WO2003002174A1

WO2003002174A1 - Method and device for detecting the detachment of the venous needle from a patient during dialysis

Info

Publication number: WO2003002174A1
Application number: PCT/IB2002/002354
Authority: WO
Inventors: Carlo Alberto Lodi; Francesco Paolini; Massimo Fava
Original assignee: Gambro Lundia Ab
Priority date: 2001-06-29
Filing date: 2002-06-24
Publication date: 2003-01-09
Also published as: ATE355092T1; ITMI20011395A1; ES2283567T3; US20040171977A1; DE60218460D1; DE60218460T2; EP1399204B1; EP1399204A1; ITMI20011395A0; US7648474B2

Abstract

A method of detecting the detachment of the venous needle (13) from a patient (P) during an extracorporal blood treatment in a dialysis machine (1) having an extracorporal blood circuit (2) provided with an arterial branch (8) and a venous branch (10) comprises the measurement of the arterial presure (Pa) in the arterial branch (8) and the venous pressure (PV) in the venous branch (10), and the determination of whether or not decreases of the arterial pressures (Pa) and pressures (PV) are occuring during the dialysis treatment in normal conditions.

Description

METHOD AND DEVICE FOR DETECTING THE DETACHMENT OF THE VENOUS NEEDLE FROM A PATIENT DURING DIALYSIS

DESCRIPTION

The present invention relates to a method of detecting the detachment of the venous needle from a patient during an extracorporeal blood treatment in a dialysis machine. As is known, blood consists of a liquid component called the blood plasma and a corpuscular component formed by the blood cells, including the red corpuscles among other components. In renal insufficiency, the blood has, in addition to the aforesaid components, particles of low molecular weight (referred to below as solute) which have to be eliminated by a dialysis treatment carried out with a dialysis machine.

A dialysis machine of the known type generally comprises an extracorporeal blood circuit, a dialysate circuit and a filter, which is located in the aforesaid circuits and comprises a blood compartment and a dialysate compartment, which are separated from each other by a semi- permeable membrane, and through which pass, respectively, the blood to be treated and the dialysate, generally flowing in counter-current mode.

During the dialysis treatment, the undesired particles contained in the blood migrate from the blood compartment to the dialysate compartment through the semi-permeable membrane both by diffusion and by convection, as a result of the passage of some of the liquid contained in the blood towards the dialysate compartment. Thus the patient will have lost some weight by the end of the dialysis process.

The extracorporeal circuit is connected to the patient by means of an arterial needle and a venous needle, which are inserted into fistulas formed in the patient's cardiovascular system, so that they can, respectively, collect the blood to be treated and return the treated blood to the patient's cardiovascular system. The extracorporeal circuit comprises a peristaltic pump and a dropper located in the arterial branch and in the venous branch respectively. The detachment of one of the aforesaid needles from the fistula causes an interruption of the access to the patient's cardiovascular system. The detachment of the venous needle, if not detected in good time, has particularly serious consequences, because it can cause a significant blood loss in the patient. Various attempts have therefore been made to provide methods for detecting the detachment of the aforesaid needles, and particularly of the venous needle.

One of the aforesaid known methods is described in WO 99/12588. This method is based on the electrical conductivity of the blood, and consists of the injection of a current into a closed circuit consisting of the extracorporeal circuit and the patient's cardiovascular system, and the measurement, by means of a measuring instrument located in the aforesaid extracorporeal circuit, the current variations which are caused by the detachment of one or both of the needles. For this method, the current injection and the measurement of the current variation have to be carried out by inductive coupling, in other words by means of windings located at specified points along the extracorporeal blood circuit. The method described above has various drawbacks. In particular, this method, although theoretically valid, cannot provide satisfactory results from the practical point of view, since the high electrical impedance produced by the peristaltic pump, which effectively interrupts the continuity of the blood flow, makes it necessary to operate with relatively high currents in order to make use of the low conductivity of the materials, generally PVC, which are used to form the extracorporeal circuit, the filter, the peristaltic pump and the dropper. The use of relatively high currents is most inadvisable in a machine connected to a patient, and, even if these currents could be used, it would not be possible to transmit them by means of an inductive coupling, which, among other considerations, generates additional parasitic currents which interfere with measurements. In some dialysis machines, the dropper also creates a high impedance, of the same order of magnitude as that created by the peristaltic pump, and thus exacerbates one of the problems described above.

Consequently, because there is a requirement to operate with relatively low currents, and because the impedance of the peristaltic pump, and of the dropper in most cases, is high, the detachment of one of the needles causes current variations which are not easily identifiable and which can be confused with the background noise of the measuring instrument.

Furthermore, this method does not allow for the fact that the patient may be connected to earth and that the filter itself is necessarily connected to earth, since the dialysate circuit is connected to earth to meet the requirements of the safety regulations for dialysis machines. Therefore the electrical circuit assumed in the aforesaid application does not truly represent the real analogy of a dialysis machine in electrical terms.

It is also known from US 6 221 040 a method for monitoring vascular access using pressure signals in a way different from the present invention.

The object of the present invention is to provide a method of detecting the detachment of the venous needle from a patient during an extracorporeal blood treatment in a dialysis machine, which overcomes the drawbacks of the known art.

According to the present invention, a method is provided for detecting the detachment of the venous needle from a patient during an extracorporeal blood treatment in a dialysis machine having an extracorporeal blood circuit comprising an arterial branch and a venous branch, the method comprising the steps of measuring the arterial pressure in the arterial branch and the venous pressure in the venous branch, and determining whether or not essentially simultaneous decreases of the arterial and venous pressures are occurring during the dialysis treatment in normal conditions .

The present invention also relates to a device for detecting the detachment of the venous needle from a patient during an extracorporeal blood treatment in a dialysis machine .

According to the present invention, a device is provided for detecting the detachment of the venous needle from a patient during an extracorporeal blood treatment in a dialysis machine having an extracorporeal blood circuit comprising an arterial branch and a venous branch, the device being characterized in that it comprises pressure detectors for measuring the arterial pressure in the arterial branch and the venous pressure in the venous branch, and a control unit for determining whether or not decreases of the arterial and venous pressures are occurring during the dialysis treatment in normal conditions.

Note that the control unit evaluates preferably if said decreases of the venous and arterial pressures are occurring in a time interval, which is relatively short (some seconds) .

To enable the present invention to be more clearly understood, a preferred embodiment of it will now be described, purely by way of example and without restrictive intent, with reference to the attached figures, of which

Figure 1 is a schematic view, with parts removed for clarity, of a dialysis machine fitted with a device for detecting the detachment of the venous needle, constructed according to the present invention; - Figure 2 is a graph showing the blood flow recorded in the extracorporeal blood circuit in a dialysis machine during an experimental test which simulates a dialysis treatment with detachment of the venous needle; and

Figures 3 and 4 are graphs showing the venous pressure and arterial pressure measured in the extracorporeal blood circuit of the dialysis machine during the experimental tests to which the graph of Figure 2 relates. In Figure 1, the number 1 indicates the whole of a dialysis machine connected to a patient P. The machine 1 comprises an extracorporeal blood circuit 2, a dialysate circuit 3 and a filter 4, which comprises a blood compartment 5 and a dialysate compartment 6 separated by a semi-permeable membrane 7.

The extracorporeal blood circuit 2 comprises an arterial branch 8, in which is located a peristaltic pump 9 providing a flow Qb of blood, and a venous branch 10, in which is located a dropper 11. The arterial branch 8 has one end connected to the blood compartment 5 and one end provided with an arterial needle 12, which, when in use, is inserted into a fistula (not shown) in the patient P to collect the blood from the cardiovascular system of the patient P, while the branch 10 has one end connected to the blood compartment 5 and an opposite end provided with a venous needle 13, which, when in use, is inserted into the aforesaid fistula (not shown) to return the treated blood to the cardiovascular system of the patient P. The branches 8 and 10 are tubes made from plastic material, generally PVC, and are used, respectively, to supply the blood to be treated to the compartment 5 and to introduce the treated blood leaving the compartment 5 into the cardiovascular system. The filter 4 and the dropper 11 are also made from plastic material, generally PVC.

The machine 1 also comprises a device 14 for detecting the detachment of the venous needle 13. The operation of the device 14 is based on experimental measurements carried out by the applicant. The graphs in Figures 2 to 4 relate to experimental measurements made by the applicant and show a transitory time interval _tl in which the blood flow Qb is made to vary; two time intervals _t2 and _t3 in which the blood flow Qb is kept essentially constant; and a time interval _t4 in which the blood flow is reduced to zero, or in other words the dialysis treatment is interrupted. The measurements which were made indicated that, during dialysis treatment in standard conditions, in other words with a constant blood flow Qb, the variations of the arterial pressure Pa and venous pressure Pv found in the arterial branch 8 and in the venous branch 10 respectively are essentially of opposite sign. In other words, a decrease in arterial pressure Pa in the arterial branch 8 generally corresponds to an increase in the pressure Pv in the venous branch 10, and vice versa. The applicant has found that, when the venous needle 13 is detached in the interval _t3, both the arterial pressure Pa in the arterial branch 8 and the venous pressure Pv in the venous branch 10 decrease significantly when the blood flow Qb is constant.

In order to determine the variations of arterial pressure Pa and venous pressure Pv indicating the detachment of the venous needle 13, the device 14 comprises a control unit 15, a pressure detector 16 located in the arterial branch 8 up-line from the peristaltic pump 9, a pressure detector 17 located in the venous branch 10 near the dropper 11, and an encoder 18 for measuring the speed of revolution of the rotor of the peristaltic pump 9. The control unit 15 receives a signal Sr from the encoder 18, correlated with the speed of revolution of the rotor of the peristaltic pump 9, and two signals Spa and SPv, correlated with the arterial pressure Pa and venous pressure Pv, from the two detectors 16 and 17 respectively.

The unit 15 can process the signals Sr, Spa and SPv, and comprises three derivation units 19p and 19r, which derive the signals Spa, SPv and Sr with respect to time and supply corresponding signals dSpa, dSPv and dSr, two rectification units 20 for rectifying the derived signals dSPa and dSPv and for supplying two signals RSPa and RSPv, a comparison unit 21, which receives the signal dSR and compares it with an interval I of acceptability stored in a store 22 and emits a digital signal SDl at the output as a function of the comparison with the interval I of acceptability. The unit 15 comprises an adder unit 23, which adds the rectified signals RSPa and RSPv, and emits a signal SA equal to the sum of the rectified signals RSPa and RSPv, a comparison unit 24, which receives the output signal SA from the adder unit 23, compares the signal SA with a threshold value TV contained in a store 25, and emits a digital signal SD2. The unit 15 also comprises two conversion units 26 for converting the signals RSPa and RSPv into digital signals SD3 and SD4 respectively, and a logical operator unit 27 which receives the digital signals SDl, SD2, SD3 and SD4, compares them with a truth table, and emits a control signal SC.

The dialysis machine 1 comprises a control unit 28, which is connected to the control unit 15 of the device 14 for receiving the control signal SC, and is also connected to the peristaltic pump 9. The unit 28 comprises an acoustic warning device 29 and a visual indicator 30 to alert the operator and user to the detachment of the venous needle 13.

In use, the dialysis machine 1 is connected to a patient P as shown schematically in Figure 1. During a dialysis treatment in standard conditions, the blood flow Qb is kept essentially constant as shown in the graph of Figure 2 in the intervals _t2 and _t3. In Figure 2, the blood flow Qb varies in an initial time interval _tl, and is then kept constant in successive time intervals _t2 and _t3, until it is brought to zero in the interval _t4 following the detachment of the venous needle 13.

The graphs of Figures 3 and 4, which have a time scale identical to the time scale of the graph of Figure 2, show the generally differing trends of the variations of the venous pressure Pv and arterial pressure Pa with a constant flow Qb in the time interval _t2, and the uniform decrease in the venous pressure Pv and arterial pressure Pa in the time interval _t3, during which the venous needle 13 has become detached and the peristaltic pump 9 has not yet been stopped. The peristaltic pump 9 is then stopped and the dialysis treatment is interrupted to prevent loss of blood from the patient P.

With reference to Figure 1, during the dialysis treatment the speed of revolution of the peristaltic pump 9 and the arterial pressure Pa and venous pressure Pv are constantly measured by the encoder 18 and by the detectors 16 and 17. The speed of revolution of the rotor of the peristaltic pump 9 is correlated with the flow Qb, and this measurement is equivalent for practical purposes to a measurement of the flow Qb, once the characteristics of the pump 9 and the dynamic conditions of the extracorporeal circuit 2 are known. The pressure signals SPa and SPb undergo derivation in the corresponding derivation units 19p, and the derived signals dSPa and dSPv are rectified in the corresponding rectification units 20. In the rectification unit 20, each of the signals RSPa and RSPv takes a value of zero when the corresponding input signal dSPa or dSPv is positive (increasing pressure) and takes a positive value, proportional to the input signal dSPa or dSPv, when the corresponding input signal dSPa or dSPv is negative (falling pressure) . The derived signal dSr is compared with the interval I of acceptability in the comparison unit 21, which supplies a digital signal SDl which is equal to one when the derived signal dSr falls within the acceptability interval (constant flow Qb) and is equal to zero when the derived signal dSr falls outside the acceptability interval (variable flow Qb) . In practice, the signal SDl is equal to one when the flow Qb is essentially constant, and equal to zero when the flow Qb is significantly varied.

The adder unit 23 adds the rectified signals RSPa and RSPv and compares the sum SA with the threshold value TV, and supplies a digital signal SD2 which is equal to one when the sum SA is greater than the threshold value TV, and a digital signal SD2 which is equal to zero when the sum SA is smaller than the threshold value TV. The values of the digital signals SD3 and SD4 are equal to one when the corresponding rectified signals RSPa and RSPv are greater than zero, and equal to zero when the corresponding rectified signals RSPa and RSPv are equal to zero. The logical operator unit 27 receives the signals SDl, SD2, SD3 and SD4 and compares these signals with a truth table, and supplies at its output a digital signal SC which is equal to one when all the signals SDl, SD2, SD3 and SD4 are equal to one, while the signal SC takes a value equal to zero when only one of the signals SDl, SD2, SD3 and SD4 is equal to zero. From the practical point of view, with reference to Figures 2 to 4 and to the time interval _t2, the flow Qb is constant and the signal SDl is equal to one, the rectified signals SD3 and SD4 will both be equal to zero or at least one will be equal to zero. Because of the slight variations of the pressures Pa and Pv in the interval _t2, the sum SA is less than the threshold value TV, which is selected experimentally to discriminate negligible variations of the arterial pressures Pa and venous pressures Pv from significant variations. Consequently, the signal SC is equal to zero.

With reference to the interval _t3, the abrupt decrease of the arterial pressures Pa and venous pressures Pv causes both the signals RSPa and RSPv to be positive and their sum SA to be greater than the threshold value TV. This causes SD2, SD3 and SD4 to be equal to one. The constancy of the flow Qb also causes the signal SDl to be equal to one, and therefore the signal SC will also be equal to one, which is the value that indicates that the venous needle has become detached.

The signal SD2 provides a measurement of the degree of the decrease of the arterial pressures Pa and venous pressures Pv and the threshold value TV makes it possible to discriminate the very slight decreases in the aforesaid pressures, which may occur from time to time even without the detachment of the venous needle, from the significant decreases which occur when the venous needle 13 actually becomes detached.

The signal SC is transmitted to the unit 28, which emits an alarm signal AS to stop the peristaltic pump 9 and the dialysis treatment when SC is equal to one.

As an alternative to the stopping of the peristaltic pump 9, or in addition to it, the alarm signal AS can trigger the activation of the acoustic warning device 29 and/or the visual indicator 30.

Claims

1. Method of detecting the detachment of the venous needle (13) from a patient (P) during an extracorporeal blood treatment in a dialysis machine (1) having an extracorporeal blood circuit (2) comprising an arterial branch (8) and a venous branch (10) , the method comprising the steps of measuring the arterial pressure (Pa) in the arterial branch (8) and the venous pressure (Pv) in the venous branch (10), and determining whether or not decreases of the arterial pressures (Pa) and venous pressures (Pv) are occurring during the dialysis treatment in normal conditions.

2. Method according to Claim 1, characterized in that the flow of blood (Qb) along the extracorporeal blood circuit (2) is measured, and in that a check is made to determine whether the blood flow (Qb) is essentially constant in a time interval in which the said decreases of arterial pressure (Pa) and venous pressure (Pv) have occurred.

3. Method according to Claim 2, characterized in that the value of the said decreases of the arterial pressure (Pa) and venous pressure (Pv) is evaluated.

4. Method according to Claim 3, characterized in that a signal (SA) correlated with the sum of the decreases of arterial pressure (Pa) and venous pressure (Pv) is compared with an experimentally determined threshold value (TV) .

5. Method according to Claim 4, characterized in that an alarm signal (AS) is emitted when all the following conditions are present in the said time interval: a decrease in arterial pressure (Pa) ; - a decrease in venous pressure (Pv) ; the signal (SA) correlated with the sum of the decreases of arterial pressure (Pa) and venous pressure (Pv) is greater than the said threshold value (TV) ; and the flow (Qb) is essentially constant.

6. Method according to Claim 5, characterized in that the said blood flow (Qb) is stopped in the said extracorporeal circuit (2) by means of the said alarm signal (AS) , to interrupt the dialysis treatment.

7. Method according to Claim 5 or 6, characterized in that an acoustic warning device (29) is activated by means of the said alarm signal (AS) .

8. Method according to one of Claims 5 to 7, characterized in that a visual indicator (30) is activated by means of the said alarm signal (AS) .

9. Device for detecting the detachment of the venous needle (13) from a patient (P) during an extracorporeal blood treatment in a dialysis machine (1) having an extracorporeal blood circuit (2) comprising an arterial branch (8) and a venous branch (10), the device (14) being characterized in that it comprises pressure detectors (16, 17) for measuring the arterial pressure (Pa) in the arterial branch (8) and the venous pressure (Pv) in the venous branch (10), and a control unit (15) for determining whether or not decreases of the arterial pressures (Pa) and venous pressures (Pv) are occurring during the dialysis treatment in normal conditions.

10. Device according to Claim 9, characterized in that it comprises means (18) for measuring the flow (Qb) of blood along the extracorporeal blood circuit (2) , the said control unit (15) comprising means (19r, 21) for determining whether the blood flow (Qb) is essentially constant.

11. Device according to Claim 10, characterized in that the said determining means comprise a derivation unit (19r) for emitting a signal correlated with the derivative of the blood flow (Qb) and a first comparison unit (21) for determining whether the signal correlated with the derivative of the flow (Qb) falls within an interval (I) of acceptability.

12. Device according to Claim 10 or 11, characterized in that the said control unit (15) comprises means (23, 24, 25) for discriminating the value of the decreases of the arterial pressure (Pa) and venous pressure (Pv) .

13. Device according to Claim 12, characterized in that the said control unit (15) comprises a logical operator unit (27) which can emit a control signal (SC) as a function of the decreases of arterial pressure (Pa) and venous pressure (Pv), the output signal from the second comparison unit (24), and the output signal from the first comparison unit (21) .

14. Dialysis machine comprising a control device (14) according to any one of Claims 9 to 13, characterized in that it comprises an additional control unit (28) which can receive a control signal (SC) from the said control unit (15) and emit an alarm signal (AS) as a function of the control signal (SC) .

15. Machine according to Claim 14, characterized in that it comprises a peristaltic pump (9) located in the said arterial branch (8), and a dropper (11) located in the said venous branch (10), the said peristaltic pump (9) being stoppable by means of the said alarm signal.

16. Machine according to Claim 15, characterized in that the said detectors (16, 17) comprise a first detector (16) located in the arterial branch (8) up-line from the peristaltic pump (9), and a second detector (17) located in the venous branch (10) near the dropper (11) .

17. Machine according to any one of Claims 14 to 16, characterized in that the said additional control unit (28) comprises an acoustic warning device (29) which can be activated by means of the said alarm signal (AS) .

18. Machine according to any one of Claims 14 to 17, characterized in that the said additional control unit (28) comprises a visual indicator (30) which can be activated by means of the said alarm signal.