a figure which shows what made the whole cylinder of the automatic peritoneal dialysis apparatus of FIG. 1 the aseptic structure. It is a figure which shows the structure which uses a flexible bag in the automatic peritoneal dialysis apparatus of FIG. It is a figure which provided the thin film bellows structure in the cylinder rear-end part, and made the cylinder aseptic structure. It is a figure which shows the structure of the other Example of the automatic peritoneal dialysis apparatus of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 1st dialysate container 2 1 conduit | pipe 4 cylinder 5 piston 6 cylinder rear end flange 7 piston rear end side flange 8 position detection sensor 9 conduit 10 second dialysate container 11 manifold 12 conduit 13 storage container 14 heating means 15 conduit 16 Patient 17 Conduit 18 Drainage container 19 Conduit opening / closing means (interlocking cam + pusher)
25 Rotating shaft 26 Interlocking cam 27 Pusher 28 Conduit 29 Pusher receiving groove 30 Rubber cover 31 Sealed container 32 Flexible bag 33 Thin film bellows 1K Conduit opening / closing means 2K Conduit opening / closing means 3K Conduit opening / closing means 4K Conduit opening / closing means 5K Conduit opening / closing means

Claims (12)

As means for aspirating or feeding peritoneal dialysate or drainage from the patient's abdominal cavity and measuring the amount transported by the suction or feeding, the cylinder and the cylinder are reciprocated in the axial direction to move each of the cylinders to the cylinder. An automatic peritoneal dialysis device having a piston capable of sucking or feeding and metering therein. As a means for aspirating or feeding peritoneal dialysate or drainage from a patient's abdominal cavity and measuring the amount transported by the suction or feeding, it is provided with a flexible bag housed in a sealed container Automatic peritoneal dialysis machine. The automatic peritoneal dialysis apparatus according to claim 1 or 2, wherein the means for measuring the suction or liquid feeding and the transport amount by the suction or liquid feeding is of a sterile structure. The automatic peritoneal dialysis apparatus according to claim 1 or 3, wherein a piston position detection sensor is provided in the vicinity of the outside of the cylinder. As a conduit opening and closing device for transporting peritoneal dialysate or drainage from the patient's abdominal cavity, (1) the conduit opening and closing means is a combination of interlocking cams and pushers, and the number of conduits is the same; (2) The conduit opening / closing means is mounted on a rotating shaft, (3) the number of rotating shafts is smaller than the number of the conduit opening / closing means, and (4) any number of rotation shafts is rotated. The automatic peritoneal dialysis apparatus according to claim 1, further comprising a conduit opening and closing device capable of opening the conduit. 6. The automatic peritoneal dialysis apparatus according to claim 5, wherein the opening / closing means is attached to the rotating shaft with a phase difference. The automatic peritoneal dialysis apparatus according to claim 5 or 6, wherein the conduit opening and closing device is capable of opening only one conduit and closing the remaining conduits. The automatic peritoneal dialysis device according to any one of claims 5 to 7, wherein the conduit opening and closing device is a conduit opening and closing device having two or more rotating shafts. The conduit opening / closing device has two rotating shafts, and three of the conduit opening / closing means are attached to one rotating shaft, and two of the conduit opening / closing means are attached to the other rotating shaft. The automatic peritoneal dialysis device according to claim 8. At least a dialysate container (consisting of one or more dialysis containers; hereinafter referred to as the first dialysate container) (A), a peritoneal catheter inserted into the abdominal cavity of the patient's abdominal cavity or an extension connected thereto Tube (B), drainage container (C) from the patient's peritoneal cavity and means (D) for aspirating, delivering and metering peritoneal dialysate and the drainage from the patient's peritoneal cavity are provided by a multi-branch conduit (manifold). The automatic peritoneal dialysis device according to any one of claims 1 to 9, which is connected. The automatic dial according to claim 10, wherein a dialysate container (hereinafter referred to as a second dialysate container) in which a dialysate having a concentration different from the dialysate in the first dialysate container is connected is connected. Peritoneal dialysis machine. The automatic peritoneal dialysis apparatus according to claim 10 or 11, wherein at least a part of a peritoneal catheter inserted into a patient's abdominal cavity or a conduit connected to an extension tube connected thereto is formed of a flexible thin film.

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