JP2001061959A - Blood circuit suitable for labor-saving hemodialysis machine - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood circuit suitable for the purpose of saving labor in a hemodialysis treatment step and performing the step safely and promptly. SOLUTION: The arterial circuit and the bypass circuit have a bypass circuit for connecting the arterial circuit and the venous circuit, opening and closing means are provided in the arterial circuit and the bypass circuit, and a vein chamber equipped with a filter is provided in the venous circuit. Blood circuit.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a blood circuit, and more particularly to a blood circuit that is optimal for a hemodialysis apparatus capable of saving labor.

[0002]

2. Description of the Related Art For the treatment of patients with renal insufficiency, hemodialysis for dialyzing and purifying blood and its components has been widely performed. Hemodialysis is a therapy that maintains blood by removing harmful substances and excess water by bringing blood taken out of a patient's body into contact through a semipermeable membrane. In order to perform the above hemodialysis, not only the dialysis treatment itself, but also preparations and related miscellaneous tasks put a great burden on medical staff.

For example, before dialysis, there is a priming operation performed for the purpose of filling the blood circuit, removing air bubbles, washing the dialyzer and the blood circuit, and the like. At the start of dialysis, a priming solution filled in the blood circuit or the dialyzer is provided. It is necessary to perform a blood removal operation for discarding the blood and replacing it with blood flowing out from the patient artery side. In addition, during hemodialysis, it is necessary to carefully monitor the biological index values from the patient and perform fluid replacement if necessary, in order to respond to hypotension and dehydration symptoms that occur during hemodialysis. It is necessary to perform the operation of returning and collecting the patient's blood remaining in the circuit. Since the above operations and preparations require time and effort, many solutions have been proposed for some time, but it is hard to say that methods and apparatuses that can greatly reduce the burden on staff have become widespread.

[0004] For example, in order to save labor in priming operation, Japanese Utility Model Publication No. Hei 5-19076 and Japanese Patent Laid-Open Publication No. Hei 6-47090
And Japanese Patent Application Laid-Open No. 8-38597 are disclosed. For labor saving of fluid replacement operation, Japanese Patent Publication No. 1-5909 and Japanese Patent Publication No.
No. 12944 and the like are disclosed. Regarding the blood returning operation, see Japanese Utility Model Publication No. 3-46767,
No. 38 is disclosed.

[0005] Japanese Patent Publication No. Hei 3-37951 and Japanese Patent Publication No. 5-15464 disclose the above-mentioned replacement fluid and blood return in order to save labor and economically. In the above publication, the dialysate is back-filtered using a dialysis membrane of a dialyzer, and the filtrate is transferred to the blood circuit side to replace the fluid,
There is disclosed an apparatus in which blood in a circuit is replaced with a filtrate to perform blood return. The above method has an advantage that hemodialysis can be performed at low cost by performing replacement fluid and blood return with a filtered dialysate instead of an expensive drug solution (saline solution).

[0006]

However, what is disclosed in these prior applications is a single operation or a combination of two operations, and a method utilizing the principle of back filtration for the above operation is disclosed. Only the replacement fluid or blood return. It is certain that time and labor will be reduced by simplifying each of these operations independently, but by reducing labor over each operation, the burden on medical staff will be further reduced. . That is, even if the priming operation is excluded, the blood removal operation, the replacement fluid operation, and the blood return operation are performed in a series of flows during hemodialysis, and even if each is labor-saving alone, If the next operation is not labor-saving, the effect is small. In addition, it is not meaningful for a person to cooperate each operation in order to solve the time constraint of the medical staff.

At the time of blood return operation, which is currently delayed in automation,
By removing the arterial cannula from the patient's artery and connecting the cannula to a fluid replacement line (such as physiological saline), the fluid is returned from the arterial circuit to the venous circuit with the replacement fluid. Then, when most of the blood in the blood circuit is returned by the replacement fluid, the venous cannula is removed from the patient.

[0008] At present, such operations are performed in many facilities, and the blood return operation has not been automated. Therefore, automation or labor saving of this blood return step is an important point for automation of the entire hemodialysis step. for that reason,
Various ideas for labor-saving blood return operations have been considered. For example, one of them is to return blood in a circuit to a patient by back filtration of a hemodialyzer. In that case, the venous circuit is good, but this causes a problem in blood return in the arterial circuit. In normal hemodialysis, blood flows from the arterial circuit to the venous circuit, and thrombus generated in the arterial circuit is removed by a filter provided in the venous chamber, so that there is no problem.

However, in the case of blood return by back filtration, the flow of the fluid in the arterial circuit is opposite to the normal flow, and the generated thrombus is directly sent to the patient's artery. Since it is not assumed that blood returns directly into the body from the artery side, the arterial side circuit often has no filter even though it has a chamber for removing bubbles. Even if a filter is provided, in the case of blood return by back filtration, the filter is located upstream, so that the thrombus generated by the sliding portion of the blood pump and the pillow is not removed. In addition, if a filter is provided on the artery side, problems such as an increase in cost, disturbance of blood flow, and some effects on the blood system arise. However, in the arterial circuit, a large number of portions having a larger diameter such as a pillow, a chamber, and a segment tube for a blood pump are provided, so that a thrombus is easily formed. Therefore, performing a blood return operation by back filtration using a normal blood circuit has been a problem.

Accordingly, it is an object of the present invention to provide a blood circuit suitable for a hemodialysis apparatus which can save a whole series of operations and treatments for hemodialysis. Each operation of priming operation, blood removal operation, replacement fluid, blood return operation in hemodialysis,
In particular, it is an object of the present invention to provide a blood circuit suitable for a labor-saving hemodialysis apparatus that solves the problem of the blood return operation.

[0011]

According to the present invention, there is provided an extracorporeal circulating blood circuit for purifying blood, wherein the blood circuit has an arterial circuit and a venous circuit, and the arterial circuit has one end thereof. An artery-side connecting portion communicating with the arterial-side shunt is formed at the other end of the dialyzer-side first end connected to the hemodialyzer.
A connection is formed, the vein side circuit is formed at one end with a vein side connection communicating with the vein side shunt, and at another end a dialyzer side second connection connected to the hemodialyzer is formed. A venous chamber provided with a filter is provided in the middle of the venous circuit, an arterial branch is formed in the arterial circuit near the arterial connection, and the branch is connected to the venous chamber and the dialyzer-side second connection. A bypass circuit that communicates with the upstream venous circuit or between the arterial bifurcation and the venous chamber;
The above-mentioned object is attained by a blood circuit, wherein an opening / closing means is provided, and a second opening / closing means is provided in a circuit between the artery-side branch portion and the artery-side connecting portion.

The operation mechanism of the above-described configuration during the blood return operation will be briefly described below. A reverse filtration means is provided in the dialysate circuit so that the reverse filtration of pushing water from the dialysate side into the blood circuit side is performed in contrast to the dialyzer performing water removal from the blood through the dialysis membrane. do. And let the reverse filtration means function,
The dialysate is pushed from the dialysate side of the dialyzer to the blood side.
The fluid injected on the blood side returns to the patient through the arterial circuit and the venous circuit.

When a normal blood circuit is used, the blood returned to the patient through the venous circuit passes through the venous chamber on the way. Therefore, even if a thrombus or the like is formed, the blood is removed by the filter attached to the chamber. Is done. However, the blood that has passed through the arterial circuit is returned to the patient without removing the thrombus generated in the blood pump sliding portion, the pillow portion, or the like, because the chamber with the filter is not installed in the arterial circuit.

In the blood circuit having the configuration of the present invention, the second opening / closing means is closed at the time of blood return, so that blood return from the arterial connection portion is interrupted. Then, during normal hemodialysis, the closed first opening / closing means is opened. Then, the blood that has passed through the arterial circuit flows into the venous chamber or the venous circuit upstream of the venous chamber via the bypass circuit. At this time, at the time of hemodialysis, the rotation of the blood pump driven to feed the liquid from the arterial side connection portion toward the dialyzer is reversed, or the pump segment tube is detached from the blood pump.

According to the configuration of the present invention, even if a thrombus is formed in the arterial circuit, it can be effectively removed in the venous chamber. Of the volume of fluid pushed from the dialysate side to the blood side, the blood that could not be pumped from the arterial circuit is returned to the patient through the venous circuit. Removed by the venous chamber.

[0016]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Preferred embodiments of the present invention will be described below with reference to the drawings. FIG. 1 shows a blood circuit 1 for extracorporeal circulation according to the present invention. The blood circuit 1 has an arterial circuit 2 and a venous circuit 3. The arterial circuit 2 has an arterial-side connecting portion 4 connected to the arterial-side shunt at one end, and a dialyzer-side first connecting portion 5 connected to a hemodialyzer at another end. The vein circuit 3 has a vein-side connecting portion 6 connected to a venous-side shunt at one end, and a dialyzer-side second connecting portion 8 connected to a hemodialyzer 7 at another end. An arterial branch 9 is provided in the blood circuit near the arterial connection 4. A venous chamber 10 is provided in the middle of the venous circuit 3.
Let it be 2.

A bypass circuit 1 for connecting the arterial branch 9 to the venous chamber 10 (or the upstream venous circuit 12).
Form 3 The bypass circuit 13 is provided with first opening / closing means 14 for opening / closing the circuit. The first opening / closing means is not particularly limited as long as it opens and closes the circuit. However, if the blood return operation is automatically performed, the first opening / closing means may be a solenoid valve capable of controlling opening and closing of the circuit by starting back filtration. Such a device or a device whose opening and closing can be easily controlled by a control device are preferable.

The arterial circuit 2 is equipped with a blood pump 15 which is rotatable in both forward and reverse directions, so that the fluid flowing in the arterial circuit can be moved in the forward direction (from the arterial connection 4 to the dialyzer 7) in the reverse direction. Liquid can also be sent in the direction. In addition to the blood pump 15, the arterial circuit 2 includes an arterial chamber 16 for removing air, and a negative pressure detecting means for detecting a negative pressure in the circuit. Part 17
May be formed.

It is desirable that the arterial branch 9 is located as close as possible to the arterial connecting part 4. This is because the blood remaining in the arterial circuit after dialysis can be returned to the patient without waste. More specifically, the distance between the bifurcation 9 and the arterial connection 4 is preferably 20 cm or less. However, if this interval is too short, it will be difficult to mount an opening / closing means (provided between the branch portion 9 and the artery-side connecting portion 4) described later, and a predetermined distance is required. In addition, since the bypass circuit 13 is connected to the branch 9, if the distance between the branch 9 and the artery-side connection 4 is short,
The degree of freedom is reduced when the arterial connection is detached. Therefore, it is more preferable that the distance between the branch portion 9 and the arterial side connection portion 4 is 5 to 20 cm . A second opening / closing means 11 is provided between the branching part and the vein-side connecting part to shut off the flow path therebetween.

First opening / closing means 1 provided in a bypass circuit
4 is preferably as close to the branch 9 as possible so that blood does not flow into the bypass circuit during normal hemodialysis. The distance between the branch portion 9 and the first opening / closing means 14 is 10
cm or less, and the smaller the interval is, the more the stagnant portion of blood can be reduced. The above interval is preferably 1.0 to 5.0 cm in consideration of the mounting of the first opening / closing means. The second opening / closing means 11 provided near the artery-side connection portion 4 also
Like the first opening / closing means described above, there is no particular limitation, but a device that can be easily opened / closed by a solenoid valve or a control device is preferable.

The venous connection site of the bypass circuit 13 may be either the venous chamber 10 or the upstream side of the venous chamber, that is, the upstream venous circuit 12 between the dialyzer and the venous chamber. It is more desirable to connect the bypass circuit to the venous chamber. I mean,
This is because if an extra branch is provided in a circuit that is in contact with blood during dialysis, blood flow may be disturbed or stagnation may occur at that portion, which is not preferable. If a connection site (branch) is formed in the upper part 18 of the vein chamber, the above-mentioned problem can be solved because the blood does not come into contact with the stored blood in the vein chamber even during hemodialysis.

A procedure for performing hemodialysis treatment and blood return using the blood circuit of the present invention will be briefly described below. In normal hemodialysis, the second opening / closing means 11 is open and the first opening / closing means 14 is closed. The blood removed from the patient's body via a shunt (not shown) passes through the dialyzer 7 from the arterial-side connection part 4, and blood purification and water removal are performed by the dialysis membrane in the dialyzer. The purified blood is returned to the patient through the vein circuit, through the vein-side connecting portion 6, and back into the patient. The blood flow rate is controlled by driving the blood pump, and the number of revolutions is controlled according to the condition of the patient, the dialysis status, and the like. By making the dialysate side circuit negative pressure by the reverse filtration means provided in the dialysate side circuit, water is removed from the blood circuit side to the dialysate side circuit.

After completion of the dialysis, the blood pump is stopped, the second opening / closing means 11 is closed, and the first opening / closing means 14 is opened. Next, a positive pressure is applied to the dialysate circuit side by a reverse filtration means (described later) provided in the dialysate side circuit. As a result, the dialysate in the dialysate circuit side is back-filtered to the blood circuit side, and the back-filtered dialysate replaces the replacement fluid, so that the blood remaining in the blood circuit can be collected. The reverse filtration means is driven, and the blood pump 15 is rotated in a direction opposite to that during hemodialysis. The back filtrate flowing into the blood circuit can flow through the arterial circuit and the venous circuit.

The flow rate of the back filtrate flowing through the arterial circuit or the venous circuit (more precisely, the upstream venous circuit 12) can be controlled by rotating the blood pump. The total flow of the reverse filtrate, that is, the total flow of the reverse filtrate that has flowed into the blood circuit, minus the arterial flow controlled by the blood pump is the remaining flow that flows through the upstream venous circuit 12.

At the start of blood collection, the blood remaining in the arterial circuit flows into the venous chamber 10 from the branch portion 9 through the bypass circuit 13 together with the reverse filtrate, and the blood flowing from the upstream venous circuit and the reverse Merge with filtrate.
The blood that has flowed into the venous chamber is removed from blood clots, foreign matter, aggregates, and the like by a filter provided in the chamber, and is returned to the patient via the vein-side connecting portion 6.

Shortly after the blood collection operation is started, when the ratio of the back-filtration liquid to the liquid flowing in the circuit becomes large, the back-filtration means and the blood pump are stopped, and the shunt is removed from the patient. be able to. In some cases, when the risk of thrombus inflow has ceased, the first opening / closing means is closed and the second opening / closing means is opened, so that the reverse filtrate can be supplied not only from the vein-side connection section 6 but also from the artery-side connection section 4. Alternatively, the back-filtration means and the blood pump may be stopped after flowing into the patient.

With the above configuration, blood that has passed through the arterial circuit can be removed from the blood clot by the filter in the venous chamber. Therefore, even if an arterial chamber, a segment tube for a blood pump, or a pillow for negative pressure detection is provided downstream of the arterial branch, that is, in the arterial circuit from the branch 9 to the dialyzer, problems due to thrombus are reduced. We were able to.

As means for back-filtrating the dialyzer 7, FIG.
As shown in FIG. 3, a replacement fluid pump 21 may be provided in parallel with a liquid sending pump 20 provided in the upstream dialysate circuit 19, or a drainage fluid provided in the downstream dialysate circuit 22 as shown in FIG. The pump 23 may be provided with a water removal pump 24 in parallel. In FIG. 2, in order to perform the reverse filtration, the replacement fluid pump 21 may be driven in the same direction as the liquid feeding pump 20, and in order to perform the reverse filtration in FIG. What is necessary is just to drive the water removal pump 24.

[0029]

EXAMPLE After the completion of hemodialysis, the blood pump was stopped and the first
The first solenoid valve of the opening / closing means was opened, and the second solenoid valve of the second opening / closing means was closed. After the replacement fluid pump shown in FIG. 2 was driven to perform reverse filtration by the dialyzer, the blood pump was started to be driven in a reverse rotation to that during hemodialysis. The pushing of the fluid from the dialysate side to the blood circuit side is 250 ml / min, and the pumping speed of the blood pump is 150 ml / min. Of the amount of liquid pushed into the blood circuit, the amount of liquid sent by the blood pump is returned to the patient through the arterial circuit, bypass circuit, venous chamber, and downstream venous circuit. The remaining fluid is returned to the patient through the upstream venous circuit, the venous chamber, and the downstream venous circuit. In the blood circuit made of translucent vinyl chloride resin, the color of the fluid flowing through the lumen changes from red to transparent, so when the blood is replaced with the back-filtration solution, the blood pump and the replacement fluid on the dialysate side Stop the pump and cut off communication between the patient and the blood circuit.

[0030]

At present, the manual blood return operation can be automated or simplified, so that all the steps in the hemodialysis treatment can be saved. Also,
Blood having a risk of forming a thrombus can be safely and promptly returned to the patient. Furthermore, the configuration and arrangement of the blood circuit required for automating the blood return operation need not be changed or specially considered for thrombus formation and safe blood return to the patient.

[Brief description of the drawings]

FIG. 1 is a schematic diagram showing an outline of a blood circuit according to one embodiment of the present invention.

FIG. 2 is a schematic diagram showing one embodiment of a back filtration means in the blood circuit of the present invention.

FIG. 3 is a schematic diagram showing another embodiment of the back filtration means in the blood circuit of the present invention.

[Explanation of symbols]

 1. Blood circuit for extracorporeal circulation 2. 2. Arterial (blood) circuit 3. vein (blood) circuit Arterial connection part 5. 5. First connection part on dialyzer side 6. Vein-side connection part Hemodialysis machine 8. 8. Dialyzer side second connection part Arterial bifurcation 10. Venous chamber 11. Second opening / closing means 12. 12. upstream venous circuit Bypass circuit 14. First opening / closing means 15. Blood pump 16. Arterial chamber 17. Pillow section 18. Top of vein chamber 19. Upstream dialysate circuit 20. Liquid sending pump 21. Refill pump 22. Downstream dialysate circuit 23. Drain pump 24. Water removal pump

 ──────────────────────────────────────────────────続 き Continuation of the front page (72) Inventor Hiromi Asabe 1930-1 Nakahara, Fukuoka-machi, Fagawa Prefecture Fukuoka Prefecture 4C077 AA05 BB01 DD07 EE01 EE03 GG11 HH03 HH13 KK25 LL01

Claims (6)

[Claims] 1. An extracorporeal circulation blood circuit for blood purification,
The blood circuit has an arterial circuit and a venous circuit, and the arterial circuit has an arterial connecting portion formed at one end thereof and communicating with the arterial shunt, and another end connected to the hemodialyzer. The vein-side circuit is formed at one end thereof with a venous-side connection portion communicating with the venous-side shunt, and the other end is connected to the hemodialyzer at the other end. 2
A connecting part is formed, a venous chamber provided with a filter is provided in the middle of the venous circuit, an arterial branch is formed in the arterial circuit near the arterial connecting part, and the branch is connected to the venous chamber and the dialyzer. Forming a bypass circuit for communicating with the upstream venous circuit (between the second connecting portion) and the arterial branch portion and the venous chamber, and providing the bypass circuit with a first opening / closing means; A blood circuit, wherein a second opening / closing means is provided in a circuit between the artery-side branch part and the artery-side connection part. 2. The blood circuit according to claim 1, wherein the arterial circuit is equipped with a blood pump that rotates in both forward and reverse directions. 3. The distance between the arterial branch portion and the arterial connection portion is 5 mm.
The blood circuit according to claim 1, wherein the blood circuit is not more than ２０20 cm. 4. The arterial circuit between the arterial branch and the dialyzer-side first connecting portion is provided with negative pressure sensing means for sensing a negative pressure of the pump segment tube and / or the blood circuit. 4. The blood circuit according to any one of Items 3 to 3. 5. A dialysate-side circuit provided with back-filtration means for back-filtering the dialyzer, wherein the back-filtration means is a replacement fluid pump provided in parallel with the dialysate-side upstream circuit. The blood circuit according to any one of the above items. 6. A dialysate-side circuit provided with back-filtration means for back-filtering the dialyzer, wherein the back-filtration means is a water removal pump provided in parallel with the dialysate-side downstream circuit. The water pump is rotatable in both forward and reverse directions.
The blood circuit according to any one of the above items 4.