JP4757168B2 - Method for feeding back-filtered dialysate in hemodialyzer and hemodialyzer - Google Patents

Description

  BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method for feeding a reverse filtration dialysis fluid in a hemodialysis device and a hemodialysis device using the method, and in particular, the interior is divided into two chambers by a diaphragm made of a stretchable elastic membrane for supplying dialysate In a hemodialysis apparatus having a chamber, a reverse filtration dialysate that can automatically and efficiently deliver the reverse filtration dialysate in the blood circuit or / and during priming, blood return, or replacement of a hemodialysis element And a hemodialysis apparatus using the method.

  In a hemodialysis machine that performs hemodialysis between a blood circuit and a dialysate circuit via a dialysis membrane, the pressure on the dialysate circuit side is made higher than the pressure on the blood circuit side, and fresh dialysate is passed through the dialysis membrane. A method of feeding the dialysate into the blood circuit from the dialysate circuit side, that is, a method of feeding the dialysate by a reverse filtration method is known (for example, Patent Document 1). By feeding the reverse filtered dialysate, for example, blood remaining in the blood circuit can be returned to the patient's body.

  On the other hand, as a hemodialysis apparatus, a hemodialysis apparatus of a type in which a chamber in which the inside is divided into two chambers by a diaphragm made of a stretchable elastic membrane is provided in a dialysate circuit (for example, Patent Document 2, Patent) Reference 3). In this type of hemodialysis apparatus, there are usually provided at least two chambers each consisting of a metering container divided into two chambers by a stretchable diaphragm as described above, and one chamber of one chamber receives fresh dialysate. And the used dialysate discharged from the other chamber is drained to a drain circuit, and fresh dialysate contained in one chamber of the other chamber is supplied to a hemodialysis element containing a dialysis membrane, Hemodialysis is performed by allowing spent dialysate from the hemodialysis element to flow into the other chamber. Then, hemodialysis is continuously performed by sequentially switching between a chamber for receiving fresh dialysate and a chamber for supplying fresh dialysate to the hemodialysis element.

  In this chamber-type hemodialysis apparatus, as it is, the reverse-dialysis dialysate cannot be fed into the blood circuit for the following reason. That is, one of the two chambers having a stretchable diaphragm forms a closed circuit with the hemodialysis element, and fresh dialysate from one chamber of the chamber enters the hemodialysis element. At the same time, the used dialysate is returned from the hemodialysis element to the other chamber. At this time, the other chamber receives a new dialysate and discharges the used dialysate to the outside. The two chambers alternate, with one chamber in the former state and the other chamber in the latter state. The chamber supplying fresh dialysate to the hemodialysis element forms a closed circuit with the hemodialysis element, so that the fresh air in one of the small chambers supplied to the hemodialysis element is pushed by the diaphragm. The amount of dialysate and the amount of spent dialysate drained from the hemodialysis element and flowing into the other chamber are exactly the same, corresponding to the amount of change in the elastic diaphragm. Therefore, with this system, it is usually impossible to generate a pressure in the dialysate circuit that can supply fresh dialysate into the blood circuit by reverse filtration. The liquid cannot be performed.

  In general, there are two types of hemodialyzers: a high flow pump for feeding dialysate, for example a gear pump, and a low flow pump for removing water in the patient, for example a piston pump. A pump is in use. A high flow pump is used to deliver dialysate to the hemodialysis element and a low flow pump is used to remove excess water from the patient's body through the dialysis membrane of the hemodialysis element. When using these pumps to send back-filtered dialysate, high-flow pumps can send back-filter dialysate in large quantities, but it is difficult to manage the accuracy of the flow rate. In addition, the low flow rate pump has high accuracy of flow rate, but the amount of reverse filtration dialysate cannot be obtained in large quantities, or if the flow rate is forcibly increased, the accuracy of water removal, which is the original purpose of use, is reduced. There is a problem.

In addition, if the hemodialysis machine is equipped with a separate pump for feeding the reverse filtration dialysate to send the reverse filtration dialysate, a space for installing a large device in the dialyzer is required. It becomes complicated. This increases the cost of the entire apparatus and reduces the maintainability of the apparatus.
JP-A-63-260570 Japanese Patent Publication No.56-82 Japanese Patent Publication No. 61-25382

  Therefore, the problem of the present invention is that the above-described chamber-type hemodialysis apparatus can deliver the reverse filtration dialysate with a very simple improvement and can deliver the reverse filtration dialysate at a high flow rate. An object of the present invention is to provide a method of feeding a reverse filtration dialysate in a hemodialysis apparatus and a hemodialysis apparatus using the method.

  In order to solve the above-mentioned problems, in the present invention, in the chamber type hemodialysis apparatus, the flow path of the dialysate in the hemodialysis apparatus is devised as follows in order to obtain a high flow reverse filtration dialysate with high precision In order to enable the desired reverse filtration dialysate to be sent, one two-way solenoid valve is added as shown in an embodiment described later. Thus, it becomes possible to obtain a high flow reverse filtration dialysate with high accuracy by a simple method.

  That is, in the hemodialysis apparatus according to the present invention, the reverse filtration dialysate feeding method is performed through a dialysis membrane between a blood circuit that circulates blood between the patient's body and a dialysate circuit that circulates the dialysate. A hemodialysis element for performing hemodialysis is provided, and a dialysate circuit is provided with a telescopic diaphragm and a fresh dialysate side chamber for storing fresh dialysate and a used dialysate side chamber for storing used dialysate. Using a hemodialyzer having at least two chambers each consisting of a quantitative container divided into two chambers, receiving fresh dialysate into the fresh dialysate side chamber of one chamber, and using the used dialyzers of the one chamber through a diaphragm The used dialysate that is pushed out and discharged from the liquid side chamber is sent to the used dialysate side chamber of the other chamber, and is pushed out of the fresh dialysate side chamber of the other chamber through the diaphragm and discharged. The fresh dialysate, was fed to a hemodialysis element comprises a method for causing to flow into the blood circuit of the sent fresh dialysate by reverse filtration system through a dialysis membrane.

  In the method according to the present invention, the used dialysate that has been conventionally discharged from the used dialysate chamber of one chamber to the drain circuit is sent to the used dialysate chamber of the other chamber. The diaphragm of the other chamber is pushed by the liquid, the fresh dialysate is forced out of the fresh dialysate side chamber of the other chamber, and the fresh dialysate pushed out of the fresh dialysate side chamber is discharged. Delivered to the hemodialysis element. By forming a series of these systems, the pressure for receiving the fresh dialysate into the fresh dialysate side chamber of the one chamber (for example, the pressure by the pump) is substantially directly applied to the hemodialysis element. It can be used as the delivery pressure of fresh dialysate, and can be back-filtered through a dialysis membrane without the need for a separate pump. It becomes possible. A pump provided for receiving fresh dialysate is usually provided with a relatively large capacity pump in order to complete the reception in a short time. That is, although it is a chamber type hemodialysis apparatus, the reverse filtration dialysate can be fed at a desired high flow rate with only a very simple improvement.

  In the method of feeding the reverse filtration dialysate in the hemodialysis apparatus according to the present invention, when the reception of the fresh dialysate into the one chamber is completed, the chamber is switched between the two chambers, and the fresh dial into the other chamber is obtained. Starting to receive dialysate and starting to feed fresh dialysate filled in the fresh dialysate side chamber of one of the chambers to the hemodialysis element, continuously dialyzing fresh dialysate Can be delivered to the element. This makes it possible to easily allow the reverse filtration dialysate to flow into the blood circuit in a necessary amount.

  In the liquid delivery method according to the present invention, the amount of fresh dialysate delivered to the hemodialysis element depends on the capacity of the chamber composed of the metering container. Therefore, in particular, when fresh dialysis fluid is continuously fed to the hemodialysis element while switching the chambers as described above, it is easy to consider by considering the capacity of each chamber, the number of times of switching, and the number of times of feeding. It becomes possible to control the liquid feeding amount with high accuracy.

  In addition, the flow rate of liquid to be fed to the hemodialysis element can be calculated from the completion time of receiving fresh dialysate into the chamber or the chamber switching time. If the flow rate is calculated and the liquid feeding time is taken into consideration, the liquid feeding amount can be controlled with higher accuracy.

  In addition, if a means for detecting that all of the fresh dialysate in the chamber has been sent to the hemodialysis element is provided, the chamber can be switched based on detection by the detection means, Efficient chamber switching to achieve is possible.

  In addition, the dialysate circuit has a means for detecting pressure, and when the pressure detected by the detection means is determined to be abnormal, the supply of fresh dialysate to the hemodialysis element is interrupted or stopped. In addition, when an abnormality occurs in the dialysate circuit, it can be quickly dealt with.

  And a means for detecting the pressure in the blood circuit of fresh dialysate sent by reverse filtration into the blood circuit, and if the pressure detected by the detecting means is determined to be abnormal, the hemodialysis element It is also possible to interrupt or stop the delivery of fresh dialysate to the blood circuit so that a rapid response can be made when an abnormality occurs in the blood circuit.

  In addition, the amount of fresh dialysate to be fed into the blood circuit by reverse filtration can be automatically controlled based on a preset amount. That is, with the series of operations, it is possible to automatically control the reverse filtration liquid feeding amount.

  Furthermore, the present invention provides a method for feeding priming, returning blood or replacement fluid by flowing the fresh dialysate in the dialysate circuit through the dialysis membrane into the blood circuit using the above-described method of feeding the reverse filtration dialysate. A hemodialysis apparatus that can be used is also provided. That is, by carrying out the reverse filtration dialysate as described above, the priming in the blood circuit before hemodialysis and the blood remaining in the blood circuit are pushed back into the patient's body by the reverse filtration dialysate. Blood can be returned. Furthermore, since the fresh dialysate is kept extremely clean, it can be used as a replacement fluid. Instead of the replacement fluid in which normal physiological saline or the like is used, or together with the normal replacement fluid. The freshly filtered dialysate can be supplied into the blood circuit as a replacement fluid.

  As described above, according to the method for feeding the reverse filtration dialysate in the hemodialysis apparatus according to the present invention and the hemodialysis apparatus using the method, the chamber type hemodialysis apparatus can be improved with a very simple improvement. The reverse filtration dialysate can be sent, and the reverse filtration dialysate can be sent at a high flow rate and with high accuracy without adding a new pump. The reverse filtration dialysate can be easily and automatically sent. In addition, priming, blood return, or replacement fluid can be easily and efficiently performed in a desired form using a reverse filtration dialysate.

Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.
1 to 3 show a hemodialysis apparatus for carrying out a method for feeding a reverse filtration dialysate according to an embodiment of the present invention. FIG. 1 shows a form during priming, and FIG. 2 shows normal blood. FIG. 3 shows a specific example of a blood circuit and its priming configuration.

  First, with reference to FIG. 2, the form during normal hemodialysis will be mainly described. The hemodialysis apparatus in the present invention is configured as a so-called chamber type hemodialysis apparatus. Reference numeral 1 denotes a hemodialysis element having a dialysis membrane 2 made of, for example, a hollow fiber. In the hemodialysis element 1, a dialysis fluid is circulated through a blood circuit 3 that circulates blood between the patient's body. Hemodialysis is performed between the fluid circuit 4 and the dialysis membrane 2. The blood circuit 3 includes an arterial blood circuit 5 connected to the patient's artery side and a venous blood circuit 6 connected to the vein side. As shown in FIG. 3, the blood circuit 3 includes an arterial blood circuit 5, an arterial circuit clamp 7, an arterial bubble detector 8, a blood pump 9 including a tube pump, a drip chamber, in the blood flow direction. 10 is provided, and the drip chamber 10 is provided with an arterial blood circuit pressure sensor 11. The venous blood circuit 6 is provided with a drip chamber 12, a venous bubble detector 13, and a venous circuit clamp 14 in order in the direction of blood flow. The drip chamber 10 has a venous blood circuit pressure sensor 15. Is provided. FIG. 3 shows a connection state when priming in the blood circuit 3 is performed using the reverse filtration dialysate, and at this time, the arterial needle connecting portion 16 and the venous needle connecting portion 17 are connected to each other, The supplied reverse filtration dialysate is formed so as to be able to circulate in the blood circuit 3. The air present in the blood circuit 3 and the reverse filtration dialysate used for priming are discharged from an overflow line provided in the drip chambers 10 and 12.

  The flow of the dialysate in the dialysate circuit 4 is performed as follows. As shown in FIG. 2, in the present embodiment, chambers (A), (B) 21, 22 including two metering containers are provided in the dialysate circuit 4. The chambers (A) and (B) 21 and 22 accommodate fresh dialysate side chambers 25 and 26 containing fresh dialysate and used dialysate by diaphragms 23 and 24 made of elastic elastic membranes. It is divided into two chambers, the used dialysate side chambers 27 and 28. At the time of hemodialysis, for example, as shown in FIG. 2, the fresh dialysate contained in the fresh dialysate side chamber 26 of the chamber 22 is pushed out to the diaphragm 24 and fed into the hemodialysis element 1 for hemodialysis. The used dialysate is returned to the used dialysate side chamber 28. This circuit is formed as a closed circuit, and the amount of liquid fed and the amount of return are substantially the same and correspond to the amount of movement of the diaphragm 24. Circulation of the dialysate is performed by a negative pressure circulation pump 29 provided in the return side circuit. The dialysate circuit 4 is provided with a flow switch 30, a bypass valve 1 (31), a bypass valve 2 (32), and a dialysate pressure sensor 33, and a negative pressure release valve for the return side circuit. 34 is provided. A water removal pump 35 is connected to the upstream side of the negative pressure circulation pump 29 so that excess water from the patient can be removed. When the chamber 22 side is used for hemodialysis, on the chamber 21 side, fresh dialysate is supplied to the fresh dialysate side chamber 25 by the deaeration pump 36 via the flow switch 37. The inside of the side chamber 25 is filled with fresh dialysate. At the same time, the used dialysate stored in the used dialysate side small chamber 27 is discharged to the outside through the drain circuit 38 together with water removal by the water removal pump 35. A pair of switching valves 39 (normally closed two-way solenoid valves) are provided for the fresh dialysate side chambers 25 and 26 and the used dialysate side chambers 27 and 28 of the chambers (A) and (B) 21 and 22, respectively. The chambers used for hemodialysis and the chambers for receiving fresh dialysate can be alternately switched by the on / off operation of each switching valve 39. By this switching, the dialysate can be continuously supplied to the hemodialysis element 1. Reference numeral 40 denotes a normally open two-way solenoid valve added in the present invention, and the valve 40 is closed when a reverse filtration dialysate to be described below is fed. It remains open during hemodialysis. Except for the valve 40, it is the same as the conventional apparatus, and the operation for hemodialysis is also the same.

  Next, referring to FIG. 1, the feeding of the reverse filtration dialysate in the present invention will be described. The negative pressure circulation pump 29 and the dewatering pump 35 are not operated, and the deaeration pump 36 is operated under the condition that the valve 40 composed of a two-way electromagnetic valve is turned on and the valve 40 is closed. Fresh dialysate is received in the fresh dialysate side chamber 25. At this time, the diaphragm 23 is pushed to the used dialysate side chamber 27 side, and the used dialysate is pushed out from the used dialysate side chamber 27 of the chamber 21 through the diaphragm 23 and discharged. The used dialysate that has been pushed out and discharged is sent to the used dialysate side chamber 28 of the other chamber 22, and the diaphragm 24 is pushed toward the fresh dialysate side chamber 26, and the chamber 22 passes through the diaphragm 24. Fresh dialysate is pushed out from the fresh dialysate side chamber 26 and discharged. The fresh dialysate pushed out and discharged is sent to the hemodialysis element 1. Since these series of systems are closed systems, the pressure by the deaeration pump 36 acts as the liquid feeding pressure to the hemodialysis element 1 through the operation of the diaphragm 23 and the diaphragm 24. Therefore, a pressure sufficiently higher than the pressure in the blood circuit 3 is applied, and the fed fresh dialysate flows into the blood circuit 3 through the dialysis membrane 2 by a reverse filtration method.

  At this time, the dialysate pressure sensor 32 can detect the pressure in the dialysate circuit 4 during reverse filtration. Therefore, when an abnormality occurs in the pressure in the dialysate circuit 4, the delivery of fresh dialysate to the hemodialysis element 1 can be interrupted or stopped. Further, as shown in the priming embodiment of FIG. 3, the pressure in the blood circuit 3 of the fresh dialysate sent to the blood circuit 3 by reverse filtration is the pressure sensor 11 in the arterial blood circuit and / or the vein. Since it can be detected by the side blood circuit pressure sensor 15, even when the pressure detected by these sensors is determined to be abnormal, the delivery of fresh dialysate to the hemodialysis element 1 can be interrupted or stopped. These determinations and interruption or suspension of liquid feeding can be automatically controlled by providing control devices 41 and 42 as shown in FIG.

  Further, the chamber 22 for feeding fresh dialysate to the hemodialysis element 1 and the chamber 21 for receiving fresh dialysate are alternately switched by the on / off operation of each switching valve 39. By this switching, the reverse filtration dialysate is continuously fed into the blood circuit 3. That is, when the reception of the fresh dialysate into the chamber 21 is completed, the chambers are switched between the two chambers 21 and 22 and the reception of the fresh dialysate into the other chamber 22 is started. By starting the feeding of the fresh dialysate filled in the chamber 25 to the hemodialysis element 1, the fresh dialysate can be continuously fed to the hemodialysis element 1.

  Since the amount of the fresh dialysate to be fed to the hemodialysis element 1 depends exclusively on the capacity of the chambers 21 and 22 consisting of the metering containers, the fresh dialysate is used while switching the chamber as described above. When the liquid is continuously fed to the hemodialysis element 1, the volume of each chamber, the number of times of switching, and the number of times of liquid feeding can be taken into account, so that the amount of liquid feeding can be easily controlled with high accuracy.

  The deaeration pump 36, which is a pump provided for receiving fresh dialysate, is usually provided with a relatively large capacity pump in order to complete the reception in a short time. Although it is a hemodialysis apparatus, the reverse filtration dialysate can be sent at a desired high flow rate by only a very simple improvement by adding the valve 40 and performing predetermined control. Further, the total amount of the solution can be easily set to a desired amount by continuously performing the chamber switching.

  Further, from the time when the fresh dialysate is received into the chamber or the chamber switching time, for example, when the chambers are alternately switched and the fresh dialysate is continuously fed to the hemodialysis element 1, the chamber switching interval is set. From the time, it is possible to easily calculate the amount of liquid delivered per unit time, that is, the flow rate, which is being delivered to the hemodialysis element 1 at that time. If the flow rate is calculated and the liquid feeding time is taken into consideration, the liquid feeding amount can be controlled with higher accuracy.

  Further, if a means for detecting that all of the fresh dialysate in the chamber has been sent to the hemodialysis element is provided, for example, although not shown, a means for detecting the behavior of the diaphragm (for example, the diaphragm is completely If a touch sensor or the like for detecting the movement to the fresh dialysate side chamber is provided, the chamber can be switched based on detection by the detection means, and efficiency for achieving continuous liquid feeding And safer and more reliable chamber switching.

  In addition, the total amount of fresh dialysate used that is fed into the blood circuit by reverse filtration can be automatically controlled based on a preset amount. That is, as described above, the amount of liquid to be fed and the flow rate can be controlled with high accuracy, so that the feeding can be easily stopped when the total amount of fresh dialysate to be fed reaches the set value. This control can also be automatically controlled along with the above series of operations.

  1 and 3 exemplify the case where priming is carried out, the fresh dialysate in the dialysate circuit is passed through the dialysis membrane using the above-described method for feeding the reverse filtration dialysate according to the present invention. Is allowed to flow into the blood circuit by a reverse filtration method to return blood or replace fluid.

  The method according to the present invention can be applied to a chamber-type hemodialysis apparatus, and it is possible to efficiently perform priming, blood return, and replacement fluid using the hemodialysis apparatus.

It is an equipment system diagram showing a form at the time of priming of a hemodialysis apparatus for carrying out a liquid feeding method of reverse filtration dialysate concerning one embodiment of the present invention. FIG. 2 is an equipment system diagram showing a form during hemodialysis of the apparatus of FIG. 1. FIG. 2 is a partial device system diagram showing details on the blood circuit side of the apparatus of FIG. 1.

Explanation of symbols

1 hemodialysis element 2 dialysis membrane 3 blood circuit 4 dialysate circuit 5 arterial blood circuit 6 venous blood circuit 7 arterial circuit clamp 8 arterial bubble detector 9 blood pump 10 drip chamber 11 pressure sensor 12 in the arterial blood circuit Drip chamber 13 venous air bubble detector 14 venous circuit clamp 15 venous blood circuit pressure sensor 16 arterial needle connection 17 venous needle connection 21, 22 chamber 23, 24 diaphragm 25, 26 fresh dialysate side chamber 27, 28 Used dialysate side chamber 29 Negative pressure circulation pump 30 Flow switch 31 Bypass valve 1
32 Bypass valve 2
33 Dialysis fluid pressure sensor 34 Negative pressure release valve 35 Dewatering pump 36 Deaeration pump 37 Flow switch 38 Drain circuit 39 Switching valve 40 Normally open two-way solenoid valve 41, 42 Control device

Claims (9)

  A hemodialysis element that performs hemodialysis via a dialysis membrane between a blood circuit that circulates blood between the patient's body and a dialysate circuit that circulates dialysate is provided in the dialysate circuit. A hemodialysis apparatus having at least two chambers composed of a metering container divided into two chambers, a fresh dialysate side chamber containing fresh dialysate and a used dialysate side chamber containing used dialysate by a diaphragm. Used, receiving the fresh dialysate into the fresh dialysate side chamber of one chamber, and using the used dialysate to be pushed out of the used dialysate side chamber of the one chamber through the diaphragm and discharged The fresh dialysate is sent to the hemodialysis element after being pumped and discharged from the fresh dialysate side chamber of the other chamber through the diaphragm. Dialysis membrane And wherein the to flow into the blood circuit by reverse filtration scheme, feeding method of the inverse filtered dialysate in hemodialysis apparatus.   When the reception of fresh dialysate into the one chamber is completed, the chamber is switched between both chambers, and the reception of fresh dialysate into the other chamber is started. 2. The reverse filtration dialysis in the hemodialysis apparatus according to claim 1, wherein the fresh dialysate is continuously fed to the hemodialysis element by starting the delivery of the fresh dialysate filled to the hemodialysis element. Liquid feeding method.   The method for feeding a reverse-filtered dialysate in a hemodialysis apparatus according to claim 1 or 2, wherein the amount of fresh dialysate sent to the hemodialysis element depends on the capacity of a chamber comprising a metering container.   The method for feeding a reverse-filtered dialysate in a hemodialysis apparatus according to claim 2 or 3, wherein the flow rate of liquid to be fed to the hemodialysis element is calculated from the completion time of receiving fresh dialysate into the chamber or the chamber switching time.   The hemodialysis according to any one of claims 2 to 4, further comprising means for detecting that all of the fresh dialysate in the chamber has been sent to the hemodialysis element, and switching the chamber based on detection by the detection means. A method for feeding back-filtered dialysate in the apparatus.   A means for detecting pressure in the dialysate circuit, and when the pressure detected by the detection means is determined to be abnormal, the delivery of fresh dialysate to the hemodialysis element is interrupted or stopped; Item 6. A method for feeding a reverse filtration dialysis solution in the hemodialysis device according to any one of Items 1 to 5.   Means for detecting the pressure in the blood circuit of fresh dialysate sent by reverse filtration into the blood circuit, and if the pressure detected by the detection means is determined to be abnormal, The liquid feeding method of the reverse filtration dialysate in the hemodialysis apparatus according to any one of claims 1 to 6, wherein the feeding of the fresh dialysate is interrupted or stopped.   The reverse filtration dialysis in the hemodialysis apparatus according to any one of claims 1 to 7, wherein the amount of fresh dialysate fed into the blood circuit by reverse filtration is automatically controlled based on a preset amount. Liquid feeding method.   Using the method according to any one of claims 1 to 8, it is possible to perform priming, blood return, or fluid replacement by flowing fresh dialysate in the dialysate circuit through the dialysis membrane into the blood circuit. Hemodialysis machine.

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