Relative pump calibration for ultrafiltration control in a dialysis apparatus
10328192 ยท 2019-06-25
Assignee
Inventors
Cpc classification
A61M1/1645
HUMAN NECESSITIES
F04B13/00
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
F04B51/00
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
A61M2205/12
HUMAN NECESSITIES
A61M1/34
HUMAN NECESSITIES
A61M1/1647
HUMAN NECESSITIES
A61M1/165
HUMAN NECESSITIES
A61M2205/52
HUMAN NECESSITIES
F04B49/065
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
F04B23/06
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
International classification
F04B13/00
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
A61M1/34
HUMAN NECESSITIES
F04B49/06
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
F04B23/06
MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
Abstract
A control unit (30) is arranged to control a dialysis fluid distribution system (12) comprising two volumetric pumps (P1, P2) and a dialyzer (13). The control unit (30) is operable in a calibration mode, to establish a bypass flow path that bypasses the dialyzer (13) and extends between the pumps (P1, P2) and to operate the pumps (P1, P2) at first and second calibration speeds so as to balance the flow rates generated by the pumps (P1, P2), e.g. based on a measured pressure or fluid level in dialysis fluid distribution system (12). The control unit (30) determines, based on the first and second calibration speeds, a relation between the stroke volumes of the pumps (P1, P2). The control unit (30) is further operable in a treatment mode, to establish a main flow path that extends between the first and second pumps (P1, P2) via the dialyzer (13) and to control the first and second pumps (P1, P2), based on the relation between their stroke volumes, to operate at a respective treatment frequency so as to generate a selected ultrafiltration rate in the dialyzer (13).
Claims
1. A dialysis apparatus, comprising: a dialyzer; a dialysis fluid distribution system connected for fluid communication with the dialyzer and comprising a first pump and a second pump, the dialysis fluid distribution system being operable to selectively establish a main flow path that extends between the first and second pumps via the dialyzer, and a bypass flow path that bypasses the dialyzer and extends between the first and second pumps; and a control unit electrically connected to the dialysis fluid distribution system and configured to control a respective frequency of the first and second pumps, wherein the first and second pumps are configured to generate a respective flow rate by repeatedly discharging, at the respective frequency, a respective stroke volume of dialysis fluid; wherein the control unit is configured to, in a calibration mode, (i) operate the dialysis fluid distribution system to establish the bypass flow path, (ii) control the first pump to operate at a first calibration frequency and the second pump to operate at a second calibration frequency so as to balance the flow rates generated by the first and second pumps, and (iii) determine relative calibration data that represents a relation between the stroke volumes of the first and second pumps based on the first and second calibration frequencies; and wherein the control unit is configured to, in a treatment mode, (i) operate the dialysis fluid distribution system to establish the main flow path, (ii) assign a predefined nominal stroke volume to the first pump, (iii) set a respective treatment frequency of the first pump to generate, based on the predefined nominal stroke volume of the first pump, a first flow rate of dialysis fluid, (iv) set a respective treatment frequency of the second pump to generate a second flow rate of dialysis fluid that differs from the first flow rate by a selected ultrafiltration rate, and (v) control the first and second pumps, based on the relative calibration data, to operate at the respective treatment frequencies of the first and second pumps to generate the selected ultrafiltration rate in the dialyzer.
2. The dialysis apparatus of claim 1, wherein, in the treatment mode, a stroke volume of the second pump is set to generate the second flow rate based on the predefined nominal stroke volume of the first pump.
3. The dialysis apparatus of claim 1, wherein the control unit is configured to set the respective treatment frequencies of the first and second pumps such that one of the first or second flow rates is equal to a selected flow rate of dialysis fluid out of or into the dialyzer.
4. The dialysis apparatus of claim 3, wherein the control unit is further configured to receive a first set value that represents the selected flow rate of dialysis fluid out of or into the dialyzer, and a second set value that represents the selected ultrafiltration rate.
5. The dialysis apparatus of claim 1, wherein the control unit, in the treatment mode, is configured to set the respective treatment frequencies of the first and second pumps according to:
6. The dialysis apparatus of claim 1, wherein said relation between the stroke volumes of the first and second pumps is equal to the inverse of the relation between the first and second calibration frequencies.
7. The dialysis apparatus of claim 1, wherein the control unit is further configured to, in the calibration mode, store the relative calibration data in an electronic memory for subsequent retrieval by the control unit in the treatment mode.
8. The dialysis apparatus of claim 1, wherein the dialysis fluid distribution system further comprises a flow difference meter configured to generate an output signal representative of a difference between the flow rates generated by the first and second pumps, wherein the control unit is operable, in the calibration mode, to balance the flow rates generated by the first and second pumps based on the output signal of the flow difference meter.
9. The dialysis apparatus of claim 8, wherein the flow difference meter comprises a pressure sensor arranged to sense a pressure of the dialysis fluid in the dialysis fluid distribution system, and wherein the output signal represents said pressure.
10. The dialysis apparatus of claim 8, wherein the bypass flow path is connected in fluid communication with a chamber in the dialysis fluid distribution system, wherein the flow difference meter comprises a level detector, which is arranged to generate the output signal to indicate at least one level of dialysis fluid in the chamber, and wherein the control unit is operable, in the calibration mode, to balance the flow rates between the first and second pumps by generating a stabilized level of dialysis fluid in the chamber as indicated by the output signal.
11. The dialysis apparatus of claim 10, wherein the level detector is configured to indicate a range of levels of dialysis fluid in the chamber.
12. The dialysis apparatus of claim 10, wherein the level detector comprises a pressure sensor which is arranged to sense a pressure in the dialysis fluid distribution system such that an invariant pressure indicates that the level of dialysis fluid is stabilized in the chamber.
13. The dialysis apparatus of claim 12, wherein a top portion of the chamber contains a gas and is sealed during the calibration mode, wherein the pressure sensor is configured to generate the output signal to represent the pressure of the gas in the chamber.
14. The dialysis apparatus of claim 9, wherein the pressure sensor is arranged to be included in both the bypass flow path and the main flow path.
15. The dialysis apparatus of claim 12, wherein the pressure sensor is connected to the chamber so as to sense a hydrostatic pressure of the dialysis fluid in the chamber.
16. The dialysis apparatus of claim 1, wherein the control unit is configured to, in the calibration mode, operate the first and second pumps to balance the flow rates of dialysis fluid at different working points of the dialysis fluid distribution system; determine the relative calibration data for each of the different working points; and generate a calibration function that relates the relative calibration data to the different working points; and wherein the control unit is configured to, in the treatment mode at a current working point of the dialysis fluid distribution system, obtain current relative calibration data by use of the calibration function and the current working point; and control the first and second pumps, based on the current relative calibration data, to operate at the respective treatment frequency so as to generate a selected ultrafiltration rate in the dialyzer.
17. The dialysis apparatus of claim 16, wherein the control unit is configured to identify the different working points and the current working point based on an output signal from a pressure sensor arranged to sense a pressure of the dialysis fluid in the dialysis fluid distribution system.
18. The dialysis apparatus of claim 16, wherein the control unit is configured to (i) validate the dialysis fluid distribution system, and (ii) operate the dialysis fluid distribution system to (a) establish the bypass flow path, (b) control the first and second pumps to balance their flow rates at a validation working point of the dialysis fluid distribution system, (c) determine the relative calibration data for the validation working point, and (d) validate the dialysis fluid distribution system by comparing the relative calibration data for the validation working point with an output value of the calibration function at the validation working point.
19. The dialysis apparatus of claim 18, wherein the control unit is configured to take dedicated action based on a difference between the relative calibration data for the validation working point and the output value, said dedicated action comprising at least one of: initiating an alarm, and adjusting the calibration function.
20. The dialysis apparatus of claim 19, wherein the control unit is configured to adjust the calibration function by adding the difference to the calibration function.
21. The dialysis apparatus of claim 16, wherein the control unit is configured to obtain the current relative calibration data by retrieving a current output value of the calibration function at the current working point and compensate the current output value for one or more estimated or measured pressure differences within the dialysis fluid distribution system between the treatment mode and the calibration mode.
22. The dialysis apparatus of claim 21, wherein the one or more pressure differences relate to at least one of: an inlet of the first pump, an outlet of the first pump, an inlet of the second pump, and an outlet of the second pump.
23. The dialysis apparatus of claim 1, wherein the control unit is configured to, during the treatment mode, operate a source to generate dialysis fluid by dosing a concentrate into water, said concentrate comprising sodium bicarbonate, and wherein the control unit is configured to, during the calibration mode, disable the dosing of said concentrate into the water.
24. The dialysis apparatus of claim 1, wherein the control unit, in the calibration mode, is configured to assign a respective predefined nominal stroke volume to the first and second pumps, operate the first and second pumps at a first and a second start frequency, respectively, such that the first start frequency multiplied by the predefined nominal stroke volume of the first pump is essentially equal to the second start frequency multiplied by the predefined nominal stroke volume of the second pump, and modify at least one of the first and second start frequencies until the flow rates of dialysis fluid generated by the first and second pumps are balanced.
25. The dialysis apparatus of claim 1, wherein each of the first and second pumps comprises a respective pulse generator arranged to generate one or more pulses for each stroke volume displaced by the first and second pump, respectively, and wherein the control unit, in the calibration mode, is configured to represent the first and second calibration frequencies by a first number of pulses and a second number of pulses, respectively, generated by the respective pulse generator during a test period while the flow rates of dialysis fluid generated by the first and second pumps are balanced.
26. The dialysis apparatus of claim 1, wherein the first pump is located upstream of the dialyzer in the main flow path and the second pump is located downstream of the dialyzer in the main flow path.
27. The dialysis apparatus of claim 1, wherein each of the first and second pumps is one of a diaphragm pump and a piston pump.
Description
BRIEF DESCRIPTION OF DRAWINGS
(1) Embodiments of the invention will now be described in more detail with reference to the accompanying schematic drawings. Throughout the description, the same reference numerals are used to identify corresponding elements.
(2)
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DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS
(15)
(16) The dialysis fluid circuit 12 extends from a source 17 of fresh dialysis fluid to a receptacle or drain 18 for spent dialysis fluid. The dialysis fluid circuit 12 includes an arrangement of fluid lines that define an inlet conduit 19 connected to an inlet of the dialysis fluid side 15 of the dialyzer 13, an outlet conduit 20 connected to an outlet of the dialysis fluid side 15 of the dialyzer 13, and a bypass conduit 21 that extends between the inlet and outlet conduits 19, 20. A first pump P1 (upstream pump) is arranged in the inlet conduit 19 to pump dialysis fluid from the source 17, and a second pump P2 (downstream pump) is arranged in the outlet conduit 20 to pump dialysis fluid towards the receptacle 18. A first and a second three-way valve VV1, VV2 are arranged in the inlet conduit 19 and the outlet conduit 20, respectively, and are connected to the bypass conduit 21. The first valve VV1 is operable to establish fluid communication either between the first pump P1 and the dialyzer 13, or between the first pump P1 and the bypass conduit 21. The second valve VV2 is operable to establish fluid communication either between the dialyzer and the second pump P2, or between the bypass conduit 21 and the second pump P2. A chamber 26, denoted calibration chamber in the following, is arranged in fluid communication with the bypass conduit 21 via a connecting conduit 27. A level detector 28 is installed to generate a sensor signal C.sub.L which is indicative of at least one fluid level L in the calibration chamber 26. The level detector 28 may be of any conventional type that allows single-point, multi-point or continuous level detection, such as an ultrasonic detector, an optical detector, a capacitive detector, a microwave sensor, a hydrostatic sensor, a magnetic float detector, etc. In a specific embodiment, described below with reference to
(17) The pumps P1, P2 are volumetric pumps, which means that each pump is configured to generate a given flow rate by repeatedly discharging a respective stroke volume of dialysis fluid. Volumetric pumps are well-known per se and are also referred to as positive displacement pumps. A volumetric pump is configured to drive a fluid by trapping a fixed and well-defined volume of the fluid in a pump chamber and by forcing (displacing) that trapped volume through a pump outlet by a movable pumping element, e.g. a piston or a diaphragm. Volumetric pumps that may be used in the embodiment of
(18) Each pump P1, P2 is equipped or associated with a respective pulse generator SC1, SC2 that generates one or more pulses for each stroke volume that is displaced by the pump P1, P2. Such pulse generators are well-known in the art and may e.g. be implemented as a pulse encoder or a tachometer. Each pulse may correspond to a predefined displacement of above-mentioned pumping element. As indicated in
(19) As indicated, the system 10 further includes an electronic control unit 30. The control unit 30 has a signal communication interface 31 for electrical connection to electrically responsive components in the dialysis fluid circuit 12. Specifically, the control unit 30 is operable to receive the sensor signal C.sub.L from the level detector 28 and the pulse signals C.sub.SC1, C.sub.SC2 from the pulse generators SC1, SC2. The control unit 30 is further operable to generate and output control signals C.sub.P1, C.sub.P2 for controlling the operation of the pumps P1, P2 and control signals C.sub.VV1, C.sub.VV2 for controlling the switching of the valves VV1, VV2. The control unit 30 may implement further functions of the dialysis apparatus and may be included as a part of a control system for the dialysis apparatus. The control unit 30 may be a computer, or a similar data processing device, with adequate hardware for acquiring, processing and generating signals in accordance with different embodiments of the invention. Embodiments of the invention may be implemented by software instructions that are supplied on a computer-readable medium for execution by a processor 32 in conjunction with an electronic memory 33 in the device 30, as indicated in
(20) The system 10 is operable in a treatment mode or procedure, in which the control unit 30 controls the dialysis fluid circuit 12 to generate a flow of dialysis fluid through the dialysis fluid side 15 of the dialyzer 13. During the treatment mode, the pumps P1, P2 are set to generate different flow rates, such that the flow rate of the downstream pump P2 exceeds the flow rate of the upstream pump P1 by the desired ultrafiltration rate in the dialyzer 13. As explained in the Background section, the ultrafiltration rate (or UF rate) is the rate of fluid removal from the blood that takes place in the dialyzer 13. In blood treatment, ultrafiltration generally denotes a process of removing water from blood plasma. The blood is passed on the blood side 14 of the dialyzer 13, and a gradient of pressure is created through the semipermeable membrane 16 by the difference in flow rates between the pumps P1, P2. The pressure gradient forces fluid through the pores of the membrane 16. The pores filter electrolytes and small and middle sized molecules (up to 20,000 to 30,000 daltons) from the blood plasma.
(21) The volumetric pumps P1, P2 are manufactured with a nominal stroke volume. However, the actual stroke volume of an individual pump may differ from the nominal stroke volume due to tolerances in manufacture and assembly of the pump. Further, the stroke volume may change during operation of the pump, e.g. due to build-up of deposits or contaminations in the pump chamber or due to wear of the pumping element or the pump chamber. Depending on the type of pump, the stroke volume may also vary depending on the fluid pressure at the inlet and/or outlet of the pump.
(22) Even small differences between the actual and nominal stroke volumes of the pumps P1, P2 may lead to a large deviation between the desired UF rate and the actual UF rate that is generated by the flow rate difference between the pumps P1, P2. This sensitivity will be illustrated by reference to a numeric example. Assume that the pumps P1, P2 are identical to the degree that their nominal stroke volume is 3.8 ml but that their actual stroke volumes deviate by 1% and +1%, respectively, from the nominal stroke volume. Also assume that the set value for the inlet flow of dialysis fluid to the dialyzer is 500 ml/min and that the desired UF rate is 500 ml/h. Using the nominal stroke volumes to achieve this UF rate, the speed of pump P1 is set to 500/3.8=131.58 strokes/min and the speed of pump P2 is set to (500+500/60)/3.8=133.77 strokes/min. However, based on the actual stroke volumes, the pump P1 will generate a flow rate of 131.58*3.8*1.01=505.00 ml/min and pump P2 will generate a flow rate of 133.77*3.8*0.99=503.25 ml/min. Thus, the actual UF rate is (503.25505.00)*60=105 ml/h. This means that instead of removing 500 ml fluid per hour from the blood, the system will pump 105 ml fluid per hour into the blood.
(23) It is realized that proper control of the UF rate may require the pumps P1, P2 to be manufactured with very tight tolerances so that the actual stroke volumes closely correspond to the nominal stroke volumes. To overcome this drawback, embodiments of the invention take the approach of relatively calibrating the pumps P1, P2 before or even during ongoing blood processing. To this end, the system 10 is configured to be operable in a calibration mode or procedure, in which a relation between the actual stroke volumes of the pumps P1, P2 is determined by clever control of the pumps P1, P2 and use of the calibration chamber 26. The calibration mode is implemented by the control unit 30, which generates dedicated control signals C.sub.P1, C.sub.P2, C.sub.VV1, C.sub.VV2 based on the sensor signal C.sub.L, and processes the pulse signals C.sub.SC1, C.sub.SC2 for determination of the relation between the actual stroke volumes. In the following, the actual stroke volumes of the pumps P1, P2 are represented as S1, S2, respectively, and the nominal stroke volumes of the pumps P1, P2 are represented as S1.sub.n, S2.sub.n, respectively.
(24) An embodiment of the calibration mode 100 is represented in the flow chart of
(25) In step 103, while the pumps are operated to generate a stabilized fluid level in the chamber 26, the current speed of the respective pump P1, P2 is determined. In the following, the current speeds are also denoted calibration frequencies and are represented as n1.sub.c, n2.sub.c. In one embodiment, the control unit 30 determines the current speeds n1.sub.c, n2.sub.c based on the current set values for the pumps P1, P2. In an alternative embodiment, to increase accuracy, the control unit 30 counts the number of pulses in the pulse signals C.sub.SC1, C.sub.SC2 during a predefined time period, which may but need not be the same for both pumps P1, P2. The current speeds n1.sub.c, n2.sub.c may be represented by the respective count of pulses or by a frequency value which is generated based on the count of pulses (e.g. by dividing the count of pulses by the respective time period).
(26) In step 104, the pumps P1, P2 are relatively calibrated, by calculating a ratio R between their actual stroke volumes S1, S2. The rationale behind this operation is that that balanced flows for volumetric pumps are given by:
n1.sub.c.Math.S1=n2.sub.c.Math.S2(1)
(27) and thus the stroke volume ratio R is given by:
(28)
(29) In step 105, the stroke volume ratio R is stored in the electronic memory (33 in
(30) As noted, the system 10 in
(31)
(32) Thus, step 205 assumes that the actual stroke volume Si is equal to the nominal stroke volume S1.sub.n. As will be shown below, even if this assumption is generally incorrect and introduces an error in the flow of dialysis fluid generated by pump P1, the impact of this error on the UF rate is limited by proper use of the stroke volume ratio R when setting the speed of the downstream pump P2. In step 206, the speed n2 of the downstream pump P2 is calculated and set to achieve a difference of flow rates between the pumps P1, P2 equal to the ultrafiltration rate Q.sub.UF, given by the relation between the actual stroke volumes S1, S2 obtained in the calibration mode 100 and represented by the stroke volume ratio R. Specifically, the downstream pump P2 should be set to generate a flow rate Q2 which is equal to Q.sub.MAIN+Q.sub.UF. Given the assumption that the actual stroke volume of the upstream pump P1 is S1.sub.n, the actual stroke volume S2 of the downstream pump P2 is estimated as:
(33)
(34) Based on the estimated stroke volume S2.sub.est, the speed n2 of the downstream pump P2 is set to:
(35)
(36) Following step 206 and as indicated by thick arrows in
(37) It is to be understood that the set value Q.sub.UF may vary during a treatment, and the control unit 30 will control the speed n2 of the downstream pump P2 accordingly. The set value Q.sub.MAIN is typically held constant during a treatment, although it can certainly be varied if desired.
(38) The accuracy of the resulting UF rate is dependent on the accuracy of the stroke volume ratio R, which in turn is dependent on the accuracy of the calibration frequencies n1.sub.c, n2.sub.c that are determined in step 103 in the calibration mode 100. It should be noted that the relative calibration of the pumps is independent of the volume of the calibration chamber 26. As noted above, a deliberate error is introduced in step 205 when the actual stroke volume of one of the pumps P1, P2 is set equal to the nominal stroke volume. However, this error has limited impact on the resulting UF rate as will be shown in the following. The actual stroke volumes are represented as S1=S1.sub.n*e1 and S2=S2.sub.n*e2, where e1, e2 are relative errors caused by the difference between the actual and nominal stroke volumes. The actual UF rate Q.sub.UF.sub._.sub.real is given by, using Eq. (5) and Eq. (3):
(39)
(40) Further, since
(41)
(42) it is possible to re-write Eq. (6) as:
Q.sub.UF.sub._.sub.real=e1.Math.(Q.sub.MAIN+Q.sub.UF)Q.sub.MAIN.Math.e1=Q.sub.UF.Math.e1(8)
(43) As seen, the resulting error in the actual UF rate is proportional to the relative difference or error between the actual and nominal stroke volumes for the upstream pump P1, which is assumed to have an actual stroke volume equal to the nominal stroke volume. Reverting to the numeric example given above, where the actual stroke volumes of the pumps P1, P2 in
(44) It should be understood that
(45) In a further variant, the set value Q.sub.MAIN instead represents the flow of dialysis fluid out of the dialyzer 13. The skilled person can readily adapt steps 205-206 to this situation. In many dialysis systems, it is desirable to maintain a constant flow of dialysis fluid from the source 17, e.g. when the source 17 is configured to prepare the dialysis fluid by mixing of one or more concentrates with water. The complexity of such a source 17 may increase if the source 17 need to handle momentary changes in the amount of dialysis fluid to be output. In such dialysis systems, the embodiment in
(46) Reverting to the calibration mode 100 in
(47) It is also conceivable that the control unit 30, when in calibration mode 100, executes steps 102-103 to determine relative calibration data, e.g. stroke volume ratios R, for a number of different working points of the dialysis fluid circuit 12, and that the control unit 30 in step 104 stores a calibration function in the electronic memory 33, where the calibration function may be implemented as individual combinations of relative calibration data and the different working points, or as a mathematical function that represents the functional relationship between the relative calibration data and the different working points. Such a variant may be desirable if the actual stroke volumes are known to vary during operation of the dialysis fluid circuit 12. For example, the actual stroke volumes may vary if there is a leakage flow of dialysis fluid past the pumping element in the respective pump P1, P2 (e.g. a backflow from the outlet to the inlet of the respective pump, or a reverse backflow from the inlet to the outlet) and if this leakage flow changes with operating condition. The leakage flow may e.g. vary with the fluid pressure at the inlet and/or outlet of the respective pump. To counteract such variations in the actual stroke volumes, the control unit 30 may in step 203 retrieve from the memory 33 the relative calibration data (e.g. stroke volume ratio R) for the working point that comes closest to the current working point of the dialysis fluid circuit 12, or by inputting the current working point to the above-mentioned mathematical function. The working point may be represented by any combination of set values and/or measurement data, such as the set value Q.sub.MAIN or one or more measured pressure values that represent the fluid pressure at the inlet/outlet of one or both pumps P1, P2. In one example, a pressure differential between the inlet and the outlet of the respective pump P1, P2 is measured and used to represent the working point of the dialysis fluid circuit 12. In another example, which is further described below with reference to
(48) It is to be understood that the control unit 30 may be operated in the calibration mode at any time, e.g. at manufacture of a dialysis machine that includes the dialysis fluid circuit, at scheduled maintenance, before start of a dialysis treatment, intermittently during a dialysis treatment, or after a completed dialysis treatment. Each calibration mode results in relative calibration data that quantifies the relation between the actual stroke volumes S1, S2 of the pumps P1, P2.
(49)
(50)
(51) In an alternative embodiment (not shown), the pressure sensor 28A is instead installed at the bottom of the calibration chamber 26 to sense the hydrostatic pressure of the dialysis fluid. As is well-known, the hydrostatic pressure varies in proportion to the fluid level because of the increasing weight of dialysis fluid exerting downward force from above. To reduce the impact of changes in gas pressure in the space above the dialysis fluid, the valve VV4 may be controlled to open during the level sensing. In a variant, the valve VV4 is omitted and the chamber 26 is open to ambient atmosphere.
(52)
(53) Since the dialysis fluid is an incompressible fluid, comparatively small differences between the flow rates of the pumps P1, P2 during the calibration mode may give rise to large pressures in the dialysis fluid. Excessive pressures in the dialysis fluid may cause leaks or damage the pumps P1, P2, the valves VV1, VV2, connectors, tubings, etc in the dialysis fluid circuit 12. Thus, it may be desirable to add compliance to the dialysis fluid circuit 12, i.e. an ability of the dialysis fluid circuit 12 to expand and contract passively with changes in pressure in the dialysis fluid. Such compliance may be provided by the tubings that define the conduits 19, 20, 21. However, a more controlled compliance may be achieved by installing a compliance chamber in fluid communication with the bypass flow path in the dialysis fluid circuit 12. By ensuring that the compliance chamber is partially filled with dialysis fluid, differences between the flow rates of the pumps P1, P2 will cause dialysis fluid to enter or leave the compliance chamber and thereby reduce the risk for excessive pressures in the dialysis fluid circuit 12. The skilled person realizes that the chambers 26 shown in
(54)
(55) In all embodiments disclosed herein, the chamber 26 may be an existing chamber that serves another purpose in a dialysis apparatus. Such an existing chamber may be intermittently switched into fluid communication with the bypass flow path between the pumps P1, P2 during the calibration mode. Alternatively, the chamber 26 may be permanently connected in fluid communication with both the main flow path and bypass flow path. In one example, the chamber 26 is part of a device for removing gas (e.g. carbon dioxide or air) from the dialysis fluid. Taking the embodiment in
(56) As noted above, the control unit 30 may be configured to determine the relative calibration data for a number of working points of the dialysis fluid circuit 12. These different working points may be given by different pressures measured by the pressure sensor 28A in any of the embodiments shown in
(57) The control unit 30 may be operable to generate and store the calibration function during manufacture of the system 10, so that the calibration function is available for retrieval when the system 10 is subsequently operated in the treatment mode 200. Suitably, the calibration function is generated based on stroke volume ratios R for at least three different pressures, which are well-distributed within the normal range of operating pressures for the treatment mode 200. The control unit 30 may be further operable to execute the calibration mode 100 for re-generation of the calibration function whenever there is a change to the configuration of the system 10, e.g. during service and maintenance. The re-generated calibration function is stored in memory 33. In the following, the generation of the calibration function is referred to as service calibration. It is conceivable to execute the service calibration more frequently, e.g. at start-up of the system 10 in preparation of each treatment. The service calibration results in a new calibration function being generated and stored in the system 10, e.g. in memory 33.
(58) In one embodiment, the control unit 30 is configured to execute the calibration mode 100 for validation of the system 10 in preparation of each treatment, and possibly at one or more time points during the treatment. In the following, this validation process is denoted treatment calibration. The treatment calibration is executed for the purpose of verifying that the stored calibration function adequately represents the system 10 and, if necessary, updating the calibration function, which suitably is implemented as a mathematical function and stored in the memory 33. Both the service calibration and the treatment calibration involves establishing the bypass flow path, controlling the pumps P1, P2 to balance their flow rates, and computing the relative calibration data based on the pump speeds. The treatment calibration differs from the service calibration in that it does not determine a sufficient number of data points to completely re-generate the calibration function, but rather determines one data point, or at least no more than a few different data points, to be used for validation based on an existing calibration function. Thereby, the treatment calibration is more time and processing efficient than the service calibration.
(59) The rationale for performing the treatment calibration is that the relation between the stroke volumes of the pumps P1, P2 may change during use of the system 10, e.g. as a result of wear and deterioration of the pumps P1, P2, changes in the pressure of the fresh dialysis fluid supplied by the source 17, changes to the main flow rate Q.sub.MAIN, changes in the flow resistance of the receptacle 18, etc. Generally, any change of an operating parameter that affects the pressures at the inlet and outlet of the respective pump P1, P2 may cause a change in the stroke volume ratio.
(60) It may be advantageous to perform the treatment calibration at start-up of the system 10 in preparation of each treatment and/or at one or more time points during each treatment, to ensure that the stored calibration function is representative for the system 10. This will increase the accuracy and robustness of the UF control. The treatment calibration may be governed by pre-scheduling or requested by control logics, or a combination thereof. Such control logics may initiate a treatment calibration whenever one or more specific operating parameters of the system 10 are changed, e.g. the main flow rate Q.sub.MAIN, the temperature of the fresh dialysis fluid, the UF rate Q.sub.UF, etc. The pre-scheduling may include an early treatment calibration (e.g. 5-15 minutes into treatment) followed by fixed or increasing intervals between subsequent treatment calibrations. Increasing the number of treatment calibrations during the treatment may be an option to achieve a higher UF accuracy, e.g. in the case of pediatric or acute treatments.
(61) During the treatment calibration, the control unit 30 calculates a stroke volume ratio R (relative calibration data) for a validation working point, which is defined by a measured pressure or a measured level in the chamber 26 (if present). The control unit 30 then retrieves the calibration function from memory 33, and adjusts parameters of the calibration function such that it matches the acquired data point, i.e. the calculated stroke volume ratio R and the measured pressure/level. For example, as shown in
(62) In one implementation, the control unit 30 stores the adjusted calibration function 50 in memory 33 to replace the calibration function 50. Thus, in this implementation the adjusted calibration function 50 is accessed based on the current pressure to acquire a corresponding value of the stroke volume ratio for UF control (cf. step 203 in
(63) In another implementation, the control unit 30 stores, in memory 33, both the calibration function 50 obtained by the latest service calibration and the adjusted calibration function 50 obtained by the latest treatment calibration. In this implementation, the adjusted calibration function 50 is used temporarily for UF control in the subsequent treatment mode (cf. step 203 in
(64) The service and treatment calibrations are further exemplified in
(65) Returning to the flow chart in
(66) It is to be understood that shifting the calibration function by the offset value, as described above and illustrated in
(67) In one embodiment, errors caused by varying pressure conditions around the pumps between the calibration and treatment modes are reduced by computing a compensation value as a function of a set of operating parameters for the system 10. The set of operating parameters estimates the changes in the pressures at the inlets and outlets of the pumps P1, P2 when switching between the calibration and treatment modes. At lest part of these operating parameters may be measured in the system 10, while others may be estimated from set values for the system 10. In the following discussion, the pressures at the inlet and outlet of the upstream pump P1 are denoted p.sub.1 and p.sub.2, respectively, and the pressures at the inlet and outlet of the downstream pump P2 are denoted p.sub.3 and p.sub.4, respectively.
(68) The following linear compensation function may be used:
R=R+(c.sub.p1p1)+(c.sub.p2p2)+(c.sub.p3p3)+(c.sub.p4p4)(9)
(69) In the compensation function, R is the compensated ratio, R is the ratio that is obtained for a current pressure during a treatment mode, by use of data obtained in a calibration mode, the differential parameters p1, p2, p3 and p4 represent differences in pressure p.sub.1, p.sub.2, p.sub.3 and p.sub.4, respectively, between the calibration mode and the treatment mode, and c.sub.p1, c.sub.p2, c.sub.p3 and c.sub.p4 are compensation factors. The compensation factors may be determined empirically or theoretically. The ratio R may be obtained in any of the ways described hereinabove. Thus, the ratio R may be given as an output value of a calibration function 50, 50 which has been obtained during the calibration mode. Alternatively, if the system 10 is controlled such that the working point (pressure) is the same during treatment calibration and during the treatment mode, the ratio R may be obtained by performing a treatment calibration at the current pressure.
(70) In one embodiment, the system 10 is provided with pressure sensors (not shown) that measure all of the pressures p.sub.1, p.sub.2, p.sub.3 and p.sub.4. Based on this data, Eq. (9) yields a compensated ratio R for a given ratio R.
(71) In another embodiment, assumptions are made to reduce the cost and complexity of evaluating the compensation function.
(72) One assumption may be that the pressure p.sub.1 is invariant between the calibration and treatment modes, i.e. p1=0. This assumption is valid at least if the main flow rate Q.sub.MAIN is the same or similar in these modes.
(73) Another assumption is that the pressure p.sub.3 is invariant between the calibration and treatment modes. This assumption presumes that the control unit 30 maintains (substantially) the same working point between the treatment mode and the calibration mode (treatment calibration), as described above. The pressure p.sub.3 in the treatment mode is governed by the pressures on the blood side (inlet and outlet of the dialyzer 13) and the flow conditions through the dialyzer 13 on the dialysis fluid side (through flow rates Q.sub.1 and Q.sub.2). As long as the main flow rate, Q.sub.MAIN, and the UF rate, Q.sub.UF, are constant during the treatment mode, the pressure p.sub.3 will only change if the ultrafiltration coefficient changes (for example as a consequence of a clotted dialyzer). It is also assumed that the variations in pressure p.sub.3 during the treatment mode will be compensated for by the calibration function. Under these assumptions, the compensation function need not compensate for the pressure difference p3. Otherwise, compensation for p3 is straight-forward since the pressure p.sub.3 may be given by, or at least estimated from, the pressure readings of the sensor 28A.
(74) Another assumption is based on the fact that the pressure p.sub.4 will decrease when switching from the treatment mode to the calibration mode since the fluid flow rate generated by the pump P2 will decrease with the size of the UF rate Q.sub.UF, thus lowering the flow resistance in the drain path downstream of the pump P2. Tests show that the pressure difference p4 correlates strongly with ultrafiltration. Hence, it is assumed that Q.sub.UF may be used instead of p4 in the compensation function.
(75) In total, these assumptions yield the following simplified compensation function:
R=R+(c.sub.p2p2)+(c.sub.p4Q.sub.UF)(10)
(76) It should be noted that the UF rate Q.sub.UF may be a small quantity in many dialysis settings. Hence, the pressure difference p4 may have a minor impact on the accuracy of the ratio R. Under such circumstances, the compensation function need not compensate for the pressure difference p4.
(77) When applying the compensation function, the present applicant has surprisingly found that a small error may persist between the set value Q.sub.UF and the actual UF rate Q.sub.UF.sub._.sub.real. This UF error has been found to correlate with the main flow rate Q.sub.MAIN. A corresponding compensation term may therefore be added to the compensation function according to Eq. (10):
R=R+(c.sub.p2p2)+(c.sub.p4Q.sub.UF)+(c.sub.MAINQ.sub.main)(11)
where c.sub.MAIN is an empirically determined compensation factor. A corresponding compensation term may be added to the compensation function according to Eq. (9). It is realized that the dependence on Q.sub.MAIN may alternatively be overcome by calculating the ratio R in a service or treatment calibration, in which Q.sub.MAIN is the same as in the treatment mode.
(78) Depending on the configuration and operation of the system 10, the compensation function may differ from examples described above. For example, the pressure differentials may be included in any combination in the compensation function, or only one of the pressure differentials may be included. Furthermore, other functional relations, linear or non-linear, between the ratio R (or any other type of relative calibration data) and the pressure differential(s) are conceivable.
(79) The use of a compensation function will be further described with reference to the flow chart in
(80)
NaHCO.sub.3+CH.sub.3COOH<-->CH.sub.3COONa+H.sub.2CO.sub.3(l)+CO.sub.2(l) H.sub.2CO.sub.3(l)<-->CO.sub.2(l)<-->CO.sub.2(g)
(81) This means that carbonic acid and CO.sub.2 in the fresh dialysis fluid will have a corresponding equilibrium partial pressure in the gas phase. Whether this equilibrium partial pressure is achieved or not depends on the contact time, the contact surface and flow conditions. When the fresh dialysis fluid containing CO.sub.2 enters the compliance chamber 26, CO.sub.2 will be released from the dialysis fluid so that it moves towards the equilibrium partial pressure of CO.sub.2. Thereby, the compliance gas mass (and hence the total pressure between the pumps P1, P2) will increase until equilibrium is reached. If pressure control is active during the calibration mode, the pump P2 will increase its rotational speed in order to keep the pressure/level constant in the compliance chamber 26. If the speed n2.sub.c of the pump P2 is determined before equilibrium is reached, the calculated stroke volume ratio R will be incorrect. One solution to this problem is to use a long stabilization time at each pressure set point during the service calibration. To reduce the total time for the service calibration, the control unit 30 may instead be configured to disable the dosing of sodium bicarbonate into the mixing block 44 during the service calibration.
(82) 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 spirit and the scope of the appended claims.
(83) For example, the system for ultrafiltration may include more than one upstream pump and/or more than one downstream pump. The relative calibration data may be determined for these pumps as described herein, by establishing the bypass flow path between pairs of upstream and downstream pumps and performing steps 102-105 for each pair of upstream and downstream pumps.
(84) The upstream and downstream pumps are volumetric pumps and maybe implemented as either piston pumps or diaphragm (membrane) pumps. It is to be understood that the upstream and downstream pumps may have different nominal stroke volumes. It is also possible that the upstream and downstream pumps are of different designs or types.
(85) The skilled person also realizes that there are alternatives to using a pressure sensor or a level sensor for balancing the flow rates of the pumps during the calibration mode. For example, the level sensor 28 in
(86) Even if it is possible to use the pressure sensor 28A to both identify an invariant level in the compliance chamber 26 and to determine a pressure representative of a working point of the system 10, it is quite possible to implement the system 10 with separate devices for determining level and pressure. As noted above, the pressure of the working points need not be determined at the location of the compliance chamber 26, but may in principle be determined anywhere within the dialysis fluid circuit 12. If the pressure is measured in the inlet conduit 19 between the pump P1 and the valve VV1, Equations (9)-(11) are modified by replacing p.sub.2 with p.sub.3 and p2 with p3. It is also to be noted that Equations (9)-(11) are also applicable if the set value Q.sub.MAIN represents the flow of dialysis fluid out of the dialyzer 13 and the UF rate is controlled by adjusting the speed of the upstream pump P1. Furthermore, is may be noted that the compliance chamber 26 may instead be located in fluid communication with the inlet conduit 19 upstream of the first valve VV1.
(87) In the foregoing description, the control unit 30 controls the UF rate exclusively by setting the speeds of the upstream and downstream pumps, using the relative calibration data obtained in the calibration mode, to achieve a desired difference in the flow rates between the upstream and downstream pumps. In an alternative embodiment, the control unit 30 sets the flow rates of the upstream and downstream pumps equal, using the relative calibration data obtained in the calibration mode, and controls the UF rate by operating a dedicated UF pump (filtration pump), which is connected to the outlet conduit 20 between the downstream pump P2 and the dialyzer 13, as is well-known in the art and described in the Background section. It is also conceivable to configure the control unit 30 to set the UF rate by a combination of controlling a separate UF pump and controlling the difference in flow rates between the upstream and downstream pumps.