RU2407554C1 - Physiological autohemotransfusion unit with two peristaltic pumps - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, particularly to systems for blood sampling and purification to be redelivered to a body of the operated patient. A physiological autohemotransfusion unit with two peristaltic pump contains an evacuated cardiotomy reservoir, a replaceable container for blood separation in an autohemotransfusion apparatus, an erythrocyte storage capacitor used to collect and store erythrocytes to be delivered to the patient during the operation, a wound blood suction pipeline connected to an input of the evacuated cardiotomy reservoir, a filtered blood storage capacitor used to collect and store the filtered blood to be delivered to the patient during the operation, five manual plugs, as well as six junction lines. The first line connects the evacuated cardiotomy reservoir to the replaceable container for blood separation in the autohemotransfusion apparatus, with the integrated first elastic insert which is a flow element for the first peristaltic pump. The second pipeline connects the erythrocyte storage capacitor to the specified first line in front of the specified first elastic insert. The third line for erythrocyte redelivery to the patient is connected to the erythrocyte storage capacitor and supplied with the second elastic insert which is a flow element for the second peristaltic pump. The fourth line for anticoagulant supply is connected to the wound blood suction pipeline. The fifth line for irrigating solution supply is connected to the specified first line in front of the specified first elastic insert. The evacuated cardiotomy reservoir is supplied with an in-built wound blood filter. The sixth line connects the filtered blood storage capacitor to the first line between the specified first elastic insert and the replaceable container for blood separation in the autohemotransfusion apparatus. The first plug is mounted on the first line between the cardiotomy reservoir and the specified first elastic insert. The second plug is arranged on the second line. The third plug is arranged on the fifth line. The fourth plug is provided on the first line in front of the replaceable container for blood separation in the autohemotransfusion apparatus. The fifth plug is arranged on the sixth line.

EFFECT: reduced intraoperative donor blood consumption, optimum work load of the use autohemotransfusion apparatus depending on the operative conditions and ensured possibility of simultaneous filtered blood and separated erythrocyte redelivery to the patient.

5 cl, 5 dwg

Description

The invention relates to medical equipment, in particular to systems for the selection and purification of blood with their return to the body of the operated patient.

A cardinal problem in modern surgery is the replenishment of blood loss to the patient during surgery. As a rule, donor blood is used for this, which requires its large reserves. The limited supply of donated blood significantly reduces the possibility of surgical operations in extreme conditions. One of the solutions to this problem is autohemotransfusers that process wound blood, which allows you to return the selected blood components to the patient directly during the operation. In the autohemotransfuser, the blood processing tract is performed in the form of a separate replaceable circuit called the physiological unit, which is disposable and is replaced with a new one at each operation.

Known disposable physiological unit for separating blood into fractions containing a device for blood sampling, containers for storing physiological solutions, as well as containers for collecting red blood cells, white blood cells, platelets and blood plasma. The specified device for the selection of blood and containers are interconnected by flexible elastic tubes made of silicone. At the same time, in flexible tubes going to the corresponding nodes, for example, to a container or separator, there are insert tubes that are flow elements for peristaltic pumps pumping blood, isolated blood components and solutions (see USSR author's certificate No. 1599023 A1, A61M 1 / 34, 10/15/1990). This physiological unit is designed to work with a donor. However, it is not intended to work with the patient during surgery and cannot process wound blood. In addition, it is assembled by tightly connecting the free ends of the pipelines with containers and tees. Assembly of the block immediately before the operation significantly reduces its reliability.

Also known are physiological blocks for autohemotransfusers used in the treatment of wound blood, each of which solves the particular task of processing and returning wound blood to a patient during an operation.

In particular, a physiological block for an autohemotransfuser is known, which contains a vacuum cardiotomy reservoir, a container with an anticoagulating physiological solution, a container with washing solution, a container for storing filtered blood, a suction primary blood collection pipe connected to the inlet of a vacuum cardiotomy tank, and also connecting pipelines, including the first pipeline connecting the container with an anticoagulating saline solution with a suction tube a primary blood collection duct, a second pipeline with a filter installed in it, connecting the evacuated cardiotomy reservoir with an autohemotransfuser, in which the blood is purified from carbon dioxide, saturated with oxygen and heated, a third pipeline connecting the autohemotransfuser with a container for storing filtered blood, the fourth pipeline for returning blood to the patient, for example, through a dropper, and a fifth pipeline connecting the container with the wash solution to the autohemotransfuser (see US patent No. 5837140, 210/483, B01D 29/05, 11.17.1998). This device allows you to return wound blood to the patient, which reduces the flow of donated blood, but it does not allow you to divide the blood into components and return to the patient only those blood components, the return of which is necessary during a specific operation, and to remove those blood components whose return to the patient is undesirable, white blood cells.

Also known is a tract for treating wound blood in an autohemotransfuser described in RF patent No. 2284194 C1, A61M 1/38, 09/27/2006. The physiological unit for an autohemotransfuser contains an evacuated cardiotomy reservoir, a replaceable container for blood separation in an autohemotransfuser, an erythrocyte storage tank for collecting and storing red blood cells and delivering them to a patient during surgery, and a suction wound blood collection pipe connected to the inlet of a vacuum cardioma. In addition, the physiological unit also contains connecting pipelines, including a first pipeline connecting the evacuated cardiotomy reservoir with a removable container for separating blood in an autohemotransfuser, with the first elastic insert installed in it, which is a flow element for the first peristaltic pump, and a second pipeline connecting the storage erythrocyte container with the specified first pipe before the specified first elastic insert, the third pipe for return erythrocytes to a patient connected to an erythrocyte storage tank, equipped with a second elastic insert, which is a flow element for a second peristaltic pump, a fourth anticoagulation solution supply pipe connected to a wound blood suction pipe, and a fifth wash solution supply pipe connected to said first piping before said first elastic insert.

In the device according to this patent, it is possible to remove from the patient’s blood those components whose return to the patient is undesirable during this particular operation. At the same time, this patent provides for the effective return of red blood cells to the patient, as the most valuable part of the blood, directly during the operation. However, the use of this technical solution requires the use of donated blood in almost the same amounts as in conventional operations.

When equipping surgical centers with equipment, it is impossible to predict what type of blood treatment will be required during the operation, and, therefore, universal equipment is required that allows blood to be processed during the operation or to return wound blood to the patient. A simple combination of well-known technical solutions does not solve this problem, since it is necessary to coordinate the operation of the wound blood filtration chain and its return to the patient and the wound blood processing chain to components and the return of the selected blood components to the patient.

An object of the present invention is to develop a physiological block of an autohemotransfuser that provides treatment of wound blood and returns to the patient whole blood or isolated blood components. An additional objective of the invention is the creation of an effective and easy-to-use physiological unit for an autohemotransfuser, which provides the specified task.

The stated technical problems are solved by the fact that the physiological unit of the autohemotransfuser, which has two peristaltic pumps, contains an evacuated cardiotomy reservoir, a removable container for blood separation in the autohemotransfuser, an accumulative capacity for red blood cells, designed to collect and store red blood cells and issue them to the patient during the operation, which sucks the pipeline collection of wound blood connected to the input of the evacuated cardiotomy reservoir, as well as connecting pipelines, including e includes a first pipeline connecting the evacuated cardiotomy reservoir with a removable container for separating blood in an autohemotransfuser, with a first elastic insert installed therein, which is a flow element for the first peristaltic pump, a second pipeline connecting the erythrocyte storage tank with the first pipeline in front of the first elastic insert, the third pipeline for the return of red blood cells to the patient, connected to the storage capacity for red blood cells, equipped with the second elastic insert, which is a flow element for the second peristaltic pump, the fourth pipeline for supplying an anticoagulant solution connected to the suction pipe for collecting wound blood, and the fifth pipe for supplying a washing solution connected to the specified first pipe before the first elastic insert, according to the invention, is provided storage tank for filtered blood, designed to collect and store filtered blood and dispense it to the patient in the operation time, five manually controlled overlapping devices and the sixth pipeline, and the evacuated cardiotomy reservoir is equipped with a device for filtering wound blood installed inside it, while the sixth pipeline connects the storage tank for filtered blood with the first pipeline between the first elastic insert and a removable container for blood separation in the autohemotransfuser, wherein the first shutoff device is installed on the first pipeline between the cardiotomy res with a reservoir and said first elastic insert, a second shut-off device is installed on the second pipeline, a third shut-off device is installed on the fifth pipeline, a fourth shut-off device is installed on the first pipeline in front of the removable blood separation container in the autohemotransfuser, and the fifth shut-off device is installed on the sixth pipeline.

The physiological unit can be equipped with a seventh pipeline connected to the storage tank for filtered blood, while the seventh pipeline can be equipped with means for connecting the injector or the injector itself to return the filtered blood to the patient.

Preferably, a wound blood filtering device is installed in the upper part of the cardiotomy reservoir, and the first conduit is connected to the lower part of the cardiotomy reservoir.

In addition, the physiological unit can be equipped with an additional waste collection tank and an eighth pipeline connecting the waste collection tank with a removable blood separation container in the autohemotransfuser, and a manually controlled shut-off device installed in this pipeline.

Providing the physiological unit with a storage tank for filtered blood, designed to collect and store filtered blood and dispense it to the patient during surgery, and the sixth pipeline, with the indicated piping connection scheme, provides an additional function of collecting wound blood filtered in a cardiotomy reservoir and the possibility of returning it directly to the patient during the operation, and the choice of return mode: to return the whole blood or the selected blood components immediately prior to surgery or during surgery. Depending on the mode of operation, the overlapping devices of the autohemotransfuser are turned off, either if the whole blood is returned to the patient, and the possibility of pumping blood to the erythrocyte container is excluded, or the sixth pipeline, excluding the possibility of pumping red blood cells to the filtered blood tank. At the same time, supplying the physiological block with five manually controlled shut-off devices, for example, clamps, with the indicated arrangement of them on the pipelines, allows the use of this physiological block in autohemotransfusers that do not have their own shut-off devices or have an insufficient number of shut-off devices.

The supply of the physiological block with the seventh pipeline connected to the storage tank for filtered blood, as well as the supply of the seventh pipeline with the means for connecting the injector or the injector itself to return the filtered blood to the patient, allows in urgent situations, for example, in the field, and, in case of emergency, an immediate maximum replenish blood loss to the patient, use all resources (accumulated red blood cells and filtered wound blood), while the losses are replenished to JVI by volume - Returns the filtered wound blood loss and maximum replenishment erythrocytes providing nutrition of oxygen. The compatibility of the returned blood and red blood cells with the patient’s blood is ensured automatically.

The installation of a device for filtering wound blood in the upper part of the cardiotomy reservoir, while the first pipeline is connected to the lower part of the cardiotomy reservoir, provides a more rational scheme for filtering wound blood.

The technical result from the use of this invention is to reduce the need for donated blood during surgery, in the optimal use of an autohemotransfuser, depending on the conditions of the operation and the possibility of simultaneous return to the patient of filtered blood and separated red blood cells.

Figure 1 shows a diagram of a physiological block of autohemotransfusers having their own pipeline shut-off devices and their own waste disposal path; figure 2 - design of an evacuated cardiotomy reservoir; figure 3 is a diagram of a physiological unit with manually controlled shut-off devices, for example, clamps, in relation to autohemotransfusers equipped with their own waste disposal path; 4 is a diagram of a physiological unit with manually controlled shut-off devices and a waste collection tank; figure 5 is a diagram of the use of a physiological block. The same functional elements in all the drawings are denoted by the same positions.

The physiological unit for the autohemotransfuser in the first configuration (Fig. 1) contains an evacuated cardiotomy reservoir 1, a removable container 2 for blood separation in the autohemotransfuser, an accumulation tank 3 for red blood cells, designed to collect and store red blood cells and give them to the patient during surgery, a storage tank 4 for filtered blood, designed to collect and store filtered blood and give it to the patient during the operation, the suction pipe 5 connected to the input 6 of the evacuated car diotomy reservoir 1, having at its end a device 7 for suctioning wound blood from the area of operation, and connecting pipelines.

Connecting pipelines include:

a first pipe 8 connected to the lower part of the cardiotomy reservoir 1 and connecting this reservoir to a removable container 2 for separating blood in an autohemotransfuser, with a first elastic insert 9 installed therein, which is a flow element for the first peristaltic pump 10 of an autohemotransfuser;

a second pipe 11 connecting the storage capacity 3 for red blood cells with the first pipe 8 before the first elastic insert 9;

a third conduit 12 connected to an erythrocyte storage tank 3, provided with a second elastic insert 13, which is a flow element for the second peristaltic pump 14, and means 15 for connecting the injector or the injector itself to return the red blood cells to the patient;

a fourth conduit 16 for supplying an anticoagulating solution connected to a suction line 5 for collecting wound blood, having at its end means 17 for connecting an injector or the injector itself for connecting to a container with an anticoagulating solution (not shown in FIG. 1);

the fifth pipe 18 for supplying a washing solution connected to the first pipe 8 in front of the first elastic insert 9 and having at least one means 19 for connecting the injector or the injector itself for connecting to the tank with the washing solution (in FIG. shown);

the sixth pipe 20 connecting the storage tank 4 for filtered blood with the first pipe 8 between the first elastic insert 9 and a removable container 2 for separating blood in an autohemotransfuser.

Figure 1 also shows the seventh conduit 21 connected to the storage tank 4 for filtered blood and equipped with means 22 for connecting the injector or the injector itself to return the filtered blood to the patient. This pipeline may not be included in the basic package of the physiological unit, since in most cases similar pipelines available in the operating rooms will be used.

The physiological unit in the first configuration involves its use in autohemotransfusers equipped with their own automatically controlled shut-off devices shown in figure 1 squares (without positions), as is done in the autohemotransfuser according to the patent of the Russian Federation No. 2284194.

Vacuum cardiotomy reservoir 1, shown in figure 2, is made in the form of a glass 23 with a cover 24. The bottom 25 of the glass 23 is made of a convex conical shape. Inside the tank 1, in its upper part, there is a device 26 for filtering wound blood connected to the lid 24, including a filtering element 27 made in the form of a bag. The cover 24 of the glass 23 is equipped with an inlet pipe 6 for supplying wound blood to the filtering device 26 and a pipe 28 for connecting an autohemotransfuser to the vacuum system.

The physiological unit for the autohemotransfuser in the second configuration, shown in figure 3, contains the same functional elements (positions 1-22) as in figure 1, and differs from it only by the presence of five manually controlled overlapping devices, for example, clamps (position 29-33). Therefore, to simplify the description of the elements from the first to the twenty second is not given.

The first shut-off device 29 is installed on the first pipe between the cardiotomy reservoir 1 and the first elastic insert 9, the second shut-off device 30 is installed on the second pipe 11, the third shut-off device 31 is installed on the fifth pipe 18, and the fourth shut-off device 32 is installed on the first pipe 8 in front of the removable container 2 for blood separation in an autohemotransfuser, and the fifth shutoff device 33 is installed on the sixth pipeline 20.

The described physiological unit is only a particular example of the implementation of the present invention, since the physiological unit may vary depending on the design of the autohemotransfuser and its technological capabilities.

The physiological unit for a fully equipped autohemotransfuser, shown in Fig. 4, contains the same functional elements (positions 1-22 and 29-33) as in Figs. 1 and 3, and differs from them by the presence of an additional waste collection tank 34 , the eighth pipeline 35 connecting the waste collection container 34 to a removable blood separation container 2 in an autohemotransfuser, and a manually controlled shut-off device 36 installed in the pipeline 35.

On the pipeline for supplying an anticoagulating solution, the pipeline for returning red blood cells to the patient, the pipeline for returning the filtered blood to the patient, and the pipeline for supplying the washing solution, any equipment that is used in normal practice during operations and for blood transfusion to the patient — filters, droppers, clamps, etc. (not shown in the drawing). Couplings can be used as means for connecting injectors, and known shut-off devices made of polymeric materials, the construction of which is shown, in particular, in the description of the invention according to US patent No. 5634893, can be used as hand-operated shutoff devices.

The physiological unit is supplied by the manufacturer as a fully assembled stand-alone device, sterilized and packaged in a sealed bag, i.e. fully prepared for use, and removed from the packaging immediately before the operation.

In preparation for the operation, the circuit shown in figure 5 is assembled. In addition to the elements shown in figures 1-4, which are directly part of the physiological unit supplied by the manufacturer, a container 37 with an anticoagulating physiological solution (for example, heparin) and at least one container 38 with washing solution are attached to the physiological block.

The first elastic insert 9 in the first pipe 8 is inserted into the first peristaltic pump 10 of the auto-transfuser, the second elastic insert 13 in the third pipe 12 is inserted into the second peristaltic pump 14 of the auto-transfuser, the replaceable container 2 is fixed in the auto-transfuser. The cardiotomy reservoir 1 is connected to the vacuum system of the autohemotransfuser and a vacuum is created in it, which is maintained throughout the operation. The physiological unit is ready for use.

The following describes the procedure for using the physiological unit, assuming that it is equipped with manually controlled overlapping devices.

In the erythrocyte separation mode, the shutoff devices 29 and 32 in the pipeline 8 and the shutoff device 36 in the pipeline 35 are open, the remaining shutoff devices 30, 31 and 33 are closed. Wound blood is aspirated through pipeline 5 to the cardiotomy reservoir 1. In the aspiration pipeline 5, an anticoagulant solution is added to it from the reservoir 37. In the cardiotomy reservoir 1, wound blood is filtered, and the filtered blood flows into the lower part of the cardiotomy reservoir and then is transferred by the first peristaltic pump through pipeline 8 10 into a removable container 2, in which erythrocytes are separated by centrifugal forces, and the remaining part of the blood is discharged through a pipe 35 to a waste tank 34 s. During the separation, the number of red blood cells accumulated in the removable container 2 is monitored. According to the accumulation of the erythrocyte portion, the valve - shut-off device 29 is closed, the shut-off device 31 is opened, and the washing solution is supplied from the container 38 to the peristaltic pump 10 and the removable container 2. , the overlapping device 30 opens and the washed (clean) red blood cells by the first peristaltic pump 10 are pumped into the storage tank 3 for red blood cells. After which the cycle repeats. As necessary, the red blood cells from the storage tank 3 are returned through the pipe 12 through the means 15 to the patient using the second peristaltic pump 14. The overlap device 30 is closed. Red blood cell pumping to the patient does not interfere with the work of cleaning and separation of wound blood.

In the return mode of the filtered blood, the shutoff device 29 in the pipeline 8 and the shutoff device 33 in the pipe 20 are open, the remaining shutoff devices 30, 31, 32 and 36 are closed. Wound blood is aspirated through pipeline 5 to the cardiotomy reservoir 1. In the aspiration pipeline 5, an anticoagulant solution is added to it from the reservoir 37. In the cardiotomy reservoir 1, wound blood is filtered, and the filtered blood enters the lower part of the cardiotomy reservoir and then is pumped by the first peristaltic pump 10 through the pipeline 20 into the storage tank 4 for filtered blood, from where it is returned to the patient through the pipe 21 through the device 22. When working in the return mode of filtered blood, the separation of red blood cells is impossible.

The proposed invention allows to implement another mode of operation, during which the patient can simultaneously return the filtered wound blood, i.e. wound blood collected directly at a given point in time, and previously accumulated separated red blood cells. When operating in this mode, the shut-off device 29 in the pipeline 8 and the shut-off device 33 in the pipeline 20 are opened, which ensure the return of the filtered wound blood, and the shut-off devices 30, 31 and 36 are closed. In this mode, the blood filtered in the cardiotomy reservoir through the means 22 is returned to the patient and at the same time, the accumulated red blood cells are returned to the patient through means 15. Such a simultaneous return to the patient of filtered blood and red blood cells can be very important in critical situations, when donor blood plasma is additionally used in large doses to make up for blood loss.

The claimed physiological unit can be manufactured industrially using known, blood-compatible materials. The implementation of elastic inserts, which are flow elements for peristaltic pumps, is not difficult for specialists. Inserts for peristaltic pumps are, as a rule, in the form of elastic tubes equipped with known elements for tight connection with the tubes of the physiological unit, for example, in the form of fittings. Such elastic tube inserts are shown, in particular, in a device for separating blood into fractions, according to the copyright certificate SU 1599023.

Claims (5)

1. The physiological unit of an autohemotransfuser having two peristaltic pumps, containing a vacuum cardiotomy reservoir, a replaceable container for blood separation in an autohemotransfuser, an erythrocyte storage tank designed to collect and store red blood cells and dispense them to a patient during surgery, a suction wound blood collection pipe connected to to the inlet of the evacuated cardiotomy reservoir, as well as connecting pipelines, including the first pipeline connecting the vacuum a removable cardiotomy reservoir with a replaceable container for blood separation in an autohemotransfuser, with a first elastic insert installed in it, which is a flow element for the first peristaltic pump, a second pipeline connecting the erythrocyte storage tank with the first pipeline in front of the first elastic insert, the third pipeline for return red blood cells to a patient connected to an erythrocyte storage tank equipped with a second elastic insert, which is flow-through an element for a second peristaltic pump, a fourth pipeline for supplying an anticoagulant solution connected to a suction pipe for collecting wound blood, and a fifth pipe for supplying a washing solution connected to said first pipe before said first elastic insert, characterized in that it is provided with a storage tank for filtered blood designed to collect and store filtered blood and dispense it to the patient during surgery, five manually controlled shut-off devices and a sixth pipeline, and the evacuated cardiotomy reservoir is equipped with a device for filtering wound blood installed inside it, while the sixth pipeline connects the storage tank for filtered blood with the first pipeline between the specified first elastic insert and a removable container for blood separation in the autohemotransfuser, the first a shut-off device is installed on the first pipe between the cardiotomy reservoir and said first elastic insert minutes, the second shut-off device is mounted on the second conduit, a third shut-off device is mounted on the fifth conduit, the fourth shut-off device is installed on the first line before the replaceable container for blood separation in autogemotransfuzere, and the fifth shut-off device is installed at the sixth pipeline. 2. The block according to claim 1, characterized in that it is equipped with a seventh pipeline connected to a storage tank for filtered blood. 3. The block according to claim 2, characterized in that the seventh pipeline is equipped with means for connecting the injector or the injector itself to return the filtered blood to the patient. 4. The block according to claim 1, characterized in that the device for filtering wound blood is installed in the upper part of the cardiotomy reservoir, and the first pipeline is connected to the lower part of the cardiotomy reservoir. 5. The block according to claim 1, characterized in that it is equipped with an additional waste collection container and an eighth pipeline connecting the waste collection container with a removable blood separation container in the autohemotransfuser, and a manually controlled shut-off device installed in this pipeline.

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