External functional means, blood treatment apparatus for receiving an external functional means in accordance with the invention, and method

Abstract

An external functional means comprises at least one housing body, at least one chamber integrated into the housing body for receiving medical fluids, at least one passage integrated into the housing body for receiving and/or conducting a medical fluid, and at least one valve means completely or partly integrated into the housing body for controlling or regulating a fluid flowing through the external functional means. The invention further specifies a blood treatment apparatus and methods which may be carried out by means of the external functional means of the invention and by means of the blood treatment apparatus, respectively.

Claims

1. A medical device, comprising: at least one housing body, at least one chamber integrated into the housing body for receiving medical fluids; at least one passage integrated into the housing body for at least one of receiving and conducting a medical fluid; at least one valve completely or partly integrated into the housing body for controlling or regulating a fluid flowing through the medical device; and at least one venous blood chamber; wherein the medical device is a cassette configured for a blood treatment by dialysis having at least one single-needle chamber for a single-needle access to a patient; wherein the single-needle chamber is disposed on a venous blood side of the medical device and above the venous blood chamber relative to an orientation of the medical device during its use, the single-needle chamber being in fluid communication with the at least one passage integrated into the housing body for at least one of receiving and conducting a medical fluid only via the venous blood chamber.

2. The medical device according to claim 1, further comprising at least one surface on which a cover is provided, the cover being part of the at least one integrated valve.

3. The medical device according to claim 2, wherein the cover is connected by at least one of friction, form closure, and material connection to the housing body in at least one portion thereof.

4. The medical device according to claim 3, wherein the cover is connected to the housing body by at least one peripheral weld.

5. The medical device according to claim 3, wherein the cover is additionally connected to the housing body by non-peripheral or dot-shaped or local welds.

6. The medical device according to claim 3, wherein the cover is connected at two sides or bilaterally with at least one structure of the medical device.

7. The medical device according to claim 6, wherein the at least one structure is the at least one housing body.

8. The medical device according to claim 2, wherein the cover is a film.

9. The medical device according to claim 1, further comprising connections configured to connect the medical device to an extracorporeal circuit in fluid communication.

10. The medical device according to claim 9, further comprising at least one addition site including at least one septum and configured to supply a fluid which is not blood or not exclusively blood, into an interior or into a line section of the medical device.

11. The medical device according to claim 9, wherein the blood treatment cassette comprises, in a portion of an extracorporeal circuit contained in the blood treatment cassette, at least one arterial cassette-integrated chamber and at least one venous cassette-integrated chamber, wherein the cassette comprises at least one film as a cover, and wherein at least one of an arterial and a venous pressure present in the extracorporeal blood circuit is measurable through the intermediary of the film.

12. The medical device according to claim 11, further comprising a sensor configured to measure at least one of the arterial and venous pressure above at least one of the arterial and venous chamber through the intermediary of the film.

13. The medical device according to claim 1, further comprising a supplying line for an anticoagulant, the supplying line being completely or partly arranged in an upper area with respect to an alignment of the medical device during use, or in a border area of the medical device.

14. The medical device according to claim 1, further comprising at least one heparin line arranged at least in an area of the medical device that, during use of the medical device, is arranged in an upper area of the medical device.

15. The medical device according to claim 1, further comprising at least one handle bar or handhold for at least one of connecting and separating the medical device with or from a treatment apparatus.

16. The medical device according to claim 1, further comprising at least one fill post configured to extract a fluid which is not blood, or not exclusively blood, from the medical device while the medical device is connected with a treatment apparatus for the purpose of its use.

17. The medical device according to claim 1, further comprising at least one tube fixation configured to fix at least one section of at least one tube at the medical device while the medical device is coupled to a treatment apparatus.

18. The medical device according to claim 1, wherein the medical device is adapted to be connected in fluid communication to at least one peristaltic pump by two connectors.

19. The medical device according to claim 18, wherein the peristaltic pump is a roller pump.

20. The medical device according to claim 18, further comprising at least one pump tube segment.

21. The medical device according to claim 1, further comprising at least one valve having a) at least one bar formed on the housing body and b) at least one portion of the cover, wherein the at least one bar and the at least one portion of the cover are operable by an actor of a blood treatment apparatus acting on the at least one bar via the cover in order to alter a passage of fluid.

22. The medical device according to claim 1, wherein the fluid includes at least one of a) substituate, b) heparin, c) blood, d) saline solution, and e) air.

23. The medical device according to claim 1, wherein the medical device is adapted to be coupled to a blood treatment apparatus.

24. The medical device according to claim 23, wherein the medical device is configured to be coupled to the blood treatment apparatus via a reception means.

25. The medical device according to claim 23, wherein the medical device is adapted to be coupled to the blood treatment apparatus at an inclination angle of substantially or precisely 8 degrees relative to a vertical.

26. The medical device according to claim 23, wherein the medical device is adapted to be coupled to the treatment apparatus at a surface of the medical device facing the cover.

27. The medical device according to claim 1, comprising at least one substituate addition site having at least one of a) touch-protection element and b) a drip-protection element.

28. The medical device according to claim 27, wherein the drip-protection element is provided as an integrated closure sleeve.

29. The medical device according to claim 1, wherein the medical device is configured to perform a blood treatment using a double-needle access to a patient.

30. The medical device according to claim 1, wherein the at least one single-needle chamber includes a blood surge redirection element.

31. The medical device according to claim 1, wherein the venous blood chamber is subdivided into at least one upper space and at least one lower space by a cross-sectional restriction of the housing body.

32. The medical device according to claim 31, wherein the upper space and the lower space are in fluid communication or connection with each other, and the upper space is configured to admit or generate a tangential inflow of fluids flowing through the medical device.

33. The medical device according to claim 31, wherein the upper space includes a region for generating a stable rotational flow of the fluids flowing through the medical device.

34. The medical device according to claim 33, wherein the lower space includes a region that is substantially or entirely free from rotational flow of the fluids flowing through the medical device.

35. The medical device according to claim 31, wherein walls of at least one of the upper space and the lower space of the venous blood chamber are adapted to an inclination of the medical device against a vertical of the blood treatment apparatus.

36. The medical device according to claim 1, wherein at least one wall of the venous blood chamber comprises at least one indentation.

37. The medical device according to claim 1, wherein the housing body is configured as a hard part.

38. The medical device according to claim 1, further comprising a tamper protection.

39. The medical device according to claim 38, wherein the tamper protection is provided via a configuration of a substituate addition site.

40. The medical device according to claim 38, wherein the tamper protection is provided via a touch-protection element or a closure sleeve of a substituate addition site, at least one of based on a change of the position of the touch-protection element or closure sleeve within or relative to the cassette and based on a change of the shape of the touch-protection element or closure sleeve.

41. The medical device according to claim 1, further comprising a protection against reuse.

42. The medical device according to claim 41, wherein the protection against reuse is via a configuration of the substituate addition site.

43. The medical device according to claim 41, wherein a closure sleeve is made unusable for reuse.

44. A blood treatment apparatus, comprising: a dialysis apparatus wherein the blood treatment apparatus is in receipt of at least one medical device according to claim 1.

45. The blood treatment apparatus according to claim 44, further comprising at least one of at least one a) control means b) actor, and c) sensor, configured to at least one of drive and operate the medical device.

46. The blood treatment apparatus according to claim 44, further comprising at least one reception means for receiving the medical device.

47. The blood treatment apparatus according to claim 46, wherein the reception means comprises a coupling surface for coupling the medical device.

48. The blood treatment apparatus according to claim 47, wherein the coupling surface is inclined by an angle against a vertical relative to the orientation of the blood treatment apparatus during its use or to the center of the Earth.

49. The blood treatment apparatus according to claim 48, wherein the angle is between 5 and 11 degrees.

50. The blood treatment apparatus according to claim 48, wherein the angle is substantially or precisely 8 degrees.

51. A method, compising: treating the blood of a patient using the medical device of claim 1.

52. The method according to claim 51, wherein the blood is treated using a double-needle method.

53. The method according to claim 51, wherein the blood is treated using a single-needle method.

54. The method of claim 51, further comprising: conducting blood through a dialyzing filter to dialyze the blood; and storing the blood that has passed through the dialyzing filter in a single-needle chamber of the medical device, wherein the blood is dialyzed in the dialyzing filter before entering into the single-needle chamber.

55. The method according to claim 51, further comprising: inserting the medical device in a blood treatment apparatus; and using sensors of the blood treatment apparatus to examine whether the medical device inserted in the blood treatment apparatus has already been used.

56. A method, comprising: dialyzing blood using a double-needle procedure, wherein the dialyzing includes a pre-dilution; during the dialyzing, operating the medical device according to claim 1.

57. A method, comprising: dialyzing blood using a double-needle procedure, wherein the dialyzing includes a post-dilution; and during the dialyzing, operating the medical device according to claim 1.

58. A method, comprising: dialyzing blood using a double-needle procedure, wherein the dialyzing includes at least one pre-dilution step and at least one post-dilution step; and during the dialyzing, operating the medical device according to claims 1.

59. A method, comprising: dialyzing blood using a single-needle procedure; and during the dialyzing, operating the medical device according to claim 1.

60. A dialysis apparatus, comprising: the medical device according to claim 1, wherein the dialysis apparatus is configured to control the cassette.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 shows a lateral view of an external functional means of the invention provided, in accordance with a preferred embodiment, having a cover means on its front side.

(2) FIG. 2 shows the external functional means of FIG. 1 with the cover means swung open following destructive cutting.

(3) FIG. 3 shows the external functional means of FIG. 1 and FIG. 2 from its rear side.

(4) FIG. 4 shows in a simplified schematic representation a phase during the performance of a preparatory or priming process in accordance with the invention prior to performing a blood treatment process.

(5) FIG. 5 shows in a simplified schematic representation a phase during the performance of a rinsing-process in accordance with the invention prior to performing a blood treatment process.

(6) FIG. 6 shows in a simplified schematic representation a phase during the performance of a first process in accordance with the invention for connecting a patient to an extracorporeal circuit of a blood treatment apparatus.

(7) FIG. 7 shows in a simplified schematic representation a phase during the performance of a second process in accordance with the invention for connecting a patient to an extracorporeal circuit of a blood treatment apparatus.

(8) FIG. 8 shows in a simplified schematic representation a phase during the performance of a first blood treatment process in accordance with the invention.

(9) FIG. 9 shows in a simplified schematic representation a phase during the performance of the blood treatment process of FIG. 8 by using pre-dilution.

(10) FIG. 10 shows in a simplified schematic representation a phase during the performance of the blood treatment process in accordance with the invention of FIG. 8 by using post-dilution.

(11) FIG. 11 shows in a simplified schematic representation a phase during the performance of the blood treatment process in accordance with the invention of FIG. 8 by using mixing dilution (pre-dilution).

(12) FIG. 12 shows in a simplified schematic representation a phase during the performance of the blood treatment process in accordance with the invention of FIG. 8 by using mixing dilution (post-dilution).

(13) FIG. 13 shows in a simplified schematic representation a phase during the performance of a second blood treatment process in accordance with the invention by using a single-needle access.

(14) FIG. 14 shows in a simplified schematic representation a phase during the performance of a first blood recirculation process in accordance with the invention.

(15) FIG. 15 shows in a simplified schematic representation a phase during the performance of a second blood recirculation process in accordance with the invention.

(16) FIG. 16 shows in a simplified schematic representation a phase during the performance of an emptying process in accordance with the invention following the performance of a blood treatment process.

(17) FIG. 17 shows in a simplified schematic representation an external functional means according to the invention in a further embodiment, in a view onto its front side.

(18) FIG. 18 shows in a simplified schematic representation a detail of the representation of FIG. 17.

(19) FIG. 19 shows in a simplified schematic representation the external functional means according to the invention in the further embodiment of FIG. 17 shown in a perspective view onto its back side.

(20) FIG. 20 shows in a simplified schematic representation a detail of the representation of FIG. 19.

(21) FIG. 21 shows in a simplified schematic representation the external functional means according to the invention in a view onto its front side.

(22) FIG. 22 shows in a simplified schematic representation a detail of the representation of FIG. 21.

(23) FIG. 23 shows in a simplified schematic representation a further detail of the representation of FIG. 21.

(24) FIG. 24 shows in a simplified schematic representation one embodiment according to the invention of the external functional means.

(25) FIG. 25 shows in a simplified schematic representation a detail of the representation of FIG. 24.

(26) FIG. 26 shows in a simplified schematic representation a further detail of the representation of FIG. 24.

DETAILED DESCRIPTION

(27) In the figures of the drawings, same reference numerals designate same or identical elements.

(28) For an exemplary explanation of the present invention, a blood treatment apparatus is selected as a treatment apparatus, and a blood treatment method as a method.

(29) The standard arrows in the figures indicate the direction of the blood stream. The block arrows indicate the respective direction of the substituate stream. The double block arrows indicate the respective direction of the dialyzing liquid stream.

(30) FIG. 1 shows a lateral view of an external functional means which is provided with a cover means at the surface one looks upon in FIG. 1.

(31) The external functional means is here exemplarily configured as a cassette 1000.

(32) The cassette 1000 comprises a hard part 1. As is exemplarily shown in FIG. 1, the hard part 1 comprises chambers, passages and valves. As is furthermore exemplarily shown in FIG. 1, the chambers, passages and valves are integrated into the hard part 1 or are at least partly formed by the hard part 1.

(33) The cassette 1000 of FIG. 1 is provided at its front side with a cover means, in the present case, for example, a film 3. The cover means may be welded in a flat manner, i.e., planarly, onto the hard part 1.

(34) An embodiment involving a three-dimensional configuration of the weld and seal contour is also possible in accordance with the invention.

(35) The cover means may close the chambers and/or passages of the hard part 1 of the cassette 1000, namely, against a side facing away from the hard part 1 of the cover means and/or against the atmosphere.

(36) As may be seen in FIG. 1, the film 3 rests on the hard part 1 of the cassette 1000 at a peripheral sealing bar 4. The film 3 is welded with the hard part 1 of the cassette 1000 at a peripheral weld 5.

(37) The peripheral sealing bar 4 may alternatively be realized in an exposed manner.

(38) The film 3 may be connected to the hard part 1 of the cassette 1000 at additional local welds (not shown). These may also be peripheral, i.e., closed in the sense of a terminating limitation similar to a ring, and/or dot-shaped.

(39) The film 3 may locally be connected, e.g., welded, with the hard part 1 of the cassette 1000 in form of a dot or a line, in particular at the marginal zones of the liquid-conducting passages.

(40) The film 3 may be connected to the hard part 1 of the cassette 1000 by laser welding. Here, it is advantageous if the local application of heat is carried out by using light-absorbing components. The light-absorbing component(s) may be part of the material of the film and/or of the hard part, or a layer disposed between film and hard part or above the film. The layer may be a film layer.

(41) The cassette 1000 may be coupled to a blood treatment apparatus (not shown in FIG. 1) at least by its front side shown in FIG. 1. An exemplary technique for suitable coupling of a cassette 1000 to a coupling surface of a blood treatment apparatus is described in German Patent Application Nos. 10 2009 012 633.3 having the title “Vorrichtung zum Verbinden einer externen Funktionseinrichtung mit einer Anordnung, Anordnung aufweisend eine solche Vorrichtung und Verfahren zum Verbinden” [Device for connecting an external functional means to an arrangement, arrangement including a like apparatus, and connecting method] as filed with the German Patent and Trademark Office on Mar. 10, 2009, and 10 2009 012 632.5 having the title “Abdichtungseinrichtung zum Abdichten eines Volumens einer medizinischen Behandlungsanordnung gegen ein weiteres Volumen sowie Anordnung und Verfahren” [Sealing means for sealing a volume of a medical treatment arrangement against another volume, as well as arrangement and method] also filed with the German Patent and Trademark Office on Mar. 10, 2009, the respective disclosures of which are herewith fully incorporated by way of reference thereto.

(42) The cassette 1000 may be coupled to a coupling surface of the blood treatment apparatus by the plane of the film 3 or through the intermediary of the latter. The coupling surface may preferably be realized three-dimensionally.

(43) The coupling surface of the blood treatment apparatus may be inclined to the rear, for instance at an upper portion thereof shown in FIG. 1 by 8 degrees against a vertical line extending from top to bottom in FIG. 1 (in the direction extending from the observer into the plane of drawing in FIG. 1).

(44) The cassette 1000 comprises an arterial patient connection 7.

(45) The cassette 1000 further comprises an arterial pressure measurement chamber 9. The latter may include corresponding sensors. The sensors may transmit signals, preferably via cabling. The sensors may, however, alternatively or also be configured to transmit signals in a wireless manner.

(46) The cassette 1000 comprises a connector 11 for the exit of blood from the cassette 1000 as well as a connector 13 for the entry of blood into the cassette 1000.

(47) The two connectors 11 and 13 are adapted to be connected to a pump tube segment or pump tube set of a blood pump.

(48) The cassette 1000 further comprises a chamber 15 including a pressure measurement site for pressure measurement in the extracorporeal blood circuit upstream from the dialyzer (“pre-filter”) or downstream from the pump (“post-pump”), respectively.

(49) At the chamber 15 the pressure in the extracorporeal circuit upstream from the dialyzer may be measured across the film 3 or via the film 3.

(50) The cassette 1000 comprises an arterial filter conduit 17 as well as a venous filter conduit 19.

(51) The interior of the cassette 1000 includes a venous blood chamber 21. The venous blood chamber 21 is subdivided into an upper space 23 and a lower space 25.

(52) The upper space 23 of the venous blood chamber 21 may admit a laterally tangential inflow of blood. Here, blood may flow in laterally through the inlet (on the left side in FIG. 1) into the upper space 23 and spread out tangentially to the walls of the upper space 23. A laterally tangential inflow of blood may create a zone with a substantially or completely stable rotational flow of blood in the upper space 23 of the venous blood chamber 21.

(53) The lower space 25 of the venous blood chamber 21 may represent a calming zone for the blood stream. Such a calming zone may possibly have substantially no rotational flow or no rotational flow of the blood present therein at all.

(54) The venous blood chamber 21 is subdivided into the upper space 23 and the lower space 25 by a cross-sectional restriction 27 of the hard part 1 of the cassette 1000. The cross-sectional restriction 27 reduces the cross-section of the venous blood chamber 21 in its width and depth so as to result in a shoot or rapid, whereby a fluid having traversed the venous blood chamber 21 of the cassette 1000 will flow with slower flow velocity. The upper space 23 and the lower space 25 are in fluid communication.

(55) By means of such a construction, i.e., a subdivision of the venous blood chamber 21 into a zone with substantially or completely stable rotational flow of the blood and a calming zone for the blood stream, it is advantageously possible to achieve an efficient separation of air from the blood or fluid.

(56) Walls of the upper space 23 and of the lower space 25 of the venous blood chamber 21 may suitably be adapted to an inclination of the upper portion of the cassette 1000 in FIG. 1 against the vertical, for example a rearward inclination of the upper part of the cassette 1000 shown in FIG. 1 by 8 degrees (into the plane of drawing). It may suitably have a rounded shape so as to advantageously represent a rheologically optimized contact surface for fluids passing through the venous blood chamber 21.

(57) The cassette 1000 comprises a clot trap 29.

(58) As a clot trap, it is possible and preferable to use a clot trap as disclosed in German Patent Application No. 10 2009 024 495.6 having the title “Gerinnselfänger, externe Funktionseinrichtung, Blutkreislauf sowie Behandlungsvorrichtung” [Clot trap, external functional means, blood circuit and treatment apparatus] to the applicant of the present invention that was filed with the German Patent and Trademark Office on Jun. 10, 2009. The relevant disclosure thereof is herewith fully incorporated by way of reference thereto.

(59) At the clot trap 29, it is possible to measure the pressure in the extracorporeal circuit through the film 3 or across the film 3, in particular after passage through the dialyzer.

(60) The cassette 1000 comprises a venous patient connection 31.

(61) The cassette 1000 further comprises an arterial heparin addition site 33. Here, it should be noted that the heparin addition site 33 (just like a venous heparin addition site 37) may also be suited and intended for adding other pharmacologically active agents than heparin, which are, only in a preferred manner, anti-coagulants or combinations of active agents. This should also be noted whenever heparin is mentioned previously or in the following in any kind of context.

(62) The cassette 1000 comprises a check valve 35 of the arterial heparin addition site 33.

(63) Exemplary check valves for the use as check valve 35 of the arterial heparin addition site 33 and also as further check valves of the cassette 1000 are disclosed in German Patent Application No. 10 2009 024 469.7 to the applicant of the present invention having the title “Ventilvorrichtung, Ventileinsatz, externe Funktionseinrichtung, Behandlungsvorrichtung sowie Verfahren” [Valve device, valve insert, external functional means, treatment apparatus, and method] as filed with the German Patent and Trademark Office on Jun. 10, 2009, and U.S. Provisional Patent Application No. 61/185,603, also filed on Jun. 10, 2009, the relevant disclosures of which are herewith fully incorporated by way of reference thereto.

(64) The cassette 1000 comprises an arterial heparin addition valve 36. By means of the arterial heparin addition valve 36, the addition of heparin into the arterial filter conduit 17 may be controlled or regulated.

(65) The arterial heparin addition valve 36 may be configured as a so-called phantom valve.

(66) The expression “phantom valve” as presently used designates an element having an actor surface that may be reached by means of an actor (in the present case, for example, an actor membrane) that may adopt the function of a valve.

(67) The actor membrane can be made to move, dilate or curve etc. in one direction by applying a force on it, e.g., a pressing force. As a result of its movement or dilatation, the actor membrane may come into contact with an element such as a sealing means, e.g. a bar, or move away from the latter. The actor membrane may thus, for example, effect or enhance or terminate or reduce a sealing effect.

(68) When the force acting on the actor membrane is ceased to apply or is released, the latter may return, for example, to a basic position, e.g., a non-curved condition.

(69) A phantom valve for use as an arterial heparin addition valve 36 as well as further phantom valves of the cassette 1000 may be configured with or from a bar portion of a passage at the hard part 1 of the cassette 1000 and a portion of the film 3 contacting or facing the bar portion.

(70) Phantom valves may be operated through actors of the blood treatment apparatus.

(71) In order to close a phantom valve, the portion of the film 3 may be pressed onto the bar portion. In order to open the phantom valve, the portion of the film 3 may again be raised from the bar portion.

(72) Further examples and/or embodiments for phantom valves may be found in German Patent Application No. 10 2009 012 632.5 having the title “Abdichtungseinrichtung zum Abdichten eines Volumens einer medizinischen Behandlungsanordnung gegen ein weiteres Volumen sowie Anordnung und Verfahren” [Sealing means for sealing a volume of a medical treatment arrangement against another volume, as well as arrangement and method], as filed with the German Patent and Trademark Office on Mar. 10, 2009 by the present applicant. The relevant disclosure thereof is herewith fully incorporated by way of reference thereto.

(73) The cassette 1000 comprises a venous heparin addition line or site 37. The venous heparin addition site 37 may be configured as a Luer-connector.

(74) The cassette 1000 comprises a check valve 39 of the venous heparin addition site 37.

(75) The cassette 1000 comprises a venous heparin addition valve 40. With the aid of the venous heparin addition valve 40, the addition of heparin into the venous filter conduit 19 may be controlled or regulated.

(76) The cassette 1000 comprises a substituate addition site 41 or a substituate connector, respectively.

(77) The substituate addition site 41 may be a connection means as described in German Patent Application No. 10 2009 024 575.8 to the present applicant having the title “Verbindungseinrichtung und Verfahren zum Verbinden wenigstens zweier fluidführender medizintechnischer Systeme, sowie medizintechnische Vorrichtung” [Connection means and method for connecting at least two fluid-conducting medical-technical systems, as well as a medical-technical apparatus] as filed with the German Patent and Trademark Office on Jun. 10, 2009, and U.S. Provisional Patent Application No. 61/185,687, also filed on Jun. 10, 2009. The relevant disclosures thereof are herewith fully incorporated by way of reference thereto.

(78) The substituate addition site 41 may be provided with a touch-protection element (not shown). The substituate addition site 41 may be provided with a drip-protection element (not shown). The drip-protection element may be realized through an integrated closure sleeve. The drip-protection element may prevent residues of substituate and/or blood from dripping out when the cassette 1000 is released and subsequently removed from the blood treatment apparatus.

(79) The drip-protection element may be provided as a removable element. Moreover, it may be configured as a hood or lid.

(80) The substituate addition site 41 or some other portion of the cassette 1000 may moreover provide a tamper protection, as a result of which the user recognizes readily, or at one glance, whether the cassette 1000 has already been used. This tamper protection may be realized by means of the touch-protection element, the closure sleeve, and/or some other structure. Preferably, the corresponding structure may recognizably change its position inside or relative to the cassette 1000. Preferably it may change its shape.

(81) Moreover, the substituate addition site 41 or some other portion of the cassette 1000 may provide a protection against reuse. In a preferred manner, the cassette 1000 is made unusable by means of a closure sleeve—preferably in an irreversible manner—with respect to an attempted reuse. If the cassette 1000 should nevertheless be used again, sensors of the blood treatment apparatus do not measure the signal characteristics that would be measured during use of a new cassette. This may be due to the fact that liquid can not enter into the cassette 1000 or into the substituate addition site 41, or at least not in a sufficient or usual quantity. The control unit of the blood treatment apparatus may recognize this. A warning may be triggered.

(82) As a tamper protection or a protection against reuse, it is preferably possible to use a tamper protection or protection against reuse as disclosed by the applicant of the present invention in German Patent Application No. 10 2009 024 575.8 having the title “Verbindungseinrichtung und Verfahren zum Verbinden wenigstens zweier fluidführender medizintechnischer Systeme, sowie medizintechnische Vorrichtung” [Connection means and method for connecting at least two fluid-conducting medical-technical systems, as well as a medical-technical apparatus] that was filed with the German Patent and Trademark Office on Jun. 10, 2009, and U.S. Provisional Patent Application No. 61/185,687, also filed on Jun. 10, 2009. The relevant disclosures thereof are herewith fully incorporated by way of reference thereto.

(83) The cassette comprises a connector 43 for the exit of substituate from the cassette 1000 as well as a connector 45 for the entry of substituate into the cassette 1000.

(84) The connectors 43 and 45 are adapted to be connected to a pump tube segment or a pump tube set of a substituate pump.

(85) The cassette 1000 comprises a check valve 47 for the addition of substituate. Substituate may be introduced into a substituate conduit 49 by operating the check valve 47.

(86) The cassette 1000 comprises a pre-dilution addition valve 51. The pre-dilution addition valve 51 may be configured as a phantom valve.

(87) The cassette 1000 comprises a post-dilution addition valve 53. The post-dilution addition valve 53 may be configured as a phantom valve.

(88) The cassette 1000 comprises a single-needle sterile membrane 55.

(89) The cassette 1000 comprises a single-needle chamber 57. In FIG. 1, the single-needle chamber 57 is disposed above the venous blood chamber 21.

(90) Inside the single-needle chamber 57 a blood surge redirection element 59 is arranged. The blood surge redirection element 59 may serve for decelerating a blood surge and/or cancelling its impulse.

(91) A connection to an inside of the single-needle chamber 57 may be provided by means of connection means as disclosed by the applicant of the present invention in German Patent Application No. 10 2009 024 467.0 having the title “Einrichtung sowie externe Funktionseinrichtung and Behandlungsvorrichtung zum Behandeln von medizinischen Fluiden” [Device and external functional means and treatment apparatus for the treatment of medical fluids] that was filed with the German Patent and Trademark Office on Jun. 10, 2009, and U.S. Provisional Patent Application No. 61/185,604, also filed on Jun. 10, 2009. The relevant disclosures thereof are herewith fully incorporated by way of reference thereto.

(92) The cassette 1000 comprises a single-needle blood valve 61. The single-needle blood valve 61 may be configured as a phantom valve.

(93) The cassette 1000 comprises an evacuation site 63. The evacuation site 63 may serve for vacuum coupling of the cassette 1000 to the blood treatment apparatus as is described, for example, in German Patent Application No. 10 2007 042 964 A1 having the title “Vorrichtung and Verfahren zur Behandlung einer medizinischen Flüssigkeit” [Apparatus and method for treating a medical liquid] that was filed with the German Patent and Trademark Office on Sep. 10, 2007, the relevant disclosure of which is herewith fully incorporated by way of reference thereto.

(94) The cassette 1000 comprises a primary alignment center 65. The primary alignment site or center 65 may advantageously serve for aligning and/or latching of the cassette 1000 on the blood treatment apparatus.

(95) The cassette 1000 comprises a secondary alignment center or site 67. The secondary alignment site 67 may serve for aligning and/or latching of the cassette 1000 on the blood treatment apparatus.

(96) The cassette 1000 is filled with gas (e.g., sterile air) prior to beginning priming. During priming of the extracorporeal blood circuit, this gas filling has to be displaced. Insofar, a blood treatment cassette generally represents a particular challenge as there are both rising and falling conduits and moreover chambers in which no “air nests” must remain. For this purpose, the present cassette 1000 is provided with special construction features:

(97) The chamber 15 for measuring the arterial pressure is constructed such that the entire air volume may rise into a pump tube segment (e.g., into the pump tube segment 90; see, e.g., FIG. 4). Advantageously, there are no dead spaces present. Air rising by itself from the arterial pressure measurement chamber into the pump tube segment of the blood pump is forcibly conveyed through the pump tube segment from the engagement range of the blood pump (e.g., by the rollers of a roller pump). As soon as the pump ceases to exert an influence (for instance due to disengaging rollers), the air rises by itself into the cassette 1000 in the conveying direction.

(98) The venous recirculation conduit (or a venous portion 93 of the extracorporeal circuit as shown, inter alia, in FIG. 4) is a downward conduit. Starting from a particular volume flow (e.g., 200 ml/min in the case of the cassette 1000 shown in FIG. 1), air bubbles in the blood are “entrained” even against gravitational acceleration. This effect is utilized in the downward conduits. The conduit cross-sections of the downward conduits are designed with such a small size that a forcible conveyance of the air bubbles even against gravitational acceleration is successful due to the flow velocity.

(99) In the venous blood chamber 21, large cross-sections are provided, such that air bubbles may reliably rise there against the main direction of flow due to the slower or lower flow velocities present in this location.

(100) Further constructive features of the cassette 1000 are as follows:

(101) The phantom valves 40, 51 and 53 are physically oriented such that blood (which has a higher density than water or substituate etc.) has difficulty or is unable to penetrate “upward” or “sideways” into opened phantom valves while the cassette 1000 is operated with blood, for the latter descends as compared to the lighter water. Such an advantageous orientation is realized with the aid of the phantom valves 40, 51, and 53. The valve 36, on the other hand, does not have such a requirement, i.e., the orientation is not crucial there.

(102) For the same reason, the conduit passage (stub passage) below the check valve 47 for adding substituate is constructed in a rising manner. In the event of a malfunction of the pre- and/or post-dilution valves 51 and 53 and a resulting bypass flow of blood, blood cannot rise into the substituate conduit 49 any more. Rather, the blood will flow past the opening of the corresponding stub conduit.

(103) The inclination of the cassette 1000 preferably is from 5 degrees to 11 degrees, and in a particularly preferred arrangement, the 8 degrees already mentioned above.

(104) FIG. 2 shows the cassette 1000 of FIG. 1, wherein the film 3 may be seen to be cut open destructively at the left-hand margin of the cassette 1000 as well as at the top and bottom and swung open to the right for better illustration.

(105) As is shown in FIG. 2, the film 3 has a surface texture.

(106) FIG. 2 shows the elements inside the cassette 1000 which are visible in more detail after having cut open the film 3.

(107) In order to avoid repetitions, reference is made to the configurations of the individual elements discussed in the description of FIG. 1.

(108) Here it is clearly seen that the cassette 1000 comprises a sealing bar 69. The sealing bar 69 may be employed, for instance, for forming or realizing the pre-dilution addition valve 51.

(109) FIG. 3 shows the cassette 1000 from its rear side. When the cassette 1000 is coupled to the blood treatment apparatus, an observer opening a door of the blood treatment apparatus for removing the cassette 1000 will look upon this rear side.

(110) The cassette 1000 comprises a single-needle air connector 71. A support grid (not shown) of the single-needle sterile membrane 55 may be provided or arranged at the single-needle air connector 71 on the apparatus side and/or on the blood side.

(111) The cassette 1000 comprises several support bars. The support bars have different heights relative, e.g., to the plane of the film 3. The support bars are projected in the side of the cassette 1000 facing the observer in FIG. 3, i.e., out of the plane of drawing of FIG. 3.

(112) The cassette 1000 comprises support bars 73 having a height of 5 mm, support bars 75 having a height of 8 mm, support bars 77 having a height of 13 mm, support bars 79 having a height of 24 mm, and support bars 81 having a height of 31 mm. These and other numeric values should, of course, be understood to be non-limiting examples.

(113) The support bars may serve to support the cassette, in the state of being coupled to a blood treatment apparatus, against a lid of a reception means of the blood treatment apparatus for receiving the cassette. Exemplary embodiments of such a coupling of the cassette to the blood treatment apparatus are given in German Patent Application No. 10 2009 012 633.3 having the title “Vorrichtung zum Verbinden einer externen Funktionseinrichtung mit einer Anordnung, Anordnung aufweisend eine solche Vorrichtung and Verfahren zum Verbinden” [Device for connecting an external functional means to an arrangement, arrangement including a like apparatus, and connecting method] as filed with the German Patent and Trademark Office on Mar. 10, 2009, the relevant disclosure of which is herewith fully incorporated by way of reference thereto.

(114) In FIG. 3 the cassette 1000 is shown as it will be viewed by the user/observer after its coupling to the machine interface. The inclination of the cassette 1000 relative to the machine is realized with a “rearward inclination”, so that the upper edge is located at a further distance from the user/observer than the lower edge.

(115) The upwardly facing surfaces of the venous blood chamber 21 and of the single-needle chamber 57 accordingly have such an inclination that air bubbles may still reliably rise on the inside despite the inclination of the cassette 1000. As an alternative, a cassette design which does not provide any inclination of the cassette is, of course, basically also possible.

(116) In the following, different processes in accordance with the invention that may be employed using the external functional means of the invention in blood treatment methods shall be described by making reference to FIGS. 4 to 16.

(117) The blood treatment apparatus comprises an external functional means, for instance the cassette 1000 as discussed in FIGS. 1 to 3 and having the elements previously described in FIGS. 1 to 3.

(118) The blood treatment apparatus further comprises a dialyzer or dialyzing means 2000 having a dialyzing liquid inlet 2001 and a dialyzing liquid outlet 2003.

(119) The blood treatment apparatus moreover comprises an extracorporeal circuit 3000.

(120) The extracorporeal circuit 3000 comprises an arterial patient tube clamp 83 and a venous patient tube clamp 85.

(121) The extracorporeal circuit 3000 comprises a blood pump 87 having a pump tube segment 88.

(122) The extracorporeal circuit 3000 comprises a substituate pump 89 having a pump tube segment 90.

(123) The blood pump 87 and the substituate pump 89 may be configured as peristaltic pumps, for example roller pumps as shown in the figures.

(124) The expression “conveying direction” or “direction of flow” designates the usual conveying directions during a blood treatment, i.e., of the blood to be purified from a patient to a dialyzer or dialyzing means, and of the purified blood from the dialyzer or dialyzing means back into the patient. In the plane of drawing of the figure, this conveying direction is in the counter-clockwise direction.

(125) Likewise, the expressions “conveying direction” or “direction of flow” in connection with the flow of a substituate designate a usual conveying direction of the substituate during a blood treatment from the substituate addition valve 41 into the extracorporeal circuit 3000.

(126) A conveyance of fluid (in particular blood and substituate) taking place against this conveying direction is designated as conveyance or flow in the opposite direction.

(127) The extracorporeal circuit 3000 comprises an arterial portion 91 and a venous portion 93.

(128) The arterial portion 91 of the extracorporeal circuit 3000 extends from a portion for arterial connection of a patient, for instance an arterial needle, through the cassette 1000 towards a blood inlet at the dialyzing means 2000. The arterial portion 91 has various components. Thus, an arterial connection of a patient, the arterial patient connection 7, the arterial patient tube clamp 83, the arterial pressure measurement chamber 9, the chamber 15 with an arterial post- or pre-filter pressure measurement site, the pump tube segment 88 of the blood pump 87, the arterial filter conduit 17, and a blood inlet at the dialyzing means 2000 are all part of the arterial portion 91 of the extracorporeal circuit 3000.

(129) The venous portion 93 of the extracorporeal circuit 3000 extends from a blood outlet at the dialyzing means 2000 towards a portion for venous connection of a patient, for instance a venous needle. The venous portion 93 has various components. Thus, a blood outlet from the dialyzer or dialyzing means 2000, the venous filter conduit 19, the venous blood chamber 21, the clot trap 29, the single-needle chamber 57, the venous patient connection 31, the venous patient tube clamp 85, and a venous connection of a patient are all part of the venous portion 93 of the extracorporeal circuit 3000.

(130) FIG. 4 shows a phase during the performance of a preparatory process or priming process for filling the utilized fluid conduits in accordance with the method of the invention.

(131) The arterial portion 91 and the venous portion 93 of the extracorporeal circuit 3000 are connected to each other.

(132) The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 of the cassette 1000 are opened. The two patient tube clamps 83 and 85 are also opened.

(133) FIG. 4 shows the described configuration as a momentary state or a phase during the preparatory or priming process.

(134) Substituate is introduced into the extracorporeal circuit 3000 via the substituate addition site 41. To this end, the automatic substituate connector is connected. The arterial patient tube in the arterial portion 91 of the extracorporeal circuit 3000 and the venous patient tube in the venous portion 93 of the extracorporeal circuit 3000 are connected to a rinse port of the blood treatment apparatus, e.g., by means of a suitable connector providing an appropriate access from one end of the one patient tube to the other patient tube. The end of the other patient tube serves as a drain conduit into the rinse port. The connector may alternatively be situated in the arterial or venous patient conduit, i.e., the arterial portion 91 or the venous portion 93.

(135) The venous patient tube clamp 85 is closed, the post-dilution addition valve 53 is opened, the pre-dilution addition valve 51 is closed.

(136) Filling the venous blood chamber 21 is carried out by means of the substituate pump 89 through the post-dilution addition valve 53. Here, a separation of air takes place through the single-needle blood valve 61.

(137) The blood pump 87 operates in a forward direction and aspires or sucks in substituate from the venous blood chamber 21.

(138) When the level in the venous blood chamber 21 drops, replenishing via the post-dilution addition valve 53 is performed until the level detector recognizes that the predetermined filling level is exceeded. During this process, which is repeated according to need, continuous operation of the blood pump is maintained.

(139) The clot trap 29 is de-aerated “from below”: All three cassette valves (51, 53, 61) are closed. The arterial patient tube clamp 83 is opened, and the venous patient tube clamp 85 is closed. The rinse port is closed.

(140) The blood pump 87 operates in the reverse direction for a short time to convey a small volume. Hereby, a venous negative pressure and an arterial overpressure are generated in the extracorporeal circuit 3000.

(141) The venous patient tube clamp 85 is opened for as long as the a pressure equilibrium is established.

(142) Subsequently, filling of the extracorporeal circuit 3000 is continued.

(143) By means of the sensor/detector 115 at the venous patient tube clamp 85, e.g., a venous air bubble detector, the occurrence of air bubbles is detected. As soon as no air bubbles or nearly no air bubbles are detected in the course of a predetermined time interval, the extracorporeal circuit 3000 is assumed to be filled.

(144) Then the filled extracorporeal circuit 3000 is rinsed. During rinsing, substituate is conveyed through the pre-dilution addition valve 51 and discarded through the rinse port (“plug valve 97”).

(145) In the process, both the arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The blood pump 87 operates in the reverse direction and conveys a part of the substituate into the rinse port.

(146) As was already mentioned in the foregoing, as an alternative for on-line filling (where the substituate is supplied on-line in the dialysis machine), it is also possible to perform filling with an external bag containing saline solution as a source for filling liquid. To this end, the arterial patient conduit or the arterial portion 91 of the extracorporeal circuit 3000 is coupled to the bag containing saline solution. The venous patient conduit or the venous portion 93 of the extracorporeal circuit 3000 is coupled to a so-called waste bag as a sink for the used saline solution. The blood pump 87 operates in the forward direction. By opening the pre-dilution addition valve 51 and the post-dilution addition valve 53, it is also possible to fill the conduit situated between these two valves.

(147) In both methods, the patient is coupled to the extracorporeal circuit 3000 not before a predetermined rinsing quantity has been reached.

(148) FIG. 5 shows a phase of a rinsing process in accordance with the method of the invention.

(149) In order to remove the substituate circulating in the extracorporeal circuit 3000 (which is now closed) from the latter after preparation or filling (priming), the plug valve 97 is opened.

(150) The substituate pump 89 is activated again. The pre-dilution addition valve 51 is opened.

(151) The blood pump 87 and the substituate pump 89 convey the substituate out of the extracorporeal circuit 3000 via the drain conduit 95.

(152) FIG. 5 shows the described configuration as a momentary state or in a phase of the rinsing process.

(153) The blood pump 87 and the substituate pump 89 constantly convey new substituate, so that the extracorporeal circuit 3000 is rinsed. The substituate used is discarded.

(154) The blood pump 87 and the substituate pump 89 each convey in the clockwise direction. The blood pump 87 and the substituate pump 89 may convey at an offset from each other. The substituate pump 89 may rotate more rapidly than the blood pump 87.

(155) FIG. 6 shows a phase during connecting a patient 4000 to the extracorporeal circuit 3000 in accordance with the method of the invention in a first manner by means of a double-needle access 99. As all figures presenting method steps, FIG. 6 also only represents one phase.

(156) In order to couple a patient 4000 to the blood treatment apparatus, a double-needle access 99 is used.

(157) The double-needle access 99 comprises an arterial needle 101 having a fixation 102, e.g., a sleeve, tape and the like, and a venous needle 103 having a fixation 104, e.g., a sleeve, tape and the like.

(158) The arterial needle 101 is connected to the arterial patient connection 7 of the cassette 1000. The venous needle 103 is connected to the venous patient connection 31 of the cassette.

(159) The venous needle 103 is placed on the patient 4000 and immobilized or fixed. The arterial needle 101 is placed on the patient 4000 and fixed. The venous needle 103 may be connected to the patient 4000 before the arterial needle 101.

(160) As a result of filling, the extracorporeal circuit 3000 is filled with substituate. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

(161) Initially both patient tube clamps 83 and 85 are closed.

(162) The blood pump 87 is activated. The arterial patient tube clamp 83 is opened.

(163) FIG. 6 shows the described configuration as a momentary state with the arterial patient tube clamp 83 already opened, shortly before starting the blood pump 87.

(164) Blood is conveyed from the patient 4000 via the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000 and displaces or conveys the substituate. The substituate is conveyed out of the blood treatment apparatus via the dialyzing liquid outlet 2003 of the dialyzing means 2000.

(165) When the blood from the arterial portion 91 of the extracorporeal circuit 3000 arrives at a blood inlet 105 at the dialyzer or dialyzing means 2000, the arterial patient tube clamp 83 is closed and the blood pump 87 is stopped.

(166) The venous patient tube clamp 85 is opened.

(167) Blood enters into the venous portion 93 of the extracorporeal circuit 3000 in the opposite direction via the venous needle 103. The blood pump 87 is not activated.

(168) The blood may, for example, enter the venous portion 93 on account of gravity.

(169) The blood flows in the opposite direction through the venous portion 93 and enters the clot trap 29 and the venous blood chamber 21. The blood flows through the venous filter conduit 19 and enters the dialyzing means 2000 through the blood outlet 107 in the opposite direction.

(170) FIG. 7 illustrates a phase of a second mode or of an alternative process for connecting a patient 4000 to a blood treatment apparatus.

(171) The patient 4000 is connected to the extracorporeal circuit 3000 by means of an arterial needle 101 and a venous needle 103.

(172) The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

(173) Substituate is present in the entire extracorporeal circuit 3000 (except in the single-needle chamber 57).

(174) The blood pump 87 is started. The dialyzing means 2000 at this stage is not turned on.

(175) FIG. 7 shows the described configuration as a momentary state. At this time, nothing but substituate is present in the extracorporeal circuit 3000.

(176) By operating the blood pump 87, blood is conveyed out of the patient 4000 through the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000. The blood flows into the dialyzing means 2000 at the blood inlet 105 thereof, and from there through the blood outlet 107 of the dialyzing means 2000 into the venous portion 93 of the extracorporeal circuit 3000.

(177) The blood arrives in the cassette 1000 via the venous filter conduit 19 and enters into the venous blood chamber 21 in the closed position of the post-dilution addition valve 53, wherein the blood may flow tangentially into the upper space of the venous blood chamber 21.

(178) From the venous blood chamber 21 the blood leaves the cassette 1000 via the clot trap 29 to arrive back at the patient 4000 via the venous patient connection 103.

(179) FIG. 8 shows a phase of a dialysis treatment using a double-needle access to the patient.

(180) The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are closed.

(181) FIG. 8 shows the described configuration as a momentary state during a dialysis treatment under operation of the blood pump 87.

(182) The dialyzing means 2000 is operated, so that dialyzing liquid enters into the dialyzing means 2000 at the dialyzing liquid inlet 2001. In the dialyzing means the treatment of the patient's blood is performed. The dialyzing liquid exits from the dialyzing means 2000 at the dialyzing liquid outlet 2003. Spent dialyzing liquid may be discarded or purified.

(183) The blood pump 87 conveys blood from the patient 4000 via the arterial needle 101 into the arterial portion 91 of the extracorporeal circuit 3000, with the blood passing through the cassette 1000 and being conveyed to the dialyzing means 2000.

(184) The blood flows through the dialyzing means 2000 in the opposite direction to the dialyzing liquid and is purified in the process. At the blood outlet 107 of the dialyzing means 2000, the purified blood leaves the dialyzing means 2000 and flows through the venous filter conduit 19 into the cassette 1000, enters the venous blood chamber 21 and the clot trap 29, and exits from the cassette 1000 at the venous patient connection 31.

(185) The purified blood is again returned into the patient 4000 via the venous patient connection 103.

(186) Feeding of substituate does not take place at this stage. The substituate pump 89 at this stage is not operated.

(187) FIG. 9 shows a phase of the blood treatment process represented through FIG. 8 by using a pre-dilution of the blood with substituate (“on-line HDF pre-dilution”).

(188) The pre-dilution addition valve 51 is opened. The post-dilution addition valve 53 and the single-needle blood valve 61 are closed. The blood pump 87 is operated. The substituate pump 89 is started. The substituate pump 89 may be operated in synchronicity with the blood pump 87.

(189) The described configuration is represented in FIG. 9 as a momentary state, with substituate being present between pre-dilution addition valve 51 and post-dilution addition valve 53 and blood flowing through the remaining extracorporeal circuit 3000.

(190) The substituate pump 89 conveys substituate which enters the arterial portion 91 of the extracorporeal circuit 3000 at the pre-dilution addition valve 51 and mixes up with the blood in order to be purified.

(191) FIG. 10 shows a phase of the blood treatment process represented in FIG. 8 by using a post-dilution of the blood with substituate (“on-line HDF post-dilution”).

(192) The post-dilution addition valve 53 is opened. The pre-dilution addition valve 51 and the single-needle blood valve 61 are closed. The blood pump 87 is operated. The substituate pump 89 is started. The substituate pump 89 may be operated in synchronicity with the blood pump 87.

(193) The described configuration is represented in FIG. 10 as a momentary state, with substituate being present between pre-dilution addition valve 51 and post-dilution addition valve 53 and blood flowing through the remaining extracorporeal circuit 3000.

(194) The substituate pump 89 conveys substituate which enters the venous portion 93 of the extracorporeal circuit 3000 at the post-dilution addition valve 53 and mixes up with the purified blood.

(195) FIG. 11 and FIG. 12 show phases of the blood treatment process represented in FIG. 8 by using a mixing dilution of the blood with substituate (“on-line HDF mixing dilution—switched”). The expression “mixing dilution” designates diluting of the blood with substituate that alternatingly takes place via pre-dilution or post-dilution.

(196) FIG. 11 illustrates the pre-dilution interval of the mixing dilution in a momentary state;

(197) FIG. 12 illustrates the post-dilution interval of the mixing dilution in a momentary state.

(198) The process shown with the aid of FIG. 11 corresponds to the one of the process shown with the aid of FIG. 9; the process shown with the aid of FIG. 12 corresponds to the one of FIG. 10. The blood pump 87 and the substituate pump 89 rotate in synchronicity. The blood pump 87 and the substituate pump 89 may, for example, rotate faster than in the processes or process stages represented in FIGS. 9 and 10.

(199) FIG. 13 shows the cassette 1000 and the extracorporeal circuit 3000 in a phase of a dialysis treatment by means of a single-needle access to the patient (“Cassette Integrated Single Needle”).

(200) A single-needle access 109 was placed on the patient 4000 and fixed by means of a fixation 110. A fixation 110 may, for example, in turn be realized as a sleeve, a tape, or the like.

(201) The single-needle access 109 comprises a Y-piece or a Y-shaped branching 111 into the arterial portion 91 and the venous portion 93 of the extracorporeal circuit 3000.

(202) The arterial patient tube clamp 83 is opened. The venous patient tube clamp 85 is initially closed. This is not represented in FIG. 13.

(203) The blood pump 87 is started. The dialyzing means 2000 is operated. Blood from the patient 4000 is conveyed through the arterial portion 91 into the dialyzing means 2000. In the dialyzing means 2000 the blood is purified. The purified blood is introduced into the venous portion 93 of the extracorporeal circuit 3000.

(204) The blood enters into the venous blood chamber 21 of the cassette 1000. The single-needle blood valve 61 is opened. Blood flows into the single-needle chamber 57.

(205) When the single-needle chamber 57 is nearly filled, the blood pump 87 is stopped and the venous patient tube clamp 85 is opened, as may be seen in FIG. 13. The dialyzing process is stopped.

(206) The blood is discharged by gravity from the cassette 1000, the single-needle chamber 57, the venous blood chamber 21 and the clot trap 29, and recirculated into the patient 4000.

(207) When the single-needle chamber 29 is nearly emptied of blood, the blood pump 87 is started again.

(208) This phase of the blood treatment is repeated as often as necessary.

(209) FIG. 14 shows a phase of a first variant of a blood recirculation process following termination of the blood treatment.

(210) The arterial patient tube clamp 83 is opened. The venous patient tube clamp 85 is closed. The substituate pump 89 is operated.

(211) Blood is present in the extracorporeal circuit 3000. Substituate is present in the substituate conduit 49.

(212) The pre-dilution addition valve 51, the post-dilution addition valve 53, and the single-needle blood valve 61 are initially closed.

(213) The pre-dilution addition valve 51 is opened. Substituate is conveyed through the arterial portion 91 of the extracorporeal circuit 3000 towards the dialyzing means 2000.

(214) The blood which is present in the extracorporeal circuit 3000 behind or upstream from the pre-dilution addition valve 51 relative to the conveying direction is conveyed through the dialyzing means 2000 and the venous portion 93 to the patient 4000.

(215) Shortly before the substituate reaches the venous needle 103, the substituate pump 89 is stopped.

(216) The venous patient tube clamp 85 is opened. The arterial patient tube clamp 83 is closed.

(217) FIG. 14 shows the configuration of the cassette 1000 in a momentary state during the process in which the substituate is introduced upstream through the opened pre-dilution addition valve 51 into the extracorporeal circuit 3000 to displace the blood.

(218) The blood pump 87 and the substituate pump 89 are operated. The blood pump 87 rotates in the clockwise direction and thus against the conveying direction. The substituate pump rotates in the counter-clockwise direction. The blood pump 87 and the substituate pump 89 may rotate at an offset from each other.

(219) The substituate is conveyed from the post-dilution addition valve 53 into the arterial portion 91 of the extracorporeal circuit 3000 and through the pump tube segment 88 of the blood pump 87 towards the patient 4000. The substituate displaces the blood which is present in the arterial portion 91 between the arterial needle 101 and the pre-dilution addition valve 51.

(220) Shortly before the substituate reaches the arterial needle 101, the blood pump 87 and the substituate pump 89 are stopped.

(221) FIG. 15 illustrates a phase of an alternative blood recirculation process. At the arterial patient tube clamp 83 and the venous patient tube clamp 85 a respective sensor/detector 113 and sensor/detector 115 for measuring the optical density of the conduit interior of the extracorporeal circuit 3000 and for automatic recognition of the appearance of substituate are provided. Other and/or additional suitable sensors may be employed. Sensor and detector may be realized as a single-component part or as separate components.

(222) The fixation 102 of the arterial needle 101 is released and the arterial needle 101 is withdrawn. The arterial patient tube clamp 83 is opened. The pre-dilution addition valve 51 is closed.

(223) The venous needle 103 remains connected to the patient 4000. The venous patient tube clamp 85 is closed.

(224) The blood pump 87 is operated in the conveying direction and conveys blood out of the arterial portion 91 of the extracorporeal circuit 3000.

(225) In FIG. 15, a corresponding momentary state of the process showing a condition shortly after the beginning of the process is shown.

(226) The sensor/detector 113 recognizes the appearance of substituate. The blood is conveyed until it reaches the pre-dilution addition valve 51. Then the blood pump 87 is stopped.

(227) The substituate pump 89 is started. The arterial patient tube clamp 83 is closed. The venous patient tube clamp 85 is opened.

(228) The pre-dilution addition valve 51 is opened. The substituate pump 89 conveys the substituate through the arterial portion 91 of the extracorporeal circuit 3000, through the dialyzing means 2000 and the venous portion 93 of the extracorporeal circuit 3000, until the sensor/detector 115 at the venous patient tube clamp 85 recognizes the appearance of substituate.

(229) The blood is conveyed back through the venous needle 103 to the patient 4000.

(230) FIG. 16 shows the cassette 1000 and the extracorporeal circuit 3000 in a phase of an emptying process.

(231) The patient is not connected to the treatment apparatus any more. The arterial portion 91 and the venous portion 93 of the extracorporeal circuit 3000 are connected to each other.

(232) The arterial patient tube clamp 83 and the venous patient tube clamp 85 are opened. The pre-dilution addition valve 51 and the post-dilution addition valve 53 are opened, as is illustrated in FIG. 16 in the form of a momentary state.

(233) Air is introduced through the substituate addition site 41 into the extracorporeal circuit 3000 by operating the substituate pump 89. The air flows through the opened pre-dilution addition valve 51 and the opened post-dilution addition valve 53 and thus enters the extracorporeal circuit 3000.

(234) The air flows through the extracorporeal circuit 3000 and the dialyzing means 2000 in the opposite direction.

(235) The pre-dilution addition valve 51 is closed and the blood pump 87 is operated. The blood pump 87 and the substituate pump 89 convey the air in the conveying direction through the cassette 1000 into the dialyzing means 2000. The air exits at the dialyzing liquid outlet 2003.

(236) Further suitable methods for recirculation of the blood into a patient and/or for emptying the extracorporeal circuit are described, for example, in German Patent Application No. 10 2009 008 346.4 having the title “Verfahren zum Entfernen von Blut aus einem extrakorporalen Blutkreislauf for eine Behandlungsvorrichtung nach Beenden einer Blutbehandlungssitzung and Vorrichtung zum Ausführen desselben” [Method of removing blood from an extracorporeal blood circuit for a treatment apparatus following termination of a blood treatment session, and apparatus for performing said method] that was filed with the German Patent and Trademark Office on Feb. 11, 2009, the relevant disclosure of which is herewith fully incorporated by way of reference thereto.

(237) Such methods are moreover described in German Patent Application No. 10 2009 024 606.1 to the present applicant having the title “Verfahren zum Entfernen von Blut aus einem extrakorporalen Blutkreislauf, Behandlungsvorrichtung sowie Schlauchsystem” [Method of removing blood from an extracorporeal blood circuit, treatment apparatus, and tubing system] as filed with the German Patent and Trademark Office on Jun. 10, 2009. The relevant disclosure thereof is herewith also fully incorporated into the present application by way of reference.

(238) FIG. 17 shows in a simplified schematic representation an external functional means 1000 according to the invention according to a further embodiment in a view on its front side. With respect to the predominant number of its features, the cassette 1000 shown in FIG. 17 as well as in all other of the following figures corresponds to the embodiment of the cassette 1000 shown in FIGS. 1 to 16.

(239) The embodiment of the cassette 1000 shown in FIG. 17 comprises a handhold 117 for—advantageously simply and/or rapidly—assembling and/or disassembling the cassette 1000 prior to or after termination of the blood treatment. The handhold 117 can also be of use in a disassembling generally requiring more effort.

(240) The handhold can be designed such as to be actuated by means of tools, i.e., not to be actuated primarily or exclusively manually.

(241) Furthermore, the embodiment of the cassette 1000 shown in FIG. 17 comprises an extraction point or fill post 119, respectively. The fill post 119 of the cassette 1000 can be provided for extracting or sampling, respectively, substituate from the cassette 1000.

(242) The fill post 119 can be provided in addition to all structures and lines shown in FIGS. 1 to 16.

(243) The fill post 119 can be provided for not being flushed by fluid during the normal blood treatment operation of the cassette 1000. Preferably, in such a case, no fluid leaves the cassette 1000 through the fill post 119 or enters the cassette 1000 through the fill post 119 during the treatment.

(244) According to the invention, the fill post 119 can also be provided at another position than the position shown in the figures.

(245) According to the invention, the fill post 119 can, for example, in exceptional cases serve as a site or position, respectively, for extracting or removing, respectively, a fluid such as, e.g., substituate. The extracted fluid, e.g., substituate, can be used as displacing fluid upon optionally manually returning or an arterial infusion of extracorporeal blood into the vascular system of the patient through the arterial line. The latter can be of use in the case of a blockage of certain lines or in the case of a failure of cassette functions or of functions of the treatment apparatus, in that, by means of the fill post, a fluid suited for returning can be obtained with little effort.

(246) The fill post 119 can be provided at and connected with the cassette 1000 in different ways. In certain embodiments according to the invention, the fill post is integrally produced with the housing body of the cassette 1000. The fill post can be or comprise a Luer locking device injected onto the cassette.

(247) In some embodiments according to the invention, the fill post comprises a valve, in particular a switchable valve.

(248) In certain embodiments according to the invention, the fill post is also suited and provided for adding a fluid into the substituate.

(249) The external functional means 1000 of FIG. 17 further comprises tube fixations 121 and 123. The tube fixations 121, 123 which may also be provided in any number different from two can in certain embodiments advantageously prevent a disruption or damage of the tubes required for using the cassette during handling of the cassette 1000 by, for example, hanging in, e.g., the door opening of the treatment apparatus during coupling of the cassette 1000.

(250) Reference numeral 125 denotes a non-return valve or check valce which is, for example, designed such as is disclosed in German Patent Application No. 10 2009 024 469.7 to the applicant of the present invention having the title “Ventilvorrichtung, Ventileinsatz, externe Funktionseinrichtung, Behandlungsvorrichtung sowie Verfahren” [Valve device, valve insert, external functional means, treatment apparatus, and method] as filed with the German Patent and Trademark Office on Jun. 10, 2009, and U.S. Provisional Patent Application No. 61/185,603, also filed on Jun. 10, 2009.

(251) The non-return valve 125 can be an addition valve of a venous line.

(252) FIG. 17 furthermore discloses a heparin addition site 127. In the exemplary embodiment of FIG. 17, it is arranged in an upper area of the cassette 1000 above the single needle chamber 57 and above the venous blood chamber 21.

(253) The heparin addition site 127 is in fluid communication with a supplying line for heparin, shortly termed heparin line 128. In the embodiment of FIG. 17, the heparin line 128 extends from the heparin addition site 127 downwards until it reaches a level of the cassette 1000 where the venous blood chamber 21 begins.

(254) Furthermore, FIG. 17 reveals that the cassette 1000 comprises comparably less function exerting structures in a lower border area U, e.g., in the vicinity of clot trap 29 or beneath. This provides for space in the border area U of the cassette 1000 enabling the coupling of the cassette 1000 with measurement devices or the like which are, e.g., connected with the treatment apparatus, a door thereof or other devices or means, respectively. Such measurement devices can be arterial and/or venous temperature sensors, air bubble detectors, sensors for measuring an optical density, and the like.

(255) Providing space required therefore and the resulting possibility of providing the space with the afore-mentioned or other sensors thus contributes to process safety and thereby reduces or excludes risks for the patient.

(256) It should be clear that the space U may also be provided in another part or section, respectively, of the cassette 1000. Likewise, more than one of such spaces may be provided. Preferably such spaces are provided in a border or rim or edge area of the cassette 1000 and/or at or in the vicinity or proximity of supplying or discharging lines. Due to such favorable positions of possible sensors, the space directly or indirectly also serves for increasing the accessibility, for improving ergonomic aspects as well as for reducing costs, e.g., for connecting or coupling, respectively, the afore-mentioned sensors with analyzing devices (short signal lines).

(257) FIG. 18 shows in a schematic simplified manner an enlarged representation of a section A of FIG. 17. The non-return valve 125 shown in FIG. 18 in an enlarged representation can, e.g., be integrated in the cassette 1000 as a valve for post dilution addition of substituate such that it can be flushed by substituate after termination of the treatment. In this way, by using this arrangement, it can advantageously be possible to vent cavities during priming and rinsing the cassette 1000 in the proximity of the non-return valve in a more efficient way. It can advantageously be possible to avoid remaining of visible blood residues after having emptied the cassette 1000 after termination of the blood treatment. So, this can optionally contribute to a reduction of the contamination risk for third parties upon disposing the cassette 1000 after its use in case of blood residues. The non-return valve 125 is preferably arranged such as to be flushed without human assistance in particular during conventional use of the cassette 1000.

(258) Further, FIG. 18 shows a phantom valve 129 as well as a phantom valve 130. Phantom valves are specified in other sections of the application. For details, it is referred to these sections.

(259) FIG. 19 shows in a schematically simplified representation the external functional means according to the invention of the further embodiment represented in a slightly perspective view substantially from its back side.

(260) Besides the structures which have already been discussed above with respect to the other figures, the embodiment of the cassette 1000 shown in FIG. 19 further comprises an addition site 131 comprising a septum. The addition site 131 comprising the septum (also shortly termed septum addition site) is arranged at the level of the upper border or edge, respectively, of the cassette 1000 in the embodiment shown in FIG. 19. The upper border of FIG. 19 is one example of an upper area of the cassette 1000.

(261) FIG. 20 shows in a schematically simplified representation section B of the representation of FIG. 19 in an enlarged view.

(262) FIG. 21 shows in a schematically simplified representation the external functional means according to the invention in a further embodiment in a slightly perspective view, substantially viewed from its front side.

(263) Other than in the embodiment of, e.g., FIG. 17, the cassette 1000 does not comprise a fill post (denoted with reference numeral 119 there) in this further embodiment.

(264) FIG. 22 shows in a schematically simplified representation section A of the representation of FIG. 21 in an enlarged view. An arrangement of the phantom valve differing from the arrangement of FIG. 18 can well be identified. The different arrangement may result in different flushability.

(265) FIG. 23 shows in a schematically simplified representation further details, i.e. of section B, of the representation of FIG. 21.

(266) As can be seen from FIG. 23, the venous blood chamber 21 comprises an indentation 133 or contraction or an inclination modification or diminution or asymmetry of the inner and/or outer wall of the venous blood chamber 21. Both in FIG. 21 and in FIG. 23, the indentation 133 is shown at the right border and at the front side of the venous blood chamber 21.

(267) The indentation 133 can at least be present at the side facing the supplying line.

(268) The indentation 133 can be present in a section of the periphery or at the entire periphery of the rigid part of the venous chamber.

(269) In a position of use of the blood cassette 1000, the indentation 133 can be arranged substantially horizontally.

(270) In certain embodiments, the indentation 133 can correspond to or comprise a modification of the periphery and/or of the diameter of a section of the venous blood chamber 21 or of a wall thereof.

(271) In some embodiments according to the invention, with respect to a horizontal section (in relation to the representation of the cassette 1000 in FIG. 21 or of the arrangement of the cassette 1000 during its use), the indentation 133 can be or can comprise a non-semi-circular diameter of the venous blood chamber 21 (at the level of the indentation 133).

(272) In certain embodiments according to the invention, the indentation 133 can be a diminution of the cross-section of the chamber, in particular in the top to bottom direction of the representation of FIG. 21.

(273) In some embodiments according to the invention, the indentation 133 can be a section or an transition zone in or by which a larger cross-section or a larger cross-section area of the venous blood chamber 21 passes over to a smaller cross-section or a smaller cross-section area of the venous blood chamber 21, in particular in the top to bottom direction of the representation of FIG. 21.

(274) In certain embodiments according to the invention, the indentation 133 can be a dent extending along a section of the periphery of the venous blood chamber 21, in particular in the top to bottom direction of the representation of FIG. 21.

(275) In certain embodiments, the indentation 133 can result in an asymmetrical form of the venous blood chamber 21 in relation to the representation of FIG. 21 in the top to bottom direction.

(276) The indentation 133 which can partly or completely extend along the entire cross-section of the venous blood chamber 21 has surprisingly resulted in a reduced frothing or foam formation, respectively, within the venous blood chamber 21.

(277) With the optimization of the geometry of the venous blood chamber 21 achieved by means of the indentation 133 by which optionally the geometry of a single needle valve could also have been optimized, in certain embodiments of the present invention, an improved venting may be achieved prior to the beginning of the treatment. Furthermore, in some embodiments according to the invention, an improved steam flow during sterilization can be achieved. Moreover, in certain embodiments according to the invention, a reduction of eddy water spaces or areas comprising the known advantages resulting therefrom may be achieved.

(278) FIG. 24 shows in a schematically simplified representation the external functional means according to the invention in form of a cassette 1000 in a perspective, viewed from the bottom side and from the front side.

(279) FIG. 25 shows in a schematically simplified representation the section C of the representation of FIG. 24 in an enlarged view. It can be seen that a valve seating 135 of the single needle (SN) valve is lowered when compared to the proximity or adjacent bars or parts of the housing body of the cassette 1000. Hereby, the inventors could achieve fluidic advantages which could come along not only with avoiding or reducing the formation of turbulences. The lowering can be, e.g., 0.5 mm.

(280) FIG. 26 shows in a schematically simplified representation the section D of the representation of FIG. 24 in an enlarged view. It can be seen from FIG. 26 that valve seatings 137 and 139 of phantom valves are lowered against the proximity or adjacent bars or parts of the housing body of the cassette 1000. The lowering can be, e.g., 0.5 mm.

(281) The following is a List of Reference Numerals as used herein.

(282) TABLE-US-00001 Reference Numeral Description 1000 cassette 1 hard part 3 film 4 sealing bar 5 peripheral weld 7 arterial patient connection 9 arterial pressure measurement chamber 11 connector for the exit of blood from cassette 1000 13 connector for the entry of blood into cassette 1000 15 chamber with arterial post-pump, or pre-filter, pressure measurement site 17 arterial filter conduit 19 venous filter conduit 21 venous blood chamber 23 upper space of the venous blood chamber 21 25 lower space of the venous blood chamber 21 27 cross-sectional restriction of the hard part 1 29 clot trap 31 venous patient connection 33 arterial addition site 35 check valve of the arterial addition site 33 36 arterial heparin addition valve (phantom valve) 37 venous addition site 39 check valve of the venous addition site 37 40 venous heparin addition valve (phantom valve) 41 substituate addition site 43 connector for exit of substituate from the cassette 1000 45 connector 45 for entry of substituate into the cassette 1000 47 check valve for addition of substituate 49 substituate conduit 51 pre-dilution addition valve (phantom valve) 53 post-dilution addition valve (phantom valve) 55 single-needle sterile membrane 57 single-needle chamber 59 blood surge redirection element 61 single-needle blood valve (phantom valve) 63 evacuation site for vacuum coupling 65 primary alignment center 67 secondary alignment site 69 sealing bar 71 single-needle air connector 73 support bars having a height of 5 mm 75 support bars having a height of 8 mm 77 support bars having a height of 13 mm 79 support bars having a height of 24 mm 81 support bars having a height of 31 mm 2000 dialyzing means 2001 dialyzing liquid inlet 2003 dialyzing liquid outlet 3000 extracorporeal circuit 83 arterial patient tube clamp 85 venous patient tube clamp 87 blood pump 88 pump tube segment of blood pump 87 89 substituate pump 90 pump tube segment of substituate pump 89 91 arterial portion of extracorporeal circuit 3000 93 venous portion of extracorporeal circuit 3000 95 drain conduit 97 plug valve 4000 patient 99 double-needle access to patient 4000 101 arterial needle 102 fixation of arterial needle 103 venous needle 104 fixation of venous needle 105 blood inlet at the dialyzing means 2000 107 blood outlet from the dialyzing means 2000 109 single-needle access to patient 4000 110 fixation of single-needle access 109 111 Y-shaped branching of the single-needle access 109 into arterial portion 91 and venous portion 93 113 sensor/detector at arterial patient tube clamp 83 115 sensor/detector at venous patient tube clamp 85 117 handhold 119 fill post 121 tube fixation 123 125 non-return valve 127 heparin addition site 128 heparin line 129 phantom valve 130 131 addition site 133 indentation 135 valve seating 137 139