Method for continuous ambulatory peritoneal dialysis

• US 4,239,041 A
• Filed: 08/04/1978
• Issued: 12/16/1980
• Est. Priority Date: 03/03/1977
• Status: Expired due to Term

• Current Assignee: Jack W. Moncrief, Robert P. Popovich
• Original Assignee: Jack W. Moncrief, Robert P. Popovich
• Inventors: Popovich, Robert P., Moncrief, Jack W.
• Primary Examiner(s): Truluck, Dalton L.
• Application Number:
  US05/931,098
• Time in Patent Office: 865 Days
• Field of Search: 128/213 A, 128/214 R, 128/214 B, 128/227, 128/230, 210/321, 210/22
• US Class Current: 604/28
• CPC Class Codes: A61M 1/1672 using membrane filters, e.g. for sterilising the dialysate
• CPC Class Codes: A61M 1/28 Peritoneal dialysis ; Other peritoneal treatment, e.g. oxygenation
• CPC Class Codes: A61M 1/282 Operational modes
• CPC Class Codes: A61M 1/285 Catheters therefor
• CPC Class Codes: A61M 2209/088 on the body
• CPC Class Codes: A61M 25/02 Holding devices, e.g. on the body
• CPC Class Codes: A61M 5/1408 in parallel, e.g. manifolds, sequencing valves access sites A61M39/02; tube connectors A61M39/10

Abstract

A process for the removal of toxins from the body in a continuous manner while the patient is totally ambulatory. The process involves the infusion of a dialysate fluid under prescribed conditions into the peritoneal cavity. The toxic solutes are transported across the peritoneum membrane into the dialysate fluid by the natural processes of diffusion and convection. The dialysate fluid and the toxins are then removed after a prescribed residence phase. Apparatus includes an indwelling balloon catheter surgically implanted within the peritoneal cavity of a patient, a dacron cuff surgically attached to the abdominal wall, and an external quick connect coupling attached to the catheter. Apparatus may also include a wearable microbiological filter unit for reducing the risk of peritonitis during infusion of dialysate fluid.

Claims

1. A method of continuous, ambulatory peritoneal dialysis, which comprises the step of establishing a substantially constant presence of dialysate fluid within the peritoneum of a patient at all times over an extended period of time using apparatus comprising:

an in-dwelling catheter adapted to be surgically implanted in the peritoneal cavity of a patient and having a supply tubefor extending through the abdominal wall of the patient; and

a bag adapted to be interconnected with the supply tube and carried by the patient during dialysis for dispensing dialysate fluid through the supply tube to the peritoneal cavity of the patient and for receiving spent dialysate drained from the peritoneal cavity of the patient.

2. The method of claim 1 using apparatus which further comprises:

a quick disconnect coupling attached to the end of the supply tube; and

a coupling attachment on the bag for interconnection with the coupling on the end of the supply tube.

3. The method of claim 1 using apparatus which further comprises:

a coupling attached to the end of the supply tube; and

a cap for attachment to the coupling on the end of the supply tube to seal the end thereof.

5. A method for continuous ambulatory peritoneal dialysis of a patient, the patient being unattached to automatic cycling dialysis apparatus, comprising the steps of:

infusing dialysate fluid into the patient'"'"'s peritoneal cavity;

allowing the dialysate fluid to remain within the patient'"'"'s pertioneal cavity for a residence period time during which the patient remains ambulatory and unattached to a dialysis fluid supply that is in a fixed location;

draining the dialysate fluid from the patient'"'"'s peritoneal cavity after the time period; and

immediately repeating the aforesaid steps, the steps being repeated several times per day, every day, at intervals corresponding to the residence time period, so as to maintain a substantially constant presence of dialysate fluid within the patient at all times.

6. The method of claim 5 wherein the residence time period is at least four hours and the aforesaid steps are repeated at least three times in each twenty-four hour period.

7. A method for continuous ambulatory peritoneal dialysis of a patient unattached to automatic cycling dialysis apparatus, as maintenance treatment for chronic end-stage renal disease, comprising the steps of:

infusing dialysate fluid into the patient'"'"'s peritoneal cavity;

allowing the dialysate fluid to remain in the patient'"'"'s peritoneal cavity for a dwell time during which the patient is ambulatory and unattached to a dialysis fluid supply that is in a fixed location;

exchanging fresh dialysate fluid for spent dialysate fluid after the residence period of time by draining the spent dialysate fluid from the patient'"'"'s peritoneal cavity and immediately infusing fresh dialysate fluid into the patient'"'"'s peritoneal cavity;

repeating the exchange of dialysate fluid several times per day at intervals corresponding to the residence period of time such that a substantially constant presence of dialysis fluid is maintained and dialysis is occurring essentially continuous for twenty-four hours per day, every day, except for drainage and infusion times.

4. The method of claim 8 using apparatus which further comprises a wearable microbiological filter interposed between the catheter and the bag for preventing the introduction of bacteria to the peritoneum.

8. The method of claim 7, wherein the mean dwell time is at least four hours.

9. A method for continuous ambulatory peritoneal dialysis of a patient, the patient being unattached to automatic cycling dialysis apparatus, as maintenance treatment for chronic end-stage renal disease to reduce uremic toxicity, and in which nitrogen waste product removal and production are balanced at a low level of plasma urea concentration, comprising the steps of:

infusing dialysate fluid into the patient'"'"'s peritoneal cavity;

exchanging the dialysate fluid after a mean dwell time period during which the patient is ambulatory and remains unattached to a dialysis fluid supply that is in a fixed location;

repeating the step of exchanging dialysate fluid several times per day to maintain a substantially constant presence of dialysate fluid, so that dialysis is occurring essentially twenty-four hours per day, every day, except for drainage and infusion times, and is continuous.

10. A method for continuous ambulatory peritoneal dialysis of a patient, the patient being unattached to automatic cycling dialysis apparatus and having an implanted catheter that leads to the peritoneal cavity, comprising the steps of:

attaching to the catheter a small plastic bag containing about two liters of dialysate fluid;

infusing the contents of the bag into the patient'"'"'s peritoneal cavity;

allowing the dialysate fluid to remain in the patient'"'"'s peritoneal cavity for a mean dwell time of at least four hours, during which time the patient is ambulatory and remains unattached to a dialysis fluid supply that is in a fixed location;

draining the dialysate fluid from the patient'"'"'s peritoneal cavity and disconnecting the plastic bag from the catheter; and

repeating the aforesaid steps at least three times per day, every day, at intervals of at least four hours to maintain a substantially constant presence of dialysate fluid in the patient'"'"'s peritoneal cavity, so that dialysis is occurring essentially twenty-four hours per day, every day, except for drainage and infusion times, and is continuous.