The present application relates generally to heat exchange systems for patient temperature control with working fluid cassettes.
Patient temperature control systems have been introduced to prevent fever in patients in the neuro ICU due to suffering from sub-arachnoid hemorrhage or other neurologic malady such as stroke. Also, such systems have been used to induce mild or moderate hypothermia to improve the outcomes of patients suffering from such maladies as stroke, cardiac arrest, myocardial infarction, traumatic brain injury, and high intracranial pressure. Examples of intravascular heat exchange catheters are disclosed in U.S. Pat. Nos. 7,914,564, 6,416,533, 6,409,747, 6,405,080, 6,393,320, 6,368,304, 6,338,727, 6,299,599, 6,290,717, 6,287,326, 6,165,207, 6,149,670, 6,146,411, 6,126,684, 6,306,161, 6,264,679, 6,231,594, 6,149,676, 6,149,673, 6,110,168, 5,989,238, 5,879,329, 5,837,003, 6,383,210, 6,379,378, 6,364,899, 6,325,818, 6,312,452, 6,261,312, 6,254,626, 6,251,130, 6,251,129, 6,245,095, 6,238,428, 6,235,048, 6,231,595, 6,224,624, 6,149,677, 6,096,068, 6,042,559, 8,888,729, and USPPs 2013/0178923, 2013/0079855, 2013/0079856, 2014/0094880, 2014/0094882, 2014/0094883, all of which are incorporated herein by reference.
External patient temperature control systems may be used. Such systems are disclosed in U.S. Pat. Nos. 6,827,728, 6,818,012, 6,802,855, 6,799,063, 6,764,391, 6,692,518, 6,669,715, 6,660,027, 6,648,905, 6,645,232, 6,620,187, 6,461,379, 6,375,674, 6,197,045, and 6,188,930 (collectively, “the external pad patents”), all of which are incorporated herein by reference.
In general, in all of the intravascular and external patient temperature control solutions, the temperature of the working fluid flowing through the catheter or pad is regulated by a heat exchange console based on feedback provided by the patient's actual body temperature, typically core body temperature as may be variously measured rectally, esophageally, tympanic ear temperature, blood temperature in, e.g., the vena cava, etc. The working fluid temperature is regulated by thermally coupling the working fluid to heating and/or cooling elements in the console. In many cases, the working fluid is forced in a closed fluid circuit path (including the console and the catheter or pad) by a peristaltic pump acting on tubing, e.g., pump tubing or IV tubing, in the fluid circuit path.
The following patent applications are hereby incorporated by reference herein in their entirety, Ser. No. 14/534,718, filed Nov. 6, 2014, and filed concurrently herewith.
As understood herein, it is desirable to provide a fast and easy way to interconnect an intravascular heat exchange catheter or external pad with a heat exchanger.
Accordingly, a device is provided which includes a thin-walled bag supported by a frame. The bag with frame is receivable between heat exchange plates such that heat can be exchanged between working fluid flowing through the bag and at least one of the heat exchange plates. A plenum or enclosure is connected to the frame. The plenum or enclosure supports a pump tube in fluid communication with the bag. The pump tube may be configured, for example in a loop, to engage a raceway or channel of a pump so that the pump can urge against the pump tube to circulate working fluid.
The plenum or enclosure may be hingedly connected to the frame for movement between a shipping position, in which an open or closed bottom side of the plenum or enclosure is parallel to the frame and is closely spaced from the bag, and an operating position, in which the bottom side is perpendicular to the frame. In some examples, a return tube is configured for carrying working fluid from an intravascular heat exchange catheter or external heat exchange pad to the bag.
If desired, a reservoir may be in the plenum or enclosure, or be a part of the plenum or enclosure, for receiving working fluid from the bag. In this example, the pump tube can receive working fluid from the reservoir. Also, a damper or dampener tube may be in fluid communication with the pump tube for receiving working fluid from the pump tube. The dampener tube may be configured with one or more pulse dampening loops or may be a straight or substantially straight length tube. Still further, a supply tube can be in fluid communication with the dampener tube for conveying working fluid to an intravascular heat exchange catheter or external heat exchange pad. In certain embodiments, the dampener may be in a form other than a tube. The dampener may be any pulse dampener, e.g., a dampener tube, damper or other device that absorbs the shock caused by a change in the direction or the speed of fluid flow within the tubes or other shock created by the pump's action. Other examples of dampeners include but are not limited to foam and air dampeners.
In some examples, working fluid from the return tube passes through an entry tube in a top rail of the frame to enter the bag. The entry tube has a first diameter and terminates proximate to the top rail so that working fluid enters the bag proximate the top rail. A drain tube extends through the entry tube toward a bottom rail of the frame that is opposite to and parallel with the top rail, with the drain tube terminating in an opening proximate to or remaining close to the bottom rail. The drain tube can be used for emptying the bag by reversing the pump to withdraw working fluid from the bag through the drain tube.
In another aspect, a device includes a plenum or enclosure that supports a looped pump tube, and a framed thin-walled heat exchange bag connected to the plenum or enclosure. The thin-walled heat exchange bag is for holding working fluid from an intravascular heat exchange catheter or external heat exchange pad, and is configured for insertion between opposed plates to effect heat exchange between the plates and working fluid flowing through the bag. When the framed thin-walled heat exchange bag is between the plates, the looped pump tube from the plenum or enclosure is receivable in or may be positioned in a raceway or channel of a peristaltic pump.
In another aspect, a method includes engaging a loop of a pump tube supported by a plenum or enclosure with a raceway or channel of a peristaltic pump, and disposing a heat exchange bag that depends downwardly from the plenum or enclosure between opposed plates of a heat exchanger.
The details of the various embodiments described herein, both as to their structure and operation, can best be understood in reference to the accompanying drawings, in which like reference numerals refer to like parts, and in which:
Referring initially to
Instead of or in addition to the catheter 12, the system 10 may include one or more pads 18 that are positioned against the external skin of the patient 16 (only one pad 18 shown for clarity). The pad 18 may be, without limitation, any one of the pads disclosed in the external pad patents. The temperature of the pad 18 can be controlled by the control system 14 to exchange heat with the patient 16, including to induce therapeutic mild or moderate hypothermia in the patient in response to the patient presenting with, e.g., cardiac arrest, myocardial infarction, stroke, high intracranial pressure, traumatic brain injury, or other malady the effects of which can be ameliorated by hypothermia. The pad 18 may receive working fluid from the system 14 through a fluid supply line L3, and return working fluid to the system 14 through a fluid return line L4. The pump “P” may be a peristaltic pump which may engage any one of the lines L1-L4, which are typically plastic or other material IV lines, to urge working fluid through the lines through peristalsis.
The control system 14 may include one or more microprocessors 20 receiving target and patient temperatures as input and controlling, among other things, the pump “P” and a refrigerant compressor 22 and/or a bypass valve 24 that can be opened to permit refrigerant to bypass a condenser.
Turning now to
The pump 30 includes a rigid, preferably metal or hard plastic raceway or channel housing 32 and a rotor 34. The raceway housing 32 may be formed from one or more blocks of material as shown and has an inner arcuate surface 36 which may have a substantially constant radius of curvature. In some examples, the arcuate surface 36, which defines a midpoint 38 between its two ends, can extend through an arc of at least one hundred eighty degrees (180°) (e.g., where two drive rollers are used) and may extend through an arc of between one hundred eighty degrees (180°) and two hundred seventy degrees (270°). In the example shown, the arcuate surface 36 extends, from one end to the other end, through an arc of greater than 200°. For example, the arc may be about 210° to 230°. In certain embodiments, the arcuate surface of a raceway may extend through an arc equal to 360° divided by n, where n is equal to the number of drive rollers mounted on or near a rotor which is rotated relative to the raceway.
A motor 40 rotates the rotor 34 relative to the raceway 32. As well, the rotor 34 is movable translationally and/or rotationally relative to the raceway 32 as shown by the arrows 42 between a pump position, in which the rotor 34 is spaced from the midpoint 38 of the inner surface 36 of the raceway 32 a first distance, and a tube load position, in which the rotor 34 is spaced from the midpoint 38 a greater, second distance. In the pump or operating position, rollers on the rotor 34 urge against a tube such as an IV tube that is disposed between the rollers and the raceway 32. In the tube load position, the rotor 34 is sufficiently spaced from the raceway 32 to permit a tube 44 to be disposed between the raceway and rotor and to be removed therefrom, e.g., by hand. The rotor 34 may be moved translationally and/or rotationally by, e.g., an actuator stepper motor, or by a manually-actuated lever linkage, or other appropriate mechanism or means.
Mounted on the rotor 34 are one or more rollers to urge against the tube 44 to pump fluid through the tube. In the example shown in
As shown in
The tube 44 may be configured as a loop, with the ends of the loop engaged with a plenum 50 (while certain embodiments below refer to a plenum, an enclosure, compartment or other like component may be utilized) of a working fluid cassette, generally designated 52. The plenum 50 is hingedly engaged with or coupled to a framed cassette bag 54. Example details of the framed bag 54 are discussed further below. Additional example details that may be used with the working fluid cassette 52 are shown and described in U.S. patent application Ser. Nos. 14/180,613 and 14/180,655, filed Feb. 24, 2014 and incorporated herein by reference. Such a cassette can be engaged with structure in the control system 14 to exchange heat with working fluid flowing through the cassette 52 and tube 44 and being circulated by the pump 30 shown and described herein to and from a heat exchange member such as the catheter 12 and/or pad 18 through, e.g., the lines L1 and L2 shown in
When the bag 54 is disposed vertically between the cold plates 31 as described in the above-referenced U.S. patent application Ser. No. 14/180,719, the plenum 50 can be locked into place as the rotor of the pump 30 moves into the pump or operating position as described further below.
In examples, the cassette bag 54 may be made of two polymeric membranes closely spaced from each other and supported by a frame that is slidably engageable with a slot 56 on a cold plate assembly that supports the pump of
The exit tube 80 in turn enters an enclosed working fluid reservoir 84 in the plenum 50, e.g., through an entry port connector 86. The reservoir may be a separate container or manifold positioned within the enclosure or plenum or may be integral with the enclosure or plenum. The reservoir may collect or hold an amount of working fluid necessary or required to run the system. One or more level sensors may be provided in the reservoir 84 to generate a signal when the reservoir fluid level falls below a threshold. The signal can be used to activate a warning lamp or audio alarm. Note that the entry port connector 86 is located near the top of the reservoir 84 in the bottom view shown. Also, an IV bag line or tube 87 is connected to the reservoir 84 via an IV bag connector 88 to supply working fluid to the system from the IV bag 57 shown in
A single line or tube 87 in a closed fluid circuit path provides a sterile barrier or environment for the working fluid and also provides enhanced or improved convenience. Working fluid, e.g., saline, may be delivered through the line 87, and air may travel back up through the same line 87, in an opposite direction if desired, e.g., during priming, allowing for the delivery of two different fluids (e.g., water or saline and air) through the same line. The delivery of saline and air may not occur simultaneously and/or a filter may not be required. A closed fluid circuit path or closed loop system utilizing a single IV bag line or other fluid source line without a filter may work for up to 7 days, and in certain embodiments may work for more than 7 days. The pump described herein may operate in both directions, and the pump may be self-priming such that it can pump air and/or water.
Near the bottom of the reservoir 84, an outlet connector 90 establishes fluid communication between the working fluid in the reservoir 84 and the peristaltic tube 44 which extends through a tube exit opening 92 to engage the peristaltic pomp described above. The pump urges against the tube 44 to circulate working fluid in the pathway described herein. The tube 44 reenters the plenum 50 through a tube entry opening 94 to engage or be made integrally with a dampener tube 96. The tube 44 may connect to a downstream dampener or dampener tube directly or via an intermediate tribe or manifold.
As shown, the example dampener tube 96 has a larger diameter than the exit tube 80 and furthermore extends back and forth across the plenum 50 one or more or multiple times, e.g., being bent through one or more 180 degree loops as shown. Alternatively, the dampener tube may be partially or entirely located outside of the plenum, and or may be a straight or substantially straight length tube with no or minimal loops. The purpose of the dampener tube 96 is to dampen pulses in the working fluid caused by the peristaltic pumping action. The dampener tube 96 is joined to a smaller diameter working fluid supply tube 98 at a clamp-like joint 100. Working fluid is conveyed to the catheter 12 or pad 18 through the supply tube 98.
In
In contrast,
A drain tube 138 with a smaller diameter than the entry tube 130 extends through the entry tube 130 as shown toward a bottom rail 140 of the frame 60 that is opposite to and parallel with the top rail 134. The drain tube 138 terminates in an opening 142 that is proximate to (e.g., within ¼→ or so of) the bottom rail 140. When working fluid is being circulated through the catheter 12 and bag 54 during patient temperature management operation, at least a portion of the working fluid being returned from the catheter 12 to the cassette 52 exits the larger diameter opening of the entry tube 130, near the top of the cassette 52, and at least a portion of the working fluid flows down and across the bag 54 to exchange heat with the plates between which the bag 54 is disposed.
When it is desired to drain the catheter and/or bag to facilitate withdrawal of the bag 54 from the plates, which can be impeded if the bag 54 remains full of working fluid, the pump may be reversed. This evacuates working fluid from bag 54 through the drain tube 138. The evacuation causes the bag material to collapse around the larger entry tube 130, leaving most of the suction at the opening 142 of the drain tube 138. The working fluid is pumped through the drain tube 138 back into the reservoir 84 in the plenum or enclosure and from there to the IV bag. When the catheter remains connected to the cassette 52, working fluid is also evacuated from the catheter. When the catheter is not connected prior to draining the bag 54, the connectors (typically Luer fittings) that connect catheter IV lines to the supply and return lines of the cassette may be simply connected together to close the fluid loop.
In certain embodiments, a check valve 81 (
In certain embodiments, when filling the cassette bag during priming, the pump can be started and stopped in short periods to allow air to vent back through the reservoir in the plenum or enclosure. The pump may also be reversed to speed up the movement of air back through the reservoir and/or to the IV bag or fluid source. A single line may be used for delivering liquid and/or air between the reservoir and the IV bag or fluid source, allowing air to be removed from the fluid path without requiring the use of either a two-lumened spike line which may be more difficult for the user to install, or a hydrophobic vent or other filter which allows air to escape but may break down over time causing working fluid to leak out of the system.
Components included in one embodiment can be used in other embodiments in any appropriate combination. For example, any of the various components described herein and/or depicted in the Figures may be combined, interchanged or excluded from other embodiments. “A system having at least one of A, B, and C” (likewise “a system having at least one of A, B, or C” and “a system having at least one of A, B, C”) includes systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.
While various embodiments of a WORKING FLUID CASSETTE WITH HINGED PLENUM OR ENCLOSURE FOR INTERFACING HEAT EXCHANGER WITH INTRAVASCULAR TEMPERATURE MANAGEMENT CATHETER are herein shown and described in detail, the scope of the present invention is to be limited by nothing other than the appended claims.
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Number | Date | Country | |
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20180311072 A1 | Nov 2018 | US |
Number | Date | Country | |
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Parent | 14676672 | Apr 2015 | US |
Child | 16026427 | US |