Apparatus for carrying out an extracorporeal blood treatment

Abstract

The invention relates to an apparatus for carrying out an extracorporeal blood treatment in which a substitution fluid is administered to the patient, wherein the apparatus comprises an extracorporeal blood circuit and a substitution line opening into the extracorporeal blood circuit, wherein the substitution line has at least one heating container, and wherein a pump is arranged in the substitution line downstream of the heating container or containers for the conveying of substitution fluid into the extracorporeal blood circuit.

Claims

1. An apparatus for carrying out an extracorporeal blood treatment in which a substitution fluid is administered to the patient, wherein the apparatus comprises an extracorporeal blood circuit, a substitution line opening into the extracorporeal circuit blood circuit (1), and wherein the substitution line has at least one heating container, a pump is arranged downstream of the heating container or containers in the substitution line for conveying substitution fluid into the extracorporeal blood circuit, a further pump arranged upstream of the heating container or containers in the substitution line for the conveying of substitution fluid into the extracorporeal blood circuit, and a control unit connected to the upstream and downstream pumps and configured such that the upstream pump is stopped and the downstream pump is operated in an operating mode of the apparatus.

2. An apparatus in accordance with claim 1, characterized in that a clamp which inhibits the flow of substitution fluid in the closed state is arranged upstream of the heating container or containers in the substitution line.

3. An apparatus in accordance with claim 1, characterized in that the substitution line has a bypass line in the region of the downstream pump, in which bypass line a check valve is arranged which only allows a flow in the direction of the extracorporeal blood circuit.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) Further details and advantages of the invention result from the embodiments explained in the following with reference to the Figures. There are shown in the Figures:

(2) FIG. 1: a flow diagram of an apparatus for plasma exchange during the normal phase of the treatment;

(3) FIG. 2: a flow diagram of an apparatus for plasma exchange during the end phase of the treatment, with a displacement of the substitution fluid taking place with a displacement fluid;

(4) FIG. 3: a flow diagram of an apparatus in accordance with the invention for plasma exchange during the end phase of the treatment, with a displacement of the substitution fluid taking place with air;

(5) FIG. 4: a flow diagram of a variant of an apparatus in accordance with the invention for plasma exchange, with the heating containers being sucked empty during the end phase of the treatment; and

(6) FIG. 5: a flow diagram of a further variant of an apparatus in accordance with the invention for plasma exchange, with the heating containers being sucked empty during the end phase of the treatment.

(7) FIG. 1 shows an apparatus of the category during the normal phase of the treatment in which fresh substitution fluid is continuously obtained from a reservoir and is administered to the patient.

(8) The extracorporeal blood circuit of the apparatus is marked by the reference numeral 1. It comprises an arterial line 2, a plasma filter 3 and a venous line 4. An arterial port 5 is arranged at the lead side of the arterial line 2 and a venous port 6 is arranged at the return side of the venous line 4. These ports 5 and 6, which are needles, for example, serve the connection of the apparatus to a patient.

(9) An arterial clamp 7, a pressure sensor 8 for measuring the arterial pressure, a blood pump 9, a further pressure sensor 10 for measuring the pump pressure, and a line 11 for supplying an anticoagulant such as heparin are arranged staggered in the direction of flow in the arterial line 2.

(10) A drop chamber 12, a pressure sensor 13 for measuring the venous pressure and a venous clamp 14 are located in the venous line 4.

(11) In addition, a metering system 15 for citrate is connected to the arterial line 2 between the arterial port 5 and the arterial clamp 7, said metering system comprising a citrate reservoir 16 and a citrate pump 17. A metering system 18 for calcium ions which comprises a calcium ion reservoir 19 and a calcium pump 20 is connected to the venous line 4 between the venous clamp 14 and the venous port 6.

(12) The plasma filter 3 comprises a semipermeable membrane which separates the extracorporeal blood circuit 1 from a drainage system 21 for plasma separated from the blood. The drainage system 21 comprises a filtration pump 22, a pressure sensor 23 for measuring the filtration pressure and a drain 24 for collecting or disposing of the separated plasma.

(13) The apparatus furthermore comprises a substitution line 25 which opens into the venous line 4 of the extracorporeal blood circuit 1 upstream of the drop chamber 12. A reservoir 26 for substitution fluid is arranged at the lead side of the substitution line 25. A substitution pump 27 which serves the conveying of substitution fluid from the reservoir 26 into the venous line 4 is furthermore arranged in the substitution line 25. The substitution line 25 furthermore comprises heating pouches 28a and 28b which comprise a heat exchanger and which serve to raise the temperature of the substitution fluid to body temperature.

(14) FIG. 2 shows the same apparatus during the end phase of the treatment in which fresh substitution fluid is no longer obtained and administered to the patient. Instead, the remainder of the substitution fluid still located in the substitution line 25, and in particular in the heating pouches 28a and 28b, should be conveyed into the extracorporeal blood circuit 1 by displacement with a displacement fluid. For this purpose, the reservoir 26 for substitution fluid is replaced with a reservoir 29 for a displacement fluid in the end phase of the treatment. The substitution pump 27 then conveys displacement fluid out of the reservoir 29 for so long until the total volume of the substitution line 25 and of the heating pouches 28a and 28b has been flushed empty. The determination of the conveyed volume can take place, for example, with reference to a flow sensor not shown in the Figures. In this method, however, the problems named in the introductory part of the description result of a mixing and incomplete displacement.

(15) An apparatus configured in accordance with the invention during the end phase of the treatment is shown in FIG. 3.

(16) Instead of the physiological NaCl solution (cf. reservoir 29 of FIG. 2), no fluid reservoir, but rather only a sterile filter 30 is now connect to the hose system. Since the heating pouches 28a and 28b are flowed through from bottom to top, they should be removed from the heating and turned over in this solution (which is not shown in the Figure), for example suspended upside down at an infusion stand.

(17) Air is subsequently conveyed for so long by the substitution pump 27 until the plasma has been completely reinfused in the heating pouches 28a and 28b and in the hose system 25 up to the venous drop chamber 12. The reinfusion is easy to monitor by staff since the boundary layer between air and plasma is easily visible.

(18) No danger arises from this since any air conveyed is intercepted in the venous drop chamber 12 and, with large quantities, could be reliably recognized there or in a subsequent detector not shown in the Figure. The reinfusion could be automated in that the end of the reinfusion is determined by the volume to be conveyed by the substitution pump 27 or by the drop of the level in the venous drop chamber 12.

(19) Advantages of this variant comprise an almost complete plasma reinfusion, with the costs for the physiological NaCl reinfusion solution being dispensed with.

(20) A further variant in accordance with the invention of an apparatus of the category is shown during the end phase of the treatment in FIG. 4.

(21) The reinfusion of the plasma contained in the heating pouches 28a and 28b and in the line 25 takes place here by an additional pump 31 which is connected in parallel with a bypass line 32 in the substitution line 25 between the heating pouches 28a and 28b and the extracorporeal blood circuit 1. So that the heating pouches 28a and 28b can be sucked empty by this additional pump 31, a check valve 33 is arranged in the bypass line.

(22) During the reinfusion (end phase of the treatment), the substitution pump 27 is stopped and the additional pump 31 conveys the plasma located in the heating pouches 28a and 28b to the blood hose 1. The reinfusion can be automated in that the end of the reinfusion is determined by the volume to be conveyed by the additional pump 31.

(23) In a variant, a check valve can be used which is anyway present at the plasma infusion point in some devices by connecting the substitution line 25 to the additional pump 31 at the venous bubble trap 12.

(24) Advantages of this solution comprise an almost complete plasma reinfusion, with the costs for the physiological NaCl reinfusion solution being dispensed with. An automated handling of the reinfusion is furthermore possible. There is no risk for the patient for the reasons already named in connection with the discussion of FIG. 3.

(25) A further variant in accordance with the invention of an apparatus of the category is shown during the end phase of the treatment in FIG. 5.

(26) In accordance with this variant, a reclamping of the heating pouches 28a and 28b is provided for an almost complete plasma reinfusion. Before the start of the end phase of the treatment, the heating pouches 28a and 28b are removed from the substitution line 25 and are connected upstream of the substitution pump 27. The other side of the heating pouches 28a and 28b can be closed, for example using a clamp 34. The substitution line 25 is closed again at the point at which the heating pouches 28a and 28b were. The plasma located in the heating pouches 28a and 28b can now be conveyed by the substitution pump 27 to the extracorporeal blood circuit 1.

(27) Advantages of this variant comprise an almost complete plasma reinfusion, with the costs for a physiological NaCl reinfusion solution being dispensed with.

(28) A further variant in accordance with the invention will likewise be discussed with reference to FIG. 5. In accordance with this variant, a reinfusion can take place by closing the connector line to the reservoir 26 (shown in FIG. 1).

(29) This solution requires the constant reversal of the arrangement of heating pouches 28a and 28b in relation to the substitution pump 27, that is the arrangement of the substitution pump 27 downstream of the heating pouches 28a and 28b, as is shown in FIG. 5. In this variant, the plasma can first be preheated in the heating pouches 28a and 28b during the normal phase of the treatment and can then be conveyed by substitution pump 27 into the extracorporeal blood circuit 1.

(30) If the heating pouches 28a and 28b are upstream of the substitution pump 27, the access to the reservoir 26 can, for example, be closed manually for the reinfusion. This is sufficient to empty the heating pouches 28a and 28b using the substitution pump 27 without an additional pump having to be provided. The requirement is a possibility to close the access to the reservoir 26 manually or in an automated manner by a machine apparatus such as a clamp 34. After the closing, a predefined volume can be conveyed by the pump 3 which results from the calculated filling volume of the heating pouches 28a and 28b.

(31) Advantages of this variant comprise an almost complete plasma reinfusion, a saving of the costs for the physiological NaCl reinfusion solution and no costs for additional hose couplings or other additional parts.

(32) It is possible in each of the variants in accordance with the invention to configure the control unit of the apparatus such that plasma should continue to be obtained via the plasma filter 3 (zero balance) during the end phase of the treatment or whether this obtaining should stop (bolus administration).