JP4783228B2 - Priming method and apparatus for hemodialyzer - Google Patents

Description

  The present invention relates to a method and an apparatus for priming a hemodialysis apparatus, and more particularly, to a method and an apparatus capable of automatically and efficiently performing priming in a blood circuit and / or during priming of a dialyzer before hemodialysis. .

  BACKGROUND ART A hemodialysis apparatus that collects blood from an artery side of a patient, performs hemodialysis, and returns purified blood to a vein side has been widely put into practical use. In such a hemodialysis apparatus, usually, priming of a blood circuit and a hemodialysis element (dialyzer: generally called a dialyzer) is performed before starting hemodialysis. This priming method is generally performed by a method using physiological saline, and a manual is issued by the Japanese Dialysis Medical Association. In other words, using a blood circuit with a physiological saline injection circuit, and when all connections between the blood circuit and the hemodialysis element are completed, physiological saline is circulated at a flow rate of about 150 ml / min, and the hemodialysis element The blood circuit including the inside is cleaned. At this time, air bubbles in the blood circuit are removed. After the washing is completed, the filling physiological saline solution is replaced with a 500 ml pack, and the blood circuit / hemodialysis element is replaced with the filling physiological saline solution.

However, for the purpose of cost reduction etc., priming is automatically performed with dialysate that has been reverse filtered through the hemodialysis element (that is, dialysate was pushed out from the dialysate circuit side through the dialysis membrane of the hemodialysis element). Various methods have been proposed (for example, Patent Documents 1 and 2). In priming with reverse filtration dialysis fluid, a large amount of priming fluid can be secured by using reverse filtration dialysis fluid for priming / washing with physiological saline, enabling priming with a higher degree of cleaning. It becomes.
Japanese Patent Laid-Open No. 1-113064 Japanese Patent No. 2979234

  However, priming with a simple reverse filtration dialysis solution may cause the following problems, particularly when a dry type hemodialysis element (dry type dialyzer) is used. That is, the dialyzer (hemodialysis element) is an important device for hemodialysis, but there are two types of dialyzer that are filled with sterilized water and those that are not filled with sterilized water. A type of dialyzer that is not filled with sterilized water is called a dry type dialyzer.

  In priming a blood circuit using reverse filtration dialysate, particularly when a dry type hemodialysis element is used, an increase in dialysate pressure is observed. Since an abnormal increase in dialysate pressure may damage the dialysis membrane, when the dialysate pressure reaches the specified pressure, control the reverse filtration dialysate flow rate to suppress the increase in dialysate pressure. Yes. However, in the priming method in which the reverse filtration dialysis solution is simply used, the flow rate of the reverse filtration dialysis solution decreases when the increase in the dialysate pressure is suppressed, and priming takes time correspondingly.

  Further, when priming a dry type hemodialysis element, it is necessary to sufficiently remove the air present in the dialysis membrane of the hemodialysis element. At this time, it is unclear whether or not the air present in the dialysis membrane has been sufficiently removed only by feeding the reverse filtration dialysate. Furthermore, although it is considered that the air in the dialysis membrane can be removed by feeding the reverse filtration dialysis solution for a long time, there is a problem that the priming time becomes long.

  Therefore, the object of the present invention is to pay attention to the above-mentioned problems, and when priming the blood circuit using the reverse filtration dialysate, not only the reverse filtration direction but also the dialysate pushed into the blood circuit. By enabling effective use of the filtration operation in the normal filtration direction that returns to the dialysate circuit through the dialysis membrane, that is, by allowing fluid to pass through the dialysis membrane in both the normal filtration and reverse filtration directions. An object of the present invention is to provide a method and an apparatus that can suppress abnormal increase in fluid pressure and efficiently remove bubbles inside a dialysis membrane, thereby realizing more time-efficient priming.

In order to solve the above-described problems, a priming method for a hemodialysis apparatus according to the present invention includes a blood circuit for circulating blood between a patient's body and a dialysate circuit for circulating dialysate using a blood pump. A method for priming a blood circuit before hemodialysis in a hemodialysis apparatus having a hemodialysis element for performing hemodialysis via a dialysis membrane, wherein the dialysis fluid in the dialysate circuit is passed through the dialysis membrane. Priming in the blood circuit by inflowing into the blood circuit, and detecting the pressure in the blood circuit or / and the pressure in the dialysate circuit, so that the detected pressure does not exceed a predetermined set value. Control the inflow rate of the dialysate, or interrupt the inflow of the dialysate into the blood circuit when a predetermined set value is reached. / And until the detected pressure falls to a predetermined pressure, it consists of priming method for causing to flow out dialysate flowing into the blood circuit into the dialysate circuit through the dialysis membrane.

  That is, when performing priming, as a method for efficiently removing the air present in the dialysis membrane of the hemodialysis element in a short time, the reverse filtration dialysis fluid flowing into the blood circuit from the dialysis fluid circuit through the dialysis membrane is sufficient. Then, the dialysate that has flowed into the blood circuit is sent through the dialysis membrane in the positive filtration direction from the blood circuit of the hemodialysis element to the dialysate circuit. If necessary, the hemodialysis element is repeatedly pumped from the dialysate circuit to the blood circuit and from the blood circuit to the dialysate circuit to prevent abnormal increase in dialysate pressure. However, air present in the dialysis membrane can be removed efficiently and in a short time, and desirable priming can be performed.

  In the priming method of the hemodialysis apparatus according to the present invention, the dialysate circuit or / and the pressure in the blood circuit are changed, whereby the dialysate flows into and out of the blood circuit. Is possible.

In the method according to the present invention, the pressure in the blood circuit and / or the pressure in the dialysate circuit is detected, and the inflow rate of the dialysate into the blood circuit is controlled so that the detected pressure does not exceed a predetermined set value. Control or stop the inflow of dialysate into the blood circuit when a predetermined set value is reached, and / or until the predetermined time elapses after the inflow of dialysate or / and the detected pressure is a predetermined pressure The dialysate that has flowed into the blood circuit is allowed to flow out into the dialysate circuit until the pressure drops to 0 . By controlling the inflow rate of the dialysate according to the detected pressure or interrupting the inflow of the dialysate, an abnormal increase in dialysate pressure can be reliably suppressed. Also, by allowing the dialysate to flow into the dialysate circuit until a predetermined time elapses after the dialysate has flowed in and / or until the detected pressure decreases to a predetermined pressure, The outflow operation can be repeated in a time-efficient manner, and the target priming can be completed within a short time.

  Further, in the priming method of the hemodialysis apparatus according to the present invention, the priming in the arterial blood circuit having a blood pump extends from the arterial needle connection portion of the patient and from the hemodialysis element to the venous needle connection portion. It is also possible to separately perform priming in the extending venous blood circuit. If divided in this way, priming can be performed under optimum pressure conditions, and desirable priming can be performed over the entire blood circuit.

  Such a priming method of the hemodialysis apparatus according to the present invention is particularly suitable when the hemodialysis element is a dry type hemodialysis element. However, the method according to the present invention can be used not only for dry type hemodialysis elements but also for other types of hemodialysis elements.

The priming device of the hemodialysis apparatus according to the present invention includes hemodialysis through a dialysis membrane between a blood circuit that circulates blood between a patient's body and a dialysate circuit that circulates dialysate using a blood pump. A device for priming in a blood circuit before hemodialysis in a hemodialysis apparatus equipped with a hemodialysis element for performing blood flow by allowing the dialysate in the dialysate circuit to flow into the blood circuit through the dialysis membrane In order to perform priming, a dialysate feeding means for feeding dialysate to the dialysis membrane in a reverse filtration direction and means for detecting the pressure in the blood circuit and / or the pressure in the dialysate circuit , Means for controlling the inflow rate of the dialysate into the blood circuit so that the pressure detected by the pressure detection means does not exceed a predetermined set value, or dialysate into the blood circuit when the predetermined set value is reached Flow of And means for interrupting, dialysis through during and / or until the detected pressure falls to a predetermined pressure, the dialysis membrane dialysis fluid flowing in the blood circuit to the passage of time flows after a predetermined dialysate It comprises a priming device characterized by having a dialysis fluid feeding means for feeding the dialysis fluid to the dialysis membrane in the forward filtration direction so as to flow into the fluid circuit.

  In the priming device of the hemodialysis apparatus according to the present invention, means for changing the pressure in the dialysate circuit or / and the blood circuit to cause the dialysate to flow into and out of the blood circuit. It can be set as the structure which has these.

  Moreover, it can be set as the structure which has a control means which switches the inflow into the blood circuit of a dialysate, and the outflow into a dialysate circuit.

Further, in the apparatus according to the present invention, the means for detecting the pressure in the blood circuit and / or the pressure in the dialysate circuit, and the pressure detected by the pressure detecting means into the blood circuit so as not to exceed a predetermined set value. Means for controlling the inflow rate of dialysate or means for interrupting the inflow of dialysate into the blood circuit when a predetermined set value is reached, and until a predetermined time has elapsed after the inflow of dialysate Or / and means for allowing the dialysate flowing into the blood circuit to flow out into the dialysate circuit until the detected pressure drops to a predetermined pressure .

  And a means for separating the priming in the arterial blood circuit with a blood pump extending from the patient's arterial needle connection and the priming in the venous blood circuit extending from the hemodialysis element to the venous needle connection. It can also be configured.

  Such a priming device of the hemodialysis apparatus according to the present invention is particularly suitable when the hemodialysis element is a dry type hemodialysis element. However, the apparatus according to the present invention can be applied not only to dry type hemodialysis elements but also to other types of hemodialysis elements.

  Thus, according to the priming method and apparatus of the hemodialysis apparatus according to the present invention, the dialysate is fed in the reverse filtration direction and the normal filtration direction through the dialysis membrane, thereby suppressing an abnormal increase in dialysate pressure. Air bubbles inside the dialysis membrane can be efficiently removed, and desired priming can be completed within a short time. Especially for hemodialysis using a dry type hemodialysis element, priming of the blood circuit before dialysis can be performed efficiently.

Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows a hemodialysis apparatus incorporating a priming apparatus according to an embodiment of the present invention. In FIG. 1, reference numeral 1 denotes a hemodialysis element (dialyzer) provided with a dialysis membrane 2 made of a hollow fiber membrane or the like, and particularly a dry type hemodialysis element. Reference numeral 3 denotes a blood circuit that circulates blood between the patient's body, and the blood circuit 3 includes an arterial blood circuit 3a, a blood circuit 3b in the hemodialysis element 1, and a venous blood circuit 3c. Reference numeral 4 denotes a dialysate circuit for circulating the dialysate, and the dialysate circuit 4 includes a dialysate supply line 4a, a dialysate circuit 4b in the hemodialysis element 1, and a dialysate return line 4c. The dialysate is fed from a dialysate supply device 6 as a solution feeding means provided with the dialysate supply pump 5 and returned to the device 6.

  In this embodiment, the arterial blood circuit 3a and the venous blood circuit 3c are provided with pressure detecting means 7 and 8 for detecting the pressure in the blood circuit, respectively. The arterial blood circuit 3a has a blood pump for feeding the blood to the hemodialysis element 1 by squeezing a tube constituting the blood circuit by the blood feeding rotor 11 in the blood circuit squeezing unit 10. 9 is provided. The arterial blood circuit 3a and the venous blood circuit 3c are provided with bubble detecting means 12 and 13, respectively. On the upstream side of the bubble detection means 12 and the downstream side of the bubble detection means 13, an occlusion means 14 for occluding the arterial blood circuit 3a and an occlusion means 15 for occluding the venous blood circuit 3c are provided. An arterial needle connection 16 is provided at the end of the arterial blood circuit 3a, and a venous needle connection 17 is provided at the end of the venous blood circuit 3c. In this embodiment, dialysate circuit pressure detecting means 18 is also provided. The detected pressure signals of the pressure detecting means 7, 8, and 18 are sent to the control device 19, and the control device 19 operates the solenoid valve of the dialysate supply pump 5 and the closing means 14, 15 according to the detected pressure. Can be sent and can be automatically controlled according to preset conditions.

  The blood circuit 3 includes an arterial blood circuit 3 a from the arterial needle connection 16 to the hemodialysis element 1, a blood circuit 3 b in the hemodialysis element 1, and a venous blood from the hemodialysis element 1 to the venous needle connection 17. Although the circuit 3c is formed, when the method of the present invention is carried out, the dialysate that is reverse-filtered through the dialysis membrane 2 of the hemodialysis element 1 is connected to the arterial needle connection portion 16 and the venous needle connection portion 17. 3 is formed so that it can circulate in the interior. The air present in the blood circuit 3 and the dialysate used for priming are discharged from the drip chamber 20 of the arterial blood circuit and the overflow line provided in the drip chamber 21 of the venous blood circuit. ing.

The priming method according to the present invention is carried out as follows, for example, using such a priming device of a hemodialysis apparatus.
The reverse filtration dialysate is sent from the dialysate circuit 4b side of the hemodialysis element 1 through the dialysis membrane 2 to the blood circuit 3b side. The flow of the dialysate at this time is, for example, as shown in FIG. After a certain period of time or / and when a predetermined set pressure is detected (when a predetermined set pressure is detected by at least one of the pressure detection means 7, 8, 18), blood from the dialysate circuit 4 side Discontinuing the reverse filtration dialysate delivery to the circuit 3 side (controlling the rotational speed of the dialysate supply pump 5 so that the detected pressure does not exceed a predetermined set value, and allowing the dialysate to flow into the blood circuit 3b side. The speed may be controlled), and the dialysate is fed in the forward filtration direction through the dialysis membrane 2 from the blood circuit 3 side to the dialysate circuit 4 side. The flow of the dialysate at this time is as shown in FIG. 3, for example. The positive filtration dialysate may be fed until a predetermined time elapses and / or until a predetermined pressure is detected (until the pressure decreases to a predetermined pressure). Thereafter, similarly to the above, the reverse filtration dialysate is sent again from the dialysate circuit 4 side to the blood circuit 3 side for a certain time or / and until a predetermined pressure is detected.

  The above operation is automatically performed, and the dialysate feeding amount and the dialysate circuit 4 side or the blood circuit 3 side are preset and repeated a predetermined number of times. Air bubbles inside the dialysis membrane can be efficiently removed while controlling the abnormal increase in dialysate pressure appropriately and automatically by repeating back filtration and forward filtration of the dialysate in a short time. Desired priming can be completed. In particular, in hemodialysis using a dry type hemodialysis element, priming of the blood circuit before dialysis can be completed efficiently.

  The present invention is particularly suitable for priming a hemodialysis apparatus using a dry type hemodialysis element.

It is a schematic block diagram of the hemodialysis apparatus incorporating the priming apparatus which concerns on one embodiment of this invention. It is a schematic partial block diagram which shows the flow of the dialysate at the time of reverse filtration dialysate liquid feeding in the apparatus of FIG. It is a schematic partial block diagram which shows the flow of the dialysate at the time of positive filtration dialysate liquid feeding in the apparatus of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Hemodialysis element 2 Dialysis membrane 3 Blood circuit 3a Arterial blood circuit 3a
3b Blood circuit 3c in hemodialysis element Venous blood circuit 4 Dialysate circuit 4a Dialysate supply line 4a
4b Dialysate circuit 4c in the hemodialysis element Dialysate return line 5 Dialysate supply pump 6 Dialysate supply devices 7, 8, and 18 as solution delivery means Pressure detection means 9 Blood pump 10 Ironing section 11 Blood delivery rotor 12 , 13 Bubble detection means 14, 15 Occlusion means 16 Arterial needle connection part 17 Venous needle connection part 19 Controller 20, 21 Drip chamber

Claims (9)

In a hemodialysis apparatus equipped with a hemodialysis element for performing hemodialysis via a dialysis membrane between a blood circuit for circulating blood between a patient's body and a dialysate circuit for circulating dialysate using a blood pump Priming in the blood circuit before hemodialysis, the dialysis solution in the dialysate circuit is allowed to flow into the blood circuit through the dialysis membrane , and the pressure in the blood circuit is performed. Or / and detecting the pressure in the dialysate circuit and controlling the inflow rate of the dialysate into the blood circuit so that the detected pressure does not exceed a predetermined set value, or blood when a predetermined set value is reached. with interrupting the inflow of dialysate into the circuit, while between and / or detect the pressure until the end of the inflow after a predetermined time dialysate until reduced to a predetermined pressure, which is flowing into the blood circuit Priming method of hemodialysis apparatus for causing to flow out into the dialysate circuit 析液 through dialysis membrane.   The method for priming a hemodialysis apparatus according to claim 1, wherein the dialysate circuit and / or the pressure in the blood circuit is changed to cause inflow of the dialysate into the blood circuit and outflow into the dialysate circuit. . The priming in the arterial blood circuit extending from the patient's arterial needle connection to the hemodialysis element and having a blood pump and the priming in the venous blood circuit extending from the hemodialysis element to the venous needle connection are performed separately. 3. A priming method for a hemodialysis apparatus according to 1 or 2 . The priming method for a hemodialysis apparatus according to any one of claims 1 to 3 , wherein the hemodialysis element is a dry type hemodialysis element. In a hemodialysis apparatus equipped with a hemodialysis element for performing hemodialysis via a dialysis membrane between a blood circuit for circulating blood between a patient's body and a dialysate circuit for circulating dialysate using a blood pump An apparatus for performing priming in a blood circuit before hemodialysis, in order to perform priming in the blood circuit by flowing the dialysate in the dialysate circuit into the blood circuit through the dialysis membrane The reverse filtration dialysate liquid feeding means for feeding the liquid in the reverse filtration direction, the pressure in the blood circuit and / or the pressure in the dialysate circuit, and the pressure detected by the pressure detection means are set to a predetermined value. Means for controlling the inflow rate of the dialysate into the blood circuit so as not to exceed the value, or means for interrupting the inflow of the dialysate into the blood circuit when a predetermined set value is reached, and inflow of the dialysate After a predetermined time So during and / or detected pressure up to per to have to flow out until reduced to a predetermined pressure, the dialysate flows into the blood circuit into the dialysate circuit through the dialysis membrane, to the dialysate dialysis membrane A dialysis fluid priming device, comprising: a positive filtration dialysis fluid feeding means for feeding in a positive filtration direction. 6. The dialysis fluid priming device according to claim 5 , comprising means for changing the pressure in the dialysate circuit or / and the blood circuit to cause the dialysate to flow into and out of the blood circuit. apparatus. The priming device of a hemodialysis apparatus according to claim 5 or 6 , further comprising control means for switching inflow of the dialysate into the blood circuit and outflow of the dialysate into the dialysate circuit. Means for extending from a patient's arterial needle connection to a hemodialysis element and separating priming in an arterial blood circuit with a blood pump and priming in a venous blood circuit extending from the hemodialysis element to a venous needle connection Item 8. A priming device for a hemodialysis device according to any one of Items 5 to 7 . The priming device for a hemodialysis apparatus according to any one of claims 5 to 8 , wherein the hemodialysis element comprises a dry type hemodialysis element.

Images