WO2013031965A1 - Dispositif de purification du sang - Google Patents

Dispositif de purification du sang Download PDF

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Publication number
WO2013031965A1
WO2013031965A1 PCT/JP2012/072209 JP2012072209W WO2013031965A1 WO 2013031965 A1 WO2013031965 A1 WO 2013031965A1 JP 2012072209 W JP2012072209 W JP 2012072209W WO 2013031965 A1 WO2013031965 A1 WO 2013031965A1
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WIPO (PCT)
Prior art keywords
blood
arterial
venous
circuit
blood circuit
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PCT/JP2012/072209
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English (en)
Japanese (ja)
Inventor
寛 二村
横山　和巳
智洋 古橋
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日機装株式会社
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Publication of WO2013031965A1 publication Critical patent/WO2013031965A1/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
    • A61M1/3626—Gas bubble detectors
    • 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
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes

Definitions

  • the present invention relates to a blood purification apparatus for purifying a patient's blood while circulating it extracorporeally, such as dialysis treatment using a dialyzer.
  • a dialysis device as a blood purification device includes an arterial blood circuit with an arterial puncture needle attached to the tip, a blood circuit comprising a venous blood circuit with a venous puncture needle attached to the tip, an arterial blood circuit, and a vein
  • a dialyzer disposed between the side blood circuits to purify blood flowing through the blood circuit, a blood pump disposed in the arterial blood circuit, and a blood pump disposed in the arterial blood circuit and the venous blood circuit, respectively. It mainly comprises an arterial air trap chamber and a venous air trap chamber for foaming, and a dialyzer body capable of supplying dialysate to the dialyzer.
  • a storage bag containing physiological saline is connected between the arterial puncture needle and the blood pump in the arterial blood circuit via a physiological saline supply line, and during priming before dialysis treatment, dialysis is performed.
  • the physiological saline solution in the accommodation bag can be supplied into the blood circuit via the physiological saline supply line at the time of fluid replacement during treatment or when returning blood after dialysis treatment.
  • physiological saline solution is supplied into the blood circuit as a replacement liquid, and blood can be returned by replacing the blood in the blood circuit with the replacement liquid (for example, Patent Document 1). reference).
  • JP 2006-280775 A Japanese Patent Laid-Open No. 6-261938
  • the conventional blood purification apparatus has the following problems. While blood is circulating extracorporeally at the time of blood purification treatment, the upstream side of the blood pump arrangement position in the arterial blood circuit (specifically, the iron that is connected to the arterial blood circuit and is squeezed by the blood pump) Air bubbles tend to accumulate in the connection portion (T-tube or the like) to the upstream portion of the tube) or the physiological saline supply line. In particular, the upstream side of the position where the blood pump is disposed in the arterial blood circuit tends to be relatively negative pressure, and dissolved oxygen in the blood is likely to bubble.
  • a venous air trap chamber for defoaming is usually connected to the venous blood circuit, it is possible to drive the blood pump in the normal direction to connect the replacement circuit supply line in the blood circuit.
  • the air bubbles retained during the treatment can be captured in a venous side air trap chamber or the like.
  • the blood pump is reversed.
  • the blood pump In the arterial blood return process in which the blood from the connection with the replacement fluid supply line in the blood circuit to the tip of the arterial blood circuit is replaced by the replacement fluid to return blood, Moves to the distal end side of the arterial blood circuit, and the bubble detecting means disposed at the distal end of the arterial blood circuit detects the bubbles and issues an alarm.
  • An object of the present invention is to provide a blood purification device that can perform the above.
  • the invention according to claim 1 is composed of an arterial blood circuit and a venous blood circuit, a blood circuit capable of extracorporeally circulating a patient's blood from the tip of the arterial blood circuit to the tip of the venous blood circuit, and the blood
  • a blood purification means for purifying blood flowing between the arterial blood circuit and the venous blood circuit of the circuit, and disposed in the arterial blood circuit to drive the liquid in the blood circuit
  • a blood pump that can flow in a direction
  • an artery-side bubble detecting means that is disposed in the vicinity of the tip of the artery-side blood circuit, and that can detect bubbles in the liquid flowing in the flow path, and after treatment, the replacement fluid is the blood
  • a blood purification apparatus comprising: a control means capable of supplying blood to the circuit and replacing the blood in the blood circuit with the replacement liquid to return the blood. Detecting bubbles Subject to, characterized in that could carry out the recovery step of normal rotation of the blood pump.
  • the blood purification device is connected between the position of the blood pump in the arterial blood circuit and the tip of the arterial blood circuit.
  • a replacement fluid supply line capable of supplying a replacement fluid for replacing blood to the arterial blood circuit, a closed state that blocks the flow path of the replacement fluid supply line, and a flow state that allows the replacement fluid to flow freely Switching means capable of switching, and at the time of returning blood, the control means replaces blood from a connection portion with the replacement fluid supply line in the blood circuit to a tip of the venous blood circuit with the replacement fluid.
  • Blood return from the venous side blood return step and blood from the connecting part of the blood circuit to the tip of the arterial blood circuit is replaced with the replacement liquid to return the blood.
  • the blood pump is driven to rotate forward on the condition that the arterial bubble detection means has detected a bubble during the arterial blood return step, and at least the detected bubble is removed. It is a process of making it transfer to the said venous side blood return process, after making it flow from the said connection part to the said blood pump side.
  • the blood pump in the blood purification apparatus according to the second aspect, can be driven to rotate forward and reversely, and the control means can perform the blood pump in the venous blood return step. , And the blood pump is reversely driven in the arterial blood return step.
  • the arterial valve is provided so that the vicinity of the tip of the arterial blood circuit can be opened and closed, and the flow path can be closed and opened.
  • a venous valve means that is provided so as to be capable of opening and closing the vicinity of the distal end of the venous blood circuit and capable of closing and opening the flow path, and the control means includes the artery in the recovery step.
  • the side valve means and the vein side valve means are opened, and the switching means is closed.
  • the invention according to claim 5 is the blood purification apparatus according to any one of claims 2 to 4, wherein the control means alternately performs the venous return step and the arterial return step a plurality of times. And the recovery step is performed on the condition that the arterial bubble detection means detects a bubble during the arterial blood return step.
  • a sixth aspect of the present invention provides the blood purification apparatus according to any one of the first to fifth aspects, wherein the venous blood circuit or the arterial blood circuit downstream from the blood pump is defoamed. An air trap chamber is connected.
  • the switching means includes an electromagnetic valve disposed in the replacement liquid supply line, and the electromagnetic valve It is possible to switch between the closed state and the distribution state by opening and closing.
  • the switching means includes a squeezing pump disposed in the replacement fluid supply line, and The closed state and the flow state can be switched by stopping or driving the mold pump.
  • control means can perform a recovery step of driving the blood pump in a forward direction on the condition that the arterial bubble detection means has detected a bubble when returning blood.
  • the movement direction of the bubbles can be automatically changed, and the burden on the medical staff can be reduced.
  • the blood pump is driven to rotate forward on the condition that the arterial bubble detection means has detected the bubble during the arterial blood return step, and the detected bubble is at least connected to the blood pump side from the connection portion.
  • a recovery step is performed to shift to the venous side blood return step, so that when the air bubbles are detected during the arterial side blood return step, the movement direction of the bubbles can be automatically changed, The burden on workers can be reduced.
  • the blood pump can be driven forward and backward, and the control means drives the blood pump forward in the venous side blood return step, and blood in the arterial side blood return step. Since the pump is driven in reverse, the blood return by the venous side blood return step and the arterial side blood return step can be performed satisfactorily and reliably.
  • control means opens the arterial side valve means and the venous side valve means and closes the switching means in the recovery step, so that bubbles are not generated in the arterial side blood return step.
  • the moving direction of the bubbles can be changed automatically and smoothly.
  • the control means causes the venous side blood return step and the arterial side blood return step to be alternately performed a plurality of times, and the arterial side bubble detection means during the arterial side blood return step. Since the recovery process is performed on the condition that air bubbles have been detected, the blood from the connection with the replacement liquid supply line in the blood circuit to the tip of the venous blood circuit in the blood return process, and the replacement liquid in the blood circuit It is possible to prevent blood from coagulating from the connection with the supply line to the tip of the arterial blood circuit, and automatically move the air bubbles when air bubbles are detected during the arterial blood return process The direction can be changed, and the burden on the medical staff can be reduced.
  • the air trap chamber for defoaming is connected to the venous blood circuit or the arterial blood circuit downstream from the blood pump, in the venous blood return step, the air Air bubbles can be reliably captured by the trap chamber.
  • the switching means is composed of an electromagnetic valve arranged in the replacement liquid supply line, and can be switched between a closed state and a flow state by opening and closing the electromagnetic valve. It can be easily applied to a configuration in which a storage means storing physiological saline is connected to the proximal end of the replacement liquid supply line, and physiological saline as a replacement liquid is supplied to the blood circuit by its own weight.
  • the switching means is composed of the ironing type pump disposed in the replacement liquid supply line, and can be switched between the closed state and the flow state by stopping or driving the ironing type pump. Therefore, the base of the replacement fluid supply line is connected to the dialysate introduction line for supplying dialysate to the blood purification means, and the peristaltic pump is driven so that the dialysate as the replacement fluid is supplied to the blood circuit. It can be easily applied to the form of supply.
  • the schematic diagram which shows the blood purification apparatus (at the time of a venous side blood return process) which concerns on embodiment of this invention Schematic showing the blood purification device (at the time of pressure accumulation in the arterial blood return process) Schematic showing the blood purification device (at the time of blood return in the arterial blood return process) Schematic showing the blood purification device (during the recovery process) Flow chart showing control contents at the time of blood return in the blood purification apparatus.
  • the flowchart which shows the other control content at the time of blood return in the blood purification apparatus Schematic showing the blood purification device (during other recovery process and venous return process)
  • the schematic diagram which shows the blood purification apparatus which concerns on other embodiment of this invention Schematic diagram showing a blood purification apparatus according to still another embodiment of the present invention.
  • the blood purification apparatus includes a dialysis apparatus for performing dialysis treatment. As shown in FIG. 1, a blood circuit including an arterial blood circuit 1 and a venous blood circuit 2, and an arterial blood circuit 1. And a dialyzer 3 (blood purification means) interposed between the venous blood circuit 2 and purifying blood flowing through the blood circuit, a blood pump 4, and the arterial blood circuit 1 and venous blood circuit 2, respectively.
  • a dialyzer 3 blood purification means interposed between the venous blood circuit 2 and purifying blood flowing through the blood circuit, a blood pump 4, and the arterial blood circuit 1 and venous blood circuit 2, respectively.
  • the arterial blood circuit 1 is connected with an arterial puncture needle at the tip thereof, and an iron-type blood pump 4 and an arterial air trap chamber 5 for defoaming are disposed in the middle of the arterial blood circuit 1.
  • a venous puncture needle is connected to the distal end of the side blood circuit 2, and a venous air trap chamber 6 is connected to the side blood circuit 2.
  • the arterial air trap chamber 5 and the venous air trap chamber 6 are formed with an air layer, capable of capturing bubbles in the liquid, and provided with a filtration network (not shown). It is now possible to capture blood clots and the like.
  • the arterial air trap chamber 5 is disposed downstream of the blood pump 4 in the arterial blood circuit 1 (between the blood pump 4 and the dialyzer 3 in the arterial blood circuit 1).
  • the blood pump 4 is composed of a squeezing type pump disposed in the arterial blood circuit 1 and is capable of normal rotation and reverse rotation and allows fluid in the blood circuit to flow in the driving direction. That is, the arterial blood circuit 1 is connected to a corrugated tube 1a that is softer and larger in diameter than the other flexible tubes that constitute the arterial blood circuit 1, and the blood pump 4 includes the corrugated tube 1a. A roller for squeezing the tube 1a in the longitudinal direction is provided. When the blood pump 4 is driven in this manner, the roller rotates to squeeze the ironing tube 1a, and the liquid inside can flow in the driving direction (rotating direction of the roller).
  • the blood pump 4 When the blood pump 4 is driven to rotate forward (left rotation in the figure) while the patient is punctured with the arterial puncture needle and the venous puncture needle, the blood of the patient passes through the arterial blood circuit 1 and the dialyzer. After reaching 3, blood purification is performed by the dialyzer 3, and defoaming is performed in the venous air trap chamber 6, and then returns to the patient's body through the venous blood circuit 2. That is, the blood of the patient is purified by the dialyzer 3 while circulating externally from the tip of the arterial blood circuit 1 to the tip of the venous blood circuit 2 of the blood circuit.
  • the dialyzer 3 is formed with a blood introduction port 3a, a blood outlet port 3b, a dialysate inlet port 3c, and a dialysate outlet port 3d in the casing.
  • the blood inlet port 3a includes the arterial blood circuit 1.
  • the venous blood circuit 2 is connected to the blood outlet port 3b.
  • the dialysate introduction port 3c and the dialysate lead-out port 3d are connected to a dialysate introduction line La and a dialysate discharge line Lb extending from the dialyzer body B, respectively.
  • a plurality of hollow fibers are accommodated in the dialyzer 3, the inside of the hollow fibers is used as a blood flow path, and the flow of dialysate is between the hollow fiber outer peripheral surface and the inner peripheral surface of the housing. It is considered a road.
  • a hollow fiber membrane is formed in the hollow fiber by forming a large number of minute holes (pores) penetrating the outer circumferential surface and the inner circumferential surface, and impurities in the blood are passed through the membrane in the dialysate. It is comprised so that it can permeate
  • the dialyzer main body B is provided with a dual pump 17 across the dialysate introduction line La and the dialysate discharge line Lb, and the bypass line Lc that bypasses the dual pump 17 is provided in the dialyzer 3.
  • a dewatering pump 18 is provided for removing water from the flowing patient's blood.
  • one end of the dialysate introduction line La is connected to the dialyzer 3 (dialyte introduction port 3c), and the other end is connected to a dialysate supply device (not shown) for preparing a predetermined concentration of dialysate.
  • dialysate discharge line Lb is connected to the dialyzer 3 (dialysate outlet port 3d), and the other end is connected to a drain means (not shown), and the dialysate supplied from the dialysate supply device After passing through the dialysate introduction line La to the dialyzer 3, it is sent to the drainage means through the dialysate discharge line Lb.
  • a pressure sensor 21 is connected to the venous air trap chamber 6 through a monitor tube so that the fluid pressure (venous pressure) in the venous air trap chamber 6 can be measured.
  • An overflow line 20 is extended from the upper part (air layer side) of the vein-side air trap chamber 6, and an electromagnetic valve V4 is disposed in the middle thereof. Then, by opening the electromagnetic valve V4, the liquid (priming liquid or the like) flowing in the blood circuit can be overflowed via the overflow line 20.
  • a physiological saline supply line 8 (substitution liquid supply line) is connected at one end to a T-shaped tube T between the position of the blood pump 4 in the artery-side blood circuit 1 and the tip of the artery-side blood circuit 1.
  • the flow path (for example, a flexible tube etc.) which can supply the physiological saline solution (substitution liquid) for replacing with the blood in the blood circuit to the artery side blood circuit 1 is provided.
  • the other end of the physiological saline supply line 8 is connected to a storage means 9 that stores a predetermined amount of physiological saline, and an air trap chamber 7 is connected in the middle.
  • Reference numeral 16 in the figure denotes a tube detector comprising a sensor or the like for detecting the presence or absence of the physiological saline supply line 8.
  • the physiological saline supply line 8 is provided with an electromagnetic valve V3 as a switching means.
  • the electromagnetic valve V3 is provided so that the physiological saline supply line 8 can be opened and closed, and the flow path can be closed and opened. By opening and closing the electromagnetic valve V3, the physiological saline supply line 8 flows. It is possible to arbitrarily switch between a closed state in which the path is closed and a flowing state in which a physiological saline solution (substitution solution) can flow.
  • the electromagnetic valve V3 is configured such that the opening / closing operation at the time of returning blood is controlled by the control means 19 described in detail later.
  • a solenoid valve V2 as a venous valve means.
  • These solenoid valves V1 and V2 are capable of closing and opening the flow paths in the respective portions provided by opening and closing operations, and the opening and closing operations at the time of returning blood are performed by the control means 19 described in detail later. It is configured to be controlled.
  • an arterial-side bubble detecting means 10 is disposed in the vicinity of the tip of the arterial blood circuit 1 (near the electromagnetic valve V1 as the arterial-side valve means), and in the vicinity of the tip of the venous-side blood circuit 2 (the venous valve). In the vicinity of the electromagnetic valve V2 as a means), the venous side bubble detecting means 11 is disposed.
  • the arterial-side bubble detection means 10 and the venous-side bubble detection means 11 are composed of sensors that can detect bubbles in the liquid flowing in the flow path, and are electrically connected to the control means 19.
  • reference numerals 12 and 13 and reference numerals 14 and 15 denote blood discriminators disposed near the tip of the arterial blood circuit 1 and near the tip of the venous blood circuit 2 (where blood flows in the flow path). And a tube detector (a sensor or the like for detecting the presence or absence of the arterial blood circuit 1 and the venous blood circuit 2).
  • a control means 19 composed of, for example, a microcomputer is disposed.
  • the control means 19 is electrically connected to sensors such as actuators such as blood pump 4 and electromagnetic valve V3 (switching means), arterial side bubble detection means 10 and venous side bubble detection means 11 and blood discriminators 12 and 13, for example.
  • actuators such as blood pump 4 and electromagnetic valve V3 (switching means)
  • arterial side bubble detection means 10 and venous side bubble detection means 11 and blood discriminators 12 and 13
  • blood discriminators 12 and 13 for example.
  • the physiological valve (substitution) is made to flow and the physiological saline (substitution fluid) is supplied to the blood circuit, and the blood in the blood circuit is physiological saline (substitution fluid).
  • control means 19 drives the blood pump 4 to rotate forward at the time of returning blood, and from the connection portion (position of the T-shaped tube T) to the physiological saline supply line 8 in the blood circuit, the venous blood circuit 2 is connected to the physiological saline supply line 8 in the blood circuit by reversely driving the blood pump 4 to return the blood up to the tip of the blood 2 by replacing the blood with physiological saline to return the blood.
  • an arterial blood return step (see FIG. 3) for returning blood by replacing the blood from (position of the T-shaped tube T) to the tip of the arterial blood circuit 1 with physiological saline. .
  • the control means 19 transfers the detected bubble to the connecting portion (position of the T-shaped tube T). ), A recovery process (see FIG. 4) for transferring to the blood pump 4 side and then a venous blood return process is performed. That is, when the arterial bubble detection means 10 detects a bubble in the arterial blood return step, an alarm is issued directly in the prior art, whereas in the present embodiment, a recovery step is performed instead of generating an alarm.
  • the control means 19 is supposed to perform this.
  • control means 19 controls the connection from the physiological saline supply line 8 in the blood circuit (position of the T-shaped tube T) to the tip of the venous blood circuit 2.
  • a venous-side blood return step S1 is performed in which the blood is returned to a physiological saline solution (replacement solution) and returned. As shown in FIG.
  • the venous side blood return step S1 includes the electromagnetic valve V1 (arterial side valve means) being closed and the electromagnetic valve V2 (venous side valve means) being opened, as well as the electromagnetic valve V3 ( The switching means) is opened and the blood pump 4 is driven to rotate forward.
  • this first venous side blood return step S1 a predetermined amount of the blood from the connection portion (position of the T-shaped tube T) with the physiological saline supply line 8 in the blood circuit to the tip of the venous side blood circuit 2 is physiologic.
  • the blood will be returned to blood after being replaced with a saline solution (substitution solution).
  • the process proceeds to the pressure accumulation step S3.
  • the predetermined amount in S2 can be grasped by detecting the driving time or the flow rate of the blood pump 4, for example.
  • the pressure accumulation step S3 is a step performed before the arterial blood return step S4. As shown in FIG. 2, the electromagnetic valve V1 (arterial side valve means) and the electromagnetic valve V2 (venous side valve means) are in a closed state. At the same time, the electromagnetic valve V3 (switching means) is opened and the blood pump 4 is driven to rotate forward. With this pressure accumulation step S3, a physiological saline solution (substitution fluid) for use in the subsequent arterial blood return step S4 can be stored in the blood circuit downstream of the site where the blood pump 4 is disposed.
  • an arterial blood return step S4 is performed.
  • the blood from the connecting portion (position of the T-shaped tube T) with the physiological saline supply line 8 in the blood circuit to the tip of the arterial blood circuit 1 is converted into a physiological saline (substitution fluid).
  • the electromagnetic valve V1 cardiac valve means
  • the electromagnetic valve V2 venous valve means
  • the electromagnetic valve V3 is returned.
  • switching means is closed and the blood pump 4 is driven in reverse.
  • this first arterial blood return step S4 a predetermined amount of the blood from the connection portion (position of the T-tube T) to the physiological saline supply line 8 in the blood circuit to the tip of the arterial blood circuit 1 is physiologic.
  • the blood will be returned to blood after being replaced with a saline solution (substitution solution).
  • the predetermined amount in S6 can be grasped by detecting the driving time or flow rate of the blood pump 4, for example.
  • S7 is a step of determining whether or not the blood return to the blood circuit (the arterial blood circuit 1 and the venous blood circuit 2) has reached a predetermined amount (that is, whether or not a predetermined amount of replacement fluid has been delivered). If it is determined that the predetermined blood return amount has not been reached, the process proceeds to S9, in which whether or not the blood return to the venous blood circuit 2 has reached a predetermined amount (that is, the predetermined amount of replacement liquid is delivered). Or not). If it is determined in S9 that the amount of blood returned to the venous blood circuit 2 has not reached the predetermined value, the process returns to S1 and the venous blood returning step S1 is performed. In S9, the venous blood circuit 2 is returned. When it is determined that the amount of blood returned to the predetermined value has reached a predetermined value, the process returns to S3 to perform the pressure accumulation step S3 and the arterial blood return step S4.
  • control means 19 causes the venous blood return step S1 and the arterial blood return step S4 to be alternately performed a plurality of times.
  • the blood process S4 a predetermined number of times, all blood in the blood circuit is set to be replaced with physiological saline (substitution liquid).
  • the artery side bubble detection means 10 when the artery side bubble detection means 10 detects a bubble in S5, it controls to transfer to recovery process S8.
  • the recovery step S8 is performed on the condition that the arterial bubble detection means 10 detects a bubble at the time of the arterial blood return step S4, and the detected bubble is transferred to the blood pump 4 side from the connecting portion (position of the T-shaped tube T). This is a step of shifting to the venous blood return step S1.
  • the blood pump 4 is temporarily stopped and the solenoid valve V1 is closed after the artery side bubble detection means 10 detects the bubble and before the recovery process S8 is started, and the physiological saline (substitution fluid) and the bubble are closed. It is preferable to control the flow of the air to stop.
  • the electromagnetic valve V1 cardiac valve means
  • the electromagnetic valve V2 venous valve means
  • the electromagnetic valve V3 switching means
  • the blood pump 4 is slightly forward driven. The forward rotation of the blood pump 4 at this time is such that the bubbles detected by the arterial-side bubble detection means 10 are connected from the position where the arterial-side bubble detection means 10 is connected to the physiological saline supply line 8 (T-shaped tube). It is set to such an extent that it flows from the T position) to the blood pump 4 side.
  • the blood at the time of the recovery step S8 The driving amount of the pump 4 can be grasped in advance.
  • the process proceeds to the venous return process S1, and at the time of the transferred venous return process S1, the arterial air bubbles are detected in the arterial air trap chamber 5 or the venous air trap chamber 6.
  • the bubbles detected by the means 10 are captured.
  • the recovery step S8 can automatically cope with it without issuing an alarm. If the arterial blood return step S1 has already been completed a predetermined number of times when the arterial air bubble detection means 10 detects the air bubble, the apparatus does not proceed to the recovery step S8 but issues an alarm to stop the apparatus. Controlled.
  • the recovery process S8 and the venous return process S1 (which may be either process)
  • the blood pump 4 is driven to rotate forward in the side blood return step S1
  • a physiological saline solution (replacement solution) that has already been replaced with blood is introduced into the patient's body, causing a problem.
  • the electromagnetic valves V1 and V2 are closed (however, the electromagnetic valve V2 may be open).
  • the electromagnetic valve V3 is opened, the blood pump 4 is driven to rotate forward, the electromagnetic valve of the dialysate introduction line La is closed, the electromagnetic valve of the dialysate discharge line Lb is opened, and the water removal pump 18 is turned on. You may make it drive at equal speed.
  • the electromagnetic valves V2 and V3 are closed while the electromagnetic valve V1 is open, and the blood pump 4 ,
  • the electromagnetic valve of the dialysate introduction line La is closed, and the electromagnetic valve of the dialysate discharge line Lb is opened, so that the water removal pump 18 is driven at a constant speed.
  • Step S1 can be performed.
  • the control means 19 can perform the recovery step S8 for driving the blood pump 4 to rotate forward on the condition that the arterial bubble detection means 10 has detected a bubble when returning blood.
  • the recovery step S8 the blood pump 4 is driven to rotate forward so that the detected bubbles flow at least from the connecting portion (T-shaped tube T) to the blood pump 4 side, and then returned to the venous side. The process is shifted to the blood process S1, but a recovery process that drives the blood pump 4 to rotate forward is sufficient as long as the arterial bubble detection means 10 detects a bubble when returning blood.
  • the blood pump 4 is driven to rotate forward on the condition that the arterial bubble detection means 10 has detected a bubble during the arterial blood return step S4, and the detected bubble is at least connected (T-shaped). Since the recovery step S8 is performed to move to the venous blood return step S1 after flowing from the position of the tube T to the blood pump 4 side, automatically when bubbles are detected during the arterial blood return step S4 It is possible to change the moving direction of the air bubbles and to suppress the warning due to the air bubble detection, thereby reducing the burden on the medical staff. In particular, in the present embodiment, in the recovery step S8, it is preferable to cause the detected bubbles to flow downstream (dialyzer 3 side) from the position where the blood pump 4 is arranged. Even in the case of reverse driving, the bubbles are likely to stay on the outlet side (downstream side) of the ironing tube 1a and flow upstream from the ironing tube 1a (tip side of the arterial blood circuit 1). Can be suppressed.
  • the blood pump 4 can be driven forward and backward, and the control means 19 drives the blood pump 4 to rotate forward in the venous blood return step S1, and the blood pump 4 in the arterial blood return step S4. Therefore, the blood return by the venous blood return step S1 and the arterial blood return step S4 can be performed satisfactorily and reliably.
  • the control means 19 in the recovery step S8, opens the electromagnetic valve V1 (arterial side valve means) and the electromagnetic valve V2 (venous side valve means) and opens the electromagnetic valve V3 (switching means). Since it is in the closed state, when a bubble is detected in the arterial blood return step S4, the moving direction of the bubble can be automatically and smoothly changed.
  • control means 19 is configured to cause the venous side blood return step S1 and the arterial side blood return step S4 to be alternately performed a plurality of times and at the time of the arterial side blood return step S4. Since the recovery step S8 is performed on the condition that the bubble detection means 10 has detected a bubble, in the blood return process, the connection from the physiological saline supply line 8 in the blood circuit to the tip of the venous blood circuit 2 is performed. Blood and blood from the connection with the physiological saline supply line 8 in the blood circuit to the tip of the arterial blood circuit 1 can be prevented from coagulating, and bubbles can be generated during the arterial blood return step S4. When the air bubble is detected, the moving direction of the bubbles can be automatically changed, and the burden on the medical staff can be reduced.
  • an arterial blood circuit 1 downstream from the venous blood circuit 2 and blood pump 4 (dialyzer 3 side) includes an air trap chamber for defoaming (in this embodiment, the arterial air trap chamber 5 and Since the venous air trap chamber 6) is connected, air bubbles can be reliably captured by the air trap chamber (arterial air trap chamber 5 and venous air trap chamber 6) in the venous blood return step S1. . Note that only one of the arterial air trap chamber 5 and the venous air trap chamber 6 may be connected.
  • switching means that can arbitrarily switch between a closed state in which the flow path of the physiological saline solution supply line 8 (substitution fluid supply line) is closed and a distribution state in which the physiological saline solution (substitution fluid) can be circulated.
  • the switching means according to the present embodiment is composed of the electromagnetic valve V3 disposed in the physiological saline supply line 8, but instead, it may be as shown in FIG. That is, as shown in the figure, instead of the physiological saline supply line 8, a replacement fluid line having a distal end connected to the T-shaped tube T and a proximal end connected to the dialysate introduction line La in the dialyzer body B 22 (substitution liquid supply line), and an iron pump 23 (switching means) may be disposed in the middle of the line.
  • the switching means that can arbitrarily switch between a closed state in which the flow path of the replacement fluid line 22 (substitution fluid supply line) is closed and a distribution state in which physiological saline (substitution fluid) can be circulated is the replacement fluid line 22 (substitution fluid).
  • the dialysis fluid can be switched between the closed state and the flow state by stopping or driving the squeezing pump 23, so that the dialysate is supplied to the dialyzer 3 (blood purification).
  • the squeezing type pump 23 such as a replacement fluid pump
  • the dialysate as the replacement liquid is supplied to the blood circuit. It can be easily applied to the form of supply.
  • the present invention can also be applied to a device that does not include the replacement liquid supply line (physiological saline supply line 8) and switching means (electromagnetic valve V3 or ironing pump 23) as in the above embodiment.
  • the solenoid valves V1 and V2 are opened, the solenoid valve V6 of the dialysate introduction line La is opened, and the solenoid valve V5 of the dialysate discharge line Lb is opened.
  • the driving amount (flow rate) of the blood pump 4 is preferably set to about half of the driving amount (flow rate) of the dual pump 17, so that the dialyzed solution as the back-filtered replacement solution can be obtained. It flows to both the arterial blood circuit 1 and the venous blood circuit 2, and the arterial blood return process and the venous blood return process can be performed simultaneously.
  • the driving amount (flow rate) of the blood pump 4 is set substantially equal to the driving amount (flow rate) of the compound pump 17, and the arterial blood return step is performed, and the blood pump 4 is stopped and the venous blood return step. May be performed separately.
  • the blood pump 4 is driven forward to perform the recovery process. Can do.
  • the air bubbles detected by the arterial air bubble detection means 10 are moved downstream from the blood pump 4 (dialyzer 3 side). Even in the recovery step in this case, when bubbles are detected during blood return, the movement direction of the bubbles can be automatically changed, and the burden on the medical staff can be reduced.
  • the pressure accumulation process S3 is made unnecessary by arrange
  • the blood pump 4 is driven in reverse during the arterial blood return step S4. Instead, for example, a driving source such as an iron pump is provided in the middle of the replacement fluid supply line.
  • the above-described iron pump performs the same operation as described above, or the physiological saline (replacement liquid) in the storage means 9 using the potential energy generated based on the installation height of the storage means 9. ) May be supplied into the blood circuit.
  • the present invention is applied to a dialysis apparatus used at the time of dialysis treatment, but is used in another apparatus that can purify the patient's blood while circulating it outside the body (for example, blood filtration dialysis, blood filtration, AFBF).
  • the present invention may be applied to blood purification devices, plasma adsorption devices, and the like.
  • the blood purification device is equipped with a control unit that can perform a recovery step of driving the blood pump in a forward direction on condition that the arterial bubble detection unit detects a bubble when returning blood.
  • the present invention can also be applied.

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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)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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Abstract

Pour obtenir un dispositif de purification du sang qui, lorsqu'une bulle d'air est détectée au cours d'une étape de retour du sang côté artère, peut automatiquement modifier le sens de déplacement de la bulle et alléger le fardeau d'un professionnel de santé, la solution suivante est proposée. Le dispositif de purification du sang est équipé pour cela d'un moyen de commande (19) qui peut réaliser : une étape de retour du sang côté veine (S1) qui, lors du retour du sang, permet le renvoi du sang ayant remplacé celui provenant de la section d'un circuit de circulation du sang raccordant une ligne d'alimentation (8) de solution saline physiologique à l'extrémité d'un circuit (2) de circulation du sang côté veine au moyen d'une solution saline physiologique ; une étape de retour du sang côté artère (S4) qui permet de procéder au retour du sang ayant remplacé celui provenant de la section du circuit de circulation du sang raccordant la ligne d'alimentation (8) de solution saline physiologique à l'extrémité d'un circuit (1) de circulation du sang côté artère au moyen d'une solution saline physiologique ; une étape de récupération (S8) qui, à condition qu'un moyen de détection (10) de bulle côté artère détecte une bulle au cours de l'étape de retour du sang côté artère, provoque l'écoulement de la bulle détectée vers une pompe à sang (4) au moyen d'une section de raccordement et effectue ensuite la transition vers l'étape de retour du sang côté veine (S1).
PCT/JP2012/072209 2011-08-31 2012-08-31 Dispositif de purification du sang WO2013031965A1 (fr)

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JP2011189281A JP2013048803A (ja) 2011-08-31 2011-08-31 血液浄化装置
JP2011-189281 2011-08-31

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Cited By (8)

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Publication number Priority date Publication date Assignee Title
JP5851003B1 (ja) * 2014-09-12 2016-02-03 日機装株式会社 血液浄化装置
US10441699B2 (en) 2015-01-23 2019-10-15 Nikkiso Company Limited Blood purification apparatus
US10610634B2 (en) 2015-05-21 2020-04-07 Nikkiso Company Limited Blood purification apparatus
US11123463B2 (en) 2015-06-24 2021-09-21 Nikkiso Company Limited Blood purification apparatus
EP3777917A4 (fr) * 2018-03-26 2021-12-29 Nikkiso Company Limited Appareil de purification de sang et procédé de capture de bulles dans celui-ci
US11278655B2 (en) 2016-01-25 2022-03-22 Nikkiso Company Limited Blood purification apparatus
US11413387B2 (en) 2016-09-23 2022-08-16 Nikkiso Company Limited Blood purification apparatus
US11690942B2 (en) 2016-09-12 2023-07-04 Nikkiso Company Limited Blood purification apparatus with a bypass line that bypasses an ultrafiltration pump

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JPS62157543U (fr) * 1986-03-27 1987-10-06
JPH06261938A (ja) * 1992-07-07 1994-09-20 Senko Ika Kogyo Kk 透析装置及び返血方法
JP2002095740A (ja) * 2000-09-25 2002-04-02 Nipro Corp 血液回路内の残留血液返血方法および血液浄化装置
JP2004313522A (ja) * 2003-04-17 2004-11-11 Nikkiso Co Ltd 透析装置
JP2009131412A (ja) * 2007-11-29 2009-06-18 Nikkiso Co Ltd 血液浄化装置

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JPS62157543U (fr) * 1986-03-27 1987-10-06
JPH06261938A (ja) * 1992-07-07 1994-09-20 Senko Ika Kogyo Kk 透析装置及び返血方法
JP2002095740A (ja) * 2000-09-25 2002-04-02 Nipro Corp 血液回路内の残留血液返血方法および血液浄化装置
JP2004313522A (ja) * 2003-04-17 2004-11-11 Nikkiso Co Ltd 透析装置
JP2009131412A (ja) * 2007-11-29 2009-06-18 Nikkiso Co Ltd 血液浄化装置

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP5851003B1 (ja) * 2014-09-12 2016-02-03 日機装株式会社 血液浄化装置
WO2016039437A1 (fr) * 2014-09-12 2016-03-17 日機装株式会社 Dispositif de purification du sang
CN106687156A (zh) * 2014-09-12 2017-05-17 日机装株式会社 血液净化装置
US10406273B2 (en) 2014-09-12 2019-09-10 Nikkiso Company Limited Blood purification apparatus
US10441699B2 (en) 2015-01-23 2019-10-15 Nikkiso Company Limited Blood purification apparatus
US10610634B2 (en) 2015-05-21 2020-04-07 Nikkiso Company Limited Blood purification apparatus
US11123463B2 (en) 2015-06-24 2021-09-21 Nikkiso Company Limited Blood purification apparatus
US11278655B2 (en) 2016-01-25 2022-03-22 Nikkiso Company Limited Blood purification apparatus
US11690942B2 (en) 2016-09-12 2023-07-04 Nikkiso Company Limited Blood purification apparatus with a bypass line that bypasses an ultrafiltration pump
US11413387B2 (en) 2016-09-23 2022-08-16 Nikkiso Company Limited Blood purification apparatus
EP3777917A4 (fr) * 2018-03-26 2021-12-29 Nikkiso Company Limited Appareil de purification de sang et procédé de capture de bulles dans celui-ci
US11964089B2 (en) 2018-03-26 2024-04-23 Nikkiso Company Limited Blood purification apparatus and method of trapping bubbles therein

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