System and method for delivery of regional citrate anticoagulation to extracorporeal blood circuits
AssigneeHenry Ford Health System
InventorsBalazs Szamosfalvi, Stanley Frinak, Jerry Yee
Life of this patent
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Abstract
The present invention includes a comprehensive replacement fluid system and method for the delivery of regional citrate anticoagulation (RCA) to extracorporeal blood circuits, wherein the system may include an online clearance monitor (OCM) and a circuit effluent online sensor system (OSS) for the continuous determination of patient plasma content of ultrafilterable soultes.
Claims45
A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
- a hemofilter in fluid communication with the arterial and venous blood lines and having a dialysis-fluid in connector and a dialysis-fluid out connector;
- a first pre-filter infusion line and pump having a connection to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution, wherein the first pre-filter infusion solution comprises a basic citrate to acid citrate ratio of about 2:1 to 8:1;
- a second pre-filter infusion line and pump capable of a connection to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution;
- a fresh dialysis fluid line and pump capable of a connection to the hemofilter dialysis-fluid in connection for providing dialysis with a second bicarbonate-containing solution countercurrent to a direction of blood flow in the hemofilter;
- a post-filter infusion line and pump capable of a connection to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a third bicarbonate-containing solution;
- an effluent fluid line and pump connected to the hemofilter dialysis-fluid out connection for receiving filter effluent fluid;
- an additional infusion line and pump having a connection to the venous blood line downstream from the connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution;
- and
- a monitor for determining a performance of the hemofilter in removing citrate from the blood.
A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
- a hemofilter in fluid communication with the arterial and venous blood lines and having a dialysis-fluid in connector and a dialysis-fluid out connector;
- a first pre-filter infusion line and pump having a connection to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution, wherein the first pre-filter infusion solution comprises about 150-250 mmol/L sodium chloride and about 50-1000 mmol/L total citrate;
- a second pre-filter infusion line and pump capable of a connection to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution;
- a fresh dialysis fluid line and pump capable of a connection to the hemofilter dialysis-fluid in connection for providing dialysis with a second bicarbonate-containing solution countercurrent to a direction of blood flow in the hemofilter;
- a post-filter infusion line and pump capable of a connection to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a third bicarbonate-containing solution;
- an effluent fluid line and pump connected to the hemofilter dialysis-fluid out connection for receiving filter effluent fluid;
- an additional infusion line and pump having a connection to the venous blood line downstream from the connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution;
- and
- a monitor for determining a performance of the hemofilter in removing citrate from the blood.
The system according to 1, further comprising:
- sterile solution bags for the pre-filter infusion solution having connectors that only accept a unique end connector on the pre-filter infusion line;
- and
- sterile solution bags for the additional infusion solution having connectors that only accept a unique end connector on the additional infusion line.
A system for regional citrate anticoagulation in an extracorporeal blood circuit including an arterial blood line arranged to be connected to a vascular access for withdrawing blood from a patient and a venous blood line arranged to be connected to the vascular access for returning blood to the patient, the system comprising:
- a hemofilter in fluid communication with the arterial and venous blood lines and having a dialysis-fluid in connector and a dialysis-fluid out connector;
- a first pre-filter infusion line and pump having a connection to the arterial blood line upstream from the hemofilter for infusing a first pre-filter infusion solution comprising a citrate anticoagulant-containing solution;
- a second pre-filter infusion line and pump capable of a connection to the arterial blood line upstream from the hemofilter for infusing a second pre-filter infusion solution comprising a first bicarbonate-containing solution;
- a fresh dialysis fluid line and pump capable of a connection to the hemofilter dialysis-fluid in connection for providing dialysis with a second bicarbonate-containing solution countercurrent to a direction of blood flow in the hemofilter;
- a post-filter infusion line and pump capable of a connection to the venous blood line downstream from the hemofilter for infusing a post-filter infusion solution comprising a third bicarbonate-containing solution;
- an effluent fluid line and pump connected to the hemofilter dialysis-fluid out connection for receiving filter effluent fluid;
- an additional infusion line and pump having a connection to the venous blood line downstream from the connection of the post-filter infusion line for infusing an additional infusion solution comprising a calcium- and magnesium-containing solution;
- a monitor for determining a performance of the hemofilter in removing citrate from the blood;
- and
- a control program for providing a prescription for the hemofilter which ensures that a single pass removal of citrate on the hemofilter from blood into the filter effluent fluid is at least 60% during the operation of the system, monitoring the transfer of citrate from blood into the filter effluent fluid on the hemofilter;
- and adjusting a flow rate of the additional infusion solution to maintain target calcium levels in the patient's systemic blood.
Dependencies are inferred from the claim text.