JP2016067383A - Extracorporeal circulation apparatus and indwelling needle - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an indwelling needle capable of preventing the mixing-up of an indwelling needle for blood removal and an indwelling needle for blood supply, and an extracorporeal circulation apparatus.SOLUTION: An extracorporeal circulation apparatus 1 used together with an indwelling needle 20 having a marker part capable of detecting a puncture direction by an ultrasonic wave includes an extracorporeal circulation management device 10 for managing the extracorporeal circulation apparatus 1. An ultrasonic measurement device 40 for measuring a blood flow of an object person P is connected to the extracorporeal circulation management device. The ultrasonic measurement device emits a plurality of ultrasonic waves to the blood flow of the object person, receives reflected sound waves, and, from the difference information of the reflected sound waves, generates direction information on the blood flow and puncture direction information on the indwelling needle. The direction information on the blood flow and the puncture direction information are displayed in a display part 51 of the extracorporeal circulation management device.SELECTED DRAWING: Figure 2

Description

  The present invention relates to an extracorporeal circulation device and an indwelling needle used for extracorporeal circulation of blood of a patient or the like, for example.

Conventionally, for example, percutaneous cardiopulmonary support (PCPS) has been used during surgery, etc. This percutaneous cardiopulmonary support generally uses a centrifugal pump and a membrane oxygenator. Cardiopulmonary assistance is performed via the femoral artery and vein by a closed-circuit oxygenator (extracorporeal circulation device).
For this reason, an extracorporeal circulation apparatus having an artificial heart-lung machine or the like is used to circulate the patient's blood outside the body when blood supply to the patient is necessary during surgery or the like (for example, Patent Document 1).

When such an extracorporeal circulation device is used, a venous catheter inserted from the patient's femoral vein and an arterial catheter inserted from the femoral artery are used. The venous catheter is usually inserted in the same direction as the blood flow, the tip is often placed near the right atrial entrance, and the arterial catheter is often inserted in a direction opposite to the normal blood flow. Further, when inserting the venous catheter and the arterial catheter into the body, a blood removal indwelling needle and a blood sending indwelling needle for puncturing the patient's thigh or the like are used.
That is, the blood removal indwelling needle is placed in the femoral vein, and at that time, it is necessary to puncture the blood removal direction. On the other hand, the blood-feeding indwelling needle is placed in the femoral artery, but at that time, it is necessary to puncture along the direction opposite to the blood flow direction.

JP 2006-325750 A

  However, for example, when the indwelling needle for blood removal and the indwelling needle for blood delivery are quickly placed in a patient who has stopped cardiopulmonary, etc., there is a possibility that these may be mistaken.

  Therefore, an object of the present invention is to provide an indwelling needle and an extracorporeal circulation device that can prevent the infusion needle for blood removal and the indwelling needle for blood sending and the mistake in the puncture direction.

  In the present invention, the above object is an extracorporeal circulation device used together with an indwelling needle having a marker that can detect a puncture direction by ultrasonic waves, and includes an extracorporeal circulation management device that manages the extracorporeal circulation device, The extracorporeal circulation management device is connected to an ultrasonic measurement device that measures the blood flow of the subject. The ultrasonic measurement device emits and receives a plurality of ultrasonic waves in the blood flow of the subject, and these Blood flow direction information and puncture direction information of the indwelling needle are generated from the difference information of the reflected sound waves, and the blood flow direction information and the puncture direction information are displayed on the display unit of the extracorporeal circulation management device. This is achieved by an extracorporeal circulation device characterized by:

According to the configuration, the ultrasonic measurement device emits and receives a plurality of ultrasonic waves into the blood flow of the subject, generates blood flow direction information from the difference information of these reflected sound waves, and the blood Flow direction information is displayed on the display unit of the extracorporeal circulation management device.
For this reason, the person in charge who punctures the subject with the indwelling needle visually recognizes the label portion that can detect the puncture direction of the indwelling needle by ultrasonic waves, and visually recognizes the direction of blood flow, while in the appropriate direction. An indwelling needle can be punctured.

  Preferably, the indwelling needle is punctured on the vein side of the subject along the direction of blood flow and punctured on the subject's artery side along the direction opposite to the blood flow. A plurality of the labeling portions that include a blood-feeding-side indwelling needle and are distinguishable in appearance from the blood removal-side indwelling needle punctured by the subject and / or the other indwelling needle formed on the blood-feeding-side indwelling needle; Based on the marker portion indicating the puncture direction, information on whether the indwelling needle is the blood removal side indwelling needle or the blood sending side indwelling needle, the puncture direction information, and the blood flow Direction information is simultaneously displayed on the display unit.

According to the above configuration, the blood removal side indwelling needle punctured by the subject and / or the other indwelling needle formed on the blood sending side indwelling needle, the plurality of marker portions that can be distinguished from each other in appearance, and the puncture direction are shown. Based on the labeling unit, information indicating whether the indwelling needle is a blood removal side indwelling needle or a blood sending side indwelling needle, puncture direction information, and blood flow direction information are simultaneously displayed on the display unit.
Therefore, the person in charge who visually recognizes the display unit determines whether the indwelling needle already punctured by the subject is the blood removal side indwelling needle or the blood feeding side indwelling needle, or the puncturing direction is related to the blood flow direction. It is possible to quickly determine whether it is appropriate.

  Preferably, the blood removal side indwelling needle punctured by the subject and / or the other indwelling needle formed on the blood sending side indwelling needle, the plurality of marker portions that can be distinguished from each other in appearance, and the puncturing direction Based on the labeling unit and the blood flow direction information, the puncture direction information and the blood flow direction information of the blood removal side indwelling needle or the blood supply side indwelling needle are generated, and the puncture direction information and the blood flow direction information are generated. The inner product information is generated from the vector information, and appropriate information on the puncture direction of the blood removal side indwelling needle or the blood sending side indwelling needle is generated based on the inner product information. .

According to the above configuration, inner product information is generated from vector information of puncture direction information and / or blood flow direction information of the blood removal side indwelling needle and / or the blood sending side indwelling needle, and the blood removal is performed based on the inner product information. Appropriate information on the puncture direction of the side indwelling needle or the blood feeding side indwelling needle is generated.
Therefore, the extracorporeal circulation management device can automatically determine whether or not the indwelling needle puncture performed by the indwelling needle puncturing staff or the like is appropriate, and can show the result to the responsible staff or the like.

  In the present invention, the above object is used for extracorporeal circulation of the blood of the subject, and a blood removal side indwelling needle that is punctured in the direction of blood flow of blood on the vein side of the subject, A blood-feeding-side indwelling needle that is punctured in the direction opposite to the blood flow on the artery side of the person, and the blood removal-side indwelling needle and the blood-feeding-side indwelling needle each have the other indwelling needle and A plurality of distinguishable mark portions are formed, and the mark portions are achieved by an indwelling needle arranged to indicate each puncture direction.

According to the above-described configuration, the blood removal side indwelling needle and the blood feeding side indwelling needle are each formed with a plurality of marker parts that can be distinguished from the other indwelling needles in appearance, and this marker part has its puncture direction determined. Take care as shown.
For this reason, a person in charge who punctures an indwelling needle into a subject such as a patient can perform processing without confusing which indwelling needle is a blood removal side indwelling needle or a blood sending side indwelling needle.

  As described above, according to the present invention, it is possible to provide an indwelling needle and an extracorporeal circulation device that can prevent the infusion needle for blood removal and the indwelling needle for blood sending and the mistake in the puncture direction in advance. There is.

It is the schematic which shows the main structures of the extracorporeal circulation apparatus provided with the controller which is the extracorporeal circulation management apparatus of this invention, for example. It is the schematic which shows the blood removal side indwelling needle. It is the schematic which shows the blood-feeding side indwelling needle. It is a schematic explanatory drawing which shows the relationship between a probe and a blood flow. It is a schematic block diagram which shows the main structures of the controller of FIG. It is a schematic block diagram which shows the main contents of the controller various 1st various information storage part. It is a schematic block diagram which shows the main contents of the controller various 2nd various information storage part. It is a schematic block diagram which shows the main contents of the controller various 3rd information storage part. It is a schematic block diagram which shows the main structures of the ultrasonic measuring apparatus of FIG. It is a schematic flowchart which shows the main operation examples etc. of the extracorporeal circulation apparatus concerning this Embodiment. It is another schematic flowchart which shows the main operation examples etc. of the extracorporeal circulation apparatus concerning this Embodiment. It is another schematic flowchart which shows the main operation examples etc. of the extracorporeal circulation apparatus concerning this Embodiment. It is a schematic explanatory drawing for demonstrating the identification method of the direction of a blood flow. It is a schematic explanatory drawing which shows the acquisition process of direction information of the indwelling needle for blood sending. It is another schematic explanatory drawing which shows the acquisition process of direction information of the indwelling needle for blood sending. It is another schematic explanatory drawing which shows the acquisition process of direction information of the indwelling needle for blood sending. It is another schematic explanatory drawing which shows the acquisition process of direction information of the indwelling needle for blood sending. (A) is the schematic which shows the arrangement | positioning state of the ultrasonic measurement apparatus which produces | generates the indwelling needle punctured by the patient and the image data, (b) is the flow direction of the blood flow of a femoral artery FIG. 6 is a schematic explanatory diagram showing a display example of the data of “blood flow”, “red” and “blue” data of blood flow, and direction data of a blood sending indwelling needle. (A) is the schematic which shows the arrangement | positioning state of the indwelling needle for blood transmission punctured by the patient P, and the ultrasonic measuring apparatus which produces | generates the image data, (b) is the flow of the blood flow of a femoral artery It is a schematic explanatory drawing which shows the example of a display of the data of direction, the data of "red" and "blue" of blood flow, and direction data of the indwelling needle for blood sending. It is a schematic explanatory drawing for demonstrating inner product information. The direction of the blood flow direction (F) in the flow direction data of the femoral artery and the direction data of the indwelling needle for blood transmission in FIG. 19B is set to the same direction as in FIG. It is the schematic which showed the indwelling needle.

DESCRIPTION OF EMBODIMENTS Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the accompanying drawings.
The embodiments described below are preferred specific examples of the present invention, and thus various technically preferable limitations are given. However, the scope of the present invention is particularly limited in the following description. Unless otherwise stated, the present invention is not limited to these embodiments.

FIG. 1 is a schematic diagram showing a main configuration of an extracorporeal circulation apparatus 1 including a controller 10, which is an extracorporeal circulation management apparatus of the present invention.
The extracorporeal circulation apparatus 1 shown in FIG. 1 is an apparatus that extracorporeally circulates blood of the patient P. This “extracorporeal circulation” includes “extracorporeal circulation operation” and “auxiliary circulation operation”.
The “extracorporeal circulation operation” is performed by the extracorporeal circulation device 1 when blood cannot be exchanged in the patient P because the blood does not circulate in the heart of the patient (subject) P to which the extracorporeal circulation device 1 is applied. A blood circulation operation and a gas exchange operation (oxygen addition and / or carbon dioxide removal) for the blood are performed.
The “auxiliary circulation operation” is a case where blood circulates in the heart of a patient (subject) P to which the extracorporeal circulation apparatus 1 is applied and gas exchange can be performed in the lungs of the patient P. Is also to assist blood circulation. Some devices have a function of performing a gas exchange operation on blood.

By the way, in the extracorporeal circulation apparatus 1 shown in FIG. 1 according to the present embodiment, it is used, for example, when performing cardiac surgery on the patient P early in a doctor car or the like other than a hospital.
Specifically, the centrifugal pump 3 of the extracorporeal circulation device 1 is operated, blood is removed from the femoral vein (vena cava) of the patient P, and blood oxygenation is performed by exchanging blood in the artificial lung 2. After that, the “artificial lung extracorporeal blood circulation” is performed to return the blood to the femoral artery (aorta) of the patient P again. That is, the extracorporeal circulation device 1 is a device that performs substitution of the heart and lungs.

The extracorporeal circulation apparatus 1 has the following configuration.
That is, as shown in FIG. 1, the extracorporeal circulation device 1 has a “circulation circuit 1R” for circulating blood, and the circulation circuit 1R includes “artificial lung 2”, “centrifugal pump 3”, and “drive motor 4”. , “Venous side catheter (blood removal side catheter) 5”, “arterial side catheter (blood feeding side catheter) 6”, and controller 10. The centrifugal pump 3 is also called a blood pump, and pumps other than the centrifugal type can be used.

1 is inserted into the femoral vein, and at that time, the femoral vein is punctured integrally with an unillustrated metal inner needle, and thereafter It is the “blood removal side indwelling needle 20” shown in FIG. 2 that is withdrawn from the inner needle.
In addition, the artery side catheter (blood feeding side catheter) 6 is inserted from the femoral artery, and at that time, the femoral artery is punctured integrally with a puncture metal inner needle (not shown), After that, the blood supply side indwelling needle 30 shown in FIG.
FIG. 2 is a schematic diagram showing the blood removal side indwelling needle 20, and FIG. 3 is a schematic diagram showing the blood sending side indwelling needle 30.

The venous catheter 5 is connected to the centrifugal pump 3 using a blood removal tube 11. A blood removal tube (also referred to as “blood removal line”) 11 is a conduit for sending blood.
When the drive motor 4 operates the centrifugal pump 3 according to the command SG of the controller 10, the centrifugal pump 3 removes blood from the blood removal tube 11 and passed through the oxygenator 2 into the blood supply tube 12 (“liquid supply line”). It is also configured to return to the patient P via “.

The artificial lung 2 is disposed between the centrifugal pump 3 and the blood supply tube 12. The oxygenator 2 introduces oxygen gas as shown in FIG. 1 and performs a gas exchange operation (oxygen addition and / or carbon dioxide removal) on the blood.
The oxygenator 2 is, for example, a membrane oxygenator, and a hollow fiber membrane oxygenator is particularly preferably used. The blood supply tube 12 is a conduit connecting the artificial lung 2 and the artery side catheter 6.
For the blood removal tube 11 and the blood supply tube 12, for example, a synthetic resin conduit having high transparency such as vinyl chloride resin or silicone rubber can be used.
In the blood removal tube 11, blood flows in the V direction, and in the blood supply tube 12, blood flows in the W direction.

Further, the extracorporeal circulation device 1 has a “flow sensor 14” in the blood removal tube 11. The flow sensor 14 is a sensor for measuring a flow value of blood passing through the blood removal tube 11 and is a sensor for detecting an abnormality in the flow value.
An abnormality in the flow rate value is caused by a kink in the tube of the circulation line 1R, a decrease in the rotation speed of the drive motor 4 and the centrifugal pump 3, an increase in pressure loss, and the like, causing poor circulation of blood in the circulation line 1R. This may cause hypoxia or the like in the patient.

Therefore, when an abnormal flow rate occurs in the blood in the blood removal tube 11 or the like, for example, when the blood in the blood removal tube 11 or the like is blocked, the extracorporeal circulation device 1 operates in such an abnormal state. In order to prevent this, the clamp 7 (tube closing device) of FIG. 1 is arranged.
The person in charge of the extracorporeal circulation device 1 is configured to be able to stop the operation of the extracorporeal circulation device 1 urgently by using this clamp 7 when an abnormality occurs.

Moreover, the extracorporeal circulation apparatus 1 of FIG. 1 has the ultrasonic measurement apparatus 40, and this ultrasonic measurement apparatus 40 is connected so as to be communicable with the controller 10 as shown in FIG.
This ultrasonic measurement device 40 emits ultrasonic waves to the femoral vein and femoral artery of the patient P a plurality of times, and examines the difference in the reception time of the first reflected sound wave and the subsequent reflected sound wave, so that the femoral vein and femoral vein are examined. For example, only the moving blood in the artery is detected, colored, and displayed on, for example, a “touch panel 51” which is a display unit included in the controller 10 of FIG.
Specifically, as shown in FIG. 1, the ultrasonic measurement device 40 has a probe (probe) 41 that emits ultrasonic waves to an object on one end side, and this probe 41 is attached to a patient. It is configured to receive the reflected sound wave by emitting an ultrasonic wave against the femoral vein or femoral artery of P.

In addition, the above-described “color classification” has a configuration in which, for example, a blood flow approaching the probe 41 is indicated by “red”, and a blood flow away from the probe 41 is indicated by “blue”.
FIG. 4 is a schematic explanatory diagram showing the relationship between the probe 41 and the blood flow.
As shown in FIG. 4, the blood flow is displayed in different colors.

  By the way, the touch panel 51 arranged in the controller 10 of FIG. 1 is a touch panel type display, and is a display unit, for example, an electronic component that combines a display and a position input device. It is an input device that can input various information by touching.

2 and 3, the blood removal side indwelling needle 20 and the blood sending side indwelling needle 30 are respectively a blood removal side indwelling needle holding unit 22 and a blood sending side which are parts held by a person in charge or the like. While having the indwelling needle holding | maintenance part 32, it has the blood removal side indwelling needle main body 21 and the blood feeding side indwelling needle main body 31 which are the parts inserted in the blood vessel.
In the present embodiment, the blood removal side indwelling needle main body 21 and the blood supply side indwelling needle main body 31 are each provided with a plurality of, for example, substantially circular markers M that are marker portions.

In the blood removal side indwelling needle 20 of FIG. 2, two markers M are connected (or continuous) to the proximal end side (the blood removal side indwelling needle holding part 22 side) of the blood removal side indwelling needle main body 21. .
Further, one marker M is arranged on the distal end side of the blood removal side indwelling needle main body 21 with a predetermined interval from the two markers M.
On the other hand, in the blood-feeding indwelling needle 30 of FIG. 3, four markers M are arranged on the proximal end side (blood sending-side indwelling needle holding part 32 side) of the blood feeding-side indwelling needle body 31 so as to be connected.
Further, one marker M is arranged on the distal end side of the blood-feeding indwelling needle main body 31 with a predetermined interval from the four markers M. These markers M can be marked on a very shallow portion of the surface of the blood removal side indwelling needle main body 21 or the blood sending side indwelling needle main body 31 by marking with a laser, and compatibility with a living body is not impaired.

Therefore, the blood removal side indwelling needle 20 and the blood sending side indwelling needle 30 are configured such that a person in charge or the like can immediately determine which indwelling needle is at first glance from the appearance.
Specifically, in order to make it easier to visually recognize that the indwelling needle in which two markers M are connected in series is the blood removal side indwelling needle 20 and is different from the blood removal side indwelling needle 20, for example, The indwelling needles arranged by connecting the number of the markers M different from each other, for example, four are the blood-feeding indwelling needles 30. Alternatively, the markers M may have different shapes or different colors so that they can be distinguished in appearance.
In particular, when attaching the extracorporeal circulation device 1 to the patient P in a doctor car or the like in an emergency, the person in charge or the like can grasp at a glance which indwelling needle is the indwelling needle. It is possible to prevent such a difference from occurring.

Moreover, in this Embodiment, it has the structure which can grasp | ascertain the puncture direction immediately from the marker M of each indwelling needle.
Specifically, in the blood removal side indwelling needle 20 of FIG. 2, the direction of one marker M arranged at a predetermined interval from the two connected markers M is the puncture direction.
Further, in the blood-sending-side indwelling needle 30 of FIG. 3, the direction of one marker M arranged at a predetermined interval from the four connected markers M is the puncture direction.

  As described above, in the present embodiment, not only whether or not the indwelling needle is the blood removal side indwelling needle 20 or the blood sending side indwelling needle 30, but also the configuration in which the puncture direction of the indwelling needle can be grasped at a glance. Therefore, in the event of an emergency, the person in charge or the like can take care of misunderstandings and the like and can simplify the time and effort for confirmation.

  The controller 10 or the like of the extracorporeal circulation apparatus 1 shown in FIG. 1 includes a computer, and the computer includes a CPU (Central Processing Unit), a RAM (Random Access Memory), a ROM (Read Only Memory), and the like (not shown). Are connected via a bus.

FIG. 5 is a schematic block diagram showing the main configuration of the controller 10 of FIG.
As illustrated in FIG. 5, the controller 10 includes a “controller control unit 52”, and the controller control unit 52 controls a “controller side communication device 53” for communicating with other devices and the like. Further, the touch panel 51 shown in FIG. 1 is controlled.

The controller control unit 52 is also configured to control the “controller body 54”. The controller main body 54 is a device that controls blood circulation and the like of the extracorporeal circulation device 1. The controller control unit 52 also controls the “alarm device 55”.
Furthermore, the controller control unit 52 also controls the “controller-side first various information storage unit 60”, the “controller-side second various information storage unit 70”, and the “controller-side third various information storage unit 80”.
6 to 8 are respectively main diagrams of the “controller-side first various information storage unit 60”, the “controller-side second various information storage unit 70”, and the “controller-side third various information storage unit 80”. Although it is a schematic block diagram which shows the content, these content is mentioned later.

FIG. 9 is a schematic block diagram showing the main configuration of the ultrasonic measurement apparatus 40 of FIG.
As shown in FIG. 9, the ultrasonic measurement device 40 includes a “measurement device control unit 42”, and the measurement device control unit 42 controls a “measurement device side communication device 43” for communicating with the controller 10 and the like. To do. Further, the probe 41 shown in FIG. 1 is also controlled.

  Further, the measuring instrument control unit 42 controls the “measuring instrument main body 44” and the “information input device 45” for inputting various information. Then, the “color Doppler unit (program) 46” and the “measurement device side various information storage unit 47” shown in FIG. 9 are also controlled. These contents will be described later.

FIGS. 10 to 12 are schematic flowcharts showing a main operation example of the extracorporeal circulation apparatus 1 according to the present embodiment.
In the present embodiment, an example in which the extracorporeal circulation device 1 of FIG. 1 is used in a doctor car or the like in an emergency will be described below.
First, in order to place the venous catheter 5 and the arterial catheter 6 shown in FIG. 1 in the patient P housed in a doctor car or the like, the person in charge or the like is placed on the blood removal side shown in FIGS. 2 and 3, respectively. The needle 20 and the blood-feeding indwelling needle 30 are punctured into the femoral vein and femoral artery of the patient P.
At this time, when the position of the femoral vein and femoral artery of the patient P and the blood flow direction are already clear and it is not necessary to use the ultrasonic measurement device 40 of FIG. The marker M of the blood removal side indwelling needle 20 and the blood sending side indwelling needle 30 is visually recognized, and the blood removal side indwelling needle 20 and the four markers M are connected to each other. The indwelling needle arranged in this manner is determined as the blood-feeding indwelling needle 30.

Next, the person in charge or the like moves from the portion where the marker M of the blood removal side indwelling needle 20 and the blood sending side indwelling needle 30 shown in FIGS. 2 and 3 is connected to one marker M arranged at a predetermined interval. The blood removal side indwelling needle 20 and the blood supply side indwelling needle 30 are punctured with the direction of puncture as the puncture direction.
As described above, in the present embodiment, the person in charge or the like only visually recognizes the marker M of the blood removal side indwelling needle 20 and the blood supply side indwelling needle 30, and the blood removal side indwelling needle 20 and the blood sending side indwelling needle 30 are in contact with each other. Mistakes and mistakes in the puncture direction can be prevented in advance.
Therefore, it is possible to quickly and definitely perform a treatment or the like especially in an emergency.

Next, a case where the person in charge or the like uses the ultrasonic measurement device 40 of FIG. 1 when puncturing the blood removal side indwelling needle 20 and the blood supply side indwelling needle 30 into the femoral vein and femoral artery of the patient P will be described.
First, the person in charge or the like makes the probe 41 of the ultrasonic measurement device 40 of FIG. 1 abut on the femoral vein or the like of the patient P, generates an ultrasonic wave, emits it to the femoral vein or the like, and transmits the reflected sound wave. The image data is detected and displayed on the touch panel 51 of the controller 10 of FIG.
In step ST (hereinafter referred to as “ST”) 1 in FIG. 10, the “marker detection unit (program) 61” shown in FIG. 6 of the controller 10 operates, and the “marker graphic information storage unit 62” in FIG. Refer to

The marker graphic information storage unit 62 stores information on the graphic of the marker M shown in FIGS. 2 and 3, for example, a circular graphic having a predetermined diameter.
That is, the marker detection unit (program) 61 determines whether or not the marker M corresponding to the circular graphic in the marker graphic information storage unit 62 has been detected by the ultrasonic measuring device 40, and if detected, The graphic information of the marker M, for example, the information that two markers M are arranged contiguously and one marker M is arranged at a predetermined interval as shown in FIG. 63 ".

When the ultrasonic measurement device 40 determines in ST1 that the marker M has not been detected, it is determined that the person in charge has not yet punctured the blood removal side indwelling needle 20 or the like, and proceeds to ST2 in FIG. move on.
In ST2, the “color Doppler unit (program) 46” of the ultrasonic measurement apparatus 40 in FIG. 9 operates, the probe 41 fires, and the flow direction of the blood flow is specified from the difference information of the received multiple ultrasonic signals. Then, the blood flow approaching the probe 41 is processed as data that can be displayed in “red” and the blood flow away from the probe 41 as “blue”, and is stored in the “blood flow information storage unit 71” of the controller 10.
That is, the image data shown in FIG. 4 described above is generated.

Specifically, the direction of blood flow is specified by the following method. FIG. 13 is a schematic explanatory diagram for explaining a method for specifying the direction of blood flow. In FIG. 13, an image acquired by the ultrasonic measurement device 40 is displayed.
The color Doppler unit (program) 46 sequentially refers to the “pixels” displayed on the screen of the touch panel 51 illustrated in FIG. 13, and among the pixels, “R (Red, G), G (Green, B), B (Blue, It is determined whether the value of “R” of “blue)” is a predetermined value, for example, 230 or more. In the above case, the pixel is determined to be “red”, and the determined point is defined as “region 1”. To do.

Next, for example, nine RGB values around “region 1” are determined. When R is 230 or more, it is determined that the region is a part of “region 1”. Further, for nine points around each point determined to be a part of “region 1” as described above, it is determined whether or not R is 200 or more. 1 ”.
In this way, the R values of nine points around the determined points are determined, and when there is no point where R is 200 or more, “region 1” is determined and set as “red region 1”.
This red region 1 is “red region 1” shown in FIG.

Similarly, other areas are determined, and “red area 2” and “red area 3” in FIG. 13 are determined.
Further, the determination of the region is similarly performed for RGB “blue (B)”, and “blue region 1 and“ blue region 2 ”shown in FIG. 13 are determined.

Next, a region having the largest area (number of pixels) is selected from the red region and the blue region. In the example of FIG. 13, “red region 1” and “blue region 1” are selected because they have the largest areas.
Then, the coordinates of the center of gravity of these “red region 1” and “blue region 1” are obtained. In the example of FIG. 13, the points are indicated by R1 (Xr, Yr) and B1 (Xb, Yb).

For the centroid (R1) of the red region 1 and the centroid (B1) of the blue region 1, the normalized vector F in the blood flow direction is expressed by the following equation.
F = (Xb−Xr) / √ ((Xb−Xr) ² + (Yb−Yr) ² )
Therefore, the direction of blood flow in FIG. 13 is the direction of arrow F shown in FIG.

  Next, the process proceeds to ST3 in FIG. In ST3, the controller 10 displays the blood flow direction (arrow F in FIG. 13) and red and blue blood flow data stored in the blood flow information storage unit 71 on the touch panel 51 as shown in FIG. To do.

  Thereby, the person in charge who has not yet punctured the blood removal side indwelling needle 20 or the like can clearly see the direction of blood flow in the femoral vein or the like that punctures the blood removal side indwelling needle 20 or the like on the touch panel 51. Therefore, the blood removal side indwelling needle 20 and the like can be appropriately punctured in accordance with the flow.

  By the way, in ST1, the marker detection unit (program) 61 determines that the marker M corresponding to the circular graphic in the marker graphic information storage unit 62 has been detected by the ultrasonic measuring device 40, and graphic information of the marker M is detected. Is stored in the “marker provisional storage unit 63” of FIG. 6, the process proceeds to ST4 of FIG.

In ST4, the “indwelling needle determination unit (program) 64” in FIG. 6 operates and refers to the “marker array information storage unit 65” in FIG. The marker array information storage unit 65 stores the arrangement information of the markers M formed on the blood removal side indwelling needle 20 and the blood sending indwelling needle 30 and the blood sending indwelling needle main body 31 and the blood sending indwelling needle main body 31. Has been.
That is, the blood sending indwelling needle 30 is connected and four markers are arranged, and one marker is arranged at an interval, and the blood removal indwelling needle 20 is connected to the two markers. It is stored that one marker is arranged at an interval.

  Therefore, the indwelling needle determination unit (program) 64 determines whether or not the marker image data in the “marker temporary storage unit 63” corresponds to the blood sending indwelling needle 30 or the blood removal indwelling needle 20.

If it is determined in ST4 that it corresponds to the blood sending indwelling needle 30 or the blood removal indwelling needle 20, the process proceeds to ST5.
In ST5, the data of the corresponding indwelling needle (blood indwelling needle 30 or blood removal indwelling needle 20) and the arrangement state (direction, etc.) thereof are stored in the “indwelling needle type information arrangement information storage unit 66” of FIG. Let

Next, the process proceeds to ST6. In ST6, it is determined whether or not the data of the indwelling needle type information arrangement information storage unit 66 stores the blood sending indwelling needle 30 or the blood removal indwelling needle 20, and if any data is stored. , Go to ST7.
In ST7, the “indwelling needle placement direction determination unit (program) 72” in FIG. 7 operates, and with reference to the “indwelling needle type information placement information storage unit 66” in FIG. It is determined that the indwelling needle is arranged in the direction toward the marker M, and the direction (N) is stored in the “indwelling needle direction information storage unit 73” in FIG.
Specifically, this direction (N) is a direction indicated by an arrow N in FIGS.

In the present embodiment, for example, the orientation information of the blood sending indwelling needle 30 and the blood removal indwelling needle 20 is acquired by the following method. FIG. 14 to FIG. 17 are schematic explanatory views showing a process for acquiring the orientation information of the blood sending indwelling needle 30.
First, in the image displayed on the touch panel 51 shown in FIG. 14, the blood flow is displayed in red and blue as described above, and the blood sending indwelling needle 30 is also displayed.
In this state, since the marker M of the blood sending indwelling needle 30 may not be accurately grasped, the following steps are executed.

In the image of FIG. 14, red and blue portions are displayed and it is difficult to grasp the marker M, so the image is “monochrome”. FIG. 15 is a schematic explanatory diagram showing a state where an image is converted into black and white.
Next, as shown in FIGS. 16 and 17, when the brightness of the image is reduced, the marker M of the blood sending indwelling needle 30 is clearly grasped as indicated by a circle indicated by an arrow G in FIG. 17. Will be ready to

Next, one of the four connected markers M, the coordinates of the marker M1 in FIG. 17 (Xstart, Ystart), the marker M arranged at an interval, and the coordinates of the marker M2 in FIG. 17 (Xend, Yend) ) And a vector N of the blood indwelling needle 30 based on the following equation.
N = (Xend−Xstart, Yend−Ystart) / √ ((Xend−Xstart) ² + (Yend−Ystart) ² )

  Next, the process proceeds to ST8. In ST8, the “indwelling needle and blood flow direction information display unit (program) 74” in FIG. 7 operates, the blood flow direction data in the “blood flow information storage unit 71” in FIG. ”And“ blue ”data, and indwelling needle direction data in the“ indwelling needle direction information storage unit 73 ”in FIG. 7 are displayed on the touch panel 51 of the controller 10.

FIG. 18A is a schematic diagram showing an arrangement state of the blood removal indwelling needle 20 punctured by the patient P and the ultrasonic measurement device 40 that generates image data thereof, and FIG. It is a schematic explanatory drawing which shows the example of a display of the data of the blood flow direction, the data of "red" and "blue" of blood flow, and the direction data of the indwelling needle 20 for blood removal.
Specifically, as shown in FIG. 18B, the puncture direction (N) of the blood removal indwelling needle 20 and the blood flow direction (F) of the femoral vein are displayed together with images, color information, and arrow information. .

FIG. 19A is a schematic view showing the arrangement of the blood sending indwelling needle 30 punctured by the patient P and the ultrasonic measurement device 40 that generates the image data, and FIG. It is a schematic explanatory diagram showing a display example of blood flow direction data, blood flow “red” and “blue” data, and direction data of the blood sending indwelling needle 30.
Specifically, as shown in FIG. 19B, the puncture direction (N) of the blood sending indwelling needle 30 and the blood flow direction (F) of the femoral artery are displayed together with images, color information, and arrow information. .

In the present embodiment, the figure of the arrow in the blood flow direction (F) and the figure of the arrow indicating the puncture direction (N) of the indwelling needle are different from each other so that the difference can be grasped at a glance. ing.
Further, the color of the arrow indicating the puncture direction (N) of the indwelling needle is different between the blood sending indwelling needle 30 and the blood removal indwelling needle 20.
For this reason, the person in charge can grasp at a glance whether the indwelling needle is the blood sending indwelling needle 30 or the blood removal indwelling needle 20.

  As described above, in the present embodiment, the person in charge only looks at the screen of the touch panel 51, and the indwelling needle (such as the indwelling needle 20 for blood removal) punctured on the patient P is related to the blood flow direction (F). It is possible to quickly determine whether or not it is appropriate.

Next, the process proceeds to ST9. In ST9, it is displayed on the touch panel 51 whether or not to determine the appropriateness of the placement of the indwelling needle.
That is, for example, when the blood flow of the patient P is almost stopped and the person in charge or the like cannot clearly determine whether the direction of the punctured indwelling needle with respect to the blood flow is correct, or confirming his / her own judgment Appropriate judgment is requested when it is desired.

  If it is input in ST10 that an appropriate determination of the placement of the indwelling needle is requested, the process proceeds to ST11. In ST11, the “inner product information generation unit (program) 75” in FIG. 7 operates, and the blood flow direction (F) in the blood flow information storage unit 71 in FIG. Based on the direction (N) information, the inner product information (1 to −1) information is generated and stored in the “inner product information storage unit 76”.

FIG. 20 is a schematic explanatory diagram for explaining the inner product information.
An inner product (IP) of vectors when the direction (N) of the indwelling needle and the direction (F) of the blood flow in FIG. 20 are normalized (length is 1) is expressed by the following equation.
Inner product (IP) = | N | ・ | F | ・ COSθ
When N is perpendicular to F and θ is 90 ° (degrees), COSθ is “0”.
Further, when N and F are in the same direction and θ = 0 ° (degrees), COSθ is “1”.
Conversely, when N and F are in opposite directions and θ = 180 ° (degrees), COSθ is “−1”.

  In the present embodiment, this inner product is used. That is, if the direction of the indwelling needle and the direction of blood flow are the same direction, it approaches “1”, and conversely if it is the opposite direction, it approaches “−1”. The direction of the needle with respect to the blood flow direction is determined.

Specifically, first, in ST11, inner product information is generated from the direction of the indwelling needle (N) and the direction of blood flow (F).
For example, in the example of FIG. 18B, θ of the indwelling needle direction (N) and blood flow direction (F) is within 90 ° (degrees), for example, 45 °, and COSθ is “0.5”. Thus, the value is closer to “1” than “0”.

On the other hand, FIG. 21 shows the flow direction (F) direction of the blood flow direction data of the femoral artery and the direction data of the indwelling needle 30 for blood transfer in FIG. It is the schematic which showed the indwelling needle 30 for blood sending in the same direction.
In the example of FIG. 21, the θ of the indwelling needle direction (N) and the blood flow direction (F) is more than 90 ° (degrees), for example, 135 °, and COSθ is “−0.5” and “0”. It becomes a numerical value closer to “−1”.

  Therefore, in ST11, the numerical values “0.5”, “−0.5”, and the like are stored in the inner product information storage unit 76.

Next, the process proceeds to ST12. In ST12, the “inner product information determination unit (program) 81” in FIG. 8 operates, “indwelling needle type information arrangement information storage unit 66” in FIG. 6, “inner product information storage unit 76” in FIG. The indwelling needle appropriate inner product information storage unit 82 "is referred to.
Among these, the indwelling needle appropriate inner product information storage unit 82 stores inner product information corresponding to the type of the indwelling needle. For example, in the case of the blood removal indwelling needle 20, since it is necessary to puncture along the direction of blood flow, the inner product information is stored as “0.5 to 1”, for example.
On the other hand, in the case of the indwelling needle 30 for blood transmission, since it is necessary to puncture in the direction opposite to the direction of blood flow, the inner product information is stored as “−0.5 to −1”, for example.

  Therefore, in ST12, the type of indwelling needle (such as the indwelling needle 20 for blood removal) is grasped from the indwelling needle type information arrangement information storage unit 66, the actual numerical value is grasped from the inner product information storage unit 76, and the indwelling needle appropriateness is further determined. By grasping the numerical reference information from the inner product information storage unit 82, it is possible to determine whether or not the direction of the indwelling needle is appropriate. The determination result is shown in FIG. Will be stored.

For example, the description in the example of FIG.
First, the indwelling needle type information arrangement information storage unit 66 in FIG. 6 stores that the indwelling needle is the blood removal indwelling needle 20.
Further, the inner product information storage unit in FIG. 7 stores that the inner product information is “0.5”. Further, in the indwelling needle appropriate inner product information storage unit 82 of FIG. 8, in the case of the blood removal indwelling needle 20, it is stored that the reference of the inner product information is “0.5 to 1”.

  Therefore, in the example of FIG. 18B, the inner product information determination unit (program) 81 determines that the placement direction of the indwelling needle is “appropriate”, and stores the determination result of the indwelling needle appropriateness determination result information. Store in the unit 83.

Next, the process proceeds to ST13. In ST13, the determination result of the indwelling needle appropriateness determination result information storage unit 83, for example, “appropriate” is displayed on the touch panel 51 of the controller 10 in the example of FIG.
If the result is not “appropriate”, the “alarm device 55” in FIG. 5 outputs an alarm together with a display indicating “not appropriate” to alert the person in charge and the like.

  Therefore, in the present embodiment, even if it is difficult to determine whether the orientation of the indwelling needle punctured by the person in charge or the like is appropriate, the appropriate degree is automatically determined and the person in charge is in charge. Therefore, even if it is an emergency, it is possible to quickly determine whether it is appropriate.

  By the way, the present invention is not limited to the above-described embodiment.

  DESCRIPTION OF SYMBOLS 1 ... Extracorporeal circulation apparatus, 2 ... Artificial lung, 3 ... Centrifugal pump, 4 ... Drive motor, 5 ... Vein side catheter (blood removal side catheter), 6 ... Arterial side catheter (Blood feeding side catheter), 7 ... Clamp, 10 ... Controller, 11 ... Blood removal tube, 12 ... Blood feeding tube, 14 ... Flow rate sensor, 20 ... Blood removal side placement Needle, 21 ... blood removal side indwelling needle main body, 22 ... blood removal side indwelling needle holding part, 30 ... blood sending side indwelling needle, 31 ... blood sending side indwelling needle main body, 32 ... Blood-sending-side indwelling needle holding part, 40 ... Ultrasonic measuring device, 41 ... Probe, 42 ... Measuring instrument control part, 43 ... Measuring instrument side communication device, 44 ... Measuring instrument main body, 45 ... Information input device, 46 ... Color Doppler unit (program), 47 ... Various measuring device side information storage unit DESCRIPTION OF SYMBOLS 51 ... Touch panel, 52 ... Controller control part, 53 ... Controller side communication apparatus, 54 ... Controller main body, 55 ... Alarm apparatus, 60 ... Controller side 1st various information storage part 61 ... Marker detection unit (program), 62 ... Marker graphic information storage unit, 63 ... Marker temporary storage unit, 64 ... Indwelling needle determination unit (program), 65 ... Marker array information Storage unit 66 ... Indwelling needle type information arrangement information storage unit, 70 ... Second various information storage unit on the controller side, 71 ... Blood flow information storage unit, 72 ... Indwelling needle arrangement direction determination unit (Program), 73 ... Indwelling needle direction information storage unit, 74 ... Indwelling needle and blood flow direction information display unit (program), 75 ... Inner product information generation unit (program), 76 ... Inner product information Memory , 80... Controller-side third various information storage unit, 81... Inner product information determination unit (program), 82... Indwelling needle appropriate inner product information storage unit, 83. 1R ... circulation circuit, P ... patient

Claims (4)

An extracorporeal circulation device for use with an indwelling needle having a marker that can detect the puncture direction by ultrasound,
An extracorporeal circulation management device for managing the extracorporeal circulation device;
The extracorporeal circulation management device is connected to an ultrasonic measurement device that measures the blood flow of the subject.
This ultrasonic measurement device emits and receives a plurality of ultrasonic waves into the blood flow of the subject, and generates blood flow direction information and puncture direction information of the indwelling needle from the difference information of these reflected sound waves. The extracorporeal circulation apparatus displaying the blood flow direction information and the puncture direction information on a display unit of the extracorporeal circulation management apparatus. The indwelling needle includes a blood removal side indwelling needle that is punctured in the direction of blood flow on the vein side of the subject and a blood feeding side that is punctured in the direction opposite to the blood flow on the artery side of the subject Including indwelling needles,
A plurality of the labeling parts that can be distinguished from the blood removal side indwelling needle and / or the other indwelling needle formed on the blood sending side indwelling needle punctured by the subject, and the labeling part that indicates the puncturing direction Information indicating whether the indwelling needle is the blood removal side indwelling needle or the blood sending side indwelling needle, the puncture direction information, and the blood flow direction information are simultaneously displayed on the display unit. The extracorporeal circulation device according to claim 1, wherein the extracorporeal circulation device is displayed. A plurality of the labeling portions that are distinguishable in appearance from the blood removal side indwelling needle and / or the other indwelling needle formed on the blood sending side indwelling needle punctured by the subject, the labeling unit indicating the puncturing direction, and Based on the blood flow direction information, puncture direction information and blood flow direction information of the blood removal side indwelling needle or blood supply side indwelling needle are generated, and vector information of the puncture direction information and blood flow direction information The inner product information from
The configuration according to claim 1 or 2, wherein appropriate information on the puncture direction of the blood removal side indwelling needle or the blood sending side indwelling needle is generated based on the inner product information. Extracorporeal circulation device. Used for extracorporeal circulation of the subject's blood,
There is a blood removal side indwelling needle that is punctured along the direction of blood flow on the vein side of the subject, and a blood supply side indwelling needle that is punctured along the direction opposite to the blood flow on the arterial side of the subject. And
The blood removal side indwelling needle and the blood sending side indwelling needle are each formed with a plurality of marker portions that can be distinguished from the other indwelling needles in appearance, and the marker portions indicate the respective puncture directions. An indwelling needle characterized by being arranged.

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