The present invention relates to an apparatus for treating the blood and a method for initializing the same apparatus.
More precisely, the invention relates to extracorporeal treatments involving the removal of CO2.
The aforementioned treatment, like any extracorporeal treatment, necessarily involves an access to the patient through a blood vessel of appropriate size. In the case of the present invention the treatment is of the veno-venous type; the access is practiced by inserting a catheter into a vein such as, for example, the femoral vein, the jugular vein, the carotid vein or others at the discretion of the doctor.
For a generic CO2 removal treatment, blood is drawn from the vein by means of a catheter, usually two-way type. Thanks to the action of a pump (generally a peristaltic or a centrifugal pump) the blood is pushed into tubes that convey it to a medical device, called oxygenator, which provides to the gas exchange by extracting the CO2 and administering O2 thanks to a partial pressure difference through a gas-permeable membrane (generally in Polypropylene or in Polymethylpentene).
Examples of oxygenators are described in U.S. Pat. No. 6,117,390 and EP-0005866. These documents show examples of embodiment of oxygenator devices which comprise a housing provided with inlet and outlet openings for oxygen and blood and a bundle of hollow fibers, which are arranged inside the housing and allow the exchange of O2 and CO2. EP-0005866 describes an example of an oxygenator of compact dimensions; U.S. Pat. No. 6,117,390 describes an oxygenator connectable to the patient by means of a venous/arterial connection.
In an extracorporeal treatment, after passing through the oxygenator, the blood is returned to the patient through the same two-way catheter by which it was taken. The circuit, that is, the set consisting of catheter, tubes, active components (such as the oxygenator or others) is completed by accessories such as pressure sensors, flow meters, air bubble sensors, drippers, debuggers, accesses for blood collection and for the administration of drugs, anticoagulants etc., using components known to specialists in the field which for greater clarity and brevity will be omitted in the description of the present invention considering the various components as present where appropriate.
The effectiveness of gas exchange is proportional to the surface of the gas-permeable membrane, (generally expressed in square meters) and to the flow of blood that passes through it, generally expressed in ml/min (milliliters per minute). The higher the flow and the greater the exchange surface, the more effective the extraction of CO2.
It follows that, limited to the need to insert a catheter into the vein that is as small as possible to achieve the desired effect and to minimize the invasiveness of the therapy, it is the objective of this treatment, commonly called ECCO2R (Extra Corporeal CO2 Remover) to obtain the highest possible blood flow inside the oxygenator.
In the present description the term flow or flux is used to indicate the quantity of fluid (i.e. the volume of blood) passing through a section of the duct or in the device in which it moves in the unit of time.
Object of the present invention is to make this extracorporeal treatment more efficient allowing, for the same blood flow taken (and therefore returned) to the patient, to make a significantly greater flow circulate through the oxygenator, thus obtaining a better treatment efficiency and other advantages that will be described later.
It will therefore be possible to regulate the blood flow that will be withdrawn (and returned) to the patient and, at the same time, to circulate a higher blood flow in the oxygenator which, as described below, is the sum of the flow taken from the patient and the recirculated flow.
With reference to
The circuit of the present invention offers numerous advantages, among which the ones described below can be mentioned.
1) It allows, with the same flow rate taken by the patient, to subject a significantly greater flow to the action of the oxygenator (with consequent greater efficiency of CO2 extraction).
2) It allows, thanks to the greater blood flow in the oxygenator, to use an oxygenator of greater surface (and therefore greater efficiency) without the risk that the excessive slowing of the blood flow in a large surface oxygenator may give rise to stagnation, to creating preferential routes and greater risk of clots.
3) It also allows, independently of the amount of blood flow in the oxygenator, to accurately dose out the blood flow taken (and returned) to the patient.
4) In the case in which, as in the preferred solution in the present invention, the necessary air flow inside the oxygenator is sucked by a pump downstream of the gas circuit of the same oxygenator rather than pushed by a pump upstream or by a connection to a pressure regulator (from a cylinder or a distribution network as found in many hospitals), a negative pressure will be obtained in the gas compartment of the oxygenator. This solution, in addition to avoiding the risk of introducing bubbles in the blood circuit, allows the oxygenator to perform the function of eliminating the bubbles since any gas present in bubbles in the blood circuit is trapped by the fibers of the oxygenator and eliminated from the negative pressure present inside the oxygenator itself. In this case, thanks to the circuit object of the present invention it is also possible to automatically eliminate any bubbles with the method described in the following point 5).
5) Thanks to the conformation of the recirculation circuit, if air bubbles are detected in the blood flow before returning to the patient, in the section of the circuit downstream of the oxygenator and upstream of the connection where the relative sensor will be positioned, it is possible automatically eliminating the bubbles themselves by interrupting the flow to the patient in the section of the circuit indicated with (C4) in the enclosed drawings thanks to a clamp positioned there, and making the blood circulate with the bubbles through the oxygenator.
The case of air bubbles in the blood flow is currently the type of alarm whose solution requires the greatest skill to the operator and often leads to the complete replacement of the circuit with obvious economic damage, loss of time and waste of the patient's blood present in the circuit to be replaced.
6) In the case of temporary interruption of the treatment, for example for the cleaning of the catheter, it allows to keep in circulation the blood inside the oxygenator thus avoiding the risk of clots, simply blocking the flow of blood towards the patient and circulating blood only in the “loop” and in the oxygenator.
7) A further advantage relates to the methods of detecting the flow rate value within the circuit of the present apparatus, a value which, as described below, can be determined simply by measuring the pressure, thus eliminating flow meters (flux-meters) or similar sensors that generally determine a haemolysis and that usually significantly increase production costs.
Further objects and advantages of the present invention will be more evident from the following description, which refers to the attached drawings which constitute a non-limiting embodiment and in which:
An apparatus (100) according to the invention can be used for extracorporeal blood treatment with veno-venous access and is of the type comprising:
The apparatus (100), which is provided with means of veno-venous connection to the patient, is characterized in that:
As previously expressed, the apparatus is provided with a volumetric peristaltic pump (P) arranged on the high speed portion (C1): for this reason the blood flow is determined by the rotation of the pump (P).
In the present description the definitions “upstream” and “downstream” refer to the path followed by the blood in the apparatus (100). The arrows indicate the direction followed by the blood in the apparatus (100).
In the present description, the high-speed portion (C1) is also called main portion (C1); the recirculation circuit (C2) is also called secondary portion (C2).
The inlet (C3) and outlet (C4) branches are preferably supported by a single double lumen venous catheter.
In particular, the aforementioned at least one means of measuring the flow (PA; PR) can advantageously be a pressure meter suitable for measuring the pressure value within the branch (C3; C4) on which it is acting. In practice, as will be better described below, with the present apparatus it is possible to obtain the value of the blood flow in the circuit by measuring its pressure. Pressure measurement with non-hemolytic instruments significantly improves the impact of the apparatus on the patient's blood. For this purpose, known type of pressure meters and therefore not described in detail can be used.
As in the example of
Also in this case, the flow measuring means (PP) can advantageously be a pressure meter suitable for measuring the pressure value within the branch (C1) on which it is acting.
The detection of the flow measurement means (PP), in the version in which they are pressure measurers, can be used to limit the flow rate of the pump (P) so that the value of the detected pressure remains below a preset maximum pressure value; the variation over time of this measured value, with the same pump flow rate (P), will provide valid indications on the fluidity of the blood during treatment and on the possible need to change the amount of anticoagulant.
Advantageously, the first flow value (that is the value of the blood flow in branches C3 and C4 which, respectively, draw blood from the patient and return it to the same patient) can be between 0 (zero) and 500 ml/min and the flow value in the main portion (C1) can be between 0 (zero) and 2000 ml/min. In practice, in the recirculation circuit (C2) the flow will be equal to the difference between the flow of the high speed portion (C1) and the flow in the branches (C3, C4) for the blood collection and return to the patient.
The apparatus can comprise a means for closing the blood flow (K) (or clamp), arranged downstream of said second fitting (R2) and upstream of said outlet (R). Furthermore, it can comprise at least one means for detecting the presence of air bubbles in the blood (BD1, BD2) able to activate said means for closing the flow (K) in correspondence of the detection of bubbles in the circuit.
In practice, the apparatus (100), in the preferred form illustrated in
In the example of
Advantageously, the present apparatus can comprise an air suction pump (H) connected to the oxygenator (OX) at a gas outlet (42) of the latter so that the flow of gas determined inside the oxygenator (OX) consists of a downstream suction with negative pressure in the gas compartment of the oxygenator. In the drawings, the oxygenator (OX) is provided with a gas inlet (41), a gas outlet (42) on which the air/oxygen pump (H) acts, as well as a blood inlet (43) and a blood outlet (44). Furthermore, with the rectangular block (FM) an air flow meter is schematically represented and a triangular block (CO2) represents a sensor of the CO2 extracted from the blood. The air flow meter (FM) and the sensor (CO2) are appropriately connected to the control and command means of the equipment.
The oxygenator (OX) can be of the gas-permeable membrane type (for example in Polypropylene or in Polymethylpentene) with an exchange surface of between 0.4 m2 (for pediatric use) up to 1.5 m2 and more (for high efficiencies). The characteristics and component parts of the oxygenator are not described in detail since they are of a type known to technicians in the sector.
With the apparatus in operation, the blood taken from the patient by the access (A) is introduced into a ring circuit composed of the high-speed portion (C1) and the recirculation circuit (C2), connected to each other at the two fittings (R1) and (R2) that define the connections with the inlet (A) and the outlet (R), i.e. with the two-lumen catheter connected to the patient.
The flow regulation means (FD) can advantageously be constituted by a clamp regulated by a servomotor controlled by the central unit (UC) capable of reducing and possibly blocking the flow of blood in the section of conduct subjected to its action. In other words, the servomotor of the flow regulation means (FD) under command of the central unit (UC) determines the opening of the secondary portion (C2), with an activation of the clamp of the means (FD) which can advantageously be variable and gradual.
The flow regulation means (FD) are shaped so as to determine in the main portion (C1) a flow of maximum value, the value of this flow being equal to the sum of the first flow value (which is the flow with which the blood is taken from the patient and returned to the patient himself) and of the second flow value (which is the flow determined by the regulator FD in the secondary portion C2). In particular, the said maximum flow value maintained in the high speed portion (C1) corresponds to the flow determined by the pump flow rate (P).
In practice, the flow of blood taken (and returned) to the patient is determined by the value of the flow exerted by the pump (P) reduced by the part related to the flow regulator (FD). In the oxygenator (OX) passes a blood flow determined by the flow rate of the pump (P), a flow that would not be feasible with a known type of device in which the oxygenator must be traversed by the same blood collection/return flow.
In other words, the flow value in the portion (C2) (or second value) is equal to the difference between the maximum flow value generated by the pump (P) and the first flow value taken and returned to the patient, as well as the value of maximum flow in the high speed portion (C1) is equal to the sum of the flow withdrawn (and returned) to the patient (first value) and of the flow circulating in the secondary portion (C2), i.e. to the value of the flow generated by the single pump (P) and subjected to the action of the regulator (FD).
As an example and coherently with the example shown in
Referring again to the illustrated examples, the apparatus of the invention comprises a blood circuit which is suitably connected to a patient to take the blood to be treated and return the treated blood. In the drawings it is marked with (A) the entrance of the blood to be treated and with (R) the downstream exit that returns to the patient the blood that has been treated. The two accesses (A) and (R), as previously mentioned, may consist of a double lumen catheter.
This solution advantageously allows to carry out the invention thanks to a single blood pump with evident economic advantages and of treatment quality thanks to the greater efficiency in the removal of CO2, to the lower formation of coagula inside the oxygenator and, thanks to the circulation of gas in depression inside the oxygenator, also the automatic elimination of air bubbles possibly present inside the blood circuit.
The operation of the equipment object of the invention is particularly effective also on the basis of the initialization method that will be described below. In particular, it is extremely advantageous to measure the pressure instead of the flow rate compared to apparatuses of the known type.
For example, in apparatuses of the known type, i.e. in the case of circuits that use centrifugal pumps (or in any case non-volumetric pumps) it is necessary to use a flow meter since the operating speed of the pump cannot be linearly correlated with the flow rate that it generates since this flow rate is a function not only of the pump speed, but also of the resistances that the generated flow encounters.
In the present invention, with the use of a volumetric (peristaltic) pump, the flow meter is not necessary since the flow rate of the pump according to the operating speed is always known with sufficient precision. In other words, the speed of the pump substantially determines the value of the blood flow in the circuit.
The preferred version of the present invention, however, needs to know the data relating to the flow rate since the same, although known since it is generated by a volumetric pump, is subdivided into several portions of circuit of which at least that which comprises the withdrawal branches and/or of blood return to the patient needs a flow control.
In the present invention, we can advantageously use at least one of the pressure sensors (PA, PR) to correctly deduce the flow and therefore the flow rate in the concerned section of circuit.
A possible initialization method, schematically illustrated in
a) Closure of the recirculation circuit (C2); in this phase the flow regulator (FD), i.e. the relative servomotor which regulates the circuit opening value (C2) and which can completely obstruct the same recirculation circuit, is completely closed thus interrupting the recirculation; in other words, the connection from the fitting (R2) to the fitting (R1) is interrupted, with a situation that can be schematically represented by the drawing in
b) Pump activation (P); in this phase the volumetric pump (P) is activated, which starts from zero and, gradually increasing its flow rate, reaches a value of maximum pre-set pressure or test value that is detected by the pressure sensor (PA) and/or (PR), as schematically represented in
c) Memorization of the measured pressure values and their combination with the corresponding flow values; during this operation the electronic circuit, which is represented schematically by the block UC, records and stores the correspondence of values between the flow rate (which is determined by the speed of the pump P) and the pressure relative to the flow rate itself, detected by the sensor (PA) and/or (PR). It can therefore be established that for each pressure value there is a specific flow (if there are no variations on the circuit).
d) Gradual increase in pump speed up to a maximum working pressure value; in this phase the speed of the pump (P) is gradually increased up to its maximum value and therefore its flow rate (corresponding to about 2.000 ml/min) while the flow regulator valve (FD) is gradually opened (this situation is schematically represented by the secondary portion C2 which in
In this way it is possible not to use a flowmeter, which having to be non-haemolytic generally works with Doppler effect or taking advantage of the Coriolis acceleration and usually has a considerable cost.
e) Repetition of phases a) to d) at determined intervals. Given the possibility that changes occur on the characteristics of the circuit (changes in the fluidity of the blood, partial obstructions of the catheter, etc.) the calibration of the pump/pressure sensor assembly will be repeated at predetermined intervals (for example every 5 min.)
The pressure sensor (PP) upstream of the oxygenator will limit the maximum speed of the pump (P) when the read pressure value reaches a preset alarm value.
Furthermore, when at the same speed of the pump (P) the sensor (PP) will detect a tendency to increase the pressure, it will provide an alarm signal to the operator relative to the fact that the fluidity of the blood is decreasing and that it could be it is appropriate to increase the administration of anticoagulant.
In practice, the continuous feedback between the pressure sensors (PA, PR), the regulation of the pump flow (P) and the opening of the regulator valve (FD) make the system very automated, reducing the need for manual interventions and for at the same time they allow to reach high efficiencies of CO2 removal in total safety and with reduced invasiveness.
Naturally, the invention is not limited to what has been described and illustrated, but can be widely varied as regards the arrangement and the nature of the components used without thereby abandoning the inventive teaching set forth above and claimed below.
Number | Date | Country | Kind |
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102018000006973 | Jul 2018 | IT | national |
Filing Document | Filing Date | Country | Kind |
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PCT/IT2019/050158 | 7/2/2019 | WO | 00 |