RU2364423C1 - Two-way transmembrane drainage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to surgery, and can be used for debridement of purulent wounds and cavities, and for prevention and treatment of purulent-septic complications following operative interventions or wounds. A two-way transmembrane drainage accommodates a membrane capsule comprising a tubular perforated microirrigator encased in the cavity of a semipermeable membrane. The proximal part of the capsule approaches a dialysis fluid vessel through said microirrigator. The distal part of the capsule is connected to a dialysate discharge vessel through the microirrigator which represents two interrelated dropping systems without injection needles. A reversible two-clamped suction tube is used for complementary connection of the two vessels. Said tube along with the microirrigator passes through paired sleeves of the membrane capsule. Besides, the vessels are joined with paired metal needles with their ends advanced through rubber stoppers of both vessels and are supplied with paired air bleeds with air vents in the bottom.

EFFECT: ensuring high-quality energy-saving active dialysis, eliminating application of complicated, bulky active dialysis apparatuses, simplifying and reducing the cost of transmembrane dialysis technology.

2 cl, 1 dwg

Description

The invention relates to medicine, in particular to surgery, and can be used for sanitation of purulent wounds and cavities, as well as for the prevention and treatment of purulent-septic complications after surgical interventions or wounds.

The known method / Application No. 2003104838, class. A61K 31/722, BIPM No. 26, 09/20/2004 / wound membrane dialysis of purulent-inflammatory diseases, using a membrane capsule with a medicinal composition and a tubular microirrigator to replace spent dialysate, 1/3 filled with a highly osmotic 15% solution of chitosan ascorbate with a molecular weight of 15 ^± 5 kDa and a degree of deacetylation of at least 96%. However, this method does not provide constant circulation and change of intracapsular contents, which reduces the effect of exposure to drugs and contributes to the accumulation of toxins inside the membrane capsule.

A device for treating eyes is known / RF Patent No. 2163109, class. A61F 9/00, BIPM No. 5, February 20, 2001 /, including a cap, the inner side of which is covered with an elastic semi-permeable membrane, the edges of which are tightly fixed to the cap, made in the form of a segment of a ball with a system of fittings for supplying the dialysis solution from the container and its Leads from the exchange chamber. However, this device, despite the constant change of the dialysis solution, does not provide its active circulation and removal from the exchange chamber. In addition, this transmembrane dialyzer is intended only for extraocular treatment of ocular pathology.

Closest to the proposed principle of action is the method / Application No. 2003109101, class. A 61K 31/79, BIPM No. 27, September 27, 2004 / for flow-through membrane dialysis of purulent wounds using a device consisting of a membrane capsule including a tubular microirrigator with perforations, the proximal part of which is fed through a microirrigator to a peristaltic two-channel pump for active administration dialysate from the vessel with the dialysate solution, and the distal section is connected with the microirrigator to the second channel of the pump for constant aspiration and spent dialysate into the collection vessel. However, this device requires the connection of a peristaltic two-channel pump, which is technically complex, volatile, bulky and expensive.

The objective of the proposed is to simplify the technology of transmembrane dialysis, which eliminates energy consumption while maintaining the active work of the dialysate inside the membrane capsule and eliminates additional manipulations during the operation and maintenance of drainage systems.

The problem is solved due to the fact that two interconnected systems for droppers without injection needles are used as a microirrigator, and both vessels are additionally connected to each other by means of a reversible-suction tube with two clamps passing together with the microirrigator through paired fittings of the membrane capsule, and paired metal needles, the ends of which are drawn through the rubber plugs of both vessels and are equipped with paired air ducts with air holes in the base, and some of them are reversed-suction The second tube passing through the membrane capsule is equipped with microholes, an order of magnitude smaller than those located on the microirrigator.

Reversible transmembrane drainage, the design of which is shown in the drawing, includes: 1a, 1b - paired vessels from under the infusion solutions; 2a, 2b - paired rubber plugs; 3a, 3b - paired air ducts; 4a, 4b - paired air holes; 5a, 5b - paired metal needles; 6a, 6b - paired plastic infusion needles; 7a, 7b - paired air valves; 8a, 8b - paired droppers; 9 - microirrigator; 10a, 10b - paired water clamps; 11 - reverse suction tube; 12a, 12b - paired suction clamps; 13a, 13b - twin fittings; 14 - membrane capsule; 15a - perforation holes; 15b - micro holes.

To assemble this design, it is necessary to connect the paired vessels from under the infusion solutions (1a, 1b) using a reversible suction tube (11) with 2 suction clamps (12a, 12b) and metal needles (5a, 5b) at the ends, which rubber plugs are perforated (2a, 2b), as well as using 2 interconnected dropper systems forming a microirrigator (9) with 2 water clamps (10a, 10b), passing from both ends into droppers (8a, 8b) ) equipped with plastic infusion needles (6a, 6b) with air valves (7a, 7b). On the inner side of the rubber plugs (2a, 2b), air ducts (3a, 3b) with air holes (4a, 4b) are put on the ends of the metal needles (5a, 5b) in the base. The microirrigator (9) and the reversed-suction tube (11) are fixed together on both sides of the wound cavity (17) using paired fittings (13a, 13b), onto which the membrane capsule (14) is pre-fixed with threads. Throughout the cavity of the membrane capsule (14), the micro-irrigator (9) is provided with a lot of perforation holes (15a), and the reverse-suction tube (11) with a relatively small number of micro-holes (15b). Paired water (10a, 10b) and suction (12a, 12b) clamps are installed on 2 sides of the wound cavity (17). After assembly of the structure, one of the vessels (1a or 1b) is filled with a dialysis solution (solutions of antibiotics, antiseptics, polyionic solutions, etc.) and fixed on a stand (16) above the level of the wound cavity (17), and the other is placed on the floor or suspended a bed below the wound cavity (17).

The proposed drainage works as follows. Under the influence of gravity, the dialysis solution enters from the upper vessel (1a) into the lower (1b) via a micro-irrigator (9) and fills the membrane capsule (14) along the way, leaving through the perforations (15a). In this case, a rarefied space appears in the upper vessel (1a) due to a constant drop in the liquid level, and in the lower vessel (16) due to an increase in the volume of the liquid, there is a zone of increased air pressure, the only exit point of which after the end of the duct (36) is immersed in the dialysate, filling the lower vessel (16), there is a small air hole (46) at its base, through which air rushes into the upper vessel (1a), dragging the dialysis solution from the lower vessel (16). The dialysate solution, on which the suction force acts from the side of the upper vessel (1a), and the gas pressure force from the lower side (16), rises through the air duct (36) and moves with air layers upward through the reversing-suction tube (11), creating counterflow to the downward flow of fluid. Passing through the membrane capsule (14), the liquid and air intermittently and alternately exert a pressing and pulling effect on the dialysate in its cavity through the microholes (15b) in the suction tube (11), making microoscillatory movements of the dialysate solution inside the capsule (14) and creating the effect of microperistaltic a pump providing active transport of the dialysate solution through micropores in a semipermeable membrane into the wound cavity (17) and high reverse clearance of low- and medium-molecular toxins. Having reached the upper vessel (1a) via an aspiration tube (11), a dialysate with air layers rises through the air duct (3a) above the liquid level and leaves a fountain at its end, partially replenishing its amount inside the vessel (1a). During the operation of reverse transmembrane drainage, from 10 to 40% of the dialysate is returned to the upper tank (1a), which depends on the size of the air holes (4a, 4b) at the base of the paired air ducts (3a, 3b). It is necessary to use a wider reverse micro-irrigator (9), a reverse-suction tube (11) with a thicker lumen, and provide it with openings (15b), which are an order of magnitude smaller than those (15a) located on the micro-irrigator (9), in order to prevent overflow of the reverse-suction tube (11) with a dialysate solution, which prevents the dialysate upflow with air. After emptying the upper vessel (1a), the system, without dismantling, is turned over, installing the filled lower vessel (16) on the rack (16), and the upper (1a) below the level of the wound cavity (17), after which the operation cycle is repeated again. In this case, before replacing the dialysis solution, one to several cycles of drainage can be carried out. For clarity, the description of the operation of reverse transmembrane drainage will leave the designation of paired parts in the position shown in the drawing, although as they work they change exactly the opposite. After assembling the structure and linking it with the wound cavity (17), it is necessary to check the closure of all clamps (10a, 10b and 12a, 12b), and then fix the vessel (1a) with the dialysate on the rack (16). Having prepared the system for operation, to start it, first you need to open, to varying degrees, the paired water clamps (10a, 10b) of the micro-irrigator (9), making the outflow from the membrane capsule (14) somewhat less than the inflow for varying degrees of its filling with the dialysate solution, and then open both suction clamps (12a, 12b), connecting the vessels (1a, 1b) into a single vacuum space.

The rate of inflow and outflow of the dialysis solution from the membrane capsule (14) can be determined by paired droppers (8a, 8b) using paired water clamps (10a, 10b). By adjusting the gaps of the reversed-suction tube (11) relative to each other on opposite sides of the wound cavity (17), it is possible to control the ratio of pressure and suction of dialysate in the membrane capsule (14) with an upward gas-liquid flow using suction clamps (12a, 12b), controlling membrane exchange vector. To safely control the movement of the dialysate solution with air through the reversible-suction tube (11), it is desirable to carry out both suction clamps (12a, 12b) closer to the wound cavity (17) in order to avoid filling the reversible-suction tube (11) with the dialysis solution from the membrane capsule (14) ), stopping the system in case of difficulties in the movement of the upward flow of liquid and gas or in the case of improper operation of the drainage. If necessary, you can switch the drain to idle by opening the paired air valves (7a, 7b) located on the plastic infusion needles (6a, 6b), and thus ensure air through the upper valve (7a) to the upper vessel (1a) and air outlet from the lower vessel (16) to the atmosphere through the lower valve (7b), turning the reverse suction tube (11) out of operation.

The principle of operation of reverse transmembrane drainage is based on the intermittent, multidirectional effect of the upward flow of dialysate and air on the dialysis solution inside the membrane capsule, which occurs when rarefaction occurs as a result of a drop in the level of dialysis fluid in the upper vessel passing through the cavity of the membrane capsule and displacing air from the lower vessel upon receipt into it.

Dialysis is performed to stop the effects of endotoxemia, to reduce the risk of purulent-septic complications, as well as to shorten the duration of treatment and reduce mortality after surgery or wounds.

The advantages of the proposed are: complete non-volatility in combination with the activity of the dialyzer; no need to use complex, bulky devices for vigorous dialysis; technical simplicity and low cost of construction.

Claims (2)

1. Reversible transmembrane drainage, consisting of a membrane capsule comprising a tubular microirrigator with perforations, enclosed in a cavity of a semi-permeable membrane, characterized in that the proximal part of the capsule is connected through a microirrigator to a dialysis solution vessel, and the distal section is connected with a microirrigator to a vessel for spent dialysate, while as a microirrigator use two interconnected systems for droppers without injection needles, and both vessels are They are carefully interconnected by means of a reversing-suction tube with two clamps passing together with a microirrigator through paired fittings of the membrane capsule and paired metal needles, the ends of which are drawn through the rubber plugs of both vessels and equipped with paired air ducts with air holes in the base. 2. Reversible transmembrane drainage according to claim 1, characterized in that the part of the reversed-suction tube passing through the membrane capsule is provided with holes that are an order of magnitude smaller than those located on the microirrigator.

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