RU69752U1 - DEVICE FOR DIALYSIS (PERFUSION) - Google Patents

Abstract

The utility model relates to medical equipment and can be used in hospitals and on an outpatient basis for dialysis (perfusion) in patients undergoing surgery to isolate the loop of the small intestine as an artificial biological kidney. The technical result consists in the implementation of a portable portable device that allows patients who have undergone surgery to isolate the loop of the small intestine as an artificial biological kidney, to independently conduct dialysis at a household level, as well as eliminating uncontrolled stretching of the wall of the intestinal loop during dialysis. The claimed technical result is achieved due to the fact that the device for conducting dialysis, connected via tubes to an isolated intestinal loop, containing a pump, a container with a dialysis solution, is characterized in that it additionally contains a filter, the container has inlet and outlet openings to which the tubes are connected whose function is to divert from the container to the intestinal loop and drain from the intestinal loop into the filter of the dialysis solution.

Description

Application area

The utility model relates to medical equipment and can be used in hospitals and on an outpatient basis for dialysis (perfusion) in patients undergoing surgery to isolate the loop of the small intestine as an artificial biological kidney.

State of the art

According to medical statistics in the Russian Federation, about 150 thousand patients need treatment for the terminal stage of renal failure, and about 5 million in the world.

In Russia, hemodialysis using an artificial kidney is available only to less than 5% of those who need it. These are mainly patients living in the largest cities of Russia, and the remaining patients die. Patients living at the expense of an artificial kidney are constantly attached to a medical institution. Three hemodialysis per week for 5-6 hours makes their life unbearably difficult.

Despite numerous complications when using an artificial kidney: sepsis, septic endocarditis with damage to the heart valves, hemolysis, thrombosis of arteriovenous fistula with possible thromboembolism in the pulmonary artery, fistula aneurysms, congestion of the right half of the heart due to continuous discharge of arterial blood into a vein, loss of fibrin, numerous bone damage, etc., yet hemodialysis remains the most effective way to replace the lost kidney function of the existing ones. Under his protection, you can wait for the donor kidney. However, a transplanted kidney may not take root, and if it does take root, the constant intake of immunosuppressants will lead to a decrease in the body's resistance to infection and the patient may die from a banal pneumonia. So, donor kidney transplantation until the complete resolution of tissue incompatibility is not a panacea in the treatment of patients with end-stage renal failure.

There is also peritoneal dialysis. He, like hemodialysis, is carried out strictly

sterile conditions. Failure to comply with this rule can lead to such a formidable complication as peritonitis, which in the age of antibiotics in 20-25% of cases ends fatally. It is less effective and requires longer dialysis (for 8-9 hours 3-4 times a week). This method is more often used in children and young people, in whom, due to the small diameter of the vessels of the limbs, it is impossible to create an arteriovenous fistula to connect to an artificial kidney.

The methods described above for purifying blood from nitrogenous slag sometimes tie patients to specialized medical institutions for life and make their travel abroad impossible.

For more than 60 years, a method has been known to cleanse the body of nitrogenous slag by washing the small intestines with a dialysis fluid (intestinal dialysis). Among the known solutions, mention should be made of the patent KR 9602848, which describes the compositions for conducting intestinal dialysis, and the patent EG 22643, which describes the device of catheters for intestinal dialysis. A double-lumen probe is inserted through the mouth or nose into the stomach, and then under the control of an x-ray it is displaced into the small intestines. Using one channel of the probe moderately inflate the spray can. It enhances the intestinal motility, and the probe moves further, and when its end is 40 cm from the pylorus, dialysis hypertonic solution in an amount of up to 15 liters is introduced into the jejunum. The solution introduced in this way is excreted from the body along with chyme and feces naturally. Washing of the intestine in this way 3-4 times a week in the morning on an empty stomach in the intensity of excretion of urea and creatinine from the body, according to some authors, is only slightly inferior to peritoneal dialysis.

The described method is very painful and not applicable in young children and in weakened elderly patients suffering from cardiovascular diseases. With this method, the villi of the small intestines are not washed off sufficiently from mucus and chyme, which reduces the effectiveness of the method.

The introduction of a large amount of dialysis fluid into the intestines, especially in hypersthenics, leads to an increase in pressure in the abdominal cavity and, as a result, to a significant increase in the diaphragm and a decrease in the internal volume of the chest. This leads to respiratory failure and a displacement of the heart upward with an excess of the pulmonary artery and ascending aorta.

This method of intestinal dialysis, like hemodialysis, attaches the patient to the hospital for the rest of his life. He can’t leave home for more than 1-2 days,

for example, to a country house or to another city to visit relatives. His life becomes monotonous, painful and boring. Young people are particularly affected.

However, the described method for purifying the body’s liquid medium from nitrogenous slags, unlike hemodialysis and peritoneal dialysis, does not require sterility. And if we could save patients from overfilling the intestines with a huge amount of fluid and conduct a session in a medical institution under the control of X-rays, and even save the patient from ejecting from the body 4 times a week a significant part of nutrients and intestinal enzymes, then intestinal dialysis would create competition as hemodialysis, and peritenial dialysis.

The most advanced and gentle method (patent RU 2300395, А61М 1/14, 2005.08.19) for the METHOD OF APPLICATION OF THE ISOLATED HINGE OF THE THIN INTESTINE AS AN ARTIFICIAL BIOLOGICAL KIDNEY is based on washing not all intestines with a dialysis solution, but only of limited length, isolated from the main part gut surgery.

The method allows to exclude the patient’s dependence on attachment to a medical institution and is available for a wide range of patients requiring treatment of end-stage renal failure.

The method is based on the fact that a loop of the small intestine is isolated and cut off with a length not exceeding 1/3 of the entire length of the small intestine. Both ends of the isolated loop lead to the anterior abdominal wall. Conduct dialysis through an isolated loop of the intestine. Dialysis solution is pumped into the central end of the loop. In this case, the dialysis solution flows from the peripheral end of the loop into the container with the dialysis solution. In a particular case, the perfusion time is from 2 to 6 hours. The dialysis compound is packaged based on its dissolution in 5, 10, 20 liters of water. After a dialysis session, both fistulas are connected by a tube-plug. In the intervals between the sessions, the isolated loop is fed with food additives similar in composition to the chyme. The method allows to exclude the patient’s dependence on attachment to a medical institution and is available for a wide range of patients requiring treatment of end-stage renal failure.

This method is selected as the closest analogue.

The disadvantage of this method is that it does not describe a device that would allow dialysis at the household level to each patient who underwent surgery for

the above method.

Another disadvantage of this method is the uncontrolled extension of the wall of the intestinal loop, which is the triggering and supporting irritant of bowel movement, which can lead to inversion of the functioning intestines.

The purpose of this utility model is to create such a device that would allow to solve this problem and eliminate the disadvantages of the analogue.

The technical result of this model is the implementation of a portable portable device that allows patients who undergo surgery to isolate the loop of the small intestine as an artificial biological kidney to independently conduct dialysis at a household level, as well as eliminating uncontrolled stretching of the wall of the intestinal loop during dialysis.

Brief Description of the Drawings

Figure 1 shows the design of the device, where 1 is the container, 2 is the support rod of variable length, 3 is the clamp, 4 is the filter, 5 is the thermostat, 6 is the electrothermometer, 7 is the water bath, 8 is the elastic tube for insertion into the intestinal loop - the exit stream from the intestinal loop, 9 - an elastic tube for insertion into the intestinal loop - the incoming stream into the intestinal loop, 10 - inflatable cuffs.

Figure 2 shows the design of the water bath (top view), where 11 is the inlet tube, 12 is the outlet tube, 13 is the cover is 2, 14 is the cover is 1, 15 is the power wire of the heating element, 16 is the heater.

Figure 3 shows the design of the water bath (internal device is a top view with ajar lid 1), where 17 is an electric mixer.

Figure 4 shows the design of the water bath (the internal device is a top view with the covers 1 and 2 open), where 18 is the pump, 19 is the bath 1, 20 is the bath 2.

Figure 5 shows the structural device of the filter, where 21 is the container, 22 is the outlet, 23 is the filter element, 24 is the cover, 25 is the nozzle on the filter element with the inlet.

Figure 6 shows the structural device of the filter element, where 26 is a mesh elastic plate, 27 is a kapron stocking, 28 is a locking element, 29 is a fixing element.

Device essence

The claimed technical result is achieved due to the fact that the device for conducting dialysis, connected via tubes to an isolated intestinal loop, containing a pump, a container with a dialysis solution, is characterized in that it additionally contains a filter, the container has inlet and outlet openings to which the tubes are connected whose function is to divert from the container to the intestinal loop and drain from the intestinal loop into the filter of the dialysis solution. Each of the tubes is made elastic and at its end, fed to the intestinal loop, there is an inflatable cuff.

The device comprises a support rod of variable length, the function of which is to install a container on it.

Capacity is calibrated by volume.

The device contains an additional container consisting of two plastic baths, the function of one of which is filling with water, and the other is filling with a dialysis solution.

In the bath, the function of which is to fill with water, there is an electric mixer, as well as a heating element, the power supply to which is connected through a thermostat, and in the bath, the function of which is to fill with a dialysis solution, a pump (pump) is installed and an electrothermometer or temperature sensor is connected.

The filter is reusable and contains a container configured to fill / remove an absorbent substance.

To exclude uncontrolled stretching of the wall of the intestinal loop, which is the triggering and supporting irritant of bowel movement, which can lead to an inversion of functioning intestines, the dialysis solution from the water bath, the pump does not immediately go into the intestinal loop, but first fills the container (1) (see Figure 1 ) located above the level of the intestinal loop, the height of which can be adjusted using the support rod (2) and from there it enters the intestinal loop in laminar mode.

The water bath (7) contains a plastic bath - 1 (19) (see FIG. 2, FIG. 3, FIG. 4), filled with water, into which a smaller plastic bath - 2 (20) is inserted, filled with a dialysis solution.

In the bath - 1 (19) there is a heating element (16), which can be mounted on the lid - 1 (13) and can be made, for example, in the form of a portable electric heater-boiler. The heating element (16) is designed to heat the water in the bath - 1 (19) and thereby to heat the dialysis solution in the bath - 2 (20).

The temperature regulator (5) is designed to maintain the temperature of the water in the bath - 1 in a certain temperature range, due to the automatic switching on and off of the heating element (16).

The electric mixer (17) is located in the bath - 1 (19) and is used for intensive mixing of water, which allows maintaining temperature uniformity throughout the entire volume of the bath.

An electrothermometer (6) or a temperature sensor is designed to measure the temperature of the dialysate. It can be fixed on the lid - 2 (13).

Capacity (1) is graduated by volume. It is intended to fill it with a dialysis solution, from which this solution enters the intestinal loop through an elastic tube (9).

The pump (18) installed in the bath - 2 (20) is a pump, and is designed to pump the dialysis solution from the bath - 2, into the container (1). In the absence of power supply, the device can be provided with manual pumping of the dialysate solution, for example, by connecting a pumping bulb to the inlet / outlet ends of the tubes connected to the pump (18). For this reason, a pump pumping a dialysis solution should be understood not only as an automated device, but also as a mechanical one.

The support rod (2) of variable length is designed to install a tank (1) on it. Due to the possibility of changing the length of the rod, the height of the container is adjusted relative to the level of the intestinal loop and, thus, the hydrostatic pressure of the dialysis solution at the entrance to the intestinal loop. The adjustment of the rod length is possible, for example, based on the principle of telescopic extension and clamping.

Elastic tubes (8, 9), at the ends of which there are inflatable cuffs (10), are designed to divert (9) from the container to the intestinal loop, and drain (8) from the intestinal loop into the dialysate filter. Inflatable cuffs (10) are needed to tightly fix the elastic tubes in the intestinal loop.

The filter (4) is designed to clean the intestinal mucus and nitrogenous slag from the intestinal loop of the dialysis solution before it enters the bath - 2 (20).

The clamp (3) serves to stop the flow of liquid into the tank (1) from the bath - 2 (20), which allows you to adjust the flow and filling level.

The filter (4) (see Figure 5) consists of a container (21) with a cover (24) and a collapsible filter element (23) located in this container, consisting (see Figure 6) of a mesh elastic plate (26), which folds into a hollow cylinder, a nylon stocking (27) which tightens this cylinder and elements (28, 29) that close the ends of this cylinder. Inside the cylinder there remains a cavity into which a disposable adsorbing substance is poured.

The filter is reusable and contains a container filled before each session with an absorbent substance, which at the end of the procedure is removed from the filter, and the filter itself is easily disassembled and washed.

From the design of the device, the specialist understands that it allows patients who underwent surgery to isolate the loop of the small intestine as an artificial biological kidney to independently conduct dialysis at a household level.

The principle of operation of the device

Before you start using the device, you must perform the following steps.

Fill the bath - 1 with water, up to the mark - 1 (filling level), and the bath - 2 with dialysis solution up to the mark - 2. Cover the bath - 2 with a lid - 2, and the bath - 1 with a lid - 1. Fill the filter container with adsorbent material and install a filter into the device. Connect the pump to the tank with an elastic tube with red ends, previously passing it through the outlet in the lid - 2. Connect the outlet of the filter to the bathtub - 2 with an elastic tube with blue ends, passing it through the inlet in the lid - 2. Connect the outlet of the reservoir, with a red end of an elastic tube with an inflatable cuff, and the inlet of the filter, with a blue end of an elastic tube with an inflatable cuff.

Turn on the electric mixer and heating element by setting the temperature range of the dialysis solution in the bath to the temperature regulator - 2.

After reaching the temperature of the dialysis solution of the desired size (control using an electrothermometer), insert the end of the elastic tube with an inflatable cuff having a red marker into the central end of the intestinal loop and inflate the cuff.

Insert the end of the elastic tube with an inflatable cuff having a blue marker into the peripheral end of the intestinal loop and inflate the cuff. Connect the pump to the network. Using the height of the support rod and the clamp on the elastic tube connecting the pump to the container, adjust the dialysate flow rate through the intestinal loop so that its level in the container does not change. After performing all these manipulations, we will have the following picture of the operation of the device.

The dialysis solution heated to the required temperature (which throughout the procedure keeps it in the specified range due to the operation of the heating element and thermostat), is pumped through a flexible tube with red ends into the container. From a container, through an elastic tube (with a red marker), hermetically fixed with an inflatable cuff at the central end of the intestinal loop, this solution flows into the intestinal loop. Having passed through the intestinal loop, and having absorbed nitrogenous slags and excess liquid, this dialyzing solution through an elastic tube (with a blue marker) hermetically fixed using an inflatable cuff at the peripheral end of the intestinal loop enters the filter, where it is filtered and then through the elastic tube (with a blue marker) enters the bath - 2 with a dialysis solution. And this process is repeated throughout the entire cleansing procedure.

After the time has elapsed, squeeze the clamp on the elastic tube so that the dialysate does not flow into the container. After waiting for the container to empty, deflate the cuffs and remove the elastic tubes from the intestinal loop. Disconnect the pump, heating element and electric mixer from the mains.

Disconnect flexible tubes, remove covers. Disconnect filter and support bar from water bath. Drain the dialysis solution and water. Rinse all elements of the device and dry them.

The described device is reliable in operation, easy to use. Easy to disassemble and clean.

Claims (7)

1. A device for conducting dialysis, connected by means of tubes to an isolated intestinal loop, containing a pump, a container with a dialysis solution, characterized in that it further comprises a filter, the container has inlet and outlet openings to which the tubes are connected, the function of which is to divert from the container to the intestinal loop and drain from the intestinal loop into the filter of the dialysis solution. 2. The dialysis device according to claim 1, characterized in that each of the tubes is made elastic and an inflatable cuff is located at its end, fed to the intestinal loop. 3. The device for dialysis according to claim 1, characterized in that it contains a support rod of variable length, the function of which is to install a container on it. 4. The device for dialysis according to claim 1 or 2, characterized in that the capacity is calibrated by volume. 5. The device for dialysis according to claim 1, characterized in that it contains an additional container consisting of two plastic baths, the function of one of which is filling with water, and the other is filling with a dialysis solution. 6. The dialysis device according to claim 5, characterized in that in the bath, the function of which is to fill with water, there is an electric mixer, as well as a heating element, the power supply of which is connected through a thermostat, and in the bath, the function of which is to fill with a dialysis solution, a pump is installed and an electrothermometer or temperature sensor is connected. 7. The dialysis device according to claim 1, or 2, or 3, or 5, or 6, characterized in that the filter is reusable and contains a container configured to fill / remove an absorbent substance.