WO2013014470A1 - Procédé et appareil de distribution de fluide - Google Patents

Procédé et appareil de distribution de fluide Download PDF

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Publication number
WO2013014470A1
WO2013014470A1 PCT/GB2012/051826 GB2012051826W WO2013014470A1 WO 2013014470 A1 WO2013014470 A1 WO 2013014470A1 GB 2012051826 W GB2012051826 W GB 2012051826W WO 2013014470 A1 WO2013014470 A1 WO 2013014470A1
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WO
WIPO (PCT)
Prior art keywords
fluid
dispensing
hydration
signal
met
Prior art date
Application number
PCT/GB2012/051826
Other languages
English (en)
Inventor
Hugh E. Montgomery
Michael Mythen
Anthony Thorne
Original Assignee
Ucl Business Plc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ucl Business Plc filed Critical Ucl Business Plc
Publication of WO2013014470A1 publication Critical patent/WO2013014470A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/172—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic
    • A61M5/1723—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic using feedback of body parameters, e.g. blood-sugar, pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4869—Determining body composition
    • A61B5/4875—Hydration status, fluid retention of the body
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/142—Pressure infusion, e.g. using pumps
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/502—User interfaces, e.g. screens or keyboards
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/52—General characteristics of the apparatus with microprocessors or computers with memories providing a history of measured variating parameters of apparatus or patient

Definitions

  • This invention is related to the provision of fluids.
  • the invention relates to an apparatus, and associated method, for providing hydration fluids or blood to a recipient.
  • Inappropriate (generally inadequate) prescribing can have profound and detrimental consequences: patients who do not receive enough fluids become uncomfortable and dehydrated, and even modest fluid depletion decreases well-being, making it harder to cope with other symptoms, and can impair kidney function and overall surgical outcome. Even quite small volumes of additional fluid administered in the peri-operative period improve outcome in terms of complication rates, durations of hospital stay, and even mortality.
  • an apparatus for dispensing fluid comprising: a signal input device for receiving a signal, a physiological measurement analysis unit configured to analyse physiological measurements of a patient and, based on the analysis, send a signal to the signal input device, and a control unit configured to determine, in response to the signal input device receiving a signal, if dispensing criteria are met, the dispensing criteria being based on a dispensing history of a fluid.
  • This aspect of the invention allows for the determination of whether a patient is in need of hydration. If a patient is severely indisposed or under anaesthesia, for example, they may not be able tell carers if they are feeling dehydrated.
  • the invention allows for the automatic monitoring of a patient and, if the monitoring indicates a need for hydration, a signal is sent to initiate a determination as to whether dispensing hydration is appropriate. For example, the signal can be sent when the analysis indicates dehydration and/or central hypovolaemia.
  • the invention allows for the history of hydration provision to be monitored, so that the decision as to whether it is appropriate to provide hydration can be taken.
  • the invention provides an apparatus that is both responsive to the hydration levels of a patient and that also includes safeguards to prevent too much fluid being provided.
  • the apparatus can be configured to dispense fluid if it is determined by the control unit that the dispensing criteria are met. As a result, if it is judged safe to provide further hydration, a patient receives hydration in response to the sensing of dropping hydration levels.
  • the dispensing can occur by the provision of a bolus dose of fluid, or by the increasing of a background flow rate of fluid that is already being provided to the patient.
  • the physiological measurement analysis unit can be configured to analyse one or more of pulse pressure variation, stroke volume variation, systolic pressure variation and/or peak velocity variation to determine if there is insufficient hydration and / or central hypovolaemia.
  • the physiological measurement analysis unit can be configured to determine that there is insufficient hydration and/or central hypovolaemia if one or more of the of pulse pressure variation, stroke volume variation, systolic pressure variation and/or peak velocity variation has a value of 10% or more, optionally 12% or more, optionally 15% or more.
  • a blood pressure meter can be configured to provide blood pressure measurements, or parameters derived therefrom, to the physiological measurement analysis unit.
  • a blood pressure meter or other cardiac output meter can be used to obtain measurements of PPV, SVV, SPV and/ or PVV, which can be indicative of insufficient hydration and / or central hypovolaemia. This therefore allows a non- invasive method of determining if extra hydration is required.
  • the apparatus can be configured to dispense the predetermined metered amount of fluid in response to the operator confirmation input device receiving confirmation from an operator even if the control unit determines the dispensing criteria are not met.
  • the apparatus can provide guidance to an operator such as a clinician, based upon the programmed dispensing criteria, but an operator may choose to override the guidance based on their own judgement.
  • the fluid can be fluid for intravenous delivery, and the dispensing criteria are based on the dispensing history of the fluid for intravenous delivery.
  • the apparatus can be configured to dispense the fluid intravenously. As such, the fluid may be provided even if the patient is not conscious, for example.
  • the apparatus can be configured to dispense fluid as a predetermined amount of fluid, and the control unit can be further configured to determine how many times the predetermined metered amount of fluid has been dispensed in a first predetermined period, and the control unit can be configured to determine that the dispensing criteria are met if it determines that the number of times the fluid has been dispensed in the first predetermined period is less than a predetermined number of times.
  • the predetermined metered amount of fluid can be in the range of from 10 to 1000 ml, preferably from 10 to 500 ml, and more preferably from 100 to 300 ml.
  • the first predetermined period can be in the range of from 30 to 90 minutes, preferably from 45 to 75 minutes and more preferably is from 55 to 65 minutes.
  • the predetermined number of times can be in the range of from 1 to 5, more preferably from 1 to 3 and still more preferably is 2.
  • the apparatus can be configured to dispense the predetermined metered amount of fluid at a flow rate in the range of from 1 to 4000 ml/hr, preferably from 1000 to 3000 ml/hr and more preferably from 1500 to 2500 ml/hr.
  • the control unit can be further configured, in response to the signal input device receiving the signal, to determine the length of time since a predetermined metered amount of fluid was dispensed, and to determine that the dispensing criteria are not met if the determined length of time is less than a predefined length of time.
  • the control unit can be further configured, in response to the signal input device receiving the signal, to determine the total amount of fluid dispensed in a second predetermined period, and to determine that the dispensing criteria are not met if the total amount of fluid dispensed in the second predetermined period is greater than a
  • the fluid can be hydration fluid, such as a colloid, or blood.
  • hydration fluid such as a colloid
  • blood it may be preferable to provide blood to a patient suffering from central hypovolaemia whilst it may be preferable to provide a hydration fluid to a patient suffering from dehydration.
  • the method can further comprise dispensing a predetermined metered amount of hydration if it is determined that the dispensing criteria are met.
  • a method for dispensing fluid comprising: in response to a signal, initiating an alarm and determining if dispensing criteria are met, the dispensing criteria being based on a dispensing history of a fluid, and dispensing a predetermined metered amount of fluid in response to receiving a confirmation that the fluid should be dispensed.
  • a method for dispensing hydration fluid comprising: in response to a signal from a user, dispensing a predetermined metered amount of hydration fluid for oral ingestion, wherein the
  • predetermined metered amount of hydration fluid for oral ingestion is not more than 20 ml.
  • This method allows a patient to request a small amount of hydration fluid, which can then be dispensed automatically for drinking and for wetting the patient's mouth.
  • Dispensing small amounts of fluid is particularly advantageous for patients who are unable to sit up to drink normally. In that case, dispensing a large amount of fluid is potentially dangerous, as the patient may choke. In contrast, by dispensing a small amount of fluid the patient is easily able to drink, and is able to control their state of hydration even if they are relatively infirm. Further, dispensing a small amount of hydration fluid for oral ingestion is preferable for patients who are nil-by-mouth. In that case, the patient may be thirsty and dispensing a small amount of fluid will wet their mouth and relieve their thirst, without compromising their nil-by-mouth status, or can be used as a trigger for an intravenous bolus.
  • the predetermined metered amount of hydration fluid for oral ingestion is not more than 10 ml and is more preferably not more than 5 ml.
  • a method for dispensing hydration fluid comprising: in response to a signal from a user, determining if first dispensing criteria are met, the first dispensing criteria being based on a dispensing history of a hydration fluid for oral ingestion, and if it is determined that the first dispensing criteria are met, dispensing a predetermined metered amount of hydration fluid for oral ingestion.
  • This method allows for a patient to receive hydration fluid on demand, as long as dispensing criteria have been met. It is desirable for a patient to be able to administer their own hydration, as this improves their overall comfort and can accelerate patient recovery after operation. However, it is also desirable to monitor a patient's fluid intake and to ensure that a patient does not drink too much. Therefore, the method of the present aspect allows for a patient to control their hydration and to be provided with hydration fluids automatically, whilst predetermined dispensing criteria ensure that a patient does not receive too much fluid.
  • determining if the first dispensing criteria are met further comprises determining how many times the predetermined metered amount of hydration fluid for oral ingestion has been dispensed in a first predetermined period, and the first dispensing criteria are deemed met if it is determined that the number of times the hydration fluid for oral ingestion has been dispensed in the first predetermined period is less than a first
  • the dispensing criteria are based upon the dispensing history of the hydration fluid for oral ingestion. This allows for hydration fluid to be dispensed if, for example, no hydration fluid has been dispensed for a long time. In contrast if the hydration fluid has been dispensed several times recently, further hydration fluid may not be dispensed to prevent the patient receiving too much fluid.
  • the predetermined metered amount of hydration fluid for oral ingestion is not more than 20 ml, and is preferably not more than 10 ml and is more preferably not more than 5 ml.
  • dispensing small amounts of hydration fluid is particularly advantageous for patients who cannot sit up, or are nil-by-mouth.
  • the first predetermined period is in the range of from 30 to 90 minutes, preferably from 45 to 75 minutes and more preferably is from 55 to 65 minutes.
  • the first predetermined number of times is in the range of from 4 to 12, more preferably from 6 to 10 and still more preferably from 7 to 9. These parameters ensure that a patient only receives a suitable amount of fluid.
  • the method further comprises: in response to said signal from said user, determining if second dispensing criteria are met, the second dispensing criteria being based on a dispensing history of a hydration fluid for intravenous delivery, and if it is determined that the second dispensing criteria are met, the method further comprises dispensing a predetermined metered amount of hydration fluid for intravenous delivery.
  • This embodiment allows for the dispensing of both hydration fluid for intravenous delivery and hydration fluid for oral delivery.
  • the combined provision of these two forms of hydration fluid can be particularly effective for improving both the overall level of hydration in a patient and also the patient's comfort.
  • Intravenous delivery of hydration fluid ensures that the hydration level of a patient is quickly improved, whilst oral delivery of hydration fluid improves patient comfort by wetting the patient's mouth.
  • the predetermined metered amount of hydration fluid for intravenous delivery is in the range of from 10 to 1000 ml, preferably from 10 to 500 ml, and more preferably from 100 to 300 ml.
  • the second predetermined period is in the range of from 30 to 90 minutes, preferably from 45 to 75 minutes and more preferably is from 55 to 65 minutes.
  • the second predetermined number of times is in the range of from 1 to 5, more preferably from 1 to 3 and still more preferably is 2.
  • the predetermined metered amount of hydration fluid for intravenous delivery is dispensed at a flow rate in the range of from 1 to 4000 ml/hr, preferably from 1000 to 3000 ml/hr and more preferably from 1500 to 2500 ml/hr.
  • the method further comprises determining if the first dispensing criteria are met further comprises determining the length of time since a predetermined metered amount of hydration fluid for oral ingestion was dispensed, and wherein the first dispensing criteria are not met if the determined length of time is less than a predefined length of time.
  • the method further comprises dispensing a background flow rate of hydration fluid for intravenous delivery.
  • a background flow rate of hydration fluid for intravenous delivery. This allows a continuous provision of hydration fluid to the patient, which in turn helps maintain a steady level of hydration.
  • a method comprising: dispensing a background flow of hydration fluid for intravenous delivery, and in response to a signal from a user, dispensing a predetermined metered amount of hydration fluid for oral ingestion.
  • This method provides a continuous background flow of hydration fluid to the patient, helping to maintain a steady level of hydration. Nonetheless, the patient may start to feel dehydrated or thirsty. Therefore, the method provides for further hydration fluid to be dispensed orally, thus wetting the patient's mouth and improving the overall level of comfort of the patient.
  • the background flow of hydration fluid for intravenous delivery is in the range of from 0 to 1500 ml/hr, preferably from 0 to 1000 ml/hr and more preferably from 500 to 1000 ml/hr.
  • the background flow rates are suitable for maintaining a steady level of hydration in a patient.
  • hydration fluid for oral ingestion predetermined metered amount of hydration fluid for oral ingestion, wherein the signal from the user is provided via a switch forming part of a mouth assembly, and the hydration fluid for oral ingestion is dispensed through the mouth assembly.
  • the patient is able to signal for hydration fluid by using a switch in a mouth assembly.
  • This is a convenient location for providing the switch, because the patient is often provided with a mouth assembly in order to receive the hydration fluid for oral ingestion.
  • the switch is mouth operable and more preferably the switch is a pressure switch.
  • the mouth assembly can be considered to be an "automatic" or
  • the pressure switch is configured to signal when the user sucks through the mouth assembly, then the hydration fluid is dispensed when the user sucks.
  • This design provides an apparatus that is intuitive for a user to operate to obtain hydration fluid, especially for infirm patients.
  • the present invention provides a method for monitoring a hydration fluid dispensing process, the method comprising: determining the rate at which hydration fluid is leaving a reservoir, comparing said determined rate to a stored desired flow rate; providing a signal indicative of whether the stored desired rate is the same as the determined rate at which hydration fluid is leaving the reservoir, based on said comparing.
  • the method allows for the detection of a situation in which the desired flow rate is not the same as the actual flow rate from a reservoir. This may occur, for instance, if a tube through a peristaltic pump becomes blocked. Alternatively, this may occur when a feed tube works itself free of the pump - leading to a situation in which fluid is free to flow from the reservoir without impediment - a situation known as "free-flow". In either case, it is desirable to notice that the desired flow rate is not being provided as quickly as possible. Therefore, the method provides a signal that indicates whether the desired flow rate is being provided. The signal may be an audible or visual alarm, which may either begin or cease when it is determined that the rates are different. Preferably, the method further comprises sounding an alarm, when said signal is indicative that the stored desired rate is not the same as the determined rate.
  • the reservoir is provided on a load cell, and the step of determining the actual rate further comprises: determining the rate of change mass measured by the load cell. Measuring the rate of change of mass of the reservoir is a preferable way of determining the actual flow rate of fluid out of the reservoir because this is non-invasive to the hydration fluid flow path. It does not require providing any further flow meters or any other devices in contact with the fluid, and therefore reduces the risk of any contamination or fault with the equipment for providing the hydration fluid.
  • the invention provides an apparatus for dispensing hydration fluid, the apparatus comprising: a signal input device for receiving a signal from a user, the apparatus being configured such that, in response to the signal input device receiving a signal from the user, a predetermined metered amount of hydration fluid for oral ingestion is dispensed, wherein the predetermined metered amount of hydration fluid for oral ingestion is not more than 20 ml.
  • the invention provides an apparatus for dispensing hydration fluid, the apparatus comprising: a signal input device for receiving a signal from a user, a control unit configured to determine, in response to the signal input device receiving a signal from the user, if first dispensing criteria are met, the first dispensing criteria being based on a dispensing history of a hydration fluid for oral ingestion, and the apparatus being configured such that a predetermined metered amount of hydration fluid for oral ingestion is dispensed if it is determined by the control unit that the first dispensing criteria are met.
  • the invention provides an apparatus for dispensing hydration fluid, the apparatus being configured to dispense a background flow of hydration fluid for intravenous delivery, the apparatus further comprising: a signal input device for receiving a signal from a user, the apparatus being further configured such that, in response to the signal input device receiving a signal from the user, a predetermined metered amount of hydration fluid for oral ingestion is dispensed.
  • the invention provides an apparatus for dispensing hydration fluid, the apparatus comprising: a mouth assembly comprising a switch, operable by a user to send a signal, a signal input device for receiving the signal from a user, the apparatus being further configured such that, in response to the signal input device receiving the signal sent from the switch by the user, a predetermined metered amount of hydration fluid for oral ingestion is dispensed through the mouth assembly.
  • the invention provides an apparatus for monitoring a hydration fluid dispensing process, the apparatus comprising: a memory configured to store a desired flow rate, and a control unit configured to determine the rate at which hydration fluid is leaving a reservoir, and to compare the determined flow rate to the stored desired flow rate, wherein the apparatus is configured to provide a signal indicative of whether the stored desired rate is the same as the rate at which fluid is leaving the reservoir.
  • a method of treating dehydration or hypovolaemia comprising: analysing physiological measurements of a patient and, based on the analysis, sending a signal if the physiological measurements indicate central hypovolaemia and/or insufficient hydration, determining, in response to the signal, if dispensing criteria are met, the dispensing criteria being based on a dispensing history of a fluid, and dispensing the fluid to a patient, if the dispensing criteria are met, wherein analysing physiological measurements of a patient comprises analysing one or more of pulse pressure variation, stroke volume variation, systolic pressure variation and/or peak velocity variation to determine if there is central hypovolaemia or insufficient hydration.
  • Fig. 1 is a diagram of a system for providing hydration fluids in accordance with the first embodiment of the invention
  • Fig. 2 is a schematic diagram showing internal components of the pump of the system of Fig. 1;
  • Fig. 3 is a diagram of the system of Fig. 1 showing an expanded view of the mouthpiece
  • Fig. 4 is a diagram of a system for providing hydration fluids in accordance with another embodiment of the invention.
  • Fig. 5 is a diagram of a system for providing hydration fluids in accordance with another embodiment of the invention.
  • Fig. 6 is a diagram of a system for providing hydration fluids incorporating apparatus for monitoring the dispensing of the hydration fluid.
  • the system 10 comprises a reservoir 4, containing the hydration fluid for oral ingestion 7.
  • the reservoir holds at least 250 ml of hydration fluid for oral ingestion 7, more preferably holds at least 500 ml of hydration fluid for oral ingestion 7, still more preferably holds at least 1 litre of hydration fluid for oral ingestion 7 and even more preferably holds at least 3 litres of hydration fluid for oral ingestion 7.
  • the reservoir 4 itself is preferably a bag or pouch constructed from a collapsible material, e.g. a polymer.
  • the reservoir 4 is also preferably transparent, so that the hydration fluid for oral ingestion 7 may be observed in the reservoir 4.
  • the reservoir 4 may also be provided with gradations to indicate the amount of fluid remaining in the reservoir 4 or the amount of hydration fluid for oral ingestion 7 that has been emptied from the reservoir 4.
  • the reservoir 4 is a pre-filled and/or pre-sealed unit, containing a sterile hydration fluid for oral ingestion 7.
  • a sterile hydration fluid for oral ingestion 7 is preferably provided in a sterile packaging, to ensure that the reservoir 4 itself is also sterile.
  • the reservoir may be re-usable and re-fillable.
  • the reservoir 4 is attached to a tube 2 by any suitable means.
  • the tube 2 is connected to the reservoir 4 via a connection 9.
  • the tube 2 may be integrally attached to the reservoir 4, or may be detachable.
  • any suitable detachable connection may be used. Examples of possible detachable connections 9 include a screw connection, luer lock or a spear connection that punctures the reservoir 4.
  • the end of the tube 2 not connected to the reservoir 4 is connected to a mouth piece 11.
  • the mouth piece may take any form suitable for delivering hydration fluid for oral ingestion 7 from the tube 2 to the mouth of a user.
  • the mouth piece 11 may take the form of a straw or drinking tube.
  • Such a mouth piece 11 may be preferable for users who have a good range of movement and motor control.
  • the mouth piece 1 1 may take a form which is designed to be permanently positioned to provide hydration fluid to the user's gut. This includes the use of nasogastric, nasojejunal or percutaneous enterostomy tubes.
  • Such designs of mouth piece 11 may be preferable for users with limited movement and motor control.
  • the system 10 includes a means for providing fluid for oral ingestion 7 from the reservoir 4 through the tube 2 at a controlled rate.
  • the means for providing hydration fluid for oral ingestion is a peristaltic pump 1 which forces hydration fluid for oral ingestion 7 through a tube 2 using rollers to squeeze and release the tube 2.
  • any suitable means for providing hydration fluid for oral ingestion 7 can be used, such as a drip counter and controlled clamp or a different type of pump.
  • a syringe pump is not a preferred embodiment of the means for providing hydration fluid for oral ingestion 7, and according to one aspect of the invention a syringe pump is not used as a means for providing the hydration fluid for oral ingestion 7.
  • the system 10 can further comprise a user-manipulable signal input means 5 for sending a signal to the means for providing fluid, and/or another means of providing signals to control the pump 1 (not shown in Fig. 1).
  • the means for providing fluid is arranged to detect the signals from the signal input means 5 or alternative control means.
  • the signal input means 5 comprises a hand-held device with a button 6, which can be pressed by a patient.
  • the signal input means 5 is shown in Fig. 1 as connected to the pump 1 via a wire 13.
  • any suitable means of connection between the signal input means 5 and the means for providing fluid 1 may be used such as methods of wireless communication.
  • the button 6 is provided on a unit which is easy to hold.
  • the force required to press the button 6 should preferably be at least high enough to avoid the button being operated by being accidentally knocked, but low enough to allow weaker patients to operate the button 6.
  • the pump 1 of Fig. 1 has a control unit 3.
  • the control unit is within pump 1, but the control unit 3 may be a separate device to the pump 1.
  • the control unit 3 can be used, by a person other than the patient, for example the doctor or nurse, to set how the pump 1 responds to receiving a signal from the signal input means 5.
  • the control unit 3 may incorporate some form of control panel 3a, as shown in Fig. 1.
  • the control panel 3a is preferably secured either physically (e.g. with a protective cover and/or a key) or by a password to prevent unauthorised persons (including the patient) using the control panel 3 a to modify the settings of the pump 1.
  • the control unit 3 may be programmable remotely.
  • the control panel 3a can be a touch screen interface.
  • the control unit 3 can also be used by an operator other than the patient (for example a clinician) to directly control the pump 1.
  • the control unit 3 can allow the operator to change the rate of fluid dispensation, or allow the operator to control the pump to deliver a bolus dose of fluid. This is discussed in more detail below.
  • the tube 2 of Fig 1 is connected to the reservoir 4 at one end, and to the mouthpiece 11 , which is provided to a patient, at the other.
  • the patient is also provided with signal input means 5.
  • the nurse or authorised user may use the control panel 3 a to set a predetermined metered amount of hydration fluid for oral ingestion 7 that may be provided when the signal input means 5 is operated.
  • the volume of the predetermined metered amount will depend on factors such as the size and hydration of the patient.
  • the predetermined metered amount of hydration fluid for oral ingestion 7 is preferably not more than 20 ml, more preferably not more than 10 ml and even more preferably not more than 5 ml.
  • the small volumes allow enough hydration fluid for oral ingestion 7 to be dispensed to the patient to wet the patient's mouth, without compromising the nil-by-mouth status of the patient.
  • the predetermined metered amount may be in the range of from 10 to 500 ml.
  • the predetermined amount may be kept small (i.e. 20ml or less) but the frequency of which the amounts be dispensed may be increased.
  • the control unit 3 may also used to set a "lock out" period of time after a
  • predetermined metered amount cannot be dispensed. This period is preferably in the range of from 1 to 30 minutes, for example 1 to 15 minutes, more preferably 2 to 10 minutes.
  • control unit may be programmed to provide the predetermined metered amount only a limited number of times in a predetermined period of time.
  • predetermined period of time is preferable in the range of from 30 to 90 minutes, more preferably 45 to 75 minutes, still more preferably from 55 to 65 minutes and in a preferred embodiment is 60 minutes.
  • the limited number of times is preferably in the range of from 4 to 12, more preferably from 6 to 10, still more preferably from 7 to 9 and in a preferred embodiment is 8.
  • control unit 3 may also be used to set a maximum value of fluid which may be dispensed in a period, for example, 100 to 800 ml per hour. If this amount of fluid has already been dispensed, the pump will not dispense any further liquid in response to user signals.
  • the patient may use the signal input means to request hydration fluid for oral ingestion 7 when, for example, they are feeling especially thirsty or dehydrated.
  • the patient operates the signal input means 5, by pressing the button 6, to send a signal to the pump 1.
  • the pump 1 in response to receiving the signal via the signal input device 12, 12a may dispense the predetermined metered amount of hydration fluid for oral ingestion 7.
  • the control unit 3 is configured to determine if the dispensing criteria are met.
  • control unit 3 determines that the dispensing criteria have been met, based on information stored in the memory 21, the pump 1 is configured to dispense the
  • the pump 1 In the case that the dispensing criteria are met, and the pump 1 dispenses the predetermined metered amount of hydration fluid for oral ingestion 7, the pump 1 updates the dispensing history information stored in the memory 21 with information regarding the dispensing operation.
  • the control unit 3 uses the updated dispensing history information to determine whether the dispensing criteria are met.
  • a patient using the system 10 is able to control, within some
  • the patient need only be able to operate the signal input means 5 that preferably comprises a button 6. It is likely that a patient will be able to operate a button 6 even when they are not able to hold a drink themselves. Further, in the case where small amounts of hydration fluid for oral ingestion 7 are being dispensed, it is easy for a patient to swallow the liquid, even if they are lying down.
  • the signal input means is incorporated into the mouthpiece which delivers the hydration fluid for oral ingestion 7 to a user's mouth.
  • a signal input means 35 may be provided within the mouthpiece 11 itself.
  • the signal input means 35 may be a switch, such as a pressure switch which is capable of detecting when a user sucks on the mouthpiece 11.
  • Such an embodiment may be considered to be an "electronic drinking straw”. Sucking on mouthpiece 11 initiates the automatic dispensing of hydration fluid 7.
  • the pressure switch 35 detects that the user is sucking and sends a signal to the signal input means 12, 12a of the pump 1.
  • the communication between the pressure switch 35 and the signal input means 12, 12a may use wired or wireless communication techniques. In the embodiment of Fig. 3, wireless communication is used between the mouthpiece 35 and the signal input means 12, 12a.
  • the pump 1 may or may not be programmed to use dispensing criteria to determine whether hydration fluid for oral ingestion 7 should be dispensed. If the pump 1 is not so programmed, or it is determined that the dispensing criteria are met, then the predetermined metered amount of hydration fluid for oral ingestion 7 is dispensed. As a result, the user does not need to maintain their suction on the mouthpiece 11 in order to obtain the hydration fluid for oral ingestion 7 because it is automatically dispensed. Such an embodiment is particularly preferable for infirm patients, because it makes it very easy for them to obtain hydration fluid.
  • FIG. 4 shows an alternative embodiment. This embodiment incorporates the system discussed with reference to Figures 1-3. However, the pump 41 differs from the pump 1 of the previous embodiments in that it may dispense two different fluids.
  • the pump 41 therefore incorporates two means for providing fluid, each of which may also be a peristaltic pump which forces fluid through a tube 2, 42 using rollers to squeeze and release the tube 2, 42.
  • the second means for providing fluid may be used for providing hydration fluid for intravenous delivery 47 or blood, for example.
  • Hydration fluids for intravenous delivery 7 may comprise or consist of crystalloids, electrolytes and/or colloids. Hydration fluid for intravenous delivery 47 may not be suitable for use as a hydration fluid for oral ingestion 7 and vice versa.
  • Further examples of hydration fluids include for intravenous use include, saline solution (particularly 0.45% and 0.9% w/v of NaCl in water - e.g.
  • suitable hydrations fluids include water, but more generally include any palatable liquid (both those with or without flavour or nutritional value, and including fluids with nutritional supplements or electrolyte solutions).
  • colloids such as, but not limited to, albumin-, dextran-, hetastarch- and gelatin-containing solutions
  • blood products including packed red cells, platelets and clotting factors, as well as artificial blood substitutes.
  • the fluid for intravenous delivery 47 is provided via tube 42 from a reservoir 4.
  • the other end of tube 42 is connected to a cannula or needle 8 which may be intravenously inserted into a patient.
  • the second means for providing fluid may also be controlled via the control unit 3 and control panel 3a.
  • the background flow rate will depend on factors such as the patient's size and their condition.
  • the background flow rate of a fluid, particularly hydration fluid will be in the range of from 40 to 1000 ml per hour. More preferably in the range of 50 to 500 ml per hour and even more preferably from 75 to 250 ml per hour.
  • the background flow rate may be lowered to 30 ml per hour.
  • the pump 41 may also be configured to provide a bolus dose of fluid for intravenous delivery 47 in response to the pump 41 receiving a signal via the signal input unit 12, 12a.
  • the pump 41 may be configured to provide hydration fluid for intravenous delivery 47 as well as or instead of the hydration fluid for oral ingestion 7 in response to receiving a signal from a user.
  • the bolus of fluid for intravenous delivery 47 is a predetermined metered amount, and the volume of the bolus will also depend on factors such as the size and condition of the patient. However, the volume of the bolus, particularly for hydration fluid, is preferable in the range of from 10 to 1000 ml, more preferably from 10 to 500 ml and more preferably from 100 to 300 ml.
  • the rate at which the pump 41 pumps fluid for intravenous delivery 47 from the reservoir 44 through the tube 42 will increase so as to provide the bolus amount as well as the background amount of hydration fluid for intravenous delivery 47.
  • the pumping rate used to provide the bolus is preferably in the range of from 25 to 250 ml per minute, more preferably 50 to 200 ml per minute and still more preferably 75 to 100 ml per minute.
  • the dispensing may be conditional upon the control unit 3 of the pump 41 determining that dispensing criteria have been met.
  • the dispensing criteria may be based upon the dispensing history of the hydration fluid for intravenous delivery 47.
  • the bolus may only be dispensed if the control unit 3 determines that the number of times the hydration fluid for intravenous delivery 47 has been dispensed in a predetermined period is less than a predetermined number of times.
  • the predetermined period and predetermined number of times may be different to the predetermined period and predetermined number of times used to determine whether dispensing criteria based upon the dispensing history of the hydration fluid for oral ingestion 7 are met.
  • the predetermined period used in the dispensing criteria concerning the dispensing history of the hydration fluid for intravenous delivery 47 is preferably in the range of from 30 to 90 minutes, more preferably from 45 to 75 minutes and still more preferably from 55 to 65 minutes and even more preferably is 60 minutes.
  • the predetermined number of bolus doses used in the dispensing criteria based upon the history of the dispensing of the hydration fluid for intravenous delivery 47 is preferably in the range of from 1 to 5, more preferably from 1 to 3 and still more preferably is 2.
  • the volume of the bolus dose itself is preferably in the range of from 10 to 1000 ml, preferably from 10 to 500 ml and more preferably from 100 to 300 ml.
  • the pump 1 may be controlled via a controller 50, which may be a stand-alone controller or another device that incorporates a controller.
  • the controller 50 can be incorporated into the pump 1.
  • the controller 50 serves as an alternative (or additional) means of sending a signal to the signal input device 12,12a to the signal input means 5.
  • the controller 50 is an example of a physiological measurement analysis unit that is configured to analyse physiological measurements of a patient, and send a signal based on the analysis. For example, the signal can be sent if the analysis indicates that insufficient hydration and/or central hypovolaemia.
  • the controller 50 can have one or more signal receivers 51,52, which can receive signals representing physiological measurements, or parameters derived therefrom, to be processed by the controller.
  • the signal receivers 51 ,52 can receive the signals through a wired connection (electrical or optical for example) or wirelessly.
  • the controller sends a signal to the signal input device 12,12a indicating a need for hydration based upon the signals received via one or more signal receivers 51,52.
  • a patient under anaesthesia can be monitored using one or more sensors
  • the controller 50 can analyse the signals to determine whether the patient is sufficiently hydrated and/or suffering from hypovolaemia. Based on this analysis, the controller 50 can, if necessary, provide a signal to the signal input device 12,12a indicating a need for fluid to be dispensed.
  • This system could automatically dispense fluid, such as a hydration fluid or blood, to a patient in response to the signal, based on the pump's programming, either by dispensing a bolus dose of fluid or increasing a background flow rate for example.
  • the fluid could be dispensed intravenously or possibly via a nasogastric tube for example.
  • the patient will not be able to accept or refuse the extra fluid themselves.
  • the controller 50 can send a signal to the pump 1.
  • the pump 1 upon receiving the signal can then turn on an alarm 23, which can be audible, visual or both, to alert an operator such as a clinician.
  • the alarm 23 can be local to the pump 1 (as shown) or could be remote, such as an alarm in a nursing station or a pager.
  • the pump 1 may also provide information via the control unit 3, based on the signal received from the controller 50, so the operator can assess whether it is appropriate to provide extra hydration. That is, the control unit 3 can incorporate a display unit to display whether the dispensing criteria have been met. The operator may also be able to make a decision based on information provided directly by the sensors 61,62 or the controller 50.
  • control panel 3 can use the control panel 3 to initiate a bolus dose or increased background flow rate of fluid. This can be possible even if the system has determined that the programmed dispensing criteria are not met. That is, the operator can override the recommendations of the system, based on their own judgement.
  • the control panel 3 acts a confirmation input device, allowing the operator to confirm that a patient requires extra fluid and that, for example, an extra bolus of fluid should be dispensed.
  • the system can be set up to judge whether extra fluid is advisable based on the dispensing criteria previously discussed, and provide a judgement result to the operator (again, via the control panel 3 for example) to assist the operator in determining whether to approve the dispensation of further fluid.
  • An example of the operation of the system of Figure 5 would start with a sensor 61 providing sensor information to controller 50 via signal receiver 51.
  • the controller 50 analyses the sensor information, and determines that the patient is insufficiently hydrated and/or suffering from hypovolaemia.
  • the controller 50 then sends a signal to the pump 1 via signal input device 12,12a indicating further fluid is required.
  • Pump 1 then initiates alarm 23 and displays information on the control panel 30 based on the programmed dispensing criteria as to whether it is recommended to provide extra fluid.
  • the operator in response to the alarm, can review the available information on the patient's hydration level and the recommendation of the pump 1 based on the dispensing history, and decide whether to approve extra fluid.
  • the sensors 61,62 can provide measurements of any quantities suitable for the controller 50 to infer a level of hydration or identify central hypovolaemia.
  • the sensors may detect pulse pressure variation (PPV), stroke volume variation (SVV), systolic pressure variation (SPV) and/or peak velocity variation (PVV) as an indicator of central blood volume status. This can allow detection of hypovolaemia (low blood volume) especially, for example when a patient is under positive pressure ventilation, an exhibits sinus rhythm.
  • PP max and PP m i n are the maximum and minimum pulse pressure values, respectively, during one respiratory cycle.
  • SPV and PVV are the maximum and minimum pulse pressure values, respectively, during one respiratory cycle.
  • PPV, SVV, SPV or PVV of greater than 12 to 15% can be indicative of central hypovolaemia and indicates that the heart will have a favourable response to a fluid bolus. Therefore, the controller 50 may be configured to send a signal of the pump 1 when it detects if one or more of a PPV, SPV or PVV value is 10% or more, optionally 12% or more or optionally 15% or more.
  • PPV, SPV, SVV can be determined from measurements taken by a blood pressure meter connected to an arterial line or a plethysmographic trace. PVV and SVV can be determined by cardiac output measuring devices such as an
  • sensors for detecting other physiological measurements that can be used to determine if a patient has insufficient hydration, either alone or in combination, can also be used.
  • measurements of urinary sodium levels or measurements from an electrocardiogram could be used as a factor of relevance when determining if there is insufficient hydration.
  • an indwelling sensor could be used to provide intravascular or tissue measures of osmolality.
  • the controller 50 may be configured to send a signal of the pump 1 when it detects that the osmolality is
  • Figure 5 shows only a single mode of providing fluid (a needle 8 for providing intravenous fluid delivery)
  • the controller 50 and sensors 61,62 could be used in a combined oral/intravenous system.
  • a similar alarm protocol could be used to ensure a patient remains hydrated even if they are awake/active (i.e. not sedated). This would help prevent patients becoming dehydrated, even if they are nominally able to access hydration themselves.
  • the system would be similar to the system of Fig. 4, with pump 41.
  • the pump 41 may be operated in several different modes.
  • the pump 41 may be used in a similar fashion to pump 1. That is, the pump 41 may be used to delivery only hydration fluid for oral ingestion 7. In this mode, the pump 41 dispenses hydration fluid for oral ingestion 7 in response to receiving a signal from a user and may or may not employ dispensing criteria to determine whether the hydration fluid for oral ingestion 7 should be dispensed.
  • the pump 41 may be configured only to provide fluid for intravenous delivery 47 as bolus doses.
  • the bolus doses may be provided with a
  • the pump 41 may or may not employ dispensing criteria to determine whether the bolus dose should be dispensed.
  • the pump 41 may be used to provide fluid for intravenous delivery 47 as a background flow rate only.
  • the background flow rate is programmed into the pump 41, and does not respond to signals from a patient operated signal input means 5 to provide extra amounts of hydration fluid (either hydration fluid for oral ingestion 7 or fluid for intravenous delivery 47). However, it may respond to signals from a controller 50 and alert another operator to a need for extra fluid by providing a bolus dose or an increase in background flow rate.
  • the pump 41 may be configured to provide fluid for intravenous delivery 47 only, but using a combination of a background flow rate and bolus delivery.
  • the bolus delivery may be configured to be provided automatically, and/or in response to receiving a signal from a user such as a patient and/or another operator.
  • the pump 41 may employ dispensing criteria to determine whether the bolus should be dispensed.
  • the pump 41 may be configured to provide a background of fluid for intravenous delivery 47 and to also provide predetermined metered amounts of hydration fluid for oral ingestion 7 in response to receiving a signal from a user.
  • the pump 41 may or may not employ dispensing criteria to determine whether a predetermined amount of hydration fluid for oral ingestion should be dispensed when receiving the signal from the user.
  • the pump 41 may be configured to provide predetermined metered amounts of both the hydration fluid for oral ingestion 7 and the fluid for intravenous delivery 47.
  • the pump 41 may optionally be further configured to also provide a background flow of fluid for intravenous delivery 47.
  • the predetermined metered amount of fluid for intravenous delivery 47 may be provided at a predetermined frequency or in response to a signal. If the pump 41 is configured to dispense both the predetermined metered amounts of hydration fluid for oral ingestion 7 and the predetermined metered amounts of fluid for intravenous delivery 47 in response to the same signal, separate dispensing criteria may be used to determine whether each fluid should be dispensed. As a result, if there are different dispensing criteria programmed for the hydration fluid for intravenous delivery 47 and the fluid for oral ingestion 7, the pump 41 may dispense either both or only one of the two fluids in response to the signal from the user.
  • the modes that allow the dispensing of both fluids 7, 47 in response to the pump 41 receiving a signal from the user are particularly effective for increasing patient hydration and also increasing patient comfort. Even when only a small amount of fluid is provided orally, providing a bolus of fluid intravenously increases patient hydration whilst the small amount of oral fluid wets the patient's mouth and increases their comfort.
  • the pump 41 may be entirely controlled via external devices via input device 22, 22a.
  • the signal may be from a user controlled device such as switch 5 or mouth operated switch 35, or may be a signal from controller 50. If the signal is from the controller 50, the subsequent dispensing may be automatic or may proceed according to the semi-automatic dispensing operation previously described with reference to Figure 5.
  • the advantage of using the modes that provide hydration fluid for oral ingestion 7 is that this utilises the gut of the patient to absorb the fluids. Early use of the gut after an operation may help reduce morbidity, and is currently strongly advocated.
  • the signal input means 5, 35 is not necessarily physically attached to the pump 41.
  • the signal input means 5, 35 may be some form of remote control that communicates wirelessly with the pump 1, 41.
  • Suitable means for communication between a remote control signal input means 5, 35 and the pump 1, 41, via the detector 12, include, but are not limited to, infra-red, bluetooth, Wi- Fi or 3 G communications.
  • Figure 6 shows an example of a pump 1 which embodies an apparatus for monitoring a fluid dispensing process.
  • Figure 6 shows an apparatus based on the systems of Figures 1-3.
  • the system of Figure 4 may also be monitored by a similar method to that discussed below.
  • the reservoir 4 containing hydration fluid for oral ingestion 7 is attached to a load cell 30.
  • the load cell 30 can therefore measure the weight of the reservoir 4 containing the hydration fluid 7. This measurement can be communicated to the pump 1 via the signal input device 22.
  • the load cell 30 communicates with the pump 1 and communicates with input device of pump 1 via a wired connection 14, but any means of communication (including wireless communication) could be used.
  • control unit of pump 1 may determine the rate of change of mass of the reservoir 4 with time. This can be used to infer the rate at which the hydration fluid for oral ingestion 7 is leaving the reservoir 4. It will be readily understood that to adopt this system to the apparatus of Figure 4, each reservoir 4 would be monitored by a separate load cell 30.
  • the pump 1 may be further configured to store the rate at which the pump is dispensing hydration fluid 7 at any given time in the memory 21.
  • the control unit 3 may be further configured to determine whether the rate stored in the memory is the same (or within a predetermined tolerance of) the rate at which it is calculated hydration fluid is leaving the reservoir 4 based on the measurements of the load cell 30.
  • the pump 1 is further configured to provide a signal indicative of whether the rate stored in the memory 21 is the same as the rate at which fluid is calculated to be leaving the reservoir 4.
  • This feature of the apparatus of Figure 6 provides a safety check to ensure that the hydration fluid 7 is being dispensed from the reservoir 4 at the correct rate.
  • the reservoir 4 will be elevated with respect to the patient, and so hydration fluid 7 will flow freely from the reservoir 4 through the tube 2. This problem is known as freeflow.
  • the configuration of the pump in Figure 6 allows for the detection of free-flow, because when free-flow occurs the rate at which fluid is leaving the reservoir will be measured by the load cell 30 and will differ to the rate at which the hydration fluid is intended to be dispensed by the pump 1.
  • the pump 1 may be configured to provide a signal indicative of whether the rate stored in the memory is the same at which fluid is measured to be leaving the reservoir 4. This may comprise providing a signal such as a light or alarm when the two rates are determined to be different, and ceasing to provide the signal when the two rates are the same. Alternatively, the opposite configuration could be used, in which a signal is provided whilst the rates are the same, and is ceased to be provided when the rates are different.
  • Pumps 1 , 41 are typically operated by connecting to mains power. However, the pumps 1 , 41 may also be provided with a rechargeable battery so that they may continue operating in the event of a mains power failure. The pumps 1, 41 may also be provided with a small system sustain battery which will operate alarms for a minimum of 4 hours and maintain memory for a minimum of 100 days even if the rechargeable battery loses power.
  • KVO Keep Vein Open
  • the KVO flow rate may be approximately 5 ml/hr.
  • Pumps 1 , 41 may be further configured to determine when tubes 2, 42 become occluded. For example, sensors may detect an increase in pressure in the tubing, indicative of a blockage in the tube. Pumps 1, 41 may be further configured to reduce the pressure in the tubes 2, 42 when an occlusion is detected. Preferably, following the detection of an occlusion, the pumps 1, 41 return the tube into a neutral line pressure between 5-25 mmHg within 15 seconds, irrespective of the operating conditions. Provision of this feature is particularly preferable in the pump 41, with respect to the provision of intravenous fluids because of the greater danger to the patient when administering fluids intravenously.
  • Pumps 1 , 41 may be further configured to receive information regarding the fluid lost by a patient.
  • a further load cell 30 connected to a urine collection bag could provide information about the fluid lost by the patient.
  • the pumps 1, 41 may be configured to present this information to a doctor or nurse via a display, to assist them in assessing suitable parameters for patient hydration.
  • pumps 1 , 41 may be externally programmable to provide fluid.
  • the pumps 1, 41 may incorporate safety limits, to ensure that any programmed profile or fluid delivery remains within safe boundaries.
  • the total volume may be limited to less than 2 litres of fluid per hour.

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Abstract

L'invention concerne un procédé et un appareil de distribution de fluides. L'invention permet à un fluide d'être fourni à un patient en réponse à un signal. Le signal peut être fourni directement par un patient, ou peut être envoyé par un dispositif surveillant des mesures physiologiques du patient. Le fluide peut être administré automatiquement en réponse au signal, ou peut alerter un opérateur pour confirmer si le fluide devrait être ou non administré.
PCT/GB2012/051826 2011-07-27 2012-07-27 Procédé et appareil de distribution de fluide WO2013014470A1 (fr)

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GBGB1112910.3A GB201112910D0 (en) 2011-07-27 2011-07-27 Method and apparatus for providing fluid

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106999657A (zh) * 2014-11-27 2017-08-01 日东电工株式会社 给药机构、给药机构的使用方法、给药机构用泵单元
US20210022663A1 (en) * 2019-07-26 2021-01-28 Viavi Solutions Inc. Hydration assessment using a binary multispectral sensor
WO2023218200A1 (fr) * 2022-05-12 2023-11-16 Abtrace Limited Système de distribution de fluide

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060270971A1 (en) * 2004-09-09 2006-11-30 Mark Gelfand Patient hydration system with a redundant monitoring of hydration fluid infusion
US20090076462A1 (en) * 2007-09-13 2009-03-19 Kiani Massi E Fluid titration system
US20100081942A1 (en) * 2008-09-30 2010-04-01 The General Electric Company Method, arrangement and apparatus for monitoring fluid balance status of a subject
WO2011089394A2 (fr) * 2010-01-22 2011-07-28 Ucl Business Plc Procédé et appareil de délivrance d'un fluide d'hydratation

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060270971A1 (en) * 2004-09-09 2006-11-30 Mark Gelfand Patient hydration system with a redundant monitoring of hydration fluid infusion
US20090076462A1 (en) * 2007-09-13 2009-03-19 Kiani Massi E Fluid titration system
US20100081942A1 (en) * 2008-09-30 2010-04-01 The General Electric Company Method, arrangement and apparatus for monitoring fluid balance status of a subject
WO2011089394A2 (fr) * 2010-01-22 2011-07-28 Ucl Business Plc Procédé et appareil de délivrance d'un fluide d'hydratation

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106999657A (zh) * 2014-11-27 2017-08-01 日东电工株式会社 给药机构、给药机构的使用方法、给药机构用泵单元
US20210022663A1 (en) * 2019-07-26 2021-01-28 Viavi Solutions Inc. Hydration assessment using a binary multispectral sensor
WO2023218200A1 (fr) * 2022-05-12 2023-11-16 Abtrace Limited Système de distribution de fluide

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