Patients with acute or chronic renal failure suffer from the effects of natural toxins in the blood and/or fluid overload. Renal replacement therapy for these patients involves extracorporeal blood treatment, such as dialysis to remove the toxins or ultrafiltration to remove excess fluids. In the various forms of renal replacement therapy, a hemofilter or dialyzer is used which contains a plurality of semi-permeable hollow membrane filter fibers dividing the unit into flow channels. Blood is pumped across one side of the membrane and a dialysis solution across the other side (in the case of dialysis), or blood is pumped across one side of the membrane and excess fluid passes across to the other side (in the case of ultrafiltration). Impurities and/or excess fluid pass through the walls of the membrane by diffusion, convection, and or a combination of these processes. Other blood fluids or fluids containing blood components may be passed along a membrane as well, for example, as described in U.S. Pat. No. 7,588,550 to Leonard, et al (currently publication US2008/0009780), which is hereby incorporated by reference in the regular patent application and attached to this application as an appendix in the provisional stage.
Conventional dialyzers use a large number of microfibers in a chamber that carries the blood, or other blood fluid or fluids. Thousands of hollow semipermeable filter fibers convey blood or other blood fluid or fluids between end caps on the chamber, each of which is accessed with a port. There are one or more other ports for conveying dialysate through the chamber or filtrate may simply be drawn from the chamber, depending on the treatment.
In medical treatment devices such as dialysis machines, blood or blood fluid is conveyed through tubes and filters having various blood channels whose shapes and sizes vary with various flow characteristics. It is believed that blood should not remain stagnant for periods of time in such systems, so generally they are designed to keep blood moving and prevent blood from pooling. However, some parts of blood systems pose particular challenges, for example the transitions in the headers of dialyzers and hemofilters, for example, where stagnant zones are hard to avoid. Conditions such as the materials of which blood conveying systems are made and other factors are also believed play a role in blood coagulation in artificial blood channels.
To prevent blood from coagulating, anticoagulants such as heparin are used. The use of such agents is disfavored and there is a need in the art for improved ways of designing blood conveying devices which help to reduce coagulation and thereby provide the potential to reduce the need for anticoagulants.
A risk of thrombogenesis is minimized in a tubular fiber membrane filter by flowing blood or other fluid through a header manifold that ensures a minimum shear rate on the wetted surfaces without flow reversal, stagnation volumes, or a shear rate that is too high. In an embodiment, fluid is conveyed into a header space and into a manifold face at a perimeter of the header space. The header space has a progressively decreasing clearance that is minimal to provide for substantial shear rate and decreasing toward a minimum clearance in a region that is remote from the perimeter and vented by openings to the microtubular membrane fibers. Other features and embodiments are described.
These and other features and advantages of the disclosed embodiments are described in or are apparent from the following detailed description of structures, apparatus, systems, and method.
Various exemplary embodiments of this invention will be described in detail, with reference to the following figures, wherein:
Throughout the Figures, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components or portions of the illustrated embodiments. Moreover, while the disclosed subject matter will now be described in detail with reference to the Figures, it is done so in connection with the illustrative embodiments.
Referring to
Blood entering the inlet port 114 may circulate around a perimeter of a plenum 124 so that the blood may be conveyed uniformly about the perimeter of the plenum 124 and thereby flow toward the center of the plenum 124 as indicated by arrow 112. The space is defined between a cone shaped face 108 and the header face 102. Arrow 112 showing only an infinitesimal “spoke” of the entire radial flow which surrounds the space. The plenum 124 may be tapered by the cone shaped face 108 that intrudes into the plenum 124. The tapering of the spaced may help to force blood equally among the microtubular fiber filters 130 as indicated by arrow 110. Arrow 110 illustrates a downward flow through one of many fibers entering the fiber through the header face 102. The flow 104 around the plenum 124 may begin as a tangential flow which is directed in a circular flow 106 by a suitably shaped circumferential channel that opens to the plenum 124 along a side thereof. The flow may also simply open to the plenum 124 and be directed by a perimeter wall partly defining radial boundary of the plenum 124. The channel or perimeter boundary of the plenum 124 is not shown in
Note that the illustrations in the current application have exaggerated features, such as a perimeter plenum and header clearance and in actual embodiments, the variation in header clearance may be substantially less.
Referring now to
In the above and other embodiments, the shape of the header may be determined by any suitable mechanism to ensure as uniform, and limited in a target range, a shear rate distribution across all wetted surfaces as possible. This may be accomplished by computationally by an optimization scheme using assumed constraints or by experimental trial and error or by any other suitable means. One mechanism based on trial and error may employ real blood or other fluid susceptible to coagulation or thrombogenesis. The fluid may be pumped through various headers for a period of time and the various header designs scored based on the associated incidence of the undesired effects of thrombosis, flow stagnation, and/or other effects.
The result of optimization, no matter how wide in scope, may he a variety of different header shapes. For example, as shown in
Although the discussion herein is mostly concerned with inlet header, the embodiments also include the designs for outlet headers as well. That is, non-thrombogenic outlet header configuration may be obtained by optimizing for a target shear rate with minimal variation across all wetted surfaces. The above features are combined with the feature of a minimum flow such as at a point of minimum clearance height occupies a minimum total area, for example, located at a point (e.g., 170A and 170B) rather than along a blind perimeter 184 as in typical prior art dialyzer headers as shown in
Referring now to
Note that in variations of the foregoing and further embodiments, a plenum may be formed which has tapering provided by other configurations, including opposing conical faces (e.g., the header face may be conical). The tapering may correspond to a different shape from a cone also, for example, the face or faces defining the plenum may be curvilinear surfaces such as spheroidal shapes or complex shapes with multiple bulges including minimum heights that are not central but offset from the center (See
One of the functions of the inward-radial flow is to provide non-zero flow over all parts of the header face. In prior art devices where flow is generally radially outward, a larger perimeter of the plenum space is, essentially, a blind end of a channel. As such, the flow to a large area may be stagnant. In the present system, substantially all portions of the flow may be non-zero and substantial and perhaps only a vanishingly small area, if at all, of the header face in the middle may be associated with a near zero flow condition. Also, the height of the header space is varied to ensure that fluid moves with a minimum shear rate over all, or substantially all, wetted surfaces and the channel height combined with the effective channel trajectory may simultaneously ensure the minimum shear rate. For example, a suitable and practicable minimum may be in the range of about 250 sec−1. Note that any minimum shear rate areas can be reduced to a small area by providing that the minimum height coincides with an area of the manifold surface to permit blood to escape and a flow toward that small area. In any of the present embodiments, the rate of flow may be varied deliberately to take advantage of momentum effects that can move the point or points of minimum shear rate. In such embodiments, the pump may be regularly pulsed or varied in speed to cause the shear rate pattern to shift such that all wetted surfaces, even areas of minimum shear rate at one time, experience an elevated shear rate at other times (i.e., other times of a flow rate variation cycle).
Any of the embodiments disclosed herein can be modified by the inclusion or replacement of a portion of a wetted wall by a flexible membrane 658 as illustrated in
Referring now to
Referring now to
Note also that although the disclosed embodiments have focused on blood applications, the features of the disclosed embodiments may be applied to other types of fluids in applications other than medical treatments. The benefits of the disclosed embodiments include a design that is compatible with maintaining a minimum shear rate at all points in a flow and concomitantly in which no stagnant regions of flow may occur. Fluid outlets in a plenum space may be channels other than filter fibers in such applications. There are evident benefits for application to shear-thinning fluids.
Note that a blood fluid, such as plasma, conveyed through an extracorporeal blood circuit may cause activation of the blood when the conveyed blood fluid comes into contact with the blood. Thus coagulation does not need to occur in the extracorporeal circuit itself to present a problem. In any of the foregoing embodiments, a blood fluid or any fluid that may be altered so as to create a risk of coagulation in some fashion by flowing through an artificial fluid circuit, or any fluid that comes in contact with blood with may be so altered or any shear-thinning fluid may be usefully conveyed through the disclosed system.
In a method, blood plasma is removed from a patient by means of a membraneless separation device. The plasma is ultrafiltered in a dialyzer or hemofilter using a caps according to any of the embodiments described herein. The plasma is returned to the membraneless channel.
In another method, conventional dialysis, hemofiltration, hemodiafiltration, or other blood treatment such as apheresis or oxygenation is performed using a filter having at least an inlet cap configured according to any of the embodiments described above.
Although the disclosed subject matter has been described with preferred embodiments, it is to be understood that modifications and variations may be resorted to, without departing from the spirit and scope of this invention, as those skilled in the art will readily understand. Such modifications and variations are considered to be within the purview and scope of the disclosed subject matter.
Flow separation, in which fluids detach from boundary layers and rotate in eddies and vortices, and effectively becomes stagnant, are believed to be a stimulus to clot formation. Computational fluid dynamics (CFD) may be used to optimize the end-cap regions of the filter or dialyzer according to embodiments of the disclosed subject matter. According to a model of the end cap, the end cap region receives flowing blood plasma or blood which suddenly encounters a resistive “wall” with, for example, thousands of fiber openings. According to the model, the pressure drop may be constant along each fiber and large compared to any pressure fluctuations in the end cap. The optimization goal may be defined as to achieve approximately uniform shear rate (that is, shear within a predefined range) conditions over the end-cap wetted surfaces (or most of the surfaces) and prevent separated flows anywhere in the fluid volume of each end-cap. According to a method, an end-cap and its inlet according to the disclosed embodiments is optimized using CFD software to predict areas of separated flow and, ultimately, thrombosis and the dimensions of the end cap and inlet are modified to approach the optimum configuration.
In a typical dialyzer used in hemodialysis treatments, unfiltered plasma is pumped into tubular membrane fibers through an end-cap that forms a header space distributing. As it approaches the fiber bundle face, it encounters a resistive wall of fibers. Dialysate enters flows concurrently into the dialyzer body and removes waste and excess water from plasma via concentration gradients. Filtered plasma is then re-circulated.
Suitable software packages for CFD include Star-CCM+ v. 3.02.11 by CD-Adapco® and SolidWorks 2009 Student Edition by Dassault Systèmes SolidWorks Corp. SolidWorks is a computer-aided design (CAD) package that allows the user to effectively render a three-dimensional representation of a conceptual model. This model can then be imported into StarCCM+, the CFD package used for numerical simulations. Star-CCM+ simulates flow problems by solving one or more of three conservation equations simultaneously in order to generate a numerical solution. Each equation has the form:
where ρ is fluid density, Γφ is the diffusive flux term, u is the velocity vector, dA is the differential area vector, and dV is the control volume. φ is a variable that takes on the value 1) unity in the continuity equation, 2) {right arrow over (u)}u, v, w in the momentum equation, and 3) e in the heat equation. The four terms in the equation represent, respectively, the rate of change of the quantity in the control volume, due to convective flux, diffusive flux, and volumetric source. Equation [1] can thus be expressed in any of these forms which are then employed simultaneously to solve problems involving heat, momentum, and mass transfer. In the work reported here, only the continuity and momentum forms were employed.
To solve these equations, the package transforms the model into a system of discrete equations. Each discretized equation is then solved iteratively using the semi-implicit method for pressure linked equations (SIMPLE) algorithm, in which initial values are assigned to variables, then continuously re-calculated for small time intervals dt until a desired tolerance and convergence is reached.
A
CφC+ΣKAKφK=QC [2]
where Q is the final scalar calculated, c is the center cell, and k is a neighboring cell.
Once a CAD model is imported into Star-CCM+, both the surface and volume may be meshed. Meshing may accomplish two goals: it may reveal errors in the geometry that may have been generated during CAD drawing, and it may increase the accuracy of the final solution by discretizing the geometry into increments as small as desired. Specifically, surface meshing may allow for precise calculations at the boundaries of the 3D model, while volume meshing allows for precise calculations throughout the body of the model. Because the size of the models considered in this work measure several centimeters, a mesh base size is specified, or length of an edge of a mesh element, that ranges from 0.5 mm to 1 mm. With the Star-CCM+ feature of ‘target mesh size,’ this specification leads to a finalized mesh size of approximately 0.075 mm. For a 1 mm3 cube, this specification yields approximately 2370 volume mesh elements and 1066 surface mesh elements.
After a mesh has been successfully completed, the flow conditions may be specified to define the problem. For an ultrafilter with blood plasma as the fluid, the following conditions may be taken:
1) Laminar flow
2) Steady-state operation
3) Constant fluid density: 1025 kg/m3
4) Constant fluid viscosity: 8.89E-3 Pascal-seconds
5) Three-dimensional flow
6) Segregated flow
The surface geometry of the end-cap CAD model was partitioned into three regions: wall region, inlet surface, and outlet surface. At the inlet, a mass flow rate of 5.125E-4 kg/s is specified, which is calculated by converting the volumetric flow rate of 30 cm3/min using the plasma density of 1025 kg/m3. For the wall region, a no-slip condition may be specified; this wall region is effectively the entire wetted area of the end-cap, and excludes the exterior portions of the actual end-cap. Within the end-cap, there is an inwardly protruding dimple which has a desired effect of forcing the incoming plasma flow toward the fibers. Finally, the outlet is taken as the plane where the cap meets the dialyzer fibers, with an outlet flow rate of 5.125E-4 kg/s. Through previous trial runs, it was determined that a practical method of correctly representing several thousand fiber openings is to partition the outlet into segments (1 through 9) as illustrated in
A pinched entry point as shown in
A few embodiments are shown in
Referring to
In all of the above embodiments, the shear rate at the wetted surfaces of the head space may be between 100 sec−1 and 2000 sec−1. In all of the above embodiments, the shear rate at the wetted surfaces of the head space may be between 200 sec−1 and 2000 sec−1. In all of the above embodiments, the shear rate at the wetted surfaces of the head space may be between 400 sec−1 and 2000 sec−1. These minimum shear rates are particularly challenging to achieve in the context of very low flow rates as for example in long term plasma or blood cleansing system, such as low flow rate wearable systems. Examples of low flow rate systems are ones where the flow of fluid through the membrane filter are less than about 100 cc/min or below. Systems may also exist with flow rates of less than about 50 cc/min. Systems may also exist with flow rates of 10 cc/min or less. For example, a wearable system (running continuously to treat end stage renal failure) which separates plasma from whole blood and flows only the plasma through the membrane filter may have rates lower than 50 cc/min or even less than 10 cc/min of plasma through the membrane filter. Systems conforming to the description of
The foregoing merely illustrates the principles and examples of the disclosed subject matter. Various modifications and alterations to the described embodiments will be apparent to those skilled in the art in view of the teachings herein. It will thus be appreciated that those skilled in the art will be able to devise numerous systems and methods which, although not explicitly shown or described herein, embody the principles of the disclosed subject matter and are thus within the spirit and scope of the present invention.
The present application claims the benefit of U.S. Provisional Application Nos. 61/242,322, filed on Sep. 14, 2009; 61/242,861, filed on Sep. 16, 2009; and 61/301,127, filed on Feb. 3, 2010, the contents of which are incorporated herein by reference in their entireties.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US10/48788 | 9/14/2010 | WO | 00 | 6/6/2012 |
Number | Date | Country | |
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61242322 | Sep 2009 | US | |
61242861 | Sep 2009 | US | |
61301127 | Feb 2010 | US |