WO2012150679A1 - Dispositif de dialyse et méthode d'amorçage d'un dispositif de dialyse - Google Patents

Dispositif de dialyse et méthode d'amorçage d'un dispositif de dialyse Download PDF

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Publication number
WO2012150679A1
WO2012150679A1 PCT/JP2012/060820 JP2012060820W WO2012150679A1 WO 2012150679 A1 WO2012150679 A1 WO 2012150679A1 JP 2012060820 W JP2012060820 W JP 2012060820W WO 2012150679 A1 WO2012150679 A1 WO 2012150679A1
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WIPO (PCT)
Prior art keywords
dialyzer
blood
chamber
dialysate
passage
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PCT/JP2012/060820
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English (en)
Japanese (ja)
Inventor
満隆 上田
利春 沢田
隆一郎 美多
Original Assignee
ニプロ株式会社
澁谷工業株式会社
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Application filed by ニプロ株式会社, 澁谷工業株式会社 filed Critical ニプロ株式会社
Publication of WO2012150679A1 publication Critical patent/WO2012150679A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621—Extra-corporeal blood circuits
    • A61M1/3643—Priming, rinsing before or after use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621—Extra-corporeal blood circuits
    • A61M1/3643—Priming, rinsing before or after use
    • A61M1/3644—Mode of operation

Definitions

  • the present invention relates to a dialysis device and a priming method of the dialysis device, and more specifically, the blood circuit and the dialyzer are filled with physiological saline or the like.
  • the present invention relates to a dialysis apparatus and a priming method for the dialysis apparatus.
  • the blood circuit and dialyzer are filled with a priming solution such as physiological saline as the previous step, so that no air remains in the dialyzer and blood circuit.
  • a priming solution such as physiological saline
  • This priming is performed in order to prevent bubbles from entering the patient's body from the blood circuit during dialysis treatment.
  • a first general priming method a method using physiological saline is known, and as a second method, the fluid pressure in the dialysate circuit is more positive than the fluid pressure in the blood circuit.
  • a method is known in which dialysate is introduced into a blood chamber under pressure, so that the dialyzer is filled into the dialyzer and blood circuit by so-called “reverse filtration” (Patent Documents 1 to 3).
  • a conventional general dialyzer includes a number of hollow fiber membranes inside a cylindrical outer case, and the internal space of these hollow fiber membranes and the hollow fiber membranes. Adjacent regions at both ends are blood chambers.
  • the blood chamber communicates with the artery side passage of the blood passage through the first port which is one end of the exterior case, and communicates with the vein side passage of the blood passage from the second port which is the other end of the exterior case.
  • the blood chamber and the blood circuit (arterial side passage, venous side passage) communicating with the blood chamber are filled with the priming solution.
  • small bubbles in the hollow fiber membrane of the dialyzer It tends to accumulate in the adjacent region (first port) at the end of the hollow fiber membrane on the side (see FIG. 6).
  • the physiological saline solution as the priming solution has poor fluidity, it is difficult to reliably remove bubbles remaining in the upper part of the blood chamber in the outer case by the conventional priming method.
  • the first present invention includes a dialyzer having a blood chamber and a dialysate chamber therein, an artery having one end serving as a blood collection port, and the other end connected to one end of the blood chamber of the dialyzer.
  • a blood circuit having a side passage and one end serving as a blood return port, and the other end connected to the other end of the blood chamber, and a dialysate supply passage connected to the inlet of the dialysate chamber in the dialyzer
  • a dialysis fluid circuit having a dialysis fluid recovery passage connected to the outlet of the dialysis chamber, and a priming fluid supply means for supplying a priming fluid to the blood chamber of the dialyzer and the blood circuit
  • Gas introduction means for introducing gas into the blood circuit from a gas introduction port provided in the artery side passage or vein side passage is provided, and the gas is supplied to the blood chamber of the dialyzer and the blood circuit filled with the priming liquid.
  • the second aspect of the present invention also includes a dialyzer having a blood chamber and a dialysate chamber therein, an arterial passage and one end connected to one end of the blood chamber of the dialyzer with one end serving as a blood collection port.
  • a blood circuit having a vein-side passage connected to the other end of the blood chamber, the dialysate supply passage connected to the inlet of the dialysate chamber in the dialyzer, and the dialysis chamber
  • a dialysate circuit having a dialysate recovery passage connected to an outlet of the dialyzer, and a priming fluid supply means for supplying a priming fluid to the blood chamber of the dialyzer and the blood circuit, and the blood chamber and blood of the dialyzer
  • a first priming step for filling the blood chamber of the dialyzer and the blood circuit with a priming solution; a gas introduction step for replacing a predetermined region of the blood chamber of the dialyzer filled with the priming solution with a gas; and the gas introduction step.
  • a second priming step of refilling a predetermined region of the blood chamber replaced with gas with a priming solution.
  • the gas introduced into the blood chamber and the bubbles are integrated, and the integrated gas replaces the priming liquid, and then the priming is performed.
  • the gas in the blood chamber is discharged outside the dialyzer and the blood circuit. Therefore, the gas in the blood chamber and blood circuit of the dialyzer can be reliably removed. Therefore, air bubbles can be reliably removed from the blood chamber and blood circuit of the dialyzer without imposing a work burden on the medical staff.
  • FIGS. 3A and 3B are process diagrams when priming is performed using a physiological saline by the dialysis apparatus shown in FIG. 1, FIG. 3A shows the first stage, FIG. 3B shows the second stage, and FIG. ) Shows the third stage.
  • FIG. 4 is a process diagram when priming is performed by reverse filtration using the dialyzer shown in FIG. 1, FIG. 4 (a) shows the first stage, FIG. 4 (b) shows the second stage, and FIG. Three stages are shown.
  • the circuit diagram which shows the principal part of the other Example of this invention.
  • the dialysis apparatus 1 is powered by a power source such as a hospital outlet C and is provided in a box-shaped main body 1A.
  • the operation is controlled by the control means 1B.
  • a dialyzer 1 according to the present embodiment is connected to a dialyzer 2 having a columnar shape, which is held in a vertical direction on the side surface of the main body 1A, a blood circuit 3 connected to the dialyzer 2, and the dialyzer 2.
  • a dialysate circuit 4 provided in the main body 1A.
  • the control means 1B is provided with a screen display type operation panel 1C, and buttons, icons, and messages necessary for the operation are displayed on the screen so that operation of the apparatus and setting of various parameters can be performed. .
  • the dialysis apparatus 1 of the present embodiment is a dialysis apparatus that performs hemodialysis therapy (HD) on one patient, and performs priming before the use of the dialysis apparatus 1 is started.
  • the dialysis apparatus 1 allows the patient to supplement the dialysate via the dialyzer 2 and the blood circuit 3 by making the dialysate circuit 4 side more positive than the blood circuit 3 side during dialysis treatment. It has become.
  • the replacement of the dialysate with the patient through the dialyzer 2 and the blood circuit 3 with the dialysate circuit 4 side at a positive pressure is generally called “reverse filtration”.
  • the dialyzer 2 in priming to fill the blood circuit 3 and the dialyzer 2 with a liquid in the stage before the dialysis treatment, the dialyzer 2 is subjected to “reverse filtration” by the dialyzer 1.
  • the priming can be performed by filling the inside of the blood circuit 3 and the blood circuit 3 with the dialysate, and the priming can be performed by filling the blood circuit 3 and the dialyzer 2 with the dialysate. That is, the dialysis apparatus 1 of the present embodiment can perform priming by two types of methods, the method using the physiological saline and the method using “reverse filtration”.
  • the dialyzer 2 includes an outer case 2A made of a cylindrical resin and a number of hollow fiber membranes 2B provided in a bundle inside the outer case 2A. And the inside of each said hollow fiber membrane 2B becomes a filtration membrane (semipermeable membrane), and the adjacent area
  • the hollow fiber membrane 2B as the filtration membrane has a property of allowing liquid to pass but not allowing gas to pass.
  • the adjacent region at one end in the longitudinal direction of the hollow fiber membrane 2B is the first port 2G of the outer case 2A, and the adjacent region at the other end in the longitudinal direction is the second port 2H of the outer case 2A.
  • the internal space of both ports 2G and 2H also constitutes the blood chamber 2C, and one of the ports 2G and 2H is one end in the longitudinal direction of the blood chamber 2C, and the other is in the longitudinal direction of the blood chamber 2C. The other end.
  • one end of the artery side passage 11 is connected to the first port 2G
  • one end of the vein side passage 12 is connected to the second port 2H.
  • the dialyzer 2 is held vertically by the main body 1A so that the first port 2G is upward and the second port 2H is downward. ing.
  • the blood chamber 2C of the dialyzer 2 communicates with the blood circuit 3 so that blood flows through the blood chamber 2C.
  • the space between the inner peripheral surface of the cylindrical outer case 2A and the blood chamber 2C (each hollow fiber membrane 2B) is a dialysate chamber 2D through which dialysate flows.
  • An inlet 2E for introducing dialysate into the dialysate chamber 2D is formed at the lower part of the outer peripheral surface of the outer case 2A, and an outlet 2F for discharging dialysate at the upper part of the outer peripheral surface of the outer case 2A. Is formed.
  • the dialysate supply passage 23 of the dialysate circuit 4 is connected to the inlet 2E, and the dialysate recovery passage 24 of the dialysate circuit 4 is connected to the outlet 2F.
  • the dialysate chamber 2D communicates with the dialysate circuit 4 so that the dialysate flows in the opposite direction to the blood.
  • the dialyzer 2 is held vertically on the side surface of the main body 1A so that the inlet 2E is downward and the outlet 2F is upward during dialysis treatment.
  • the blood circuit 3 is connected to a patient to circulate blood in the blood chamber 2C of the dialyzer 2 and the dialysate from the dialysate circuit 4 to the dialysate chamber 2D of the dialyzer 2. Dialysis treatment is performed on patients.
  • the blood circuit 3 connected to the dialyzer 2 includes an arterial side passage 11 connected to a blood vessel of the patient and supplying blood to the blood chamber 2C of the dialyzer 2, and a venous side passage 12 for returning blood from the blood chamber 2C of the dialyzer 2 to the patient.
  • These passages are formed of resin tubes.
  • One end of the artery side passage 11 is connected to the first port 2G of the dialyzer 2, and the other end of the artery side passage 11 is provided with a puncture needle 11a for puncturing a patient's blood vessel.
  • a clamp means 13 for closing the artery side passage 11 a blood pump 14 for feeding blood, and a drip chamber 15 are disposed in the artery side passage 11 in order from the puncture needle 11 a side.
  • the blood pump 14 is a roller pump that squeezes the tube and supplies the blood, and the operation is controlled by the control means 1B so that blood can be supplied from the patient to the blood chamber 2C of the dialyzer 2. It has become.
  • the drip chamber 15 of the artery side passage 11 is adjusted in height by the liquid level adjusting means 5 described later.
  • One end of the atmospheric passage 6 is connected to the drip chamber 15, and a pressure gauge 16 is provided in the middle of the atmospheric passage 6.
  • One end of the vein side passage 12 is connected to the second port 2H of the blood chamber 2C of the dialyzer 2, and the other end of the vein side passage 12 is provided with a puncture needle 12a for puncturing a patient's blood vessel.
  • a drip chamber 15 ′ and a clamping means 13 ′ as a closing means for closing the vein side passage 12 are disposed in order from the dialyzer 2.
  • the drip chamber 15 ′ is also adjusted in liquid level by the liquid level adjusting means 5.
  • An atmospheric passage 6 ' is connected to the drip chamber 15', and a pressure gauge 16 'is provided in the atmospheric passage 6'.
  • the other end 6a ′ of the atmospheric passage 6 ′ is connected to the upstream portion of the atmospheric passage 6 and is connected to the atmosphere by the communication passage 7 disposed closer to the dialyzer 2 than the other end 6a ′ of the atmospheric passage 6 ′.
  • the passage 6 'and the atmospheric passage 6 communicate with each other.
  • An open / close valve V101 is disposed in the atmospheric passage 6 ′ closer to the end 6a ′ than the communication passage 7, while an air pump 8 is provided in the atmospheric passage 6 closer to the end 6a ′ than the communication passage 7. ing.
  • an open / close valve V102 is disposed in the atmospheric passage 6 closer to the dialyzer 2 than the communication passage 7, and an open / close valve V103 is provided in the atmospheric passage 6 ′ closer to the dialyzer 2 than the communication passage 7. ing.
  • the operation of each of the on-off valves V101 to V103 and the air pump 8 is controlled by the control means 1B.
  • the pressure in each drip chamber 15 and 15 'measured by the pressure gauges 16 and 16' is transmitted to the control means 1B.
  • An aseptic filter 9 for purifying the atmosphere is disposed at the other end of the atmospheric passage 6 serving as an air inlet, and the air purified by the aseptic filter 9 is drip through the atmospheric passages 6 and 6 '.
  • the liquid level adjusting means 5 is constituted by the atmospheric passages 6 and 6 ′, the on-off valves V 101 to V 103 and the air pump 8.
  • the liquid level adjusting means 5 adjusts the height of the liquid level in both the drip chambers 15 and 15 '.
  • the drip chamber 15 on the artery side has a substantially cylindrical shape which is sealed, and the upstream end of the artery side passage 11 between the dialyzer 2 and the bottom 15A is connected. Yes.
  • the downstream end of the artery side passage 11 on the blood pump 14 side is connected, and one end of the atmospheric passage 6 of the liquid level preparation means 5 is connected.
  • the configuration of the drip chamber 15 ′ on the vein side shown in FIG. 3 is the same as the configuration of the drip chamber 15 shown in FIG.
  • the upstream end of the venous passage 12 on the clamping means 13 'side is connected to the bottom 15A' of the drip chamber 15 ', and the downstream end of the venous passage 12 on the dialyzer 2 side is connected to the ceiling 15B'. While being connected, the end of the air passage 6 ′ of the liquid level adjusting means 5 is connected.
  • the amount of gas occupying the upper space in the drip chambers 15 and 15 ′ is increased or decreased by the liquid level adjusting means 5.
  • the liquid level in the drip chamber 15 can be adjusted to a required height (see FIGS. 3A and 4A).
  • the liquid level adjusting means 5 is also used for priming to fill the blood circuit 3 and the blood chamber 2C of the dialyzer 2 with dialysate before dialysis treatment.
  • the drip chamber 15 is used for priming. , 15 'is adjusted. During dialysis treatment, the liquid level in the drip chambers 15 and 15 'is maintained at a required height by the liquid level adjusting means 5.
  • the adjustment of the liquid surface height of the drip chamber 15 on the artery side by the liquid surface preparation means 5 is performed as follows.
  • the control means 1B opens the on-off valve V102 with both the on-off valves V101, V103 closed, and rotates the air pump 8 forward or backward.
  • air is introduced into the drip chamber 15 through the air pump 8 and the on-off valve V102 after the atmosphere is introduced into the atmosphere passage 6.
  • the volume of the upper space in the sealed drip chamber 15 is changed so that the liquid level of the liquid (blood, physiological saline, etc.) in the drip chamber 15 is maintained at a required height. (See FIGS. 2 and 4A).
  • the adjustment of the liquid surface height in the drip chamber 15 'on the vein side by the liquid surface preparation means 5 is performed as follows.
  • the control means 1B opens the on-off valve V103 with both the on-off valves V102 and V101 closed, and rotates the air pump 8 forward or backward.
  • air is introduced into the drip chamber 15 ′ through the air passage 6 before and after the air pump 8, the communication passage 7 and the air passage 6 ′ connected thereto.
  • the volume of the upper space in the sealed drip chamber 15 ′ is changed, so that the liquid level of the liquid (blood, physiological saline, etc.) in the drip chamber 15 ′ is maintained at a required height. (See FIGS. 2 and 3A).
  • the aseptic filter 9 Since the aseptic filter 9 is provided in the atmosphere passage 6, clean air purified by the aseptic filter 9 is introduced into both the drip chambers 15 and 15 '.
  • the liquid level adjusting means 5 is also used as a gas introducing means, and air is introduced into any of the ports 2G and 2H on the upper side in the dialyzer 2 during priming. The air and the small bubbles in the ports 2G and 2H are integrated and then discharged to the outside of the blood chamber 2c.
  • the artery-side passage 11 upstream of the blood pump 14 is connected via the connection tube 18.
  • the raw food bag 17 is connected.
  • a clamping means 19 for closing the connection tube 18 is arranged in the middle of the connection tube 18. If the clamp means 19 is opened after the saline bag 17 is connected to the artery side passage 11 via the connection tube 18, the physiological saline in the saline bag 17 flows down and the artery side passage 11, the blood chamber of the dialyzer 2 2C and the venous passage 12 are introduced.
  • priming is performed by filling the saline solution 17 in the saline bag 17 into the blood circuit 3 and the blood chamber 2 ⁇ / b> C of the dialyzer 2.
  • the dialyzer 2, blood circuit 3 and liquid level adjusting means 5 of the present embodiment are configured as described above.
  • the dialysate circuit 4 includes a dialysate supply passage 23 that supplies fresh dialysate from the first dialysate chamber 21 or the second dialysate chamber 22 to the dialysate chamber 2D of the dialyzer 2, and A dialysate recovery passage 24 for recovering the used dialysate that has passed through the fluid chamber 2D to the first dialysate chamber 21 or the second dialysate chamber 22 is provided, and these passages are constituted by resin tubes. ing.
  • the first and second dialysate chambers 21 and 22 are provided with a supply passage 25 through which fresh dialysate supplied from a dialysate production apparatus (not shown) flows, and drainage for discharging used dialysate.
  • the passage 26 is connected.
  • the first dialysate chamber 21 and the second dialysate chamber 22 have the same configuration, and the inside thereof is partitioned by two diaphragms. That is, between supply chambers 21a and 22a for supplying fresh dialysate, recovery chambers 21b and 22b for recovering used dialysate, and between these supply chambers 21a and 22a and recovery chambers 21b and 22b. It is divided into intermediate chambers 21c and 22c formed in the above.
  • the intermediate chambers 21c and 22c are filled with silicone oil, and the silicone oil in the intermediate chambers 21c and 22c is sent between the intermediate chambers 21c and 22c by the oil pump 27.
  • the volumes of the intermediate chambers 21c and 22c are increased or decreased.
  • the volume of the intermediate chambers 21c and 22c of the chambers 21 and 22 is increased or decreased by the oil pump 27, so that the dialysis solution can be supplemented to the patient by performing reverse filtration during dialysis treatment.
  • priming is performed by reverse filtration before the start of dialysis treatment.
  • the liquid supply passage 25 is provided with a liquid supply pump 31 for supplying the dialysate, and the liquid supply passage 25 is branched in two directions on the downstream side of the liquid supply pump 31 to separate the first and second dialysis.
  • the liquid chambers 21 and 22 are connected to the supply chambers 21a and 22a.
  • the branched passages are respectively provided with liquid supply valves V1 and V2 that are opened and closed by the control means 1B.
  • the dialysate supply passage 23 has an upstream portion branched in two directions and connected to the supply chambers 21a and 22a of the first and second dialysate chambers 21 and 22, respectively.
  • the branch portions are provided with supply valves V3 and V4 which are opened and closed by the control means 1B, respectively.
  • a first dialysate filter F1 and a second dialysate filter F2 for removing harmful components of the dialysate are arranged in series at a predetermined interval in a place near the dialyzer 2 in the dialysate supply passage 23.
  • a first on-off valve V5 that is opened and closed by the control means 1B is provided at a location between the second dialysate filter F2 and the dialyzer 2. Opening means 32 for opening the dialysate supply passage 23 to the atmosphere when necessary is connected to the dialysate supply passage 23 that is located between the two filters F1 and F2.
  • the first dialysate filter F1 is divided into a primary side (upstream chamber) and a secondary side (downstream chamber) by a semipermeable membrane, and dialysate passes through the semipermeable membrane from the primary side (upstream chamber). Thus, harmful components are removed when permeating to the secondary side (downstream chamber).
  • a first bypass passage 33 that connects the dialysate supply passage 23 and the dialysate recovery passage 24 is connected to the primary side (upstream chamber) of the first dialysate filter F1. Is provided with a second on-off valve V6 which is opened and closed by the control means 1B.
  • the second dialysate filter F2 is also divided into a primary side (upstream chamber) and a secondary side (downstream chamber) by a semipermeable membrane, and the dialysate passes through the semipermeable membrane from the primary side (upstream chamber). Harmful components are removed when permeating to the secondary side (downstream chamber).
  • a second bypass passage 34 that connects the dialysate supply passage 23 and the dialysate recovery passage 24 is connected to the primary side (upstream chamber) of the second dialysate filter F2.
  • a third on-off valve V7 that is opened and closed by the control means 1B is provided.
  • the first on-off valve V5 is opened, while the second on-off valve V6 and the third on-off valve V7 are closed.
  • the control means 1B closes the first on-off valve V5 and opens the second on-off valve V6.
  • the dialysate having a poor concentration can be fed to the dialysate recovery passage 24 via the first bypass passage 33 without flowing through the dialyzer 2.
  • both dialysate filters F 1 and F 2 are arranged in series in the dialysate supply passage 23, and both bypass passages 33 and 34 extend across the dialysate supply passage 23 and the dialysate recovery passage 24. Are arranged in parallel.
  • an opening means 32 is provided in order to detect leakage of both the dialysate filters F1, F2.
  • the opening means 32 includes an opening passage 35 connected between the dialysate filters F1 and F2 in the dialysate supply passage 23, and a fourth on-off valve V8 provided in the opening passage 35 and opened and closed by the control means 1B. And a check valve 36 provided in the open passage 35 for preventing the dialysate from flowing out, and a sterile filter 37 for purifying the inflowing air.
  • the opening means 32 is used for checking the leakage of the dialysate filters F1 and F2.
  • the opening means 32 is used to check for leakage before or after dialysis treatment. .
  • the control means 1B closes the first on-off valve V5 and opens the second on-off valve V6, the third on-off valve V7, and the fourth on-off valve V8. Then, the inflow of the atmosphere into the dialysate circuit 4 is allowed through the open passage 35, and the secondary side (or primary side) of the dialysate filters F1 and F2 from the secondary side (or secondary side) to the primary side (or secondary side). The leakage of the dialysate filters F1 and F2 can be inspected based on the presence or absence of inflow of air.
  • the dialysate recovery passage 24 has an upstream end connected to the dialysate chamber 2C (exit 2F) of the dialyzer 2 and a downstream portion bifurcated in two directions so that the first and second dialysate respectively.
  • recovery valves V10 and V11 Connected to the recovery chambers 21b and 22b of the chambers 21 and 22, recovery valves V10 and V11 that are opened and closed by the control means 1B are provided at the branch portions, respectively.
  • a pressure sensor 41 for measuring the pressure in the dialysate circuit 4 a dialysate pump 42 for feeding dialysate, and gas in the dialysate And a deaeration tank 43 for degassing the air.
  • a third bypass passage 44 is disposed between the deaeration tank 43 and the drainage passage 26.
  • the third bypass passage 44 is provided with a fifth on-off valve V12 that is opened and closed by the control means 1B.
  • a sixth on-off valve V13 that is opened and closed by the control means 1B is provided at a location closer to the dialyzer 2 than the connection portion of the first bypass passage 33 in the dialysate recovery passage 24.
  • the sixth on-off valve V13 is opened while the fifth on-off valve V12 is closed.
  • the fifth on-off valve V12 is opened to allow the dialysate to flow through the third bypass passage 44.
  • the drainage passage 26 has its upstream portion branched in two directions and connected to the recovery chambers 21b and 22b of the first and second dialysate chambers 21 and 22, respectively. It is connected to a drainage pipe (not shown) provided in the engine, and drainage valves V14 and V15 that are opened and closed by the control means 1B are provided at the branch portions.
  • priming for filling the blood circuit 3 and the blood chamber 2C of the dialyzer 2 with a priming solution is performed before dialysis treatment for the patient. Is done.
  • two types of priming can be performed: a method using a physiological saline solution in the saline bag 17 as a priming method and a method using a dialysate by reverse filtration. Therefore, first, a method using the physiological saline solution in the saline bag 17 as the first embodiment and the subsequent dialysis treatment will be described, and then priming by reverse filtration as the second embodiment will be described.
  • the dialyzer 2 is held upside down in the main body 1A upside down from the case of dialysis treatment.
  • maintained at the perpendicular direction the 2nd port 2H becomes an upper end, and the 1st port 2G becomes a lower end (refer Fig.3 (a)).
  • the reason why the dialyzer 2 is held upside down from that during dialysis treatment is that the blood pump 14 is disposed in the artery-side passage 11, so that bubbles are removed when removing bubbles in the liquid. This is to prevent it from stopping in the blood pump 14 and coming out of the outside.
  • the dialyzer 2 is held in the main body 1A so that the first port 2G and one end of the arterial passage 11 connected to the first port 2G become the lower end. Thereafter, as shown in FIG. 2, a medical worker at the site connects the end of the connection tube 18 continuing from the saline bag 17 to the artery side passage 11.
  • the control means 1B opens the clamping means 19 of the connection tube 18 and the blood pump 14 is rotated forward.
  • the physiological saline solution in the saline bag 17 flows down and is sent toward the dialyzer 2 by the blood pump 14. Therefore, a physiological saline solution as a priming solution is introduced into the venous passage 12 through the first port 2G of the dialysis chamber 2C and the blood chamber 2C of the dialyzer 2 from the connection location with the connection tube 18 of the artery side passage 11.
  • the control unit 1B reverses the blood pump 14 at an appropriate timing, the physiological saline is introduced from the connection portion with the connection tube 18 in the artery side passage 11 to the puncture needle 11a.
  • the physiological saline flowing down into the artery side passage 11 is discharged from the puncture needle 11a and passes through the dialyzer 2 and the vein side passage 12.
  • the saline solution is discharged from the puncture needle 12a.
  • the priming proceeds by filling the saline solution 17 of the saline bag 17 into the blood circuit 3 and the blood chamber 2C of the dialyzer 2.
  • the final priming is performed.
  • air is sent from the liquid level adjusting means 5 into the second port 2H via the drip chamber 15 'of the venous passage 12.
  • the control means 1B opens the on-off valve V103 and rotates the air pump 8 in the normal direction with the on-off valves V101, V102 of the liquid level adjusting means 5 closed.
  • control means 1B reverses the blood pump 14 and closes the venous passage 12 by the clamping means 13 ′ (see FIGS. 2, 3A, and 3B).
  • air is supplied to the upper space in the drip chamber 15 ′ via the atmospheric passage 6 ′, and the air in the upper space passes through the vein-side passage 12 and the second port 2 H of the dialyzer 2 and the hollow fiber membrane 2 B. It is supplied to the upper part (see FIG. 3B).
  • the small bubbles in the second port 2H are integrated with the newly introduced air via the drip chamber 15 ′ and the vein passage 12, and the upper end of the blood chamber 2C is integrated by the integrated air.
  • a priming solution (physiological saline) is introduced into the blood chamber 2C of the dialyzer 2 from below, while air introduction by the liquid level adjusting means 5 is performed upward into the blood chamber 2C of the dialyzer 2. It is designed to be introduced downward from. That is, the introduction direction of the priming liquid into the blood chamber 2C is opposite to the introduction direction of air.
  • the control means 1B rotates the blood pump 14 forward and reverses the air pump 8, so that the air in the upper space of the drip chamber 15 ′ is discharged through the atmospheric passage 6 ′.
  • the air in the upper region of the blood chamber 2C including the second port 2H and the air in the venous passage 12 is removed, and instead, the physiological saline is filled (see FIG. 3C).
  • the air bubbles in the second port 2H are surely removed from the dialyzer 2 and the vein passage 12.
  • priming is performed twice before and after the air is introduced into the dialyzer 2 by the liquid level adjusting means 5.
  • the operation of the blood pump 14 and the air pump 8 is stopped by the control means 1B, and the closed state of the vein side passage 12 by the clamping means 13 ′ is opened. In this way, the priming using the physiological saline solution of the raw food bag 17 is completed.
  • the following method can also be employed. That is, with the air pump 8 stopped and the on-off valve V102 closed, the control means 1B opens the on-off valves V101, V103 and reverses the blood pump 14. In this case, when the blood pump 14 is reversed, the atmosphere is introduced into the drip chamber 15 ′ and the blood circuit 3 from the atmosphere passage 6 ′ via the on-off valves V 101 and V 103.
  • the dialyzer 2 is inverted to the holding state opposite to that at the time of the priming by the medical staff at the site. That is, as shown in FIG. 1, the first port 2G is located at the upper side and the artery side passage 11 is connected thereto, and the second port 2H is located at the lower side and the venous passage 12 is connected thereto. It becomes a state. Thereafter, dialysis treatment is performed on the patient as in the conventional case. That is, first, before starting dialysis treatment, both puncture needles 11a and 12a are inserted into the patient to connect the blood circuit 3, and then the blood pump 14 is operated to circulate blood through the blood circuit 3.
  • the control means 1B opens the liquid supply valve V1 and the drainage valve V14 and closes the supply valve V3 and the recovery valve V10. Further, the control means 1B operates the liquid supply pump 31 and The first on-off valve V5 and the sixth on-off valve V13 are opened. The other on-off valves V6 to V9 and V12 are closed. Then, in the first dialysate chamber 21, the supply valve V1 and the drain valve V14 are open, so that the dialysate flows into the supply chamber 21a from the supply passage 25 and the diaphragm is in the recovery chamber 21b. The used dialysate that has been pressed and previously filled is discharged to the outside through the drainage passage 26.
  • the control means 1B opens the supply valve V4 and the recovery valve V11, and closes the supply valve V2 and the drain valve V15. Then, the used dialysate sent by the dialysate pump 42 flows into the recovery chamber 22b, so that fresh dialysate is supplied from the supply chamber 22a via the dialysate supply passage 23 to the dialysate 2 in the dialyzer 2. It will be supplied to the chamber 2D.
  • control means 1B alternately opens and closes the liquid supply valves V1 and V2, the supply valves V3 and V4, the recovery valves V10 and V11, and the drain valves V14 and V15, so that the first dialysate chamber 21 and the second dial 2
  • the fresh dialysate is supplied to the dialysate chamber 2D of the dialyzer 2 through the dialysate supply passage 23 through the dialysate chamber 22, while the used dialysate that has passed through the dialysate chamber 2D of the dialyzer 2 is supplied.
  • the liquid is alternately collected in the first dialysate chamber 21 and the second dialysate chamber 22 and discharged to the outside of the dialysate circuit 4 through the drainage passage 26.
  • the dialysate flows from the dialysate circuit 4 to the dialysate chamber 2D of the dialyzer 2, and the blood flows to the blood chamber 2C of the dialyzer 2 via the blood circuit 3, thereby preventing the patient.
  • Dialysis treatment is given.
  • the following processing is performed. That is, the required amount of silicone oil is supplied by the oil pump 27 to the intermediate chamber 21c of the first dialysate chamber 21 where the treated dialysate is collected.
  • the volume of the recovery chamber 21b becomes smaller than the volume of the supply chamber 21a of the first chamber 21, and as a result, the dialysate corresponding to the volume difference flows to the blood circuit 3 via the blood chamber 2C of the dialyzer 2. That is, it is pressed into the patient's blood. In this manner, the dialysate replacement solution is processed by reverse filtration when necessary during dialysis treatment.
  • priming using the physiological saline solution in the saline bag 17 is performed, and then dialysis treatment is performed on the patient.
  • the priming of the second system by reverse filtration which is the second embodiment is performed as follows. That is, in this case, as shown in FIGS. 1 and 4, priming is performed in a state where the dialyzer 2 is held in the vertical direction so that the first port 2G is on the upper side, as in dialysis treatment. That is, the artery side passage 11 is connected to the first port 2G on the upper side, and the vein side passage 12 is connected to the second port 2H on the lower side.
  • a dialysate recovery passage 24 is connected to the outlet 2F on the upper side, and a dialysate supply passage 23 is connected to the inlet 2E on the lower side (see FIG. 4A).
  • the control means 1B reverses the blood pump 14 so that the flow rate is about half of the flow rate by reverse filtration. Therefore, the dialysate is supplied from the dialysate supply passage 23 into the dialysate chamber 2C of the dialyzer 2, and the dialysate is press-fitted into the blood chamber 2C.
  • the dialysate press-fitted into the blood chamber 2C is distributed into the passages 11 and 12 via the ports 2G and 2H by the reverse rotation of the blood pump 14.
  • both the passages 11 and 12 are filled with the dialysate, and the dialysate is also introduced into the drip chamber 15 via the artery side passage 11.
  • the saline bag 17 storing physiological saline is not used.
  • the control means 1B once stops the reverse filtration, and in this state, the blood pump 14 is stopped and the second clamp means 13 ′ is opened. At the same time, the control means 1B opens the on-off valve V102 with the on-off valves V101, V103 closed, and rotates the air pump 8 in the normal direction. As a result, air is introduced into the drip chamber 15 via the atmospheric passage 6, so that the dialysate in the drip chamber 15 is pushed back into the blood chamber 2 ⁇ / b> C of the dialyzer 2 via the artery-side passage 11. . Along with this, the dialysate in the blood chamber 2 ⁇ / b> C is discharged to the vein side passage 12.
  • the air introduced into the drip chamber 15 is introduced into the upper part of the blood chamber 2C including the first port 2G via the artery-side passage 11, the newly introduced air and the first air are introduced first.
  • the air bubbles in the first port 2G are integrated (see FIGS. 4A and 4B). That is, the dialysate in the upper part of the first port 2G and the blood chamber 2C is replaced with air.
  • the introduction direction of the priming liquid into the blood chamber 2C is opposite to the introduction direction of air.
  • the control means 1B closes the second clamping means 13 ′ and then performs reverse filtration again with the dialysate circuit 4 (see FIG. 4C). That is, priming by reverse filtration is performed again.
  • the dialysate is introduced into the blood chamber 2 ⁇ / b> C, and further dialysate is introduced from the first port 2 ⁇ / b> G into the passage 11 and into the drip chamber 15.
  • the air in the upper portion of the first port 2G and the blood chamber 2C on the upper side is discharged to the upper space of the drip chamber 15 via the artery side passage 11. That is, the air bubbles previously in the first port 2G are reliably discharged into the drip chamber 15 together with the air introduced by the liquid level adjusting means 5.
  • the control means 1B reverses the air pump 8
  • the air in the drip chamber 15 is discharged through the atmospheric passage 6, and accordingly, the level of the dialysate in the drip chamber 15 rises to a required height. (See FIG. 4C).
  • the dialysate chamber 2D, blood chamber 2C and blood circuit 3 of the dialyzer 2 are filled with the dialysate as the priming solution by reverse filtration, and the priming is completed.
  • the priming is performed twice before and after the air is introduced into the blood chamber 2C of the dialyzer 2 by the liquid level adjusting means 5.
  • the dialyzer 2 In the case of the priming by reverse filtration, the dialyzer 2 is in the same holding state as that at the time of dialysis treatment, and thereafter, the dialysis treatment can be immediately performed. Thereafter, dialysis treatment by the dialysis apparatus 1 is performed as described above.
  • the ports 2H and 2G of the dialyzer 2 even if small bubbles remain in the ports 2H and 2G of the dialyzer 2 at the time of priming, they are located on the upper side in the final stage of priming.
  • the introduced air and the bubbles in the ports 2H and 2G are integrated.
  • the priming solution in the upper part of the blood chamber 2C located on the upper side is intentionally replaced with a required amount of air.
  • the ports 2H and 2G and the blood chamber 2C are again filled with the priming solution and the air is discharged to the outside of the blood chamber 2C, so that the air bubbles in the blood chamber 2C including the ports 2H and 2G are removed.
  • priming by reverse filtration is performed as the second priming method.
  • reverse filtration may be performed by a different method. That is, for example, as described in Japanese Patent Application Laid-Open No. 2003-180823, the present invention can be applied to remove bubbles by reversely rotating a dewatering pump provided in a dialysate recovery circuit and performing reverse filtration. Can be done. Further, the bubble removal according to the present invention can be performed even by priming by other methods.
  • the liquid level adjusting means 5 is used as the gas introducing means, but the following configuration may be employed instead. That is, as shown in FIG.
  • one gas introduction means 51 is provided in the artery side passage 11 between the drip chamber 15 on the artery side and the dialyzer 2, and the drip chamber 15 ′ on the vein side is dialyzed. What is necessary is just to provide the other gas introduction means 52 in the vein side channel
  • the gas introducing means 51 includes an atmosphere opening passage 53, an opening / closing valve V 105 provided in the atmosphere opening passage 53, an air pump 55, and a sterile filter 56.
  • the other gas introducing means 52 is also configured in the same manner as the gas introducing means 51, each constituent member corresponding to the gas introducing means 51 is indicated by “′”.
  • the gas introduction means 51 and 52 are above the dialyzer 2 held so that the longitudinal direction is the vertical direction. Air is introduced into the blood chamber 2C including each port 2G or 2H to replace the priming solution. After that, by filling the blood chamber 2C including the ports 2G or 2H of the dialyzer 2 again with the priming liquid, the air bubbles in the blood chamber 2C can be reliably removed.

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  • Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Cardiology (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
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  • General Health & Medical Sciences (AREA)
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Abstract

Cette invention concerne un dispositif de dialyse amorcé en maintenant un dialyseur (2) à l'envers, contrairement à ce qui se passe lors d'une thérapie par dialyse, puis en activant une pompe sanguine (14) qui remplit un circuit sanguin (3) et l'intérieur du dialyseur (2) avec du sérum physiologique contenu dans une poche de sérum physiologique (17). Un système d'ajustement du niveau de liquide (5) permet d'introduire de l'air circulant par une voie aérienne (6'), une chambre compte-gouttes (15') d'un circuit veineux latéral (12) et le circuit veineux latéral (12) dans la partie supérieure d'une chambre sanguine (2C) comportant un deuxième port (2H) [Fig. 3(b)]. Les petites bulles d'air présentes dans le deuxième port (2H) du dialyseur (2) sont associées avec l'air passant dans la chambre compte-gouttes (15). L'air est ensuite évacué du dialyseur (2) par le sérum physiologique qui est de nouveau introduit dans la chambre sanguine (2C). Les bulles d'air dans la chambre sanguine (2C) du dialyseur (2) peuvent ainsi être éliminées en toute sécurité dans le processus d'amorçage.
PCT/JP2012/060820 2011-05-02 2012-04-23 Dispositif de dialyse et méthode d'amorçage d'un dispositif de dialyse WO2012150679A1 (fr)

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JP2011102905A JP2012231985A (ja) 2011-05-02 2011-05-02 透析装置と透析装置のプライミング方法
JP2011-102905 2011-05-02

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US10022484B2 (en) 2013-02-06 2018-07-17 Nxstage Medical, Inc. Fluid circuit priming methods, devices, and systems

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JP6332605B2 (ja) * 2014-02-27 2018-05-30 澁谷工業株式会社 血液透析装置の洗浄装置と洗浄方法
JP6496949B2 (ja) * 2014-02-28 2019-04-10 株式会社ハイレックスコーポレーション 流体処理器着脱装置

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JPH01113064A (ja) * 1987-10-27 1989-05-01 Ube Ind Ltd 血漿交換器のプライミング方法
JPH0360671A (ja) * 1989-07-28 1991-03-15 Yokogawa Electric Corp 人工透析装置
JPH1133111A (ja) * 1997-07-14 1999-02-09 Jms Co Ltd プライミング容易な血液処理器、および該血液処理器のプライミング方法
JP2007190068A (ja) * 2006-01-17 2007-08-02 Nipro Corp 血液浄化装置及びその血液循環路の自動プライミング方法
JP2009297339A (ja) * 2008-06-16 2009-12-24 Nikkiso Co Ltd 血液浄化装置及びそのプライミング方法
JP2010125208A (ja) * 2008-11-28 2010-06-10 Asahi Kasei Kuraray Medical Co Ltd 血液体外循環装置及びそのプライミング方法
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JPH01113064A (ja) * 1987-10-27 1989-05-01 Ube Ind Ltd 血漿交換器のプライミング方法
JPH0360671A (ja) * 1989-07-28 1991-03-15 Yokogawa Electric Corp 人工透析装置
JPH1133111A (ja) * 1997-07-14 1999-02-09 Jms Co Ltd プライミング容易な血液処理器、および該血液処理器のプライミング方法
JP2007190068A (ja) * 2006-01-17 2007-08-02 Nipro Corp 血液浄化装置及びその血液循環路の自動プライミング方法
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Publication number Priority date Publication date Assignee Title
US10022484B2 (en) 2013-02-06 2018-07-17 Nxstage Medical, Inc. Fluid circuit priming methods, devices, and systems
US10835662B2 (en) 2013-02-06 2020-11-17 Nxstage Medical, Inc. Fluid circuit priming methods, devices, and systems
US11344658B2 (en) 2013-02-06 2022-05-31 Nxstage Medical, Inc. Fluid circuit priming methods, devices, and systems

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