METHOD FOR PRIMING AN EXTRACORPOREAL BLOOD CIRCUIT OF AN APPARATUS FOR EXTRACORPOREAL TREATMENT OF BLOOD AND APPARATUS FOR EXTRACORPOREAL TREATMENT OF BLOOD

Abstract

A method for priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood comprises: feeding a priming fluid in the extracorporeal blood circuit and into a blood side of a membrane gas exchanger (18); generating a transitory pressurization step or a plurality of transitory pressurization steps in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger (18).

Claims

1-15. (canceled)

16. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: an extracorporeal blood circuit; a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit; a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger comprises a blood side in fluid communication with the blood circuit and a gas side; wherein the method of priming comprises: feeding a priming fluid into the extracorporeal blood circuit and into the blood side of the membrane gas exchanger; controlling release of air bubbles from blood flowing in the extracorporeal blood circuit at a blood outlet of the membrane gas exchanger by generating a transitory pressurization step in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger.

17. The method according to claim 16, wherein the apparatus for extracorporeal treatment of blood comprises a blood treatment unit and the extracorporeal blood circuit is coupled to the blood treatment unit, wherein the membrane gas exchanger is located next to the blood treatment unit.

18. The method according to claim 17, wherein the membrane gas exchanger is located substantially at the same height of the blood treatment unit, and wherein the method comprises placing a priming fluid waste bag at the same height of the membrane gas exchanger or below the membrane gas exchanger.

19. The method according to claim 17, wherein the apparatus for extracorporeal treatment of blood comprises a disposable cartridge including the membrane gas exchanger, the blood treatment unit, and at least part of the extracorporeal blood circuit.

20. The method according to claim 16, comprising: repeating the transitory pressurization step during priming at time intervals, wherein each time interval is between 10 s and 100 s.

21. The method according to claim 16, wherein a maximum pressure at the membrane gas exchanger during the pressurization step is between 100 mmHg and 1000 mmHg.

22. The method according to claim 16, wherein a time length of each pressurization step is between 2 s seconds and 30 s seconds, wherein the time length of each pressurization step is a function of a pressure in the blood circuit measured downstream the blood pump or is being fixed.

23. The method according to claim 22, wherein the measured pressure is one of a measured return pressure, a treatment unit pressure, an effluent pressure, and an average pressure thereof.

24. The method according to claim 16, wherein generating the transitory pressurization step comprises: transiently restricting or occluding flow in a portion of the extracorporeal blood circuit downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid, the transitory pressurization step being a pressure increase with respect to a pressure regimen in place before the transitory pressurization step.

25. The method according to claim 16, wherein generating the transitory pressurization step comprises: keeping the blood pump working and closing a clamp placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid.

26. The apparatus of claim 25, wherein said closing the clamp placed downstream of the membrane gas exchanger comprises repeatedly opening and closing the clamp.

27. The method according to claim 16, wherein the apparatus for extracorporeal treatment of blood comprises an infusion line provided with an infusion pump, wherein generating the transitory pressurization step is actuated through the infusion line and the infusion pump coupled to a pump section of the infusion line and comprising: connecting the infusion line to a source of priming fluid; and activating the infusion pump; wherein the infusion line is connected to the blood circuit between the blood pump and the return clamp and, when the infusion pump is activated, the blood pump is stopped and a clamp placed on the blood circuit and downstream of the membrane gas exchanger, with respect to the flow direction of the priming fluid, is closed.

28. The method according to claim 16, wherein generating the transitory pressurization step is actuated through a deaeration chamber placed on the extracorporeal blood circuit between the blood pump and a return clamp and is actuated through an air pump connected to the deaeration chamber.

29. The method according to claim 16, wherein, at the end of priming and before patient connection, a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg.

30. The method according to claim 16, wherein at the end of priming and before patient connection: a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg; the blood pump is stopped while a clamp placed on a blood return line downstream of the membrane gas exchanger is kept closed, wherein a blood circuit portion between the blood pump and the return clamp is isolated, no air is allowed to enter into the blood circuit portion and a pressure regimen inside the blood circuit portion is kept constant.

31. The method according to claim 16, comprising, before feeding the priming fluid in the extracorporeal blood circuit, placing the membrane gas exchanger close to or at the same height of the blood treatment unit and connecting a priming fluid source bag and a priming fluid waste bag to the extracorporeal blood circuit.

32. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: a blood treatment unit; an extracorporeal blood circuit coupled to the blood treatment unit; a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit; a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger comprises a blood side in fluid communication with the blood circuit and a gas side; wherein the method of priming comprises: feeding a priming fluid in the extracorporeal blood circuit and into the blood side of the membrane gas exchanger; controlling release of air bubbles from blood flowing in the extracorporeal blood circuit at a blood outlet of the membrane gas exchanger by generating a transitory pressurization step in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger; repeating the transitory pressurization step during priming at time intervals; wherein at the end of priming and before patient connection: a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg; the blood pump is stopped while a clamp placed on a blood return line and downstream of the membrane gas exchanger is kept closed, such that a blood circuit portion between the blood pump and the return clamp is isolated, no air is allowed to enter into the blood circuit portion, and a pressure regimen inside the blood circuit portion is kept substantially constant.

33. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: a blood treatment unit; an extracorporeal blood circuit coupled to the blood treatment unit; a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit; a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger is located next to the blood treatment unit and comprises a blood side in fluid communication with the blood circuit and a gas side; wherein the method of priming comprises: feeding a priming fluid in the extracorporeal blood circuit and into the blood side of the membrane gas exchanger; filling the blood side of the membrane gas exchanger with the priming fluid; preventing gas flowing through the gas side of the membrane gas exchanger; controlling release of air bubbles from blood flowing in the extracorporeal blood circuit at a blood outlet of the membrane gas exchanger by generating a transitory pressurization step in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger; wherein generating the transitory pressurization step comprises transiently restricting or occluding flow in a portion of the extracorporeal blood circuit placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid, wherein transitory pressurization step is a pressure increase with respect to a pressure regimen in place before the transitory pressurization step.

34. The method according to claim 33, wherein generating the transitory pressurization step comprises keeping the blood pump working and closing a clamp placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid.

35. The method according to claim 34, wherein said closing the clamp placed downstream of the membrane gas exchanger comprises repeatedly opening and closing the clamp.

Description

DESCRIPTION OF THE DRAWINGS

[0086] Aspects of the invention are shown in the attached drawings, which are provided by way of non-limiting example, wherein:

[0087] FIG. 1 shows a schematic diagram of an apparatus for extracorporeal treatment of blood during treatment of a patient;

[0088] FIG. 2 shows the apparatus of FIG. 1 during a priming procedure according to one aspect of the invention;

[0089] FIG. 3 shows a schematic diagram of an alternative embodiment of an apparatus for extracorporeal treatment of blood;

[0090] FIG. 4 shows the apparatus of FIG. 1 during a priming procedure according to another aspect of the invention;

[0091] FIG. 5 shows a possible embodiment of the apparatus of FIGS. 1 and 2;

[0092] FIG. 6 is a graph showing a pressure trend during priming related to an embodiment of the invention;

[0093] FIG. 7 is a flowchart of one embodiment of a method of the invention;

[0094] FIG. 8 is a graph showing correlation between intensity of intensity of pressure peaks and bubbling free time during priming;

[0095] FIG. 9 is a graph showing correlation between pressurization time and bubbling free time during priming.

DETAILED DESCRIPTION

[0096] Non-limiting embodiments of an apparatus 1 for extracorporeal treatment of blood—which may implement innovative aspects of the invention—are shown in FIGS. 1 to 5. In below description and in FIGS. 1 to 5 same components are identified by same reference numerals.

[0097] In FIG. 1 it is represented an apparatus for the extracorporeal treatment of blood 1 comprising a blood treatment unit 2 (such as an hemofilter, an ultrafilter, an hemodiafilter, a dialyzer, a plasmafilter and the like) having a primary chamber 3 and a secondary chamber 4 separated by a semi-permeable membrane 5; depending upon the treatment, the membrane 5 of the blood treatment unit 2 may be selected to have different properties and performances. A blood withdrawal line 6 is connected to an inlet of the primary chamber 3, and a blood return line 7 is connected to an outlet of the primary chamber 3. In use, the blood withdrawal line 6 and the blood return line 7 are connected to a needle or to a catheter or other access device (not shown) which is then placed in fluid communication with the patient P vascular system, such that blood may be withdrawn through the blood withdrawal line 6, flown through the primary chamber 3 and then returned to the patient's vascular system through the blood return line 7. An air separator, such as a deaeration chamber 8, may be present on the blood return line 7. Moreover, a safety return clamp 9 controlled by a control unit 10 may be present on the blood return line 7, downstream the deaeration chamber 8. A bubble sensor 8a, for instance associated to the deaeration chamber 8 or coupled to a portion of the line 7 between the deaeration chamber 8 and the return clamp 9 may be present: if present, the bubble sensor 8a is connected to the control unit 10 and sends to the control unit 10 signals for the control unit 10 to cause closure of the return clamp 9 in case one or more bubbles above certain safety thresholds are detected. The blood flow through the blood lines is controlled by a blood pump 11, for instance a peristaltic blood pump, acting either on the blood withdrawal line 6 or on the blood return line 7. The embodiment of FIGS. 1 and 2 shows the blood pump 11 coupled to a pump section of the withdrawal line 6. An operator may enter a set value for the blood flow rate Q.sub.B through a user interface and the control unit 10, during treatment, is configured to control the blood pump 11 based on the set blood flow rate Q.sub.B. The control unit 10 may comprise a digital processor (CPU) with memory (or memories), an analogical type circuit, or a combination of one or more digital processing units with one or more analogical processing circuits. In the present description and in the claims it is indicated that the control unit 10 is “configured” or “programmed” to execute certain steps: this may be achieved in practice by any means which allow configuring or programming the control unit 10. For instance, in case of a control unit 10 comprising one or more CPUs, one or more programs are stored in an appropriate memory: the program or programs containing instructions which, when executed by the control unit 10, cause the control unit 10 to execute the steps described and/or claimed in connection with the control unit 10. Alternatively, if the control unit 10 is of an analogical type, then the circuitry of the control unit 10 is designed to include circuitry configured, in use, to process electric signals such as to execute the control unit 10 steps herein disclosed. An effluent fluid line or spent dialysate line 12 is connected, at one end, to an outlet of the secondary chamber 4 and, at its other end, to a waste which may be a discharge conduit or an effluent fluid container collecting the fluid extracted from the secondary chamber. An effluent pump 13 that operates on the effluent fluid line 12 under the control of the control unit 10 to regulate the flow rate Q.sub.eff across the effluent fluid line. The apparatus of FIG. 1 includes a dialysis line 14 connected at one end with a liquid inlet and at its other end with the inlet of the secondary chamber 4 of the treatment unit 2 for supplying fresh dialysis liquid to the secondary chamber 4. A dialysis fluid pump, not shown, is operative on the dialysis fluid line 14 under the control of the control unit 10, to supply fluid from a dialysis liquid container to the secondary chamber 4 at a flow rate Q.sub.dial.

[0098] The embodiment of FIG. 1 presents an infusion line 15 connected to the blood withdrawal line 6 between the blood pump 11 and the treatment unit 2. This infusion line 15 supplies replacement fluid from an infusion fluid container 16 connected at one end of the infusion line 15. Note that, alternatively or in addition to the infusion line 15, the apparatus of FIG. 1 may include a post-dilution fluid line (not shown) connecting an infusion fluid container to the blood return line 7. Furthermore, an infusion pump 17 operates on the infusion line 15 to regulate the flow rate Q.sub.rep through the infusion line 15. Note that in case of two infusion lines (pre-dilution and post-dilution) each infusion line may be provided with a respective infusion pump. The apparatus for the extracorporeal treatment of blood 1 further comprises a membrane gas exchanger 18 placed on the blood return line 7, i.e. downstream of the treatment unit 2 with respect to a flow direction of blood during treatment. The membrane gas exchanger 18 comprises a gas permeable membrane 100 separating a blood side and a gas side. A first section 7a of the blood return line 7 coming from the treatment unit 2 is connected to a blood inlet 18c of the blood side of the membrane gas exchanger 18 and a second section 7b of the blood return line 7, connected to the needle or to the catheter, is connected to a blood outlet 18d of the blood side of the membrane gas exchanger 18. The gas side of the membrane gas exchanger 18 is provided with a respective gas inlet 18a and gas outlet 18b for ventilating gas (e.g. air or oxygen).

[0099] The internal structure of the membrane gas exchanger 18 may be per se known. The gas permeable membrane 100 may comprise a plurality of hollow fibers. The ventilating gas (e.g. oxygen, air) is passed through the inside (gas side) of the hollow fibers, while the blood is passed around (blood side) the hollow fibers to accomplish gas exchange by diffusion. The membrane gas exchanger 18 is operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit. The membrane gas exchanger 18 may be an oxygenator and/or a CO.sub.2 remover. For example, oxygen diffuses from the gas side into the blood and carbon dioxide CO.sub.2 diffuses from the blood side into the gas for disposal. The apparatus 1 of FIG. 1 can deliver stand-alone CO.sub.2 removal as well as dialysis and CO.sub.2 removal combined in the same blood circuit.

[0100] The apparatus 1 shown in FIGS. 1 and 2 is also provided with a safety withdrawal clamp 19 controlled by the control unit 10 and present on the blood withdrawal line 6 and upstream of the blood pump 11.

[0101] The blood withdrawal line 6, the blood return line 7, the first chamber 3 of the treatment unit 2 and the blood side of the membrane gas exchanger 18 form part of an extracorporeal blood circuit of the apparatus 1. The effluent fluid line 12, the dialysis fluid line 14, the fluid chamber 4 of the treatment unit 2 form part of a fluid circuit of the apparatus 1. The infusion line 15 is connected to the blood circuit between the return clamp 9 and the blood pump 11. In FIGS. 1 and 2 the infusion line 15 is connected to the blood circuit between the blood pump 11 and the blood treatment unit 2. Pressure pods may also be present on the blood circuit and on the fluid circuit to monitor liquid/blood pressures. Each pressure pod comprises a hollow body with an intermediate flexible membrane which delimits a gas chamber and a liquid/blood chamber with inlet and outlet for connection to the blood circuit or to the fluid circuit.

[0102] The apparatus 1 shown in FIGS. 1 and 2 comprises a treatment unit pressure pod 20 placed on the blood withdrawal line 6 just upstream of the treatment unit 2, an access pressure pod 21 placed on the blood withdrawal line 6 just downstream of the access device and of the patient P, an effluent pressure pod 22 placed on the effluent line 12 between the treatment unit 2 and the effluent pump 13.

[0103] The blood pump 11, the effluent pump 13, the infusion pump 17 and possible other pumps (not shown) are operatively connected to the control unit 10 which controls said pumps. The control unit 10 is also operatively connected to sensors (like flow sensors) on the blood circuit and/or fluid circuit and, in particular, to the pressure pods 20, 21, 22 and the bubble sensor 8a. The control unit 10 is also operatively connected to clamps and valves, like the return clamp 9 and the withdrawal clamp 19. The control unit 10 is also connected to the user interface, not shown, for instance a graphic user interface, which receives operator's inputs and displays the apparatus outputs. For instance, the graphic user interface may include a touch screen, a display screen and hard keys for entering user's inputs or a combination thereof. During extracorporeal blood treatment, the control unit 10 is configured to control at least the pumps 11, 13, 17 to make sure that a prefixed patient fluid removal is achieved in the course of a treatment time, as required by a prescription provided to the control unit 10, e.g. via the user interface. A blood warming device 33 may optionally be place on the blood return line 7 between the membrane gas exchanger 18 and the deaeration chamber 8. The apparatus 1 of FIGS. 1 and 2 is configured to deliver Continuous Renal Replacement Therapy (CRRT) in combination with ECCO.sub.2R therapy or ECCO.sub.2R therapy alone.

[0104] The control unit 10 is also configured for commanding execution of a task for priming the extracorporeal blood circuit before treatment of a patient, according also to the method of the present invention.

[0105] A configuration of the apparatus of FIG. 1 for priming the blood circuit is shown in FIG. 2. A priming fluid source bag 23 (e.g. saline bag) is connected to the withdrawal line 6 of the blood circuit. A priming fluid waste bag 24 is connected to the return line 7 of the extracorporeal blood circuit. A further priming fluid source bag 25 may be connected to the infusion line 15. An air pump 26 may be connected to the gas chamber of the treatment unit pressure pod 20. An air pump 26 may also be connected to the upper part of the deaeration chamber 8 allowing level adjustment in said deaeration chamber. FIG. 5 shows a possible embodiment of the apparatus of FIGS. 1 and 2, wherein the extracorporeal blood treatment unit 2, the membrane gas exchanger 18 and at least part of the extracorporeal blood circuit are part of a disposable cartridge 27 mounted on a supporting frame 28. The supporting frame 28 comprises a casing 29 supported by an upright 30 with a support base 31 configured to rest on the ground. The casing 29 supports and/or houses mechanical and/or electronic devices of the apparatus 1, such as the control unit 10, the blood pump 11, the return clamp 9, the withdrawal clamp 19, the pressure sensors to be connected to pressure pods 20, 21, etc. The casing 29 comprises carrier for the cartridge 27, not visible, and it is further provided with supporting elements 32, such as hooks, for hanging fluid bags. FIG. 5 shows the apparatus 1 in the priming configuration in which the priming fluid source bag 23 and the priming fluid waste bag 24 hang under the casing 29. The membrane gas exchanger 18 is located next to the blood treatment unit 2 and substantially at the same height of the blood treatment unit 2. The priming fluid source bag 23 and the priming fluid waste bag 24 are placed below the membrane gas exchanger 18.

[0106] In order to prime the extracorporeal blood circuit, the return clamp 9 and the withdrawal clamp 19 are opened and the blood pump 11 is activated to make the priming fluid flow from the priming fluid source bag 23 towards the priming fluid waste bag 24 and flowing through the primary chamber 3 of the blood treatment unit 2 and the blood side of the membrane gas exchanger 18. During priming, no gas flows through the gas side of the membrane gas exchanger 18. Once the priming fluid fills the blood side of the membrane gas exchanger 18, optionally when the priming fluid reaches the deaeration chamber 8, the return clamp 9 is closed and reopened while the blood pump 11 keeps working, in order to generate a transitory pressurization step in the priming fluid and in the blood side of the membrane gas exchanger 18. In an embodiment of the method or task for priming, the return clamp 9 is repeatedly closed and opened in order to generate a plurality of transitory pressurization steps in the priming fluid and in the blood side of the membrane gas exchanger 18. The generation of one or more pressurization step/s may be repeated several times during priming. This prevents release of air bubbles at the outlet of the membrane gas exchanger 18. The effect of the pressurization step may result from the forcing of some fluid into the hydrophobic pores of the membrane leading to a reduction of gas transfer, as well as from the removal of micro-air bubbles, accumulated at the membrane wall, through the membrane and before their aggregate into macro-bubbles. For instance, when the priming fluid reaches the deaeration chamber 8, a first series of pressurization steps may be actuated by intermittently closing the return clamp 9 at periodic time intervals T. By closing and opening the return clamp 9, to generate pressurization step or steps, a portion of the blood circuit placed downstream of the membrane gas exchanger 18 with respect to a flow direction of the priming fluid is occluded. In a variant of the method, the return clamp 9 may be partially closed in order to restrict the portion of the blood circuit placed downstream of the membrane gas exchanger 18. According to a different embodiment for generating the pressurization step or steps, after that the priming fluid from the priming fluid source bag 23 has reached the deaeration chamber 8, the blood pump 11 is stopped, the return clamp 9 is closed and the infusion pump 17 is intermittently activated to pump priming fluid from the further priming fluid source bag 25 through the infusion line 15 and into the extracorporeal blood circuit and to generate said pressurization step/s in the membrane gas exchanger 18. According to a further different embodiment for generating the pressurization step or steps, after that the priming fluid from the priming fluid source bag 23 has reached the deaeration chamber 8, while the blood pump keeps working, the air pump 26 connected to the treatment unit pressure pod 20 is activated intermittently to generate pressure pulses in the air chamber of the treatment unit pressure pod 20 while blood pump 11 is stopped and the return clamp 9 is closed. The pressure pulses in the air chamber pushes and deforms the intermediate flexible membrane which transfers said pressure pulses to the priming fluid in the blood chamber of the treatment unit pressure pod 20 and in the blood treatment circuit. According to a different embodiment for generating the pressurization step or steps, the blood pump 11 is stopped, the return clamp 9 is closed and the air pump 26 connected to the deaeration chamber 8 is activated intermittently to generate pressure pulses in the upper part of the deaeration chamber 8 and into the priming fluid in the lower part of said deaeration chamber 8. Optionally, at the end of priming and before patient connection, the blood pump 11 is still motionless while the return clamp 9 placed on a blood return line 7 and downstream of the membrane gas exchanger 18 is kept closed, while, optionally, the blood pump 11, the infusion pump 17, the dialysate pump 13 or air pump 26 are activated to build up some positive pressure level. Even if, like in FIG. 5, the membrane gas exchanger 18 is located close to the blood treatment unit 2 and substantially at the same height of the blood treatment unit 2, the priming fluid source bag 23 and the priming fluid waste bag 24 and, optionally, also the further priming fluid source bag 25 (not shown in FIG. 5) are placed below the membrane gas exchanger 18, bubble formation is prevented. Therefore, free and user friendly positioning of the membrane gas exchanger 18 and of the bags is allowed and no specific component designed to control bubbling during priming is required. FIGS. 3 and 4 show a different embodiment of the extracorporeal blood treatment 1 during patient treatment (FIG. 3) and priming sequence (FIG. 4). The same reference numerals for the same elements of FIGS. 1 and 2 have been used. The extracorporeal blood treatment 1 of FIGS. 3 and 4 does not comprise the blood treatment unit 2 but it's only equipped with the membrane gas exchanger 18. The membrane gas exchanger 18 is the only device in the circuit and the apparatus 1 is configured to deliver only ECCO.sub.2R therapy (stand-alone ECCO.sub.2R). Priming of the extracorporeal blood circuit and generation of transitory pressurization step/s may be accomplished as in the apparatus of FIGS. 1 and 3 through the return clamp 9 and/or the air pump 26 connected to the pressure pod 20 placed upstream of the membrane gas exchanger 18. The control unit 10 is configured to control the pressurizations step/s and, optionally, a time length Δt of each pressurization step or of each pressurization step. The pressurization step/s may be fully automated and may not require any user intervention.

[0107] It is noted that usually a peristaltic pump moves the priming fluid inside the blood lines during priming. Clearly a peristaltic pump, by its own nature, produces an oscillating pressure around a mean pressure value. The described pressurization step is intended to be an increase of the mean pressure inside the blood line portion with respect to the mean pressure existing prior the pressurization step. See FIG. 6, wherein the oscillating pressure around a mean pressure value generated by the blood pump is hardly visible in the form of pressure irregularities along the two parallel (thin) lines representing the average/mean pressure. The lower line is the mean pressure when no pressurization step is occurring, while the upper line represent the mean pressure value during the pressurization step. According to some embodiments, the time length Δt is fixed. According to other embodiments, the time length Δt is function of one or more parameters. By way of example, the time length Δt may be function of a measured return pressure captured through the bubble sensor 8a and/or a treatment unit pressure captured through the treatment unit pressure pod 20 and/or an effluent pressure captured through the effluent pressure pod 22.

[0108] The time length Δt of each pressurization step may be between 2 s and 30 s, optionally between 5 s and 10 s, and each time interval T between one pressurization step and the following may be between 10 s and 100 s, optionally between 20 s and 80 s, optionally between 40 s and 60 s. A maximum pressure P.sub.max at the membrane gas exchanger 18 during the pressurization step or steps may be between 100 mmHg and 1000 mmHg, optionally between 400 mmHg and 600 mmHg. At the end of priming sequence and before patient connection, a pressure in the blood circuit and in the blood side of the membrane gas exchanger 18 is kept between 20 mmHg and 400 mmHg, optionally between 50 mmHg and 100 mmHg. Analysis of the impact of the maximum pressure P.sub.max and of the time length Δt of the pressurization step on the bubble formation at the membrane gas exchanger outlet 18d was performed.

[0109] Used materials, samples and parameters were the following: [0110] PrisMax extracorporeal blood treatment monitor; [0111] PrismaFlex set cartridge equipped with membrane gas exchanger arm; [0112] three samples of membrane gas exchanger S1, S2 and S3; [0113] pressure sensor with data logging; [0114] saline solution as priming fluid; [0115] room temperature; [0116] fixed flow rate and fixed position of priming waste/collection bag.

Definitions

[0117] T.sub.bb: time in seconds for air bubbles to be seen back at the membrane gas exchanger outlet 18d after a pressurization step; [0118] P.sub.max: maximum pressure or pressure peak in mmHg recorded through a pressurization step; [0119] T.sub.p: time in seconds with pressure above +300 mmHg during a pressurization step; [0120] IntP: integral of the pressure-time signal during the pressurization step expressed in mmnHg×s; [0121] P.sub.range: pressure range in mmHg of P.sub.max.

[0122] The time length Δt mentioned above is correlated to T.sub.p and IntP.

[0123] The investigation was split in two parts.

[0124] Part 1

[0125] Impact of the maximum pressure P.sub.max on the T.sub.bb has been investigated. Next Tables 1, 2 and 3 report for T.sub.bb, P.sub.max and P.sub.range recorded throughout all pressurization steps/challenges.

TABLE-US-00001 TABLE 1 S1 Challenge 1 6 11 12 3 5 8 9 2 4 7 10 P.sub.max 162 175 193 139 266 225 217 338 464 674 682 412 IntP 692 579 1117 242 1331 670 655 1216 1410 1712 2147 1623 P.sub.range P.sub.max< 200 200 < P.sub.max < 400 400 < P.sub.max < 700 T.sub.bb 60 50 40 30 70 70 60 50 110 80 100 70 Mean & Std 45 ± 13 63 ± 10 90 ± 18

TABLE-US-00002 TABLE 2 S2 Challenge 2 6 9 12 4 5 8 10 1 2 7 11 P.sub.max 102 145 194 129 229 319 317 332 446 619 492 617 IntP 430 510 1002 307 1142 1104 1008 1162 1409 1495 2200 2065 P.sub.range P.sub.max < 200 200 < P.sub.max < 400 400 < P.sub.max < 700 T.sub.bb 15 15 35 10 30 30 40 35 100 50 70 60 Mean & Std 19 ± 11 34 ± 5 70 ± 22

TABLE-US-00003 TABLE 3 S3 Challenge 2 5 10 12 1 4 7 11 3 6 8 9 P.sub.max 152 137 152 199 331 300 316 247 650 538 630 403 IntP 431 791 830 411 870 861 1038 653 2280 1324 1409 955 P.sub.range P.sub.max < 200 200 < P.sub.max < 400 400 < P.sub.max < 700 T.sub.bb 30 26 25 20 55 40 40 30 85 55 70 50 Mean & Std 25 ± 4 41 ± 10 65 ± 16

[0126] Comments

[0127] Four challenges were performed with peak pressure <200 mmHg, four challenges with 200<peak pressure<400 mmHg and four challenges with 400<peak pressure<700 mmHg for each of the three tested Falcon gas exchangers. Mean return pressure level was about −15 mmHg during priming (outside challenges). Tables 1, 2 and 3 and FIG. 8 show that bubbling free time T.sub.bb increases when pressurization pressure is increased.

[0128] Part 2

[0129] Impact of IntP and T.sub.p on the T.sub.bb has been investigated.

[0130] Next Tables 4 to 6 report for T.sub.bb, P.sub.peak & P.sub.range parameters recorded throughout all pressurization challenges.

[0131] Challenges are identified as follows: X_y with X and y relating to tested condition ID (A, B, C or D) and test chronology order, respectively.

[0132] A to D test conditions are referenced in reference to the pressurization time (see T.sub.p parameter).

TABLE-US-00004 TABLE 4 S1 Challenge A_5 A_7 B_6 B_8 C_2 C_3 D_1 D_4 P.sub.peak 614 616 609 560 553 491 590 616 IntP 1418 1399 4410 3490 6139 4741 11440 12375 T.sub.p 2.2 2.2 7.4 6.2 12.4 9.0 20.8 20.0 T.sub.bb 30 28 45 45 50 50 55 55 Mean 29 45 50 55

TABLE-US-00005 TABLE 5 S2 Challenge A_3 A_6 B_1 B_4 C_5 C_7 D_2 D_8 P.sub.peak 537 606 562 597 581 532 601 514 IntP 1409 2526 3939 3439 6720 5027 11483 8951 T.sub.p 2.4 4.2 5.2 6.0 11.4 9.8 18.8 17.2 T.sub.bb 30 30 63 37 47 48 50 50 Mean 30 50 48 50

TABLE-US-00006 TABLE 6 S3 Challenge A_2 A_7 B_1 B_6 C_3 C_5 D_4 D_8 P.sub.peak 454 602 598 646 592 510 607 609 IntP 1184 1255 4439 2923 5280 4834 13208 13028 T.sub.p 2.0 2.2 7.4 4.8 8.6 9.2 21.4 21.8 T.sub.bb 30 30 55 40 50 48 50 55 Mean 30 48 49 53

[0133] Comments

[0134] Mean pressure level was about −27 mmHg in run mode conditions without challenges; that can explain slightly lower Tbb values from Part II versus Part I testing.

[0135] Tables 4, 5 and 6 and FIG. 9 illustrate little dependence of bubbling free time T.sub.bb on pressurization time, with sort of threshold effect when time reaches about 5 seconds (or IntP about 4000 mmHg×s).

[0136] This investigation documents that the pressure level reached during pressurization step is the main physical parameter controlling the time during which bubbling is inhibited afterwards.

Example of Priming Sequence

[0137] connecting the priming fluid source bag 23 (e.g. saline bag) to the withdrawal line 6 of the extracorporeal blood circuit; [0138] connecting the priming fluid waste bag 24 to the return line 7 of the extracorporeal blood circuit; [0139] opening the withdrawal clamp 19 and the return clamp 9 and activating the blood pump 11 to start priming; [0140] when the priming fluid reaches the deaeration chamber 8, closing and opening the return clamp 9 at periodic time intervals T to generate pressure pulses in the priming fluid and in the blood side of the membrane gas exchanger (18); [0141] stopping the blood pump (11), closing the return clamp (9), keeping the return clamp (9) closed and waiting for patient connection.

[0142] While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiments, it is to be understood that the invention is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.