RU2031662C1 - Apparatus for peritoneal dialysis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: apparatus for peritoneal dialysis has reservoirs for purified water with level pickups, for salt concentrate and for glucose, all reservoirs are provided by valves with control units; connected with the reservoirs units for metering the above mentioned components; unit for providing continuous dialysis process; units for heating up and for sterilization of a solution, units for monitoring its temperature and electrical conductivity, metering devices for feeding and removing dialyzing solution, being in the form of translucent vessels with limit switches, the first of which is arranged higher and the second - lower, than a place of introducing of the dialyzing solution. The apparatus is provided in addition by a system for testing the dialyzing solution, being removed, by a controller and setters, console with units for setting volumes and with dialysis program blocks. EFFECT: enhanced serviceability. 4 cl, 5 dwg

Description

 The invention relates to medicine, in particular to devices for extrarenal blood purification.

 A device for intermittent pertonal dialysis is known, in which water for a dialysis solution is obtained by purifying ordinary tap water by the reverse osmosis method. After cleaning, water from the drive enters a measuring vessel in communication with the atmosphere. Upon reaching the desired dose recorded by the float sensor, the further supply of water is blocked by an electromagnetic valve, and the roller pump is turned on, which pumps a certain dose of glucose-salt concentrate into the measuring vessel with water. The latter depends on the operating time of the roller pump tuned to a specific speed, and is controlled by a time delay relay. The correct dilution is controlled by the electrical conductivity of the dialysate. Next, the solution is heated in a heat exchanger and sterilized by passing through a bactericidal filter (0.2 μm). At the stage, the solution is completely ready for consumption. The task of the remaining elements of the hydraulic circuit is: pour a certain dose of dialysis solution into the abdominal cavity, provide it with exposure in the abdominal cavity, drain the spent solution and start the next cycle of the process. The above operations are carried out by the inlet and drain solenoid valves, including their timer and a camera to control the dose of the drain. With the raising of the spent solution to a certain point, the float sensor gives the command to start the next cycle and open the drain valve of the discharge dose control chamber.

The most significant disadvantages of this device are:
incomplete use of the power reserve of the dialysis solution preparation unit, since the latter is hydraulically and electrically tied to one dialysis in one patient, i.e. for 2-3 or more dialyses, it is simultaneously necessary to install 2-3 or more devices;
it is impossible to observe the proportion of the components of the dialysis solution within narrow limits, because in the device, it is dependent on the inertia of the float sensor, the speed of the roller pump, which varies randomly or due to oversight, the degree of pressing the tube with rollers, the inertia of the pump, relay, timer, the inevitability of deviation in the cross section of the roller segment during its production;
the impossibility of changing the glucose concentration during the dialysis process, i.e., the complete uniformity of the osmolarity of the solution-parameter, which requires special flexibility. With respect to the device, a change in the osmolarity of the solution is possible only if a battery of concentrates with different glucose contents is prepared;
the impossibility of using the dialysis solution prepared by the apparatus for other more effective methods of peritoneal dialysis, since it is necessary to interrupt the mixing proportionality block for the duration of the recharge;
inability to get a high sterilization rate.

 On the site of the bacterial filter, the rate of production of the dialysate solution slows down, which, with a gradual increase in its resistance, leads to the disruption of even such simple regimes that are inherent in intermittent dialysis. The combination of metering devices with the atmosphere necessitates air sterilizing filters, and the resistance of the filters enhances the inertia of the sensitive devices included in the dosed mixing process. It is impossible to warm up the dialysis solution to the desired temperature with a change in its speed.

 The closest known from the technical essence and the achieved result is a device for peritoneal dialysis, containing tanks of purified water with level sensors, salt concentrate and glucose, valves with control units, dosage units of the above components connected to containers, dialysis continuity ensuring unit, heating units and sterilization of the solution, control of its temperature and electrical conductivity, dispensers for feeding and removing the dialysis solution, made in the form of elastic translucent containers with limit switches, the first of which is located above, and the second is below the place of entry of the dialysis solution.

 As shown by the operation of this device, it does not allow: to change the concentration properties of the solution with sufficient and necessary accuracy; analyze and adjust the correctness of the selection of the concentration program for a particular patient, because of which the latter remains at a generally acceptable level; due to a knee with negative pressure in the dispensing system of spent dialysate formed for one reason or another, an air plug can stop the hydrodynamic process, which leads to overflow of the abdominal cavity and requires staff intervention; keep track of catheter bandwidth that is suddenly impaired, resulting in a loss of useful dialysis time; to exclude air bubbles systematically formed due to flow heating of the dialysis solution that block part of the useful dialysis area of the peritoneum, which is poorly perceived by patients; to drain poor-quality solution into the sewer without personnel intervention; achieve rapid correction of excess volume in the abdominal cavity and rapid shutdown of the patient without the help of maintenance personnel.

 A device for peritoneal dialysis is shown in the drawing.

 The device for peritoneal dialysis contains containers of purified water 1 with level sensors (not shown in the drawing), salt concentrate 2 and glucose 3, equipped with valves 4,5, 6 and 9 with control units connected to containers 1,2 and 3 of blocks 7 and 8 dosing of the above components, block 10 ensuring dialysis continuity, blocks 11 and 12, 13 and 14 of heating and sterilizing the solution, controlling its temperature and electrical conductivity, dispensers 15 and 16 for feeding and removing the dialysis solution, made in the form of elastic translucent containers 17 at the end switches 18 and 19, the first of which is located above, and the second - below the place of entry of the dialysis solution.

 The device is additionally equipped with a dialysis solution control system 20, a controller 21 and a setter 22, and formalin washing control, the dialysis continuity block 10 is combined with the dialysis fluid dispenser 15, the heating block 11 is installed in the purified water tank 1 and is additionally equipped with a control unit 28 temperature, the output from the tank 1 of purified water, the output of the dosage units 7 and 8 of glucose and salt are connected by a tee 29, and the latter is connected to the input of the sterilization unit 12, temperature control units 13 and 14 and conductivity are installed at the output of the dialysate solution dispenser 15, the dialysate solution control system 20 includes a dialysis process quality sensor 30 connected to the controller 21, a time unit for filling the filling time of the dialysis solution dispenser 31 is also connected to the controller 21 and the time and volume setting unit 24 and the formalin washing control unit 27 contains an additional container 32 (simulator of the abdomen) connected through an electromagnetic valve (not shown in the drawing) between the dispensers 15 and 16 n complements and drain; each of the dosing units 7.8 and 9 is made in the form of a volume-adjustable tank, the control unit of which is connected to the controller 21, the dialysate 15 dispensers 15 and 16 are placed on the fixed plate 33, into which one of the limit switches 18 is mounted, the sensor 34 is fixed on a translucent container 17, and above the last a movable plate 35 is installed, in which a second limit switch 19 is placed, and the limit switches 18 and 19 are connected to the units for dosing water, glucose and salt 7.8 and 9 through the volume setting unit 24 and belt.

 The limit switch 18 is made in the form of a reed switch, and the sensor 34 is in the form of a magnetic plate, the device is equipped with a remote control 37 connected via a volume and time setting unit 24, a controller 21 with a dispenser 15 and an accelerated drain unit 38 installed at the exit from the abdomen (or its simulator 32).

 An additional sensor 39 is mounted on the flexible container 18 of the dialysate removal dispenser 16, which interacts with the additional reed switch 40, and the latter is connected via the dialysate solution control system 41 and the controller 21 to the dialysis solution dispenser 15. The control of the dialysed solution to be removed can be carried out, for example, by measuring the time between two adjacent responses of the reed switch 40.

 The sensor 43 of the quality of the dialysis process is made in the form of a module that monitors, for example, the transparency of the dialysing solution to be removed, installed on the dialysis solution dispenser 16 and connected via the controller 21 to the solution parameter correction unit 43 and the alarm block 44.

 The output of the solution parameter correction block 43 is connected to a continuous dialysis solution preparation system 45 consisting of a purified water tank 1 with level and temperature control sensors 28, a salt concentrate tank 2, a glucose tank 3, salt and glucose dosing blocks 7 and 8, a heating block 11 solution, valves 4 and 5 with a control device and a unit 15 to ensure continuity of dialysis.

 The solution sterilization control unit 46 is installed directly in the dialysis solution sterilization unit 12 and is connected via the controller 21 to the alarm unit. The sterilization control unit can be made, for example, in the form of photocells that receive radiation from bactericidal lamps. When at least one of the lamps is turned off, an alarm signal is generated at the controller output.

 The temperature control unit 13 and the conductivity control unit 14 are installed directly in front of the simulator of the abdomen 32 and are sensors, each connected to its amplifier, an analog-to-digital converter through controller 21 with the dialysis solution parameters correction unit 43. Block 43 of the correction of the parameters of the solution is made in the form of an electrical circuit with power amplifiers at the outlet, through which the control units 7 and 8 of the dosage of salt and glucose, as well as block 11 of the heating solution.

 Block 47 programs of dialysis and washing from formalin is a storage device (permanent or reprogrammable) in which the program for dialysis or flushing of the hydraulic system from formalin is recorded and stored in accordance with the established algorithm of the device.

 Block 43 of the correction parameters of the dialysis solution can be performed on the basis of electronic circuits (see Count R. Electronic circuits, M .: Mir, 1989).

 Block 46 control solution sterilization of the solution can be performed, for example, on the basis of photosensors (see 750 practical electronic circuits under the editorship of R. Felix, M .: Mir, 1986, p.464).

 The sensor 41 of the quality control of the dialysis process can be performed on the basis of a scheme for measuring the transparency of a solution using photo amplifiers (see Fedorkov B.G., Telen V.A. DAC and ADC chips, operation, parameters, application, M .: Energoatomizdat, 1990, p.64).

 The control system of the removed dialysis solution can be implemented, for example, on the basis of time measurement schemes between two adjacent reed switch trips (see Gutnikov V.S. Integrated Electronics in Measuring Devices, L .: Energoatomizdat, 1988, p. 177).

 The controller 24 time and volume can be implemented, for example, similarly to that described by Colombet EA, Timers. M .: Radio and communications, 1983, p. 49.

 The controller 21 can be performed, for example, on the basis of a microprocessor kit (see Microprocessors and microcomputers in automatic control systems, L .: Mashinostroenie, 1987, p. 64).

 Block 44 alarm is a memory register with elements of light and sound signaling (see Maltsev L.A. et al. Fundamentals of digital technology, M .: Radio and communications, 1986, p. 35).

 Limit switches 18 and 19 are made on reed switches, the technical characteristics of which are given in the technical conditions ODO.360.038TU (reed switch KEM-2) and ODO.360.005 (reed switch MK-17).

 Block 47 is made on the RAM and ROM chips, (see Large Integrated Circuits Storage Devices under the editorship of A. Gordonov and Yu. N. Dyakov).

 Block 37 is a control panel with a keyboard and display elements (see J. Koffron Technical means of microprocessor systems, M.: Mir, 1983).

 The device (figure 2) works as follows.

 It is assumed that before turning on the device, its hydrostatic system (shown in FIG. 2 with a dash-dot line) is always filled with either formalin in the preservation state, or dialysis water in the system rinsing system from formalin, or dialysis solution in the dialysis mode. In the initial state, the capacities of the metering unit 15 — the receiving unit and the metering unit 16 — are drained (see figure 1).

 In order to ensure the flow of the solution in the hydrostatic system by gravity, i.e. without the use of pumps, its blocks are placed in the device one above the other vertically in the order indicated in figure 2 (highlighted by a dash-dot line).

 At the time of power-up, a reset signal is generated, which sets the device to its original state. This confirms the shutdown of blocks 15 and 16 and block 45 of the continuous preparation of the dialysis solution.

 The principle of operation of the apparatus for the regimen of formalin preservation or flushing from formalin or dialysis is one and the same. The only difference is in setting the initial parameters, such as the total number of work cycles; the number of doses of the initial filling of the abdomen; time delay values; solution concentration, etc. In addition, to work in the mode of preservation with formalin, it is necessary to disconnect 45 from the hydraulic system and connect instead the tank with formalin.

 Let us consider the operation of the apparatus by the example of its functioning in the DIALYSIS mode, as the most general.

 The operation of the device in the selected mode begins with the START command.

 As a result of hydrostatic pressure, a dialysis solution with a given concentration and a well-defined temperature will begin to flow from block 45 to block 12 of the bactericidal purification of the dialysis solution and then to block 15 (see Fig. 1). Its further downward flow is blocked by a valve at the outlet of block 15. When the solution flows through block 12, all possible bacteria are killed in it, for example, by irradiating it with radiation of special neon lamps. A high degree of bactericidal purification of the solution is provided by the choice of the number of radiation sources, their design and the rate of flow of the solution.

 At the moment of filling the tank 15 with the solution, the switch 19 is activated, and its signal starts the block 24. After a time determined by the setter 22, a signal is generated at the output of the block 24, which turns off through the controller 21 15. At the input 15, the valve closes and opens at the output, and the solution will begin to flow into blocks 13 and 14 of the control parameters of the dialysis solution and then without delay into the patient’s abdomen or simulator of the abdomen 32.

 The simulator of the abdomen 32 is usually used in the mode of preservation of the system with formalin or in the mode of flushing the system from formalin.

 At the moment of emptying the container 15 from the output 18, the signal level after a certain delay in the output of the block 24 generates a signal by which the controller 21 changes by one the state of the counter of the number of doses (SKD) located in the controller, the block 45 is turned on, and the tank 15 is filled with purified dialysis solution of the established concentration. After filling the tank 15, the switch 10 is activated, and the cycle of the apparatus described above will be repeated.

 Such a cycle will continue until the counter of the number of doses in the controller 21 is filled. The capacity of the ACS is set by the medical staff through the adjuster 22, based on the estimated volume of the dialysis solution, in which the dialysis proceeds efficiently, and the patient does not feel discomfort.

 When filling the ACS, for example, by counting a hundred pulses at the output of the controller 21, a signal is generated that turns on the drain batching unit 16 while turning on the unit 45. At the same time, while filling the capacity of block 15 (Fig. 1), the spent solution will be filled into the capacity of block 16 coming from the abdomen of the patient.

 At the moment of filling the capacity of the block 15, the switch 19 is activated, the block 24 is started, after a delay time the blocks 45, 15 and 16 are turned off, as a result of which the dialysis solution flows from the tank 15 into the patient’s stomach, and the spent solution from the tank 16 is poured into the sewer.

 After emptying the container 15, the switch 18 is activated, the block 24 is turned on, the contents of the ACS is increased by one, the blocks 45, 15 and 16 are turned on, and the container 15 is filled with the newly prepared dialysis solution, and the container 16 is filled with the spent solution, after filling the container 15, the switch 19 and etc., as described above.

 Such a cycle will remain until the filling of the access control system. At this moment, the signals from the output of the controller 21 block the operation of block 45 and block 16.

 At the same time, the potential signal from the output of the controller 21 will turn on the unit 38 for accelerated discharge of the spent solution from the patient’s abdominal cavity into the sewer. At the same time, the last dose of fresh dialysis solution will pour into the patient’s abdominal cavity, and the spent solution will be poured into the sewer from the block 16. After emptying the patient’s abdominal cavity, SKD can be reset (this circuit is not shown in the diagram) by the medical staff by sending an “end” signal.

 During dialysis, the device provides control of the parameters of the dialysis solution (for example, temperature, concentration, etc.) and its rate of leakage from the patient’s abdomen. For this, it includes: block 46 for controlling bactericidal purification (BKBO), blocks 13 and 14 for controlling parameters of the dialysis solution (BKP), block 41 for controlling the stability of the solution (BKSR), block 42 for controlling the speed (BKS) of the influx of the solution into block 16.

 If the quality of bactericidal purification of the dialysis solution has sharply decreased (extinction of bactericidal lamps), then an output is generated at the output of block 46, by which the controller 21 turns on the alarm block 44.

 At the output of blocks 13 and 14, a signal is formed that characterizes the temperature and conductivity of the solution. If the parameters are within safe limits for the patient, then these parameters are corrected to ensure the optimal dialysis regimen. If at least one of the parameters is outside the established tolerances, block 44 is turned on through controller 21.

 Block 41 was introduced to control the stability of the spent solution. The stability criterion for the solution, for example, can be its transparency. If there is excessive turbidity of the solution, then the signal from the output 41 through the controller includes a block 44.

 Block 42 is used to measure the rate of flow of the solution into the capacity of the block 16. Changes in the speed of the solution can be caused, for example, by narrowing of the catheter opening or by a variation in the diameters of the holes in various catheters.

 In this case, the signal 42 in the controller sets the amount of correction to the delay time to turn on the units of the hydrostatic system. If this is not foreseen, then as a result of the difference in the rate of inflow into the abdomen and outflow of the solution from the patient’s abdomen, the volume of the solution located in the abdominal cavity will accumulatively increase or decrease.

Claims (4)

 1. A DEVICE FOR PERITONAL DIALYSIS, containing purified water tanks with level sensors, salt concentrate and glucose, equipped with valves with control units, component dosing units connected to containers, dialysis continuity ensuring unit, heating units, solution sterilization units, solution temperature and electrical conductivity control units, dialysis fluid supply and removal dispensers made in the form of flexible containers with limit switches, the first of which is located above and the second is below the dialy of zerous solution, characterized in that the device is additionally equipped with a controller, setter, control panel with a unit for setting time and volume, a block of dialysis and washing programs from formalin, a control system for the removed solution containing a dialysis quality sensor and a unit for recording the time of filling and removing the solution, additional with a solenoid valve, a tee, and the unit for ensuring dialysis continuity is combined with the dispenser, the heating unit is installed in the tank of purified water and is equipped with a unit temperature control, dispensers for supply and removal of execution in the form of containers transparent to the light flux, each of which is located on a fixed plate with a first limit switch mounted in it and has a sensor on its upper wall, and movable plates, each of which is located above the container and has a second limit switch is mounted, wherein the first and second limit switches and the sensor of each dispenser are aligned, an additional container is placed between the feed dispenser and the removal dispenser i, the outlet of the purified water tank and the outputs of the component dosing units are connected by a tee to the input of the sterilization unit, the temperature and electrical conductivity control units are located at the outlet of the feed dispenser, dialysis quality sensor, unit for fixing the time of filling and removing the solution, block of dialysis and formalin washing programs, end switches and a solenoid valve are connected to the controller.  2. The device according to claim 1, characterized in that the limit switches are made in the form of reed switches, and the dispenser sensors are in the form of magnetic plates.  3. The device according to claims 1 and 2, characterized in that it is equipped with an accelerated drain unit installed at the output of the additional tank.  4. The device according to claims 1 to 3, characterized in that the dialysis quality sensor is made in the form of a photomodule connected to a controller and mounted on a solution removal tank.

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