METHOD FOR PRIMING AN EXTRACORPOREAL BLOOD CIRCUIT OF AN APPARATUS FOR EXTRACORPOREAL TREATMENT OF BLOOD AND APPARATUS FOR EXTRACORPOREAL TREATMENT OF BLOOD

Abstract

A method for priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood comprises: feeding a priming fluid in the extracorporeal blood circuit and into a blood side of a membrane gas exchanger (18); generating a transitory pressurization step or a plurality of transitory pressurization steps in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger (18).

Description

The invention relates to a method for priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood and an apparatus for extracorporeal treatment of blood configured to implement such method, in particular an apparatus provided with a membrane gas exchanger for the purpose of oxygenation and/or CO₂ removal.

In the field of blood extracorporeal blood treatments and therapies, membrane gas exchangers are used for the purpose of ExtraCorporeal Membrane Oxygenation (ECMO) and/or ExtraCorporeal CO₂ Removal (ECCO₂R). While originally used in dedicated systems, development of ExtraCorporeal CO₂ Removal has recently led to the introduction of membrane gas exchangers in dialysis systems for Continuous Renal Replacement Therapy (CRRT). The CRRT systems can deliver ECCO₂R therapy (stand-alone ECCO₂R), as well as CRRT and ECCO₂R combined in the same blood circuit or other therapy combinations, e.g. liver support and ECCO₂R.

In an haemodialysis treatment a patient's blood and a treatment liquid approximately isotonic with blood flow are circulated in a respective compartment of haemodialyser, so that, impurities and undesired substances present in the blood (urea, creatinine, etc.) may migrate by diffusive transfer from the blood into the treatment liquid. The ion concentration of the treatment liquid is chosen to correct the ion concentration of the patient's blood. In a treatment by haemodiafiltration, a convective transfer by ultrafiltration, resulting from a positive pressure difference created between the blood side and the treatment-liquid side of the membrane of a haemodiafilter, is added to the diffusive transfer obtained by dialysis.

Before performing an extracorporeal blood treatment, the extracorporeal blood circuit of the apparatus is primed, making a priming solution, e.g. saline, flow through the blood lines. The purpose of priming the extracorporeal blood circuit is to remove air from the blood lines, the membrane gas exchanger and the dialyzer as well as to remove possible fragments of remaining sterilizing agents or other residuals from the disposables elements before connecting a patient.

Because of their membrane properties, membrane gas exchangers require specific precautions during and after priming to prevent air intake through the membrane and formation of bubbles during the following blood treatment. For instance, it is known to position the gas exchanger device below the end of the return line during priming and to position the gas exchanger device below the patient during treatment in order to keep the circuit pressure above atmospheric pressure.

This way, the membrane gas exchanger cannot be freely positioned and the low location of said gas exchanger is not convenient for the user who has to bend for setting the gas exchanger on its holder and cannot see it when working on the user interface of the apparatus.

Document US2006167400A1 describes a blood perfusion system used in cardiopulmonary bypass procedures. The system comprises a combined oxygenator and heat exchanger. The oxygenator has an oxygenator vent tubing line from the oxygenator to a venous reservoir. The vent tubing line passes through a vent valve which is automatically opened during priming to remove air from the oxygenator. This document discloses that, by pressurizing the priming solution, coming from bags, in the oxygenator to a predetermined value, leaks in the oxygenator membrane can be detected with a liquid leak detector as fluid would transverse a leaky oxygenator membrane at a predetermined pressure.

Document EP1372759B1 describes a system for preparing and delivering gas-enriched blood. In a prime mode, the system fills a fluid supply chamber with physiologic solution and drives a piston assembly to pressurize the solution and transfer it into an atomizer chamber until appropriate level of fluid is reached. The system includes a bubble detector that interfaces with a bubble sensor to monitor the oxygen-enriched blood in a return tube for bubbles.

Document WO2017190718A1 describes an oxygenator circuit (with oxygenator, blood pump) provided with a venting device set comprising a priming liquid container, a priming compressor and a venting unit. The circuit is filled with priming liquid from the priming liquid container and the oxygenator is vented. Sensor checks whether it detects air bubbles in the priming circuit. If air bubbles are detected, the blood pump runs in pulsatile mode to deliver residual air into the oxygenator, from which the residual air can escape.

The above described prior art documents do not prevent formation of bubbles during and after priming but eliminate air from the oxygenator or from the blood lines through vent devices and/or bubble sensors. It is therefore an object of the present invention to provide a method for priming an extracorporeal blood circuit and an apparatus for extracorporeal treatment of blood configured to reliably prevent formation of bubbles in the blood circuit due to the presence of the membrane gas exchanger.

In particular, it is an object to prevent formation of bubbles due to the presence of the membrane gas exchanger at least during priming and possibly after priming, during patient treatment.

Additionally, it is an object providing a method and an apparatus configured to prevent bubble formation which do not require any additional and peculiar component/device. Another auxiliary object is to provide a method and an apparatus allowing a free and optionally user friendly positioning of the membrane gas exchanger. A further auxiliary object is to provide a priming method which may be fully automated and may not require any user intervention.

SUMMARY

At least one of the above objects is substantially reached by a method for priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood and by an apparatus for extracorporeal treatment of blood according to one or more of the appended claims. Apparatus and method according to aspects of the invention and capable of achieving one or more of the above objects are here below described.

A 1st aspect concerns a method for priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises:

• • optionally, a blood treatment unit;
  • an extracorporeal blood circuit, optionally coupled to the blood treatment unit;
  • a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit;
  • a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger comprises a blood side in fluid communication with the blood circuit and a gas side;

wherein the method comprises:

• • feeding a priming fluid in the extracorporeal blood circuit and into the blood side of the membrane gas exchanger;
  • generating a transitory pressurization step in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger to prevent release of air bubbles at a blood outlet of the membrane gas exchanger.

The effect of the pressurization step (i.e. preventing release of air bubbles at a blood outlet of the membrane gas exchanger) may result from the forcing of some fluid into the hydrophobic pores of the membrane leading to a reduction of gas transfer, as well as from the removal of micro-air bubbles, accumulated at the membrane wall, through the membrane and before their aggregate into macro-bubbles. Later description will show such effect can be investigated in a reproducible way.

In a 2nd aspect according to the 1st aspect, the method comprises: repeating the transitory pressurization step during priming.

In a 3rd aspect according to any one of the preceding aspects, the method comprises repeating the transitory pressurization step at time intervals during priming.

In a 4th aspect according to the preceding aspect, the time intervals are periodic intervals.

In a 5th aspect according to any one of the preceding aspects 3 or 4, wherein each time interval is between 10 s and 100 s, optionally between 20 s and 80 s, optionally between 40 s and 60 s.

In a 6th aspect according to any one of the preceding aspects, a time length of the pressurization step or of one or more pressurization step or of each pressurization step is fixed or is function of a measured pressure in the blood circuit, optionally measured downstream the blood pump.

In a 7th aspect according to the previous aspect, the measured pressure is a measured return pressure and/or a treatment unit pressure and/or an effluent pressure or an average pressure thereof.

In a 8^th aspect according to the 6^th or 7^th aspect, said time length is between 2 s and 30 s, optionally between 5 s and 10 s.

In a 9th aspect according to any one of the preceding aspects, a maximum pressure at the membrane gas exchanger during the pressurization step or steps is between 100 mmHg and 1000 mmHg, optionally between 400 mmHg and 600 mmHg.

In a 10th aspect according to any one of the preceding aspects, during priming, no gas flows through the gas side of the membrane gas exchanger. In a 11th aspect according to any one of the preceding aspects, generating the transitory pressurization step comprises: restricting transiently a portion of the blood circuit placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid. The transitory pressurization step is a pressure increase with respect to the pressure regimen in place before pressurization step.

In a 12th aspect according to any one of the preceding aspects 1 to 10, generating the transitory pressurization step comprises: occluding transiently a portion of the blood circuit placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid.

In a 13th aspect according to any one of the preceding aspects 11 or 12, generating the transitory pressurization step comprises: keeping the blood pump working while restricting or occluding transiently said portion of the blood circuit.

In a 14th aspect according to any one of the preceding aspects 11, 12 or 13, restricting or occluding transiently said portion of the blood circuit comprises: at least partially, optionally repeatedly closing, closing a clamp or a valve placed on the blood circuit and downstream of the membrane gas exchanger with respect to the flow direction of the priming fluid, optionally a return clamp placed in correspondence of the patient blood return access, in particular the return clamp acting on the blood return line downstream a deareation chamber and/or downstream a blood warmer.

In a 15th aspect according to any one of the preceding aspects, wherein generating the transitory pressurization step is actuated through an infusion line and an infusion pump coupled or configured to be coupled to a pump section of the infusion line. The infusion pump starts pumping fluid when the increased pressure is requested and pumps fluid for at least the time length of the pressurization step.

In a 16th aspect according to any one of the preceding aspects, wherein the apparatus for extracorporeal treatment of blood comprises an infusion line provided with an infusion pump; wherein generating the transitory pressurization step comprises:

• • connecting the infusion line to a source of priming fluid;
  • activating the infusion pump.

In a 17th aspect according to the preceding aspect, the infusion line is connected to the blood circuit between the blood pump and the return clamp, optionally between the blood pump and the membrane gas exchanger, optionally between the membrane gas exchanger and the return clamp.

In a 18th aspect according to the preceding aspect, wherein, when the infusion pump is activated, the blood pump is stopped and/or a return clamp or valve placed on the blood circuit and downstream of the membrane gas exchanger, with respect to the flow direction of the priming fluid, is closed.

In a 19th aspect according to any one of the preceding aspects, generating the transitory pressurization step is actuated through a deaeration chamber placed on the blood circuit, optionally between the blood pump and the return clamp, and an air pump connected to the deaeration chamber; and/or wherein generating the transitory pressurization step is actuated through a pressure pod placed on the blood circuit and an air pump connected to the pressure pod.

In a 20th aspect according to any one of the preceding aspects, the apparatus for extracorporeal treatment of blood comprises: at least one pressure pod placed on the blood circuit and at least one air pump connected to a gas chamber of the pressure pod separated from a blood chamber of the pressure pod by a flexible membrane; wherein generating the transitory pressurization step comprises: activating the air pump to generate pressure pulses in the air chamber of the pressure pod.

In a 21st aspect according to any one of the preceding aspects, a first transitory pressurization step in the priming fluid is generated once the priming fluid fills the blood side of the membrane gas exchanger.

In a 22nd aspect according to any one of the preceding aspects, the apparatus for extracorporeal treatment of blood comprises a deaeration chamber placed on the blood circuit and downstream of the membrane gas exchanger with respect the flow direction of the priming fluid and to a flow direction of blood during treatment; wherein a first transitory pressurization step in the priming fluid is generated when the priming fluid reaches the deaeration chamber.

In a 23rd aspect according any of the preceding aspects, at the end of priming and before patient connection, a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg, optionally between 50 mmHg and 100 mmHg.

In a 24th aspect according to any one of the preceding aspects, at the end of priming and before patient connection, the blood pump is stopped while a return clamp or valve placed on a blood return line and downstream of the membrane gas exchanger is kept closed. The blood circuit portion between the blood pump and the return clamp are substantially isolated, no air is allowed to enter into the blood circuit portion and the pressure regimen inside the blood circuit portion is kept substantially constant. Basically air cannot enter through the membrane of the gas exchanger due to overpressure in the blood side.

In a 25th aspect according to any one of the preceding aspects, before feeding the priming fluid in the extracorporeal blood circuit, it is envisaged to place the membrane gas exchanger close to the blood treatment unit and/or at the same height of the blood treatment unit.

In a 26th aspect according to any one of the preceding aspects, before feeding the priming fluid in the extracorporeal blood circuit, it is envisaged to connect a priming fluid source bag and, optionally, a priming fluid waste bag to the extracorporeal blood circuit.

A 27th aspect concerns an apparatus for extracorporeal treatment of blood comprising:

optionally, a blood treatment unit;

an extracorporeal blood circuit, optionally coupled to the blood treatment unit;

a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit;

a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit; optionally, the membrane gas exchanger being placed downstream the pump section;

a control unit configured for commanding execution of a task for priming the extracorporeal blood circuit, optionally according to the method of one or more of the preceding aspects.

In a 28th aspect according the preceding aspect 27, said task comprises the following steps:

• • feeding a priming fluid in the extracorporeal blood circuit and into the blood side of the membrane gas exchanger;
  • generating a transitory pressurization step in the priming fluid flowing in the blood circuit and in the blood side of the membrane gas exchanger to prevent release of air bubbles at a blood outlet of the membrane gas exchanger;
  • optionally, repeating the transitory pressurization step during priming, optionally at periodic intervals.

The transitory pressurization step increases pressure inside the blood side of the membrane gas exchanger and prevents air to enter through the membrane of the gas exchanges since almost any area of the gas permeable membrane in the blood side of the membrane gas exchanger experience a pressure higher than the pressure on the corresponding area of the gas permeable membrane in the air side of the membrane gas exchanger.

In a 29th aspect according to any one of the preceding aspects 27 or 28, the blood treatment unit has a primary chamber and a secondary chamber separated by a semi-permeable membrane; wherein the extracorporeal blood circuit comprises a blood withdrawal line connected to an inlet of the primary chamber and a blood return line connected to an outlet of the primary chamber; wherein the membrane gas exchanger is placed on the blood return line or on the blood withdrawal line; optionally wherein the pump section is a section of the blood withdrawal line.

In a 30th aspect according the preceding aspect 29, the apparatus comprises:

a dialysis line having one end connected to an inlet of a secondary chamber of the treatment unit and configured to convey fresh treatment liquid to the secondary chamber;

a spent dialysate line having one end connected to an outlet of said secondary chamber and configured to remove spent liquid from the secondary chamber.

In a 31st aspect according any of the preceding aspects 27 to 30, the apparatus comprises at least one infusion line connected to the blood circuit and at least one infusion pump coupled or configured to be coupled to a pump section of the infusion line.

In a 32nd aspect according the preceding aspect, the infusion line is connected to the blood circuit between the blood pump and the return clamp, optionally between the membrane gas exchanger and the blood pump, optionally between the treatment unit and the blood pump.

In a 33rd aspect according to any of the preceding aspects 27 to 32, the apparatus comprises:

at least one pressure pod placed on the blood circuit, wherein the pressure pod comprises a hollow body with an intermediate flexible membrane which delimits a gas chamber and a liquid/blood chamber with inlet and outlet for connection to the blood circuit;

at least one air pump connected to the gas chamber of the pressure pod; and/or

at least one deaeration chamber placed on the blood circuit, optionally downstream of the membrane gas exchanger with respect the flow direction of the priming fluid and to a flow direction of blood during treatment;

at least one air pump connected to the deaeration chamber, optionally to an upper part of said deaeration chamber, for allowing level adjustment in said deaeration chamber.

In a 34th aspect according to any one of the preceding aspects 27 to 33, the apparatus comprises a supporting frame configured to hold the membrane gas exchanger, at least part of the extracorporeal blood circuit and, optionally, the blood treatment unit.

In a 35th aspect according to any one of the preceding aspects 27 to 34, the membrane gas exchanger is located close to the blood treatment unit.

In a 36th aspect according to any one of the preceding aspects 27 to 35, the membrane gas exchanger is located substantially at the same height of the blood treatment unit.

In a 37th aspect according to any one of the preceding aspects 27 to 36, the apparatus comprises a disposable cartridge and said disposable cartridge comprises the blood treatment unit, the membrane gas exchanger and at least part of the extracorporeal blood circuit. In particular, the blood treatment unit, the membrane gas exchanger and part of the extracorporeal blood circuit are constrained to the disposable cartridge. The disposable cartridge includes coupling elements to couple the disposable cartridge to a front panel of a cabinet of the apparatus for extracorporeal treatment of blood.

In a 38th aspect according to any one of the preceding aspects 27 to 37, the apparatus comprises a priming fluid source bag connectable to the extracorporeal blood circuit and, optionally, a priming fluid waste bag connectable to the extracorporeal blood circuit.

In a 39th aspect according to the preceding aspect, the priming fluid source bag is connectable to the blood withdrawal line and/or to the infusion line; wherein, optionally, the priming fluid waste bag is connectable to the blood return line.

In a 40th aspect according to the preceding aspects 38 or 39 when according to aspect 34, the supporting frame comprises supporting elements for the priming fluid source bag and, optionally, for the priming fluid waste bag.

In a 41st aspect according to any one of the preceding aspects 38, 39 or 40, the priming fluid source bag and, optionally, the priming fluid waste bag are placed substantially at the same height of the membrane gas exchanger or below the membrane gas exchanger.

In a 42nd aspect according to any one of the preceding aspects 27 to 41, the apparatus comprises a deaeration chamber placed on the blood circuit and downstream of the membrane gas exchanger with respect the flow direction of the priming fluid and to a flow direction of blood during treatment; wherein said task comprises: generating a first transitory pressurization step in the priming fluid when the priming fluid reaches the deaeration chamber.

In a 43rd aspect according to any one of the preceding aspects 27 to 42, in order to generate the transitory pressurization step or steps, said task comprises: keeping the blood pump working and restricting or occluding transiently a portion of the blood circuit placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid, optionally by closing, optionally repeatedly closing, a clamp or a valve placed downstream of the membrane gas exchanger with respect to the flow direction of the priming fluid, optionally a return clamp.

In a 44th aspect according to any one of the preceding aspects 27 to 42 when according to aspect 31, in order to generate the transitory pressurization step or steps, said task comprises: connecting the infusion line to the source of priming fluid and activating, optionally intermittently, the infusion pump.

In a 45th aspect according to any one of the preceding aspects 27 to 42 when according to aspect 33, in order to generate the transitory pressurization step or steps, said task comprises: activating the air pump to generate pressure pulses in the air chamber of the pressure pod and/or in the deaeration chamber.

In a 46th aspect according to any one of the preceding aspects 27 to 45, the membrane gas exchanger is an oxygenator and/or a CO₂ remover.

In a 47th aspect according to any one of the preceding aspects 46, the membrane gas exchanger comprises a gas permeable membrane separating the blood side and gas side.

In a 48th aspect according to the preceding aspect 47, the gas permeable membrane comprises a plurality of hollow fibers.

DESCRIPTION OF THE DRAWINGS

Aspects of the invention are shown in the attached drawings, which are provided by way of non-limiting example, wherein:

FIG. 1 shows a schematic diagram of an apparatus for extracorporeal treatment of blood during treatment of a patient;

FIG. 2 shows the apparatus of FIG. 1 during a priming procedure according to one aspect of the invention;

FIG. 3 shows a schematic diagram of an alternative embodiment of an apparatus for extracorporeal treatment of blood;

FIG. 4 shows the apparatus of FIG. 1 during a priming procedure according to another aspect of the invention;

FIG. 5 shows a possible embodiment of the apparatus of FIGS. 1 and 2;

FIG. 6 is a graph showing a pressure trend during priming related to an embodiment of the invention;

FIG. 7 is a flowchart of one embodiment of a method of the invention;

FIG. 8 is a graph showing correlation between intensity of intensity of pressure peaks and bubbling free time during priming;

FIG. 9 is a graph showing correlation between pressurization time and bubbling free time during priming.

DETAILED DESCRIPTION

Non-limiting embodiments of an apparatus 1 for extracorporeal treatment of blood—which may implement innovative aspects of the invention—are shown in FIGS. 1 to 5. In below description and in FIGS. 1 to 5 same components are identified by same reference numerals.

In FIG. 1 it is represented an apparatus for the extracorporeal treatment of blood 1 comprising a blood treatment unit 2 (such as an hemofilter, an ultrafilter, an hemodiafilter, a dialyzer, a plasmafilter and the like) having a primary chamber 3 and a secondary chamber 4 separated by a semi-permeable membrane 5; depending upon the treatment, the membrane 5 of the blood treatment unit 2 may be selected to have different properties and performances. A blood withdrawal line 6 is connected to an inlet of the primary chamber 3, and a blood return line 7 is connected to an outlet of the primary chamber 3. In use, the blood withdrawal line 6 and the blood return line 7 are connected to a needle or to a catheter or other access device (not shown) which is then placed in fluid communication with the patient P vascular system, such that blood may be withdrawn through the blood withdrawal line 6, flown through the primary chamber 3 and then returned to the patient's vascular system through the blood return line 7. An air separator, such as a deaeration chamber 8, may be present on the blood return line 7. Moreover, a safety return clamp 9 controlled by a control unit 10 may be present on the blood return line 7, downstream the deaeration chamber 8. A bubble sensor 8a, for instance associated to the deaeration chamber 8 or coupled to a portion of the line 7 between the deaeration chamber 8 and the return clamp 9 may be present: if present, the bubble sensor 8a is connected to the control unit 10 and sends to the control unit 10 signals for the control unit 10 to cause closure of the return clamp 9 in case one or more bubbles above certain safety thresholds are detected. The blood flow through the blood lines is controlled by a blood pump 11, for instance a peristaltic blood pump, acting either on the blood withdrawal line 6 or on the blood return line 7. The embodiment of FIGS. 1 and 2 shows the blood pump 11 coupled to a pump section of the withdrawal line 6. An operator may enter a set value for the blood flow rate Q_B through a user interface and the control unit 10, during treatment, is configured to control the blood pump 11 based on the set blood flow rate Q_B. The control unit 10 may comprise a digital processor (CPU) with memory (or memories), an analogical type circuit, or a combination of one or more digital processing units with one or more analogical processing circuits. In the present description and in the claims it is indicated that the control unit 10 is “configured” or “programmed” to execute certain steps: this may be achieved in practice by any means which allow configuring or programming the control unit 10. For instance, in case of a control unit 10 comprising one or more CPUs, one or more programs are stored in an appropriate memory: the program or programs containing instructions which, when executed by the control unit 10, cause the control unit 10 to execute the steps described and/or claimed in connection with the control unit 10. Alternatively, if the control unit 10 is of an analogical type, then the circuitry of the control unit 10 is designed to include circuitry configured, in use, to process electric signals such as to execute the control unit 10 steps herein disclosed. An effluent fluid line or spent dialysate line 12 is connected, at one end, to an outlet of the secondary chamber 4 and, at its other end, to a waste which may be a discharge conduit or an effluent fluid container collecting the fluid extracted from the secondary chamber. An effluent pump 13 that operates on the effluent fluid line 12 under the control of the control unit 10 to regulate the flow rate Q_eff across the effluent fluid line. The apparatus of FIG. 1 includes a dialysis line 14 connected at one end with a liquid inlet and at its other end with the inlet of the secondary chamber 4 of the treatment unit 2 for supplying fresh dialysis liquid to the secondary chamber 4. A dialysis fluid pump, not shown, is operative on the dialysis fluid line 14 under the control of the control unit 10, to supply fluid from a dialysis liquid container to the secondary chamber 4 at a flow rate Q_dial.

The embodiment of FIG. 1 presents an infusion line 15 connected to the blood withdrawal line 6 between the blood pump 11 and the treatment unit 2. This infusion line 15 supplies replacement fluid from an infusion fluid container 16 connected at one end of the infusion line 15. Note that, alternatively or in addition to the infusion line 15, the apparatus of FIG. 1 may include a post-dilution fluid line (not shown) connecting an infusion fluid container to the blood return line 7. Furthermore, an infusion pump 17 operates on the infusion line 15 to regulate the flow rate Q_rep through the infusion line 15. Note that in case of two infusion lines (pre-dilution and post-dilution) each infusion line may be provided with a respective infusion pump. The apparatus for the extracorporeal treatment of blood 1 further comprises a membrane gas exchanger 18 placed on the blood return line 7, i.e. downstream of the treatment unit 2 with respect to a flow direction of blood during treatment. The membrane gas exchanger 18 comprises a gas permeable membrane 100 separating a blood side and a gas side. A first section 7a of the blood return line 7 coming from the treatment unit 2 is connected to a blood inlet 18c of the blood side of the membrane gas exchanger 18 and a second section 7b of the blood return line 7, connected to the needle or to the catheter, is connected to a blood outlet 18d of the blood side of the membrane gas exchanger 18. The gas side of the membrane gas exchanger 18 is provided with a respective gas inlet 18a and gas outlet 18b for ventilating gas (e.g. air or oxygen).

The internal structure of the membrane gas exchanger 18 may be per se known. The gas permeable membrane 100 may comprise a plurality of hollow fibers. The ventilating gas (e.g. oxygen, air) is passed through the inside (gas side) of the hollow fibers, while the blood is passed around (blood side) the hollow fibers to accomplish gas exchange by diffusion. The membrane gas exchanger 18 is operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit. The membrane gas exchanger 18 may be an oxygenator and/or a CO₂ remover. For example, oxygen diffuses from the gas side into the blood and carbon dioxide CO₂ diffuses from the blood side into the gas for disposal. The apparatus 1 of FIG. 1 can deliver stand-alone CO₂ removal as well as dialysis and CO₂ removal combined in the same blood circuit.

The apparatus 1 shown in FIGS. 1 and 2 is also provided with a safety withdrawal clamp 19 controlled by the control unit 10 and present on the blood withdrawal line 6 and upstream of the blood pump 11.

The blood withdrawal line 6, the blood return line 7, the first chamber 3 of the treatment unit 2 and the blood side of the membrane gas exchanger 18 form part of an extracorporeal blood circuit of the apparatus 1. The effluent fluid line 12, the dialysis fluid line 14, the fluid chamber 4 of the treatment unit 2 form part of a fluid circuit of the apparatus 1. The infusion line 15 is connected to the blood circuit between the return clamp 9 and the blood pump 11. In FIGS. 1 and 2 the infusion line 15 is connected to the blood circuit between the blood pump 11 and the blood treatment unit 2. Pressure pods may also be present on the blood circuit and on the fluid circuit to monitor liquid/blood pressures. Each pressure pod comprises a hollow body with an intermediate flexible membrane which delimits a gas chamber and a liquid/blood chamber with inlet and outlet for connection to the blood circuit or to the fluid circuit.

The apparatus 1 shown in FIGS. 1 and 2 comprises a treatment unit pressure pod 20 placed on the blood withdrawal line 6 just upstream of the treatment unit 2, an access pressure pod 21 placed on the blood withdrawal line 6 just downstream of the access device and of the patient P, an effluent pressure pod 22 placed on the effluent line 12 between the treatment unit 2 and the effluent pump 13.

The blood pump 11, the effluent pump 13, the infusion pump 17 and possible other pumps (not shown) are operatively connected to the control unit 10 which controls said pumps. The control unit 10 is also operatively connected to sensors (like flow sensors) on the blood circuit and/or fluid circuit and, in particular, to the pressure pods 20, 21, 22 and the bubble sensor 8a. The control unit 10 is also operatively connected to clamps and valves, like the return clamp 9 and the withdrawal clamp 19. The control unit 10 is also connected to the user interface, not shown, for instance a graphic user interface, which receives operator's inputs and displays the apparatus outputs. For instance, the graphic user interface may include a touch screen, a display screen and hard keys for entering user's inputs or a combination thereof. During extracorporeal blood treatment, the control unit 10 is configured to control at least the pumps 11, 13, 17 to make sure that a prefixed patient fluid removal is achieved in the course of a treatment time, as required by a prescription provided to the control unit 10, e.g. via the user interface. A blood warming device 33 may optionally be place on the blood return line 7 between the membrane gas exchanger 18 and the deaeration chamber 8. The apparatus 1 of FIGS. 1 and 2 is configured to deliver Continuous Renal Replacement Therapy (CRRT) in combination with ECCO₂R therapy or ECCO₂R therapy alone.

The control unit 10 is also configured for commanding execution of a task for priming the extracorporeal blood circuit before treatment of a patient, according also to the method of the present invention.

A configuration of the apparatus of FIG. 1 for priming the blood circuit is shown in FIG. 2. A priming fluid source bag 23 (e.g. saline bag) is connected to the withdrawal line 6 of the blood circuit. A priming fluid waste bag 24 is connected to the return line 7 of the extracorporeal blood circuit. A further priming fluid source bag 25 may be connected to the infusion line 15. An air pump 26 may be connected to the gas chamber of the treatment unit pressure pod 20. An air pump 26 may also be connected to the upper part of the deaeration chamber 8 allowing level adjustment in said deaeration chamber. FIG. 5 shows a possible embodiment of the apparatus of FIGS. 1 and 2, wherein the extracorporeal blood treatment unit 2, the membrane gas exchanger 18 and at least part of the extracorporeal blood circuit are part of a disposable cartridge 27 mounted on a supporting frame 28. The supporting frame 28 comprises a casing 29 supported by an upright 30 with a support base 31 configured to rest on the ground. The casing 29 supports and/or houses mechanical and/or electronic devices of the apparatus 1, such as the control unit 10, the blood pump 11, the return clamp 9, the withdrawal clamp 19, the pressure sensors to be connected to pressure pods 20, 21, etc. The casing 29 comprises carrier for the cartridge 27, not visible, and it is further provided with supporting elements 32, such as hooks, for hanging fluid bags. FIG. 5 shows the apparatus 1 in the priming configuration in which the priming fluid source bag 23 and the priming fluid waste bag 24 hang under the casing 29. The membrane gas exchanger 18 is located next to the blood treatment unit 2 and substantially at the same height of the blood treatment unit 2. The priming fluid source bag 23 and the priming fluid waste bag 24 are placed below the membrane gas exchanger 18.

In order to prime the extracorporeal blood circuit, the return clamp 9 and the withdrawal clamp 19 are opened and the blood pump 11 is activated to make the priming fluid flow from the priming fluid source bag 23 towards the priming fluid waste bag 24 and flowing through the primary chamber 3 of the blood treatment unit 2 and the blood side of the membrane gas exchanger 18. During priming, no gas flows through the gas side of the membrane gas exchanger 18. Once the priming fluid fills the blood side of the membrane gas exchanger 18, optionally when the priming fluid reaches the deaeration chamber 8, the return clamp 9 is closed and reopened while the blood pump 11 keeps working, in order to generate a transitory pressurization step in the priming fluid and in the blood side of the membrane gas exchanger 18. In an embodiment of the method or task for priming, the return clamp 9 is repeatedly closed and opened in order to generate a plurality of transitory pressurization steps in the priming fluid and in the blood side of the membrane gas exchanger 18. The generation of one or more pressurization step/s may be repeated several times during priming. This prevents release of air bubbles at the outlet of the membrane gas exchanger 18. The effect of the pressurization step may result from the forcing of some fluid into the hydrophobic pores of the membrane leading to a reduction of gas transfer, as well as from the removal of micro-air bubbles, accumulated at the membrane wall, through the membrane and before their aggregate into macro-bubbles. For instance, when the priming fluid reaches the deaeration chamber 8, a first series of pressurization steps may be actuated by intermittently closing the return clamp 9 at periodic time intervals T. By closing and opening the return clamp 9, to generate pressurization step or steps, a portion of the blood circuit placed downstream of the membrane gas exchanger 18 with respect to a flow direction of the priming fluid is occluded. In a variant of the method, the return clamp 9 may be partially closed in order to restrict the portion of the blood circuit placed downstream of the membrane gas exchanger 18. According to a different embodiment for generating the pressurization step or steps, after that the priming fluid from the priming fluid source bag 23 has reached the deaeration chamber 8, the blood pump 11 is stopped, the return clamp 9 is closed and the infusion pump 17 is intermittently activated to pump priming fluid from the further priming fluid source bag 25 through the infusion line 15 and into the extracorporeal blood circuit and to generate said pressurization step/s in the membrane gas exchanger 18. According to a further different embodiment for generating the pressurization step or steps, after that the priming fluid from the priming fluid source bag 23 has reached the deaeration chamber 8, while the blood pump keeps working, the air pump 26 connected to the treatment unit pressure pod 20 is activated intermittently to generate pressure pulses in the air chamber of the treatment unit pressure pod 20 while blood pump 11 is stopped and the return clamp 9 is closed. The pressure pulses in the air chamber pushes and deforms the intermediate flexible membrane which transfers said pressure pulses to the priming fluid in the blood chamber of the treatment unit pressure pod 20 and in the blood treatment circuit. According to a different embodiment for generating the pressurization step or steps, the blood pump 11 is stopped, the return clamp 9 is closed and the air pump 26 connected to the deaeration chamber 8 is activated intermittently to generate pressure pulses in the upper part of the deaeration chamber 8 and into the priming fluid in the lower part of said deaeration chamber 8. Optionally, at the end of priming and before patient connection, the blood pump 11 is still motionless while the return clamp 9 placed on a blood return line 7 and downstream of the membrane gas exchanger 18 is kept closed, while, optionally, the blood pump 11, the infusion pump 17, the dialysate pump 13 or air pump 26 are activated to build up some positive pressure level. Even if, like in FIG. 5, the membrane gas exchanger 18 is located close to the blood treatment unit 2 and substantially at the same height of the blood treatment unit 2, the priming fluid source bag 23 and the priming fluid waste bag 24 and, optionally, also the further priming fluid source bag 25 (not shown in FIG. 5) are placed below the membrane gas exchanger 18, bubble formation is prevented. Therefore, free and user friendly positioning of the membrane gas exchanger 18 and of the bags is allowed and no specific component designed to control bubbling during priming is required. FIGS. 3 and 4 show a different embodiment of the extracorporeal blood treatment 1 during patient treatment (FIG. 3) and priming sequence (FIG. 4). The same reference numerals for the same elements of FIGS. 1 and 2 have been used. The extracorporeal blood treatment 1 of FIGS. 3 and 4 does not comprise the blood treatment unit 2 but it's only equipped with the membrane gas exchanger 18. The membrane gas exchanger 18 is the only device in the circuit and the apparatus 1 is configured to deliver only ECCO₂R therapy (stand-alone ECCO₂R). Priming of the extracorporeal blood circuit and generation of transitory pressurization step/s may be accomplished as in the apparatus of FIGS. 1 and 3 through the return clamp 9 and/or the air pump 26 connected to the pressure pod 20 placed upstream of the membrane gas exchanger 18. The control unit 10 is configured to control the pressurizations step/s and, optionally, a time length Δt of each pressurization step or of each pressurization step. The pressurization step/s may be fully automated and may not require any user intervention.

It is noted that usually a peristaltic pump moves the priming fluid inside the blood lines during priming. Clearly a peristaltic pump, by its own nature, produces an oscillating pressure around a mean pressure value. The described pressurization step is intended to be an increase of the mean pressure inside the blood line portion with respect to the mean pressure existing prior the pressurization step. See FIG. 6, wherein the oscillating pressure around a mean pressure value generated by the blood pump is hardly visible in the form of pressure irregularities along the two parallel (thin) lines representing the average/mean pressure. The lower line is the mean pressure when no pressurization step is occurring, while the upper line represent the mean pressure value during the pressurization step. According to some embodiments, the time length Δt is fixed. According to other embodiments, the time length Δt is function of one or more parameters. By way of example, the time length Δt may be function of a measured return pressure captured through the bubble sensor 8a and/or a treatment unit pressure captured through the treatment unit pressure pod 20 and/or an effluent pressure captured through the effluent pressure pod 22.

The time length Δt of each pressurization step may be between 2 s and 30 s, optionally between 5 s and 10 s, and each time interval T between one pressurization step and the following may be between 10 s and 100 s, optionally between 20 s and 80 s, optionally between 40 s and 60 s. A maximum pressure P_max at the membrane gas exchanger 18 during the pressurization step or steps may be between 100 mmHg and 1000 mmHg, optionally between 400 mmHg and 600 mmHg. At the end of priming sequence and before patient connection, a pressure in the blood circuit and in the blood side of the membrane gas exchanger 18 is kept between 20 mmHg and 400 mmHg, optionally between 50 mmHg and 100 mmHg. Analysis of the impact of the maximum pressure P_max and of the time length Δt of the pressurization step on the bubble formation at the membrane gas exchanger outlet 18d was performed.

Used materials, samples and parameters were the following:

• • PrisMax extracorporeal blood treatment monitor;
  • PrismaFlex set cartridge equipped with membrane gas exchanger arm;
  • three samples of membrane gas exchanger S1, S2 and S3;
  • pressure sensor with data logging;
  • saline solution as priming fluid;
  • room temperature;
  • fixed flow rate and fixed position of priming waste/collection bag.

Definitions

• T_bb: time in seconds for air bubbles to be seen back at the membrane gas exchanger outlet 18d after a pressurization step;
• P_max: maximum pressure or pressure peak in mmHg recorded through a pressurization step;
• T_p: time in seconds with pressure above +300 mmHg during a pressurization step;
• IntP: integral of the pressure-time signal during the pressurization step expressed in mmnHg×s;
• P_range: pressure range in mmHg of P_max.

The time length Δt mentioned above is correlated to T_p and IntP.

The investigation was split in two parts.

Part 1

Impact of the maximum pressure P_max on the T_bb has been investigated. Next Tables 1, 2 and 3 report for T_bb, P_max and P_range recorded throughout all pressurization steps/challenges.

TABLE 1
S1
Challenge	1	6	11	12	3	5	8	9	2	4	7	10
Pmax	162	175	193	139	266	225	217	338	464	674	682	412
IntP	692	579	1117	242	1331	670	655	1216	1410	1712	2147	1623
Prange	Pmax< 200	200 < Pmax < 400	400 < Pmax < 700
Tbb	60	50	40	30	70	70	60	50	110	80	100	70
Mean & Std	45 ± 13	63 ± 10	90 ± 18

TABLE 2
S2
Challenge	2	6	9	12	4	5	8	10	1	2	7	11
Pmax	102	145	194	129	229	319	317	332	446	619	492	617
IntP	430	510	1002	307	1142	1104	1008	1162	1409	1495	2200	2065
Prange	Pmax < 200	200 < Pmax < 400	400 < Pmax < 700
Tbb	15	15	35	10	30	30	40	35	100	50	70	60
Mean & Std	19 ± 11	34 ± 5	70 ± 22

TABLE 3
S3
Challenge	2	5	10	12	1	4	7	11	3	6	8	9
Pmax	152	137	152	199	331	300	316	247	650	538	630	403
IntP	431	791	830	411	870	861	1038	653	2280	1324	1409	955
Prange	Pmax < 200	200 < Pmax < 400	400 < Pmax < 700
Tbb	30	26	25	20	55	40	40	30	85	55	70	50
Mean & Std	25 ± 4	41 ± 10	65 ± 16

Comments

Four challenges were performed with peak pressure <200 mmHg, four challenges with 200<peak pressure<400 mmHg and four challenges with 400<peak pressure<700 mmHg for each of the three tested Falcon gas exchangers. Mean return pressure level was about −15 mmHg during priming (outside challenges). Tables 1, 2 and 3 and FIG. 8 show that bubbling free time T_bb increases when pressurization pressure is increased.

Part 2

Impact of IntP and T_p on the T_bb has been investigated.

Next Tables 4 to 6 report for T_bb, P_peak & P_range parameters recorded throughout all pressurization challenges.

Challenges are identified as follows: X_y with X and y relating to tested condition ID (A, B, C or D) and test chronology order, respectively.

A to D test conditions are referenced in reference to the pressurization time (see T_p parameter).

TABLE 4
S1
Challenge	A_5	A_7	B_6	B_8	C_2	C_3	D_1	D_4
Ppeak	614	616	609	560	553	491	590	616
IntP	1418	1399	4410	3490	6139	4741	11440	12375
Tp	2.2	2.2	7.4	6.2	12.4	9.0	20.8	20.0
Tbb	30	28	45	45	50	50	55	55
Mean	29	45	50	55

TABLE 5
S2
Challenge	A_3	A_6	B_1	B_4	C_5	C_7	D_2	D_8
Ppeak	537	606	562	597	581	532	601	514
IntP	1409	2526	3939	3439	6720	5027	11483	8951
Tp	2.4	4.2	5.2	6.0	11.4	9.8	18.8	17.2
Tbb	30	30	63	37	47	48	50	50
Mean	30	50	48	50

TABLE 6
S3
Challenge	A_2	A_7	B_1	B_6	C_3	C_5	D_4	D_8
Ppeak	454	602	598	646	592	510	607	609
IntP	1184	1255	4439	2923	5280	4834	13208	13028
Tp	2.0	2.2	7.4	4.8	8.6	9.2	21.4	21.8
Tbb	30	30	55	40	50	48	50	55
Mean	30	48	49	53

Comments

Mean pressure level was about −27 mmHg in run mode conditions without challenges; that can explain slightly lower Tbb values from Part II versus Part I testing.

Tables 4, 5 and 6 and FIG. 9 illustrate little dependence of bubbling free time T_bb on pressurization time, with sort of threshold effect when time reaches about 5 seconds (or IntP about 4000 mmHg×s).

This investigation documents that the pressure level reached during pressurization step is the main physical parameter controlling the time during which bubbling is inhibited afterwards.

Example of Priming Sequence

• • connecting the priming fluid source bag 23 (e.g. saline bag) to the withdrawal line 6 of the extracorporeal blood circuit;
  • connecting the priming fluid waste bag 24 to the return line 7 of the extracorporeal blood circuit;
  • opening the withdrawal clamp 19 and the return clamp 9 and activating the blood pump 11 to start priming;
  • when the priming fluid reaches the deaeration chamber 8, closing and opening the return clamp 9 at periodic time intervals T to generate pressure pulses in the priming fluid and in the blood side of the membrane gas exchanger (18);
  • stopping the blood pump (11), closing the return clamp (9), keeping the return clamp (9) closed and waiting for patient connection.

While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiments, it is to be understood that the invention is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.

Claims

1-15. (canceled)

16. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: an extracorporeal blood circuit;a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit;a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger comprises a blood side in fluid communication with the blood circuit and a gas side;

17. The method according to claim 16, wherein the apparatus for extracorporeal treatment of blood comprises a blood treatment unit and the extracorporeal blood circuit is coupled to the blood treatment unit, wherein the membrane gas exchanger is located next to the blood treatment unit.

18. The method according to claim 17, wherein the membrane gas exchanger is located substantially at the same height of the blood treatment unit, and wherein the method comprises placing a priming fluid waste bag at the same height of the membrane gas exchanger or below the membrane gas exchanger.

19. The method according to claim 17, wherein the apparatus for extracorporeal treatment of blood comprises a disposable cartridge including the membrane gas exchanger, the blood treatment unit, and at least part of the extracorporeal blood circuit.

20. The method according to claim 16, comprising: repeating the transitory pressurization step during priming at time intervals, wherein each time interval is between 10 s and 100 s.

21. The method according to claim 16, wherein a maximum pressure at the membrane gas exchanger during the pressurization step is between 100 mmHg and 1000 mmHg.

22. The method according to claim 16, wherein a time length of each pressurization step is between 2 s seconds and 30 s seconds, wherein the time length of each pressurization step is a function of a pressure in the blood circuit measured downstream the blood pump or is being fixed.

23. The method according to claim 22, wherein the measured pressure is one of a measured return pressure, a treatment unit pressure, an effluent pressure, and an average pressure thereof.

24. The method according to claim 16, wherein generating the transitory pressurization step comprises: transiently restricting or occluding flow in a portion of the extracorporeal blood circuit downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid, the transitory pressurization step being a pressure increase with respect to a pressure regimen in place before the transitory pressurization step.

25. The method according to claim 16, wherein generating the transitory pressurization step comprises: keeping the blood pump working and closing a clamp placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid.

26. The apparatus of claim 25, wherein said closing the clamp placed downstream of the membrane gas exchanger comprises repeatedly opening and closing the clamp.

27. The method according to claim 16, wherein the apparatus for extracorporeal treatment of blood comprises an infusion line provided with an infusion pump, wherein generating the transitory pressurization step is actuated through the infusion line and the infusion pump coupled to a pump section of the infusion line and comprising: connecting the infusion line to a source of priming fluid; andactivating the infusion pump;

28. The method according to claim 16, wherein generating the transitory pressurization step is actuated through a deaeration chamber placed on the extracorporeal blood circuit between the blood pump and a return clamp and is actuated through an air pump connected to the deaeration chamber.

29. The method according to claim 16, wherein, at the end of priming and before patient connection, a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg.

30. The method according to claim 16, wherein at the end of priming and before patient connection: a pressure in the blood circuit and in the blood side of the membrane gas exchanger is kept between 20 mmHg and 400 mmHg;the blood pump is stopped while a clamp placed on a blood return line downstream of the membrane gas exchanger is kept closed,

31. The method according to claim 16, comprising, before feeding the priming fluid in the extracorporeal blood circuit, placing the membrane gas exchanger close to or at the same height of the blood treatment unit and connecting a priming fluid source bag and a priming fluid waste bag to the extracorporeal blood circuit.

32. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: a blood treatment unit;an extracorporeal blood circuit coupled to the blood treatment unit;a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit;a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger comprises a blood side in fluid communication with the blood circuit and a gas side;

33. A method of priming an extracorporeal blood circuit of an apparatus for extracorporeal treatment of blood, wherein the apparatus for extracorporeal treatment of blood comprises: a blood treatment unit;an extracorporeal blood circuit coupled to the blood treatment unit;a blood pump configured to be coupled to a pump section of the extracorporeal blood circuit;a membrane gas exchanger operatively coupled to the extracorporeal blood circuit to exchange gas with blood flowing in the extracorporeal blood circuit, wherein the membrane gas exchanger is located next to the blood treatment unit and comprises a blood side in fluid communication with the blood circuit and a gas side;

34. The method according to claim 33, wherein generating the transitory pressurization step comprises keeping the blood pump working and closing a clamp placed downstream of the membrane gas exchanger with respect to a flow direction of the priming fluid.

35. The method according to claim 34, wherein said closing the clamp placed downstream of the membrane gas exchanger comprises repeatedly opening and closing the clamp.