JP2013078690A - Apparatus and method for early stage peritonitis detection including self-cleaning effluent chamber - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide, inter alia, automated medical methods and apparatus that test PD effluent in a flow path (e.g., with an APD system or CAPD setup) to detect, for example, the onset of peritonitis, based on optical characteristics of the effluent resolved at cellular scales of distance.SOLUTION: For example, an APD machine includes, in an effluent flow path, apparatus for early stage peritonitis detection comprising an illumination source and a detector. The source is arranged to illuminate peritoneal effluent in a chamber that forms part of the flow path, and the detector is arranged to detect illuminant scattered by the effluent.

Description

  The present invention relates to an apparatus and method for medical diagnostic testing. It has applications, inter alia, for detecting the site of peritonitis during, for example, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) procedures.

  Peritoneal dialysis (PD) is a medical procedure for removing toxins from blood that utilizes a semipermeable membrane surrounding the abdominal wall or peritoneal cavity. During PD treatment, the solution is introduced into the patient's abdomen where it remains for several hours to remove hemotoxin via osmotic transport through the membrane. Upon completion of the treatment, the solution is drained from the body along with the toxin. CAPD is a manual form of this procedure that requires the patient to put in fresh PD solution and drain the used PD solution manually from the peritoneum. In APD, all procedures are handled by automated equipment.

  Peritonitis is a common complication of both CAPD and APD. Often caused by the introduction of bacteria (eg, from tubes, connectors and other devices that make up a PD transfer set) during dialysis, this peritoneal swelling is caused by vomiting, abdominal tenderness and other Main cause of symptoms. Although there is a response to antibiotics, peritonitis can end the patient's ability to stay on APD and CAPD treatment. In extreme cases it can be fatal.

  Standard tests for peritonitis, usually performed when acute clinical symptoms occur, include Gram staining, performing cell counts on peritoneal fluid, culturing that fluid, and / or culturing blood. Contains. Often these tests can only be done in the laboratory after the patient complains of symptoms. By that time, peritonitis has progressed and will require unjustified patient distress and larger treatment.

  Recently, reagent test strips have become available, allowing doctors or patients themselves to make more immediate diagnoses. However, test strips have a limited time window for usefulness and are generally unsuccessful in early detection.

  CAPD and APD patients are typically advised to maintain a keen eye for another peritonitis symptom, namely a turbid or clouded drain bag. This occurs unfortunately late, and if the PD solution remains in the body for a long time before elimination, it is further doubled (as in the case during the daytime residence of APD patients, for example) Is done. The detection of turbid effluent is more complicated in APD equipment with long discharge lines. This is because the patient can only see the drain line and not the drain bag (where turbidity is more readily apparent). In addition, blind or weakly sighted patients must rely on friends, family and / or caretakers to check the turbidity of the PD fluid used.

  The prior art uses such a turbidity automatically, for example, by using a detector located in the APD device opposite the light source located on one side of the PD effluent container. It suggests that it may be detected by detecting the total amount of incoherent polychromatic light passing through. Implementation of this technique has generally not been proven reliable due to the low signal-to-noise ratio.

  One object of the present invention is to provide an improved method and apparatus for medical diagnosis, testing and / or treatment at home or in the laboratory.

  A further object of the present invention is to provide an improved method and apparatus for PD therapy.

  A still further object of the present invention is to provide an improved method and apparatus for detecting signs of peritonitis, for example in connection with peritoneal dialysis.

  A still further object of the present invention is to provide such a method and apparatus that can be performed at a reasonable cost and still produce valid results.

  An object of the present invention is to provide an automated medical examination method and apparatus for detecting signs of peritonitis from the optical properties of PD effluent resolved on a cell scale in the flow path in one form of the present invention. Achieved by the invention.

  For example, according to one aspect of the present invention, an APD machine includes a device for early peritonitis detection that includes an illumination light source and a detector in the effluent flow path. A light source is arranged to irradiate peritoneal effluent in a chamber that forms part of the flow passage, and a detector is arranged to detect light diffused by the effluent. The detector is of cell-scale resolution, eg, a scale such that individual cell-sized biological (or other) components in the effluent can be distinguished from each other based on the diffusion event detected by the detector. Detects the diffused light at.

  A related aspect of the invention is that the detector is arranged so that individual white blood cells (WBCs) in the effluent can be distinguished from each other based on light reflection and diffusion (collectively referred to as “diffusion”). An apparatus as described above is provided. An apparatus with a detector so arranged can, for example, count such WBCs from diffusion and, further, if their counts change over time and / or from a baseline If it changes, it can signal the symptoms of peritonitis.

  Furthermore, a related aspect of the invention is that the detector is such that cell size biological (or other) different types of components in the effluent can be distinguished based on the light diffused by them. An apparatus as described above is provided. A related aspect of the invention is that the detector is arranged to allow WBCs in the effluent to be distinguished from red blood cells (RBCs), fibrin and / or other components based on diffusion. Equipment is provided.

  Another aspect of the invention is as described above, which shows the indication of peritonitis in the counting of selected biological components in the effluent, for example based on changes over time and / or from baseline. Equipment is provided. A related aspect of the present invention provides an apparatus that calculates the trend of these count changes, for example, for WBCs in emissions. A further related aspect of the present invention provides such an apparatus that calculates the trend as the slope of the curve of their counts over time and signals a sign of peritonitis when the slope exceeds a selected amount.

  Another related aspect of the invention is that the detector counts diffusion events, ie, events in which light is reflected and diffused from the effluent to the detector, based on the intensity and / or location of the diffusion event. Equipment is provided. In one such form of the invention, the detector comprises a pin diode configured to count diffusion events based on, for example, the intensity of light detected from the effluent. The device according to this aspect of the present invention provides a used PD solution of a certain intensity (or range of intensity, eg, based on the cell dimensions), eg, from a baseline and / or from a patient. For example, a sign of peritonitis can be signaled when changing between drainage and / or when the tendency of change over time exceeds a selected amount.

  In other such configurations, the detector is a charge coupled device (CCD) arranged to image the chamber, i.e., to record diffusion events based on both position and (cumulative) intensity. ). A further related aspect of the invention provides an apparatus in which the detector generates one or more histograms of such images while counting diffusion events (eg, based on intensity). A still further related aspect of the invention provides such an apparatus that generates a histogram from a number of images taken, for example, during draining of spent PD solution from a patient. As mentioned above, devices according to these forms of the present invention provide a continuous discharge of PD effluent from a baseline and / or patient over a long period of time, for example, a certain intensity (or range of intensities). For example, a sign of peritonitis can be signaled.

  Another related aspect of the invention provides an apparatus in which the histogram is formed only for selected diffusions recorded in the image, eg, diffusion events of a selected intensity and / or length. Devices according to these forms of the present invention provide continuous counts of PD emissions from baseline and / or patients over time that are prone to diffusion events likely to be caused by WBCs (and not, for example, RBCs or fibrin). When changing between drains, for example, a sign of peritonitis can be signaled.

  A further aspect of the invention provides an apparatus wherein the illumination source is a laser diode (or other light source of coherent light).

  A related aspect of the invention provides such an apparatus in which the detector is arranged to detect a lateral diffusion event, for example, a detectable event in a field of view orthogonal to the beam of light source illuminated by a laser diode. .

  A further related aspect of the invention is that the illumination source by the laser diode is arranged in the part of the flow path in which the diffusion event is counted by the detector, and in particular comprises eg a centered beam. Equipment is provided.

  A still further related aspect of the invention is an apparatus wherein the light with the laser source has a beam width selected based on the dimensional characteristics of the biological (or other) component for which the diffusion event is to be counted. I will provide a. A further related aspect of the invention provides a method wherein the beam width has a diameter approximately 1.5 times the size of the component, eg, WBCs. Yet another aspect of the present invention provides an apparatus in which the beam width has a circular and Gaussian cross section, or other beam dimensions and / or shapes.

  A further aspect of the invention provides such an apparatus wherein the detector comprises a lens arranged to resolve the light diffused from the effluent component at a cellular scale distance. A related aspect of the invention is that the lens has a depth of field that includes a substantial portion of the flow path in the field of view of the detector, for example, a depth of field that includes the flow chamber in which the diffusion event is detected. An apparatus is provided that is arranged to provide

  A further form of the invention provides an apparatus as described above in which the chamber described above induces laminar flow into the effluent. Such a chamber includes, for example, an optically clear portion having a central portion whose inner wall defines a generally cubic or cuboid parallelepiped region.

  In accordance with a related aspect of the present invention, the central portion may be coupled to the flow inlet port via a portion of the chamber having an inner wall that generally defines a pyramidal frustum. Similarly, according to a further related aspect of the invention, the central portion is connected to the flow outlet port via a portion of the chamber that also has an inner wall that also defines a generally pyramidal frustum. obtain.

  A further aspect of the invention provides an apparatus as described above, wherein the chamber comprises a deflector disposed in the flow passage. The deflector can increase the turbulence of the exhaust flowing through the chamber, increasing the number of lay nozzles of the fluid, for example, to about 100 or more, and more preferably to about 250 or more. In these and other aspects of the invention, the turbulence introduced into the flow as a result of the deflector facilitates cleaning its inner wall--for example, leukocytes, red blood cells and other components of the effluent from them. Remove.

  Another aspect of the present invention is an automated medical testing method and apparatus corresponding to those described above for detecting peritonitis signs and other conditions by examining peritoneal fluid in vivo, i.e., in the patient's peritoneum. I will provide a. According to one aspect of the invention, such an apparatus includes an illumination source and a detector that are co-located outside the patient, as described above. A first optical fiber bundle carries light from the light source to the peritoneum. A second optical fiber bundle carries the light diffused by the peritoneal fluid at the peritoneum to the detector.

  A related aspect of the invention is that the ends of the first and second fiber optic bundles transmit the light reflected and / or diffused (collectively “diffused”) on the cellular scale. The resolution described above is configured to detect on a scale such that individual cell size biological (or other) components within the peritoneal fluid are distinguishable from each other and transmit it to the detector. A device like this is provided.

  In another related aspect of the invention, one or more of the optical fiber bundles are routed from the device to the patient's peritoneum via a catheter. This may be, for example, an APD machine in which the device is used, a CAPD system, or a catheter that forms part of another device. In a related configuration, the bundle can enter the catheter by direct insertion into the catheter wall via a Y-connector.

  In yet another related aspect of the invention, light generated by a light source (eg, a laser diode) is shaped by a lens or a collimator for transfer to the peritoneum via a first optical bundle. Similarly, an additional lens or collimator may be provided at the end of the first bundle to shape the light in the peritoneum, for example to obtain a Gaussian distribution or a circular cross section. In a further related aspect of the invention, the beam of light emanating from the distal end of the first bundle has its peritoneum for the purpose of causing diffusion from the biological (and other) components of the peritoneal fluid. It can be directed to pass through the peritoneum to irradiate fluid.

  In yet another form of the invention, the second fiber optic bundle captures the light laterally diffused by the peritoneal fluid at the peritoneum-and thereby transmits it to the detector. In a related form of the invention, the bundle captures light that is back-diffused, forward-diffused and / or side-diffused in the peritoneum and transmits it to the detector.

  Another aspect of the present invention provides a device as described above that provides an indication of peritonitis or other condition via a remotely located interface. In these regards, an interface remotely located with the device may be coupled for communication via a wireless link such as a Bluetooth connection. Another form provides such a connection via a wired link or a combination of wired and wireless.

  According to yet another aspect of the present invention, the remote interface receives a cue from the aforementioned device, eg, via a liquid crystal display, light emitting diode, or other indicator, to a patient, medical personnel, or other Show it to the people. In addition, the remote interface controls the device in response to input from, for example, a patient, medical personnel, or others. This can include starting the device, beginning the interface / device connection / disconnection, specifying the device's operating mode, or otherwise.

  In yet another form of the invention, the remote interface is sized and configured to be slid into the pocket, ie, “wears”, by the patient, medical personnel, or others. .

  Yet another aspect of the present invention provides a device as described above for detecting and measuring the refractive index of peritoneal fluid in the patient's peritoneum.

  Another aspect of the invention provides an apparatus as described above for use in connection with a CAPD procedure.

  Yet another aspect of the present invention provides an apparatus as used to detect signs of peritonitis with a fluid flow established independently of the APD and / or CAPD instrument from which PD fluid is collected. Such devices have application, for example, in used PD effluent inspection bags (or other collections) when they are emptied for disposal or for further inspection.

  Yet another aspect of the present invention provides a PD kit that includes the inspection apparatus described above in addition to conventional components (such as tubing, clamps, sterile wipes, etc.).

  Yet another aspect of the present invention provides a method for examining PD discharge for signs of peritonitis in parallel with the operation described above.

  Another aspect of the present invention provides a device as described above for biopsy of peritoneal fluid and other bodily fluids containing it.

  Still other aspects of the present invention include dialysates and body organs, including properties such as refractive index, blood (RBCs), bubbles, and the presence of other undesirable by-products such as CAPD, APD, etc. There is provided an apparatus and method as described above for use in examining in vitro and in vivo properties of cavities and / or other fluids contained therein. Related aspects of the invention should provide such devices and methods for use in hemodialysis and other medical procedures.

A more complete understanding of the invention can be obtained by reference to the drawings.
1 depicts an automated peritoneal dialysis (APD) processing system of a type according to one embodiment of the invention and in which the invention may be implemented. 1 depicts an automated peritoneal dialysis (APD) processing system of a type according to one embodiment of the invention and in which the invention may be implemented. 1 depicts an automated peritoneal dialysis (APD) processing system of a type according to one embodiment of the invention and in which the invention may be implemented. 1 depicts an automated peritoneal dialysis (APD) processing system of a type according to one embodiment of the invention and in which the invention may be implemented. 1 depicts an automated peritoneal dialysis (APD) processing system of a type according to one embodiment of the invention and in which the invention may be implemented. FIG. 1 depicts a continuous portable peritoneal dialysis (CAPD) treatment system of a type according to one embodiment of the present invention and in which the present invention may be implemented. FIG. 1 depicts a continuous portable peritoneal dialysis (CAPD) treatment system of a type according to one embodiment of the present invention and in which the present invention may be implemented. FIG. 1 depicts a continuous portable peritoneal dialysis (CAPD) treatment system of a type according to one embodiment of the present invention and in which the present invention may be implemented. FIG. 3 depicts an apparatus for inspecting PD emissions, according to one embodiment of the present invention. FIG. 3 depicts an apparatus for inspecting PD emissions, according to one embodiment of the present invention. FIG. 6 depicts an image produced by a charge coupled device of a device according to one embodiment of the invention. FIG. 6 depicts a type of histogram generated from an image generated by a charge coupled device used in the practice of the present invention. FIG. 6 depicts a type of histogram generated from an image generated by a charge coupled device used in the practice of the present invention. FIG. 6 depicts a type of histogram generated from an image generated by a charge coupled device used in the practice of the present invention. FIG. 6 shows an alternative effluent flow chamber used in the system according to the invention. FIG. 6 shows an alternative effluent flow chamber used in the system according to the invention. FIG. 6 shows an alternative effluent flow chamber used in the system according to the invention. 1 depicts an APD and CAPD system according to the present invention utilizing an apparatus for in vivo testing of peritoneal fluid according to the present invention. FIG. 1 depicts an APD and CAPD system according to the present invention utilizing an apparatus for in vivo testing of peritoneal fluid according to the present invention. FIG. FIG. 8 depicts further details of the biological inspection apparatus of FIG.

  FIG. 1A depicts an automated peritoneal dialysis (APD) processing system 10 according to one embodiment of the present invention and of the type in which the present invention may be implemented. The system 10 includes other devices that facilitate the introduction of fresh peritoneal dialysis (PD) solution into the cardiovascular system 12 or the peritoneum 14 of a patient 16 and removal of spent PD solution.

  The system 10 includes a PD solution supply chamber 18, a heating chamber 20, a metering chamber 22, and a disposal chamber 24, all of which are adapted to include a PD emission inspection device (as discussed elsewhere). However, it is configured to operate in a conventional manner known in the art. Thus, the PD supply chamber 18 has a source of fresh PD solution for delivery to the patient 16, the heating chamber 20 brings the fresh PD solution to the appropriate temperature for delivery to the peritoneum, and the metering chamber 22 The PD solution drained from the peritoneum and used up is retained, for example, for weighing, and the disposal chamber 24 retains the used PD solution for disposal.

  Pump 26 is under the control of a micro-controller (not shown) to move the solution between chambers 18-24 in a conventional manner, for example, as illustrated in FIGS. 1B-1E. Operates on. Thus, for example, as shown in FIG. 1B, the pump 26 moves fresh PD solution from the source chamber 18 to the heating chamber 20, which heat chamber 20 enters the patient's peritoneum 14 via the catheter 19. It can be brought to a certain temperature before it is introduced. When the desired temperature is achieved and the procedure begins, the pump 26 opens the valve 28 and allows the heated fresh PD solution to flow into the peritoneum 14 with the aid of gravity. See FIG. 1C.

  With reference to FIG. 1D, when the PD remains in the peritoneum for a desired period of time, the spent PD solution will flow into the chamber 22 for metering (eg, to ensure that enough solution is removed from the peritoneum 14). In accordance with common practice in the art, the pump 26 opens the valve 28 so that it can. The pump 26 then moves the spent effluent from the metering chamber 22 to the disposal chamber 24 for collection prior to disposal by the patient, medical personnel, and the like. See Figure ID.

  The conventional form of the system 10 shown and described herein is for illustration only. An apparatus for inspection of PD emissions (as discussed elsewhere) is shown in FIGS. 1A-1E and in connection with APD equipment other than the modes and modes of operation described above. It will be understood that it can be used.

  FIG. 2A depicts a continuous portable peritoneal dialysis (CAPD) treatment system 30 of one type in accordance with an embodiment of the invention and in which the invention may be practiced. The system 30 includes a fresh PD solution source bag 32, used PD solution bags 34 and a Y connector 36 for coupling these bags to the peritoneal transfer set 38. System 30 is adapted to operate in a conventional manner known in the art (although it is adapted to include a PD emission inspection device as discussed elsewhere). Yes. So, for example, the patient connects the bags 32 and 34 to the Y connector 36 as shown in FIG. 2B for simple sterile cleaning of the Y connector 36. Then, as further shown in the drawing, the patient sets the connector 36 to allow fresh PD solution to flow from the bag 32 to the peritoneum with the aid of gravity. Once the PD solution has accumulated for a desired period of time, the patient resets the connector 36 to allow the used PD solution to be drained into the bag 34 for disposal. See Figure 2C.

  The conventional form of system 30 shown and described herein is for illustration only. An apparatus for inspection of PD emissions (as discussed elsewhere) is shown in FIGS. 2A-2C and in connection with CAPD equipment other than the form and mode of operation described above. It will be understood that it can be used.

  FIG. 3A includes a device 42 for examining PD discharge (ie, PD solution discharged from the peritoneum) according to the present invention, but is configured and operated in the manner of the circulator 12 (FIG. 1). The APD circulator 40 is depicted. The inspection device 42 inspects in the flow path of the circulator 40 and / or other APD systems or components that are part. The circulator 40 (comprising the testing device 42) can be used in place of the circulator 12 of the system 10 (FIG. 1), as in other APD treatment systems. Similarly, the inspection device 42 may be coupled to an exhaust flow passage (ie, a drain line) in the system 30 (FIG. 2) and also other CAPD systems as shown diagrammatically in the inserted FIG. 3B. . In addition, the device may be combined with kits for APD and CAPD procedures (eg, kits that include tubes, clamps, sterile wipes, etc.). In addition, the device 42 is coupled to the fluid flow path of a laboratory, doctor's office, hospital or home testing equipment, and kits for such testing (eg, PD effluent sample vials, storage boxes, and labels). Etc.). For convenience, the operation of the inspection device 42 will be described with respect to the circulator 40 of FIG. 3A, but it will be understood that the device 42 may be similarly configured and operated in the foregoing and other environments in which it is used.

  In overview, the illustrated device 42 can be used for PD in the flow path—here, the path from the peritoneum 14 to the disposal chamber 24—for signs of peritonitis and / or other conditions (eg, the presence of blood and / or bubbles). Inspect emissions. For this purpose, the device includes an illumination light source 44 and a detector 46. The illumination light source 44 is arranged to irradiate peritoneal effluent in the chamber 48 that forms part of the flow passage, and the detector 46 is diffused by the effluent, eg, perpendicular to the light source beam. Is arranged to detect the emitted light.

  The light source 44 and the detector 46 transmit the light reflected and / or diffused by the detector (collectively referred to as “diffused”) with cell-scale resolution, eg, isolated cells in the effluent. Is configured to detect on a scale such that biological components of different sizes can be distinguished from each other. In applications where the illustrated embodiment is directed, ie, early detection of signs of peritonitis, individual white blood cells (WBCs) in the effluent (from the erythrocytes, fibrin and other components of the effluent) Also) allows them to be distinguished from each other so that they are counted and the rate of change of their counts is detected for the purpose of signaling (cue) to detect the onset of peritonitis obtain. In other embodiments, this allows red blood cells (or other components such as bubbles) in the effluent to be distinguished from each other (as well as from WBCs, fibrin, etc.) and counted, etc. To.

  As mentioned, the detector 46 measures the light diffused from the chamber 48 at a cell-scale resolution such that the separated cell size components in the effluent can be distinguished from each other. And is configured to detect. As further mentioned, in the illustrated embodiment, this allows the individual WBCs 54 in the effluent (as well as the effluent red blood cells 56, fibrin 58 and other components) to be distinguished from each other. As such, they are counted, and the rate of change of those counts can be measured for the purpose of signaling to detect the onset of peritonitis. In other embodiments, this allows other components, such as RBCs 56, fibrin 58, etc., to be detected in the effluent for other state signaling purposes.

  The illumination light source of the illustrated embodiment comprises a low power laser diode producing a monochromatic parallel beam. Here, the wavelength corresponds to the optical detection sensitivity of the detector 46, and reflection and diffusion (collectively, as above) from at least selected components (eg, white blood cells) in the effluent. For compatibility with "diffusion"), 630 nm is selected. In other embodiments, for example, 830 nm and 780 nm lasers can be utilized, and to name just a few monochromatics at other wavelengths, or selected according to the foregoing or other criteria, Color, coherence and / or other illumination sources can also be utilized.

  Although other forms of beam can be used in other embodiments, the collimated beam produced by the laser diode 44 in the illustrated embodiment can be attributed to a gaussian or circular cross-section beam 52, such as a lens or collimator. 50 is arbitrarily formed.

  The lens 50 shapes the beam to optimize diffusion from at least selected components within the emissions. In the illustrated embodiment, this is a beam that is 1-2 times, preferably 1.5 times as large as the average size of the emission components to be detected preferentially, here WBCs. Means making. Under the conditions of an average size of 12-15 μm for neutrophils and eosinophils, 8-10 μm for lymphocytes, and 16-20 μm for monocytes, the illustrated embodiment The beam 52 is sized between 10 and 40 μm, preferably between 15 and 25 μm, more preferably 20 μm. This optimizes the device 42 for preferential detection of WBCs, for example, for red blood cells 56, fibrin 58 and other components of the PD effluent. In other embodiments, other beam sizes may be used, for example, for reasons of preferential detection of other emission components or others.

  The beam 52 in the illustrated embodiment is directed to pass through the chamber 48 to irradiate the effluent in the chamber 48, causing diffusion from biological (and other) components in the fluid. It is aimed. In the illustrated embodiment, the beam is directed through the center of the chamber 48 as shown, but in other embodiments the beam 52 may be directed otherwise.

  Returning to FIG. 3A, detector 46 detects diffusion events—that is, events where light is diffused from the effluent in chamber 48 and reaches detector 46, based on the intensity and / or location of those events. And count. In the illustrated embodiment, the detector 46 is specifically arranged to detect lateral diffusion, for example, an event in the field of view 64 about an axis 66 perpendicular to the beam 52, as shown. Yes. In other embodiments, the detector may be arranged to detect other diffusion events, eg, back diffusion, forward diffusion, side diffusion at angles β other than vertical. In the illustrated embodiment, β is approximately 90 °, but more commonly β is in the range of 30 ° to 150 °, more preferably 60 ° to 120 °, and even more preferably 80. Between 0 ° and 100 °, and even more preferably, as shown, approximately 90 °.

  In some embodiments, the detector 46 may detect the occurrence of such a diffusion event and transmit a single cell (or a small number of cells) of photodiodes, ie, pin diodes 68, for the purpose of transmitting signals. Is used. The lens 70 facilitates focusing on the diode so that it is at cell-scale resolution, for example a separate biological (or other) component in the effluent (based on such diffusion). Detect those events on a scale that can be distinguished from each other. In the illustrated embodiment, the lens 70 is selected to be preferentially focused on WBCs and is positioned (facing the chamber 48 and the diode 68). However, in other embodiments, the lens 70 can be otherwise focused. The lens 70 is further selected for a desired depth of focus within the field of view 64, for example, in the illustrated embodiment, for a depth of focus that matches the depth of the chamber 48, or a substantial portion thereof. And then placed. The chamber 48 is configured to match the size and shape of the laser beam, for example, to minimize or completely avoid reflection (or diffusion) of the beam 52 from the inner wall of the chamber itself.

  The laser diode 68 preferentially detects diffusion from selected components of the effluent—in other embodiments, RBCs, fibrin, bubbles, and other components of the effluent, here. Selected and / or otherwise configured (eg, through the use of appropriate circuitry). In any event, such selection and / or configuration may be made empirically (eg, by examining diffusion detected from the effluent of a known composition).

  The diffusion event detected and signaled by diode 68 is sent to microprocessor 62 (or other suitable element) for analysis. In the illustrated embodiment, this includes counting events signaled over time and generating an alarm. That is, for example, a count value of a certain intensity (or intensity range) is obtained, for example, from (i) a reference value set for a patient 16, (ii) continuous draining of used PD solution from that patient 16. When changing in liquid and / or (iii) its change over time, more particularly when the trend of the rate of change of counts over time (ie "critical slope") exceeds a selected amount. Such alarms may be in the form of visible and / or audible signals to the patient 16, medical personnel, or otherwise hardware that interrupts the system 12 of which the testing device 42 is a part, etc. It may be a software function that calls on such a system or otherwise.

  Other embodiments of the present invention employ a charge coupled device (CCD) instead of pin diode 68 for the purpose of detecting and signaling the occurrence of a diffusion event. As above, the lens 70 focuses on the CCD so that it detects those events with cell-scale resolution and preferentially focuses on WBCs in the illustrated embodiment (and the desired). To obtain the depth of focus). In other embodiments, the lens 70 may be focused on what is not. In the following description, since the CCD is located at the same functional location in the device 42, reference numeral 68 is used for the CCD, indicating the element that was for the pin diode.

  As with pin diodes, the CCD 68 is selected and / or otherwise configured to facilitate the discovery of diffusion from selected components of the emissions (again, here, preferentially, WBCs). ing. In this regard, the CCD 68 forms an image of the illuminated chamber 48 and records both the location and intensity of the diffusion event (again at cell scale resolution). As a result, at least selected components (eg, WBCs) in the emissions are distinguished from each other and from other components of the emissions.

  FIG. 4 depicts such an image, where it is generated from a simulated effluent containing 80 glass beads per microliter (as sized between 10-30 microns) instead of WBCs. Has been.

  The image produced by the CCD is sent to the microprocessor 62 (or other suitable element) for analysis. In the illustrated embodiment, this is binned based on intensity from each image, and more preferably from multiple images generated upon draining the used PD solution following a single PD treatment session. While making a histogram. Depending on the count value in the selected one (or more) of the histogram bins, the microprocessor 62 can issue an alarm, for example, as discussed below.

  FIGS. 5A-5C depict such histograms, where these are 40 (FIG. 5A), 80 (FIG. 5B) and zero (FIG. 5C) glass beads, as described above, per μL, respectively. It is from simulated emissions that have

  In the illustrated embodiment, it is, for example, that a certain intensity (or intensity range) count value is used, for example, (i) from a reference value set for the patient 16, (ii) used from that patient 16 And / or (iii) its change over time (i.e., from PD treatment session to session)-and more particularly the rate of change of count over time (i.e. , “Critical Slope” —provides an alarm when the trend exceeds a selected amount, again such an alarm may be in the form of a visual and / or audible signal to the patient 16, a healthcare professional, or otherwise For example, it may be hardware that interrupts the system 12 of which the inspection device 42 comprises a part, or a software function or other that calls on such a system.

  The advantage of creating a histogram from a large number of CCD images, as justified, is that it tends to emphasize intensity counts in critical areas. This improves the signal-to-noise (S / N) ratio and thereby increases the effectiveness of detection (eg, for peritonitis or other symptoms reflected by discharge). In an embodiment of the present invention using this approach, the CCD 68 (for example, to acquire these multiple images during PD solution ejection by entering “acquire” and “read” modes in succession (e.g. , By the microprocessor 62 or otherwise). Here, the former is a mode for acquiring images of the irradiated chamber 48, and the latter is a mode for reading these images into the microprocessor.

  In other embodiments of the invention, the microprocessor can perform pre-image processing before creating the histogram. Thus, for example, it is illustratively too long (eg, fibrin) or too short (eg, RBCs) together for embodiments intended to count WBCs for the purpose of peritonitis detection. Pixel values representing diffusion from the emissions component can be eliminated. Further, such pre-processing may be selected depending on the specification of the application to which the present invention is applied.

Self-Cleaning Chamber FIGS. 6A-6C depict a chamber 82 for use with the apparatus 42. This is an alternative to the chamber 48 shown in FIG. 3A and discussed above. Thus, like chamber 48, chamber 82 forms part of the flow passage for peritoneal effluent and passes through it as described all above for chamber 48 in light of the following description. The effluent flowing through may be arranged to be illuminated by the light source 44 and detected by the detector 46.

  6A and 6B depict the front and side of the chamber 82, respectively. FIG. 6C illustrates the configuration of a system according to the present invention showing the chamber 82 along with the light source 44 and the detector 46.

  Referring to FIGS. 6A and 6B, chamber 82 is as described above with effluent fluid flowing in the direction of arrows 88, 90 from the peritoneum (ie, “transport side”) to the disposal chamber (ie, “exhaust side”). Includes a fluid inlet port 84 and an outlet port 86 for connection to the effluent flow passage of the circulator 40, system 30, or other APD or CAPD system. In the illustrated embodiment, the ports 84, 86 are sized for attachment to tubing defining an exhaust flow passage in such an APD or CAPD system, but the size and configuration of the ports It will be appreciated that may vary in other embodiments.

  Chamber 82 defines an area through which effluent flowing into port 84 passes before flowing out through port 86. The chamber 82 of the illustrated embodiment is generally characterized as a rectangular parallelepiped, i.e., a cuboid, whose inner walls (shown by dashed lines) have dimensions l (length), w (width) and d (depth). It includes a central portion 82A that defines an attached fluid flow region.

  In the illustrated embodiment, the length l and the width w are approximately the same size, and both are larger than the depth d. However, other embodiments may vary with respect to these. In one embodiment of the present invention, the length l and width w are both about 5 inches or less, preferably about 3 inches or less, more preferably about 1 inch or less, while the depth d is about 1 inch or less. More preferably, it is about 1/2 inch or less, and still more preferably about 1/4 inch or less. Thus, in one particular embodiment, the length l and width w are about 1 inch and the depth d is about 1/4 inch.

  The central portion 82A is coupled to the port 84 on the inlet side via a proximal portion 82B having an inner wall (dashed line) with a shape generally characterized as a pyramidal frustum and an outlet. On the side, it is coupled to port 86 via a terminal portion 82C having an inner wall (dashed line) that is also provided with a shape generally characterized as a pyramidal frustum. The dimension of the proximal end (ie, closer to the inlet) of the frustum defined by the inner wall of portion 82B approximately matches the inner diameter of port 84, and the size of the distal end (ie, closer to the outlet) is the portion 82A. It almost matches the size of the rectangular parallelepiped defined by the inner diameter. Similarly, the dimension of the distal end of the frustum (ie, closer to the outlet) defined by the inner wall of portion 82C approximately matches the inner diameter of port 86, and the dimension of the proximal end (ie, closer to the inlet) is It substantially matches the size of the rectangular parallelepiped defined by the inner diameter of the portion 82A.

  The central portion 82A of the illustrated embodiment is optically clear and allows the light source 44 to irradiate the peritoneal discharge in the chamber 82 and detect the light diffused thereby by the detector 46, as described above. I have to. To this end, at least the central portion 82A has a light transmission of 450 nm to 890 nm (with a maximum optical loss of approximately 3 percent) and is therefore used with a light source 44 operating at a wavelength of 630 nm (+/− 20 nm). Can be made from molded plastics such as acrylic, polycarbonate and / or polystyrene, which are suitable for Of course, other plastics or materials (such as glass, ceramics, etc.) that are optically transparent at the previously discussed wavelengths can be used as well or in addition.

  In the illustrated embodiment, the refractive index of the plastic or other material from which the central portion 82A is manufactured (within the constraints discussed above) is the irradiation of the peritoneal discharge in the chamber 82 by the light source 44 and thereby It does not have a significant effect on the detection of diffused light by the detector 46. However, in other embodiments, the refractive index of the plastic or other material may be more important, for example if a portion of region 82A acts as a lens (either intentionally or otherwise). .

  Similarly, in the illustrated embodiment (again, within the constraints discussed above), the dispersion factor of the plastic or other material from which the central portion 82A is manufactured is determined by the chamber 82 by the light source 44. There is no significant effect on the irradiation of the inner peritoneal discharge and the detection by the detector 46 of the illuminant diffused thereby. This is because (i) the beam 52 passes through the wall of the central portion 82 at an angle Ω that is substantially perpendicular to the wall surface of the central portion 82, (ii) the beam is collimated, and (iii) This is the case when the beam has a diameter (and is positioned) so that no other part of the beam contacts the side of the central portion 82A, except that the beam passes. However, in other embodiments in which the beam passes through the central wall at an angle Ω other than approximately 90 °, the central portion 82A may be fabricated from a material with a lower dispersion factor.

  The portions 82B and 82C of the compartment 82 may be manufactured from the same plastic or other material as the portion 82A, but the proximal and distal portions 82B, 82C need not be optically clear, and therefore It may be manufactured from other materials as well.

  The deflector 94 is disposed at the end of the internal chamber 82 as shown. The illustrated embodiment includes an arcuate or hemispherical member located in the central region of the exhaust flow passage downstream of the region illuminated by the beam 52. Thus, for example, the deflector may be positioned at the distal end of the chamber 82 approximately centrally with respect to the x-axis and z-axis of the coordinate 96 (or otherwise with respect to the width w and depth d dimensions).

  A deflector 94, which may be connected to or integral with the end portion 82C, protrudes into the end of the central portion 82A as shown (shown as a dark, dark, curved region in the drawing). Have Other forms of deflectors suitable for disrupting the effluent flow in the manner discussed below (eg, from laminar to turbulent) can be used in addition to or in addition to the deflector 94 shown herein. . The deflector 94 may be made from other materials, but may be made from the same plastic as the portions 82A, 82B and / or 82C, or from other materials. In some embodiments, deflector 94 has a coating of Teflon or other material that resists the deposition of biological and other materials in the effluent stream.

  As a result of its inner wall shape, the chamber 82 directs the effluent flow into a laminar flow at the proximal end of the central portion 82A. The deflector 94 causes a transition from laminar to turbulent flow that increases the number of ray nozzles in the flow by dividing the boundary layer at the end of the central portion 82A, as well as at the exit (or terminal) portion 82C. When the number of lay nozzles reaches 100, vortices begin to form in the discharge. These vortices increase as the number of lay nozzles increases. The vortices help to clean the inner walls of the chamber 82-in particular, for example, the end of the central portion 82A, as well as the end portion 82C--and other components of white blood cells, red blood cells and effluents on their inner walls. Prevents adherence and / or removes already attached. Thus, in one embodiment of the present invention, the deflectors are arranged to affect the flow of effluents having a number of lay nozzles of about 100 or more, more preferably about 250 or more.

Biological Examination FIG. 7A includes an apparatus 100a according to the present invention for the detection of peritonitis by examining peritoneal fluid on the living body, ie, in the peritoneum of a patient, but with the circulator 12 (FIG. 1). ) Depicts an APD circulator 40 constructed and operated in the manner of The circulator 40 (comprising the inspection device 100a) can be used in place of the circulator 12 in the system 10 (FIG. 1), as in other APD processing systems. Similarly, the inspection apparatus 100a can be used with the system 30 (FIG. 2), as graphically depicted in the inserted FIG. 7B, as with other CAPD systems. Furthermore, the device 100a can be utilized as a stand-alone testing device (eg, for testing fluids within a patient) and / or it can be combined with a kit for APD, CAPD or other medical procedures. May be. Furthermore, the device 100a can be used alone or in combination with the foregoing in a laboratory, doctor's office, hospital or home testing device. For convenience, the operation of the inspection device 100a will be described with respect to the circulator 40 of FIG. 3A, but it will be understood that the device 100a may be similarly configured and operated in the foregoing and other environments in which it is used. I will.

  The illustrated device 100a is a living body for the onset of peritonitis and / or other symptoms (eg, the presence of blood and / or bubbles) in the abdomen rather than in the chamber 48, more particularly in the peritoneum 14 of the patient 16. Although it is a test of peritoneal fluid as described above, it generally operates in the manner of the test device 42 described above. In addition, the device 100a of the illustrated embodiment provides a measurement of the properties of the peritoneal fluid, for example its refractive index.

  When used in an APD and CAPD system (eg, as shown in FIGS. 7A-7B), this test is typically performed during PD treatment—that is, the peritoneum is fluid (eg, creatine and urea) and Performed when filled with a mixture of PD solutions. The device 100a can also be used before or after the procedure to examine peritoneal fluid that contains only bodily fluids. Taking into account the latter, the term “peritoneal fluid” as used herein with respect to the contents of the peritoneum is all combinations of fluids (eg, body fluids, PD solutions, or mixtures thereof) unless the context clearly indicates. Will be understood to mean.

  For these purposes, the device 100a utilizes a first fiber optic bundle 102 that carries light through the catheter 19 from the illumination source 44 (outside of the patient) to the peritoneum 14. The second optical fiber bundle 104 fills the catheter 19 and carries the light diffused in the peritoneum by the peritoneal fluid, for example in the direction perpendicular to the light beam, to the detector 46 (also outside the patient). . In embodiments where the device 100a is used with an APD and CAPD system, the bundle may be routed through the transfer set 38 as well.

  Referring to FIG. 8, the ends of the bundle 102 and the bundle 104 have light reflected and / or diffused (collectively “diffused”) by the latter, preferably on a cellular scale. The tip of the catheter so that the resolution, eg, a biological (or other) component of individual cell size in the peritoneal fluid is acquired on a scale that can be distinguished from each other and transmitted to the detector 46. It is fixed to the part 105. As noted above, in applications where the illustrated embodiment is directed, ie, early detection of the development of peritonitis, this is because individual white blood cells (WBCs) in peritoneal fluid (other than red blood cells, fibrin and fluids) Allows them to be distinguished from each other) As a result, they are counted and the rate of change of the count is measured for purposes of detection and warning of the onset of peritonitis. In other embodiments, this allows red blood cells (or other components, such as bubbles) in the fluid to be distinguished from each other (as well as from WBCs, fibrin, etc.), counted, etc. .

  The tip 105 may be composed of plastic, ceramic, metal or other material (or combination thereof) suitable for use in medical applications to secure the bundles 102,104. In the illustrated embodiment, it has a hollow central region and comprises a hood-shaped structure in which the ends of the bundles 102, 104 are disposed (as shown), and Through it, peritoneal fluid can pass freely as well as fresh and used dialysate. An open “face” region of the hood-shaped structure and an opening 107 at its distal end (or “top”) further facilitates the passage of such fluid. In addition, the open surfaces and openings help to ensure that the distal tips 102, 104 are exposed to typical mixing of fluid from the peritoneum. Of course, those skilled in the art will appreciate that other structures and / or arrangements may be used in addition to or instead of the tip 105.

  The fiber optic bundles 102, 104 may be routed in the illustrated manner of entering the catheter 19 from the device 100a through the catheter 19 to the peritoneum 14, for example via an integral catheter branch 19a. Alternatively, the bundles 102, 104 may be routed through a Y connector, through direct insertion into the wall of the catheter 19, or other such structure through a fiber optic bundle or catheter into the patient's body. The catheter can be entered via other techniques known in the art for routing. The bundles 102, 104 are constructed of conventional fiber optic fibers suitable for use in medical applications. Each bundle is dimensioned so that it (and its counterpart) can pass through the catheter 19 without unduly hindering dialysate flow, depending on the size of the individual fiber, from one to several hundred Between the fibers.

  As described above, the irradiation light source 44 of the apparatus 100a includes a low-power laser diode that generates a monochromatic parallel beam. The wavelength is matched to the optical sensitivity of the detector 46, and reflected and diffused from at least selected components (eg, white blood cells) in the peritoneal fluid (collectively, as described above, "diffuse" )) Is selected for the compatibility in 630 nanometers. As previously mentioned, other embodiments may be monochromatic lasers of other wavelengths, otherwise selected by the foregoing or other criteria, to name just a few examples, for example, 830 nanometers, and 780 nanometer lasers, monochromatic, polychromatic, coherent and / or other illumination sources can be utilized. The light source 44 is powered and driven by the illustrated drive circuit 108 to be adapted in accordance with the teachings of this-in the conventional manner of laser diode drive circuits known in the art.

  As described above, the collimated beam generated by the laser diode 44 of the device 100a may be shaped by a lens or columinator 50a for transfer to the bundle 102 to the peritoneum 14. In other embodiments, other shapes or beams may be used, but at the distal end of the bundle 102 to further shape the laser beam 52 into a Gaussian or circular cross-section within the peritoneal cavity 14, a lens or co A laminator 50b may be provided.

  As described above, lens 50b shapes beam 52 to optimize diffusion from at least selected components with peritoneal fluid. In the illustrated embodiment, this is a beam that is 1-2 times, preferably 1.5 times as large as the average size of the emission components to be detected preferentially, here WBCs. Means making. Under the conditions of an average size of 12-15 μm for neutrophils and eosinophils, 8-10 μm for lymphocytes, and 16-20 μm for monocytes, the illustrated embodiment The beam 52 is sized between 10 and 40 μm, preferably between 15 and 25 μm, more preferably 20 μm. This optimizes the device 42 for preferential detection of WBCs, for example, for peritoneal fluid red blood cells 56, fibrin 58 and other components. In other embodiments, other beam sizes can be used, for example, because they preferentially detect other emission components or not.

  As mentioned above, the beam 52 resulting from the bundle 102 of the illustrated embodiment is for irradiating peritoneal fluid therein for the purpose of causing diffusion from biological (and other) components within the peritoneal fluid. It is aimed to pass through the peritoneum 14.

  As described above, light diffused by the peritoneal fluid in the peritoneum 14, for example, in a direction perpendicular to the beam 52, is transmitted along the catheter 19 by the bundle of optical fibers 104 to the detector 46. From that light, the detector 46 detects and detects diffusion events (ie, events in which light is diffused by the fluid in the peritoneum 14 to the end of the bundle 104) based on the intensity and / or location of those events. In addition to counting, the refractive index of the peritoneal fluid is determined.

  In the illustrated embodiment, the distal end of the bundle 104 captures lateral diffusion, eg, an event in the field of view 64 centered on an axis 66 perpendicular to the beam 52, as shown (and detection). For transmission to the detector 46). In other embodiments, the end of the bundle captures (and transmits to the detector for detection) other diffusion events, eg, back diffusion, forward diffusion, side diffusion at a non-vertical angle β. Are arranged as follows. Thus, in the illustrated embodiment, β is approximately 90 °, more typically in the range of 30 ° to 150 °, more preferably between 60 ° and 120 °, and even more preferably between 80 ° and 100 °. In between and even more preferably, as shown, approximately 90 °.

  As described above, in some embodiments, the detector 46 may detect the occurrence of such a diffusion event and transmit a single cell (or a small number of cells) of photodiodes for the purpose of signaling. That is, the pin diode 68 is used. The lens 70 facilitates focusing on the diode so that it is at cell-scale resolution, for example a separate biological (or other) component in the effluent (based on such diffusion). Detect those events on a scale that can be distinguished from each other. In the illustrated embodiment, the lens 70 is selected to be preferentially focused on WBCs and is positioned (facing the chamber 48 and the diode 68). However, in other embodiments, the lens 70 can be otherwise focused. The lens 70 is further selected and arranged for a desired depth of focus in the field of view 64, for example, in the illustrated embodiment, for a depth of focus of about a few centimeters to about a few inches. .

  As mentioned above, the laser diode 68 may be selected components of the effluent—in other embodiments, effluent RBCs, fibrin, bubbles, or other components, but here preferentially from WBCs−. Selected and / or otherwise configured (eg, through the use of appropriate circuitry) to detect the spread of. In any event, such selection and / or configuration may be made empirically (eg, by examining diffusion detected from the effluent of a known composition).

  As mentioned above, other embodiments of the present invention employ a charge coupled device (CCD) instead of pin diode 68 for the purpose of detecting and signaling the occurrence of a diffusion event. As above, the lens 70 focuses on the CCD so that it detects those events with cell-scale resolution and preferentially focuses on WBCs in the illustrated embodiment (and the desired). To obtain the depth of focus). In other embodiments, the lens 70 may be focused on what is not. In the following description, since the CCD is located at the same functional location in the device 100a, reference numeral 68 is used for the CCD to indicate the element that was for the pin diode.

  As with pin diodes, the CCD 68 is selected and / or otherwise configured to facilitate the discovery of diffusion from selected components of the emissions (again, here, preferentially, WBCs). ing. In this regard, the CCD 68 forms an image of the illuminated chamber 48 and records both the location and intensity of the diffusion event (again at cell scale resolution). As a result, at least selected components (eg, WBCs) in the emissions are distinguished from each other and from other components of the emissions.

  As described above, the diffusion event detected and signaled by diode 68 is routed to microprocessor 62 (or other suitable element) for analysis. In the illustrated embodiment, this includes counting events signaled over time and raising an alarm. For example, an intensity (or intensity range) count value may be, for example, (i) from a reference value set for a patient 16, (ii) during continuous drainage of spent PD solution from that patient 16. And / or (iii) its change over time, and more particularly when the trend of the rate of change of counts over time (ie, “crisis slope”) exceeds a selected amount. Such alarms may be in the form of visible and / or audible signals to the patient 16, medical personnel, or otherwise hardware that interrupts the system 12 of which the testing device 100a is a part, etc. In addition, the microprocessor may be a software function or other that calls into the peritoneal system 14 based on the intensity of the diffusion event detected by the diode 68. Determining the refractive index of the body.

  In the embodiment of FIGS. 7A-7B, such alarm and refractive index measurements are transmitted from the device 100a to the remote interface unit 100b. Such transmission can be done wirelessly, wired, or a combination thereof. In the illustrated embodiment, wireless transmission through module 106 is used, which utilizes a Bluetooth wireless protocol for communicating with remote unit 100b (ie, sending and receiving information). Other embodiments may alternatively or additionally use infrared 802.11 or other wireless communication technologies (including long range wireless technologies such as satellites). In still other embodiments, a wired connection (such as a USB cable, Ethernet, etc.) can be utilized with or without such wireless technology.

  A device 100b that is sized and configured to be slid into a pocket or worn by a patient 16, a health care worker or others may be an LCD or other display 108 and / or an LED or other device. An alarm of such a refractive index measurement is received for display on the indicator 110. To this end, the device 100b further analyzes alarms and information from the device 100a regarding diffusion events, refractive index measurements and other information (eg, regarding battery level and / or other aspects of the operating state of the device 100a). A microprocessor or other circuitry (not shown) can be used. Of course, such a microprocessor or other circuit resident in device 100b can provide some or all of the functionality of microprocessor 62, thereby reducing the circuit requirements of device 100a.

  More generally, a microprocessor or other circuit resident in device 100b can control device 100a, for example, activate detector 46 and / or drive circuit 108. To this end, the device 100b activates the unit, inputs a code connecting the Bluetooth module 106, or couples / disconnects the devices 100a and 100b for communication, detector 46 and / or drive circuit 108 (and , More generally, a keyboard 112 is provided that accepts input from a patient, health care worker, or others to identify operating modes for the devices 100a and 100b) and / or the like.

  The circuitry of the devices 100a and 100b is powered by a battery such as two non-limiting examples of two flat “watch type” batteries (not shown) or others. Further, the circuit can be implemented using surface mount printed circuit board technology or others to save space. As such, the device 100a of the illustrated embodiment is approximately 1.5 inches x 1 inch x 0.5 inches. However, the dimensions of other embodiments can vary. Similarly, the device 100b of the illustrated embodiment is approximately 3 inches × 2 inches × 1 inch. But again, the dimensions of other embodiments may vary.

  There has been described and illustrated herein an apparatus and method for inspecting PD emissions for the purposes described above. It will be understood that the embodiments described herein are merely examples of the invention, and that other embodiments, including modifications therein, are within the scope of the invention. The above-described devices and methods used to detect peritonitis from PD effluent streams include dialysates and in vivo, ex vivo and blood (RBCs), air bubbles and other desirable or undesirable CAPD by-products, Applied to detect the characteristics of other fluids contained in and / or from other body organs and cavities, including detecting conditions such as APD, all non-limiting examples It will be understood that you get. It will further be appreciated that such devices and methods can be applied to the detection of bubbles and other by-products of hemodialysis.

Claims (1)

In a device that examines peritoneal dialysis (PD) effluent in the flow passage,
A. A chamber defining at least a portion of the flow passage of the peritoneal dialysis effluent;
B. An irradiation light source for irradiating peritoneal discharge in the chamber;
C. Reflected and / or diffused (collectively "diffused") by the effluent
A detector for detecting the illuminant,
D. The apparatus wherein the chamber contains a laminar flow of effluent.

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