Peritoneal dialysis system

(Background of invention) The present invention relates to a dialysis system as a whole. Specifically, the present invention relates to an automated peritoneal dialysis system. The present invention also relates to methods and devices for performing automated peritoneal dialysis.

The patient's kidney system may be upset due to illness, seizures or other causes. Any cause of renal failure causes some physiological disturbance. The balance of water, minerals and daily metabolic load is no longer possible in renal failure. During renal failure, toxic end products of nitrogen metabolism (urea, creatinine, uric acid, etc.) accumulate in blood and tissues.

Renal failure and decreased renal function are treated with dialysis. Dialysis removes waste products, toxins, and excess water from the body that would normally have been removed by the normally functioning kidneys. Dialysis for the replacement of kidney function is important for many because its treatment saves lives. People with renal failure cannot survive without at least supplementing the filtering function of the kidneys.

Hemodialysis and peritoneal dialysis are two types of dialysis treatment commonly used to treat loss of renal function. Hemodialysis treatment utilizes the patient's blood to remove waste products, toxins and excess water from the patient. The patient is connected to the dialysis device and the patient's blood is pumped through the device. A catheter is inserted into the patient's veins and arteries to allow blood flow to the hemodialysis device and drain it from the hemodialysis device. When blood passes through the dialyzer of the hemodialysis device, the dialyzer removes waste products, toxins and excess water from the patient's blood and returns the blood to the patient. Large amounts of dialysate, such as 120 liters, are used to dialyze blood during a single hemodialysis treatment. The used dialysate is discarded. Hemodialysis treatment lasts for several hours and is usually given at a dialysis center three to four times a week.

Peritoneal dialysis utilizes a dialysis solution or "dialysis product" that is injected into the patient's peritoneal cavity through a catheter implanted in the peritoneal cavity. The dialysate contacts the patient's peritoneum within the peritoneal cavity. Waste products, toxins and excess water pass from the patient's bloodstream through the peritoneum to the dialysate. The transfer of waste products, toxicants and water from the bloodstream into the dialysate occurs by diffusion and osmotic pressure, i.e., an osmotic gradient across the membrane. Used dialysate is drained from the patient's peritoneal cavity to remove waste products, toxins and excess water from the patient. This cycle is repeated.

There are various types of peritoneal dialysis treatment, including continuous outpatient peritoneal dialysis (CAPD), automated peritoneal dialysis, and continuous flow peritoneal dialysis. CAPD is a manual dialysis treatment in which the patient connects the implanted catheter to the drain and drains the used dialysis from the peritoneal cavity. The patient then connects the catheter to a bag of fresh dialysate and manually injects the fresh dialysate through the catheter into the patient's peritoneal cavity. The patient removes the catheter from the fresh dialysate bag, allows the dialysate to stay in the peritoneal cavity, and transfers waste products, toxins and excess water from the patient's bloodstream to the dialysate. After a period of residence, the patient repeats the manual dialysis procedure.

In CAPD, patients perform a cycle of excretion, retention, filling and excretion several times a day, for example four times a day. Each treatment cycle takes, for example, one hour. Manual peritoneal dialysis performed by the patient requires considerable time and patient effort. There is ample room to improve this inconvenient procedure and improve its therapeutic effectiveness in order to improve the patient's quality of life.

Automatic peritoneal dialysis (APD) is similar to CAPD in that dialysis treatment involves excretion, filling, and excretion cycles. However, the APD device automatically performs 3 to 4 peritoneal dialysis treatments, eg, overnight while the patient is asleep. The APD device connects the implanted catheter to the fluid. The APD device is also fluid connected to a container or bag of fresh dialysate, and a fluid outlet.

The APD device pumps fresh dialysate from the dialysate container and pumps it through the catheter into the patient's peritoneal cavity, causing the dialysate to stay in the peritoneal cavity, resulting in waste products, toxicants and excess water in the patient's blood. The flow can be transferred to dialysate. The APD device then pumps used dialysate out of the peritoneal cavity and drains it through a catheter. Specifically, the APD device is controlled by a computer, and dialysis treatment is automatically performed when the patient is connected to the dialysis device, for example, while the patient is sleeping. That is, the APD system automatically pumps fluid into the peritoneal cavity, retains it, pumps it out of the peritoneal cavity, and repeats this procedure.

Similar to the manual procedure, several discharge, fill and retention cycles are performed while the ADP is running. Specifically, the "last filling" is done at the end of the APD treatment and the dialysis is left in the patient's peritoneal cavity when the patient is released from the dialysis device that day. APD eliminates the need for patients to manually perform drainage, retention and filling steps.

However, the APD system needs to continue to be improved. For example, it is necessary to provide a simple APD system that is easy for patients to use and operate. In addition, there is a need to provide an APD system that is cheaper and has lower operating costs. In particular, existing APD systems need to be improved clinically, economically and ergonomically.

The APD system needs to be improved for home use. One of the common problems with current home systems is that they are prone to electric shock due to "leakage current". The current that flows from a mutually isolated conductor or between a conductor and ground is called an "leakage current." If any conductor reaches a potential above the ground potential, some current will flow from that conductor to ground. This also happens with conductors that are well insulated from ground, as there is never perfect insulation or infinite resistance. The amount of current flowing depends on (i) potential, (ii) capacitive reactance between conductor and ground, and (iii) resistance between conductor and ground.

In medical devices, several different leakage currents are defined depending on the path through which the leakage current passes. "Earth leakage current" is the current that normally flows through the ground conductor of the grounded portion for the purpose of protecting the device. In medical devices, the impedance from the exterior to the ground is usually much lower through the protective ground conductor than through the patient. However, if the protective ground conductor becomes an open circuit, there is a risk of electric shock to the patient.

"Patient leakage current" is the leakage current that flows through the patient connected to the component used. This current either flows from the component used through the patient to ground, or from an external high voltage power source through the patient to ground. Separate types of leakage current include "exterior leakage current" and "patient auxiliary current".

Leakage current is usually small, but the amount of current required to have a physiological adverse effect on the patient is also small. Therefore, the leakage current should be limited to as small as possible by the device design and within the safety limit.

<p> (Gist of the invention) The present invention generally provides an improved dialysis system and an improved dialysis method. Specifically, the present invention provides a system and method for performing automated peritoneal dialysis (APD). The system and method of the present invention provides a dialysis product to a patient and automatically performs dialysis treatment by discharging the used dialysis product from the patient.</p><p> In addition, the system and method of the present invention can perform various dialysis treatments. An example of dialysis treatment that can be performed according to the present invention includes automating the filling, retention and drainage of dialysate by a patient. The dialysis system of the present invention can automatically perform dialysis treatment for a patient, for example, dialysis treatment at night when the patient is sleeping.</p><p> Finally, a dialysis system is provided in one embodiment. The system includes a fluid supply line. The disposable unit communicates with the fluid supply line with fluid. Disposable units have at least two flexible membranes glued together at selected locations and glued to rigid plastic parts or manifolds. The membrane is either one or two layers. Preferred membrane materials are described herein. The membranes are sealed together to form a fluid pump receiver and fluid heating passage. The membrane and plastic manifold form several elastic valve chambers. The disposable unit also communicates fluidly with the patient and drain lines.</p><p> Other areas of the manifold and disposable unit have contracted or tapered ends that provide a sealing area for the membrane. The shrunk or tapered area requires less heat than the original thickness, mitigating the heat storage imbalance between the thickness of the disposable unit manifold and the thinner elastic membrane. The frame of the manifold is bowed or bent to give it firmness. The frame is asymmetric and is designed to be installed in only one direction within the hardware unit.</p><p> The hardware unit can be hand-carried to the patient's home. The patient can open the hardware unit and place the disposable unit in it, then close it and the dialysis unit and the disposable unit can jointly form a pump chamber to pump the dialysate to the patient and drain it from the patient. .. The hardware unit has an exterior that forms the pump body, valve actuators and heaters. It is possible to put the disposable unit in and out of the exterior. A pump chamber is formed by the fluid pump receiver of the disposable unit and the main body of the hardware unit. The pump chamber is operated by a pump actuator installed inside a portable hardware unit.</p><p> When packed, multiple tubes extend from the disposable unit. At the end of each tube is a connector that attaches to one body. The body becomes multiple chip protectors, holding the tubes in order according to the course of treatment. The body slides into the system hardware from one direction, allowing the patient to easily pull the tube and connector out of the chip protector organizer.</p><p> The chip protector that houses the patient's fluid connector includes a hydrophobic filter that allows air to escape but fluid does not pass. This breathable chip protector allows you to lift and balance or start the system without adjusting the fluid flow rate. The system is started by flowing the fluid through the system to the patient's fluid line until the dialysate returns to the filter, increasing the fluid pressure detected by the system. The system then stops the pump.</p><p> The hardware unit also has a controller. The controller has multiple processors, memory for each processor, and I / O capabilities. One of the processors coordinates the operation of pump actuators, valve actuators and heaters at various stages of dialysate flow, including filling, staying and discharging stages. The processor also controls several different types of sensors or receives feedback. Among the various sensors, the sensors include capacitive fluid volume sensors, dialysate temperature sensors, pressure sensors, vacuum sensors, air detection sensors, mechanical positioning sensors and the like.</p><p> In one embodiment, the system uses preset motion control and adaptive pressure control to control the fluid pressure in the fluid pump receiver. Preset pump motor acceleration is used to overcome system compliance (eg, membrane and tube flexibility), but these are not easily overcome by known proportional, differential or integrated controls. After the system overcomes compliance, the system switches to adaptive control using adaptive technology that controls pressure by precisely controlling the speed of the pump motor shaft. Adaptive parameters change over time to fine-tune the system. This method is particularly important in the patient's filling and draining cycle, allowing the patient to sense pressure fluctuations. This method also easily compensates for pressure fluctuations due to bag height and fill.</p><p> Capacitive fluid volume sensors indicate the volume of fluid in the pump chamber, which causes the sensor to generate a voltage signal indicating the volume of fluid in the fluid receiver. The controller receives the voltage signal and converts the signal into the amount of fluid or air in the elastic fluid receiver of the pump chamber.</p><p> The pump actuator can be operated mechanically or pneumatically. When mechanically driven, a pump motor drives a vacuum source such as a piston cylinder, thereby evacuating the membrane of the fluid receiver of the disposable unit. Here, a mechanical position sensor such as an encoder detects the angle of the pump motor shaft relative to the home position and sends a signal to the controller, so that the controller can control the pump motor. The encoder also provides safety feedback to the controller, which prevents the camshaft from rotating to a position where the valve is free to fill the patient once treatment begins. When the pump actuator is pneumatically operated, the system according to the embodiment uses a vacuum pump to pull the membrane of the fluid receiver apart. In this case, the system uses a vacuum sensor to detect the state of the vacuum pump and mechanical detectors such as the linear encoder to detect the state of the pump piston.</p><p> Thus, in one embodiment, the system maintains a negative pressure on one of the membranes of the fluid receiver of the disposable unit, pulling that membrane away from the other membrane and drawing the dialysate into the fluid receiver. The negative pressure on the working membrane is then released, pushing the membrane towards the other membrane and pushing the dialysate out of the pump fluid receiver. In another embodiment, the mechanical pump piston pneumatically contacts one membrane and the system mechanically pulls the membrane away from the other membrane. In some embodiments, the membrane is connected to the pump piston by negative pressure. The pump also includes a diaphragm that is pulled into the bottom of the piston head and the membrane is pulled up to the top of the piston head. In another embodiment, the system mechanically pushes one membrane and applies negative pressure to the membrane.</p><p> The system also automatically performs other necessary tasks. For example, the system automatically heats the dialysate to the required temperature and delivers the dialysate to the patient. The heater heats the fluid heating path separated by the elastic membrane of the disposable unit. In some embodiments, the heater includes an electrical heating plate. The heater also includes an infrared heating source in addition to the heating plate. In one embodiment, the fluid heating pathway and heater are in-line heaters that heat the dialysate while it is being delivered from the feed bag to the patient.</p><p> The system employs a heating control method that uses knowledge-based algorithms and fuzzy logic-based algorithms. The former uses the laws of physics, empirical data and detected input signals. The latter inputs the difference between the predetermined temperature and the actual temperature, and uses the fuzzy logic membership function and fuzzy logic rules. Each algorithm operates at a different update frequency. Each algorithm operates at a different update frequency. Each algorithm outputs a load cycle, and the system weights the fuzzy logic-based load cycle against the knowledge-based load cycle to create the overall heater-controlled load cycle. This method allows accurate temperature control of dialysate.</p><p> The system automatically expels air from the dialysate, for example through a pump chamber. The system also detects the total volume of fluid delivered to the patient and records and stores it. In addition, the system perceives the instantaneous flow velocity and pressure of fluids flowing into and out of the patient's peritoneal cavity.</p><p> The disposable unit includes a valve manifold. The manifold forms multiple valve chambers. The hardware unit includes a valve actuator that selectively and sequentially pushes at least one valve chamber. In one embodiment, the mechanically operated valve actuator includes a single camshaft and a plurality of cams. The cam pushes one membrane of the disposable unit and contacts the other membrane, blocking or impeding fluid flow. As mentioned earlier, the system uses a detector, such as a rotary encoder, to detect the angle of the camshaft relative to the home position, and the controller rotates the camshaft to create at least one valve. It can be opened and closed as desired. One camshaft is switched back and forth between the "supply and pump chamber fill position" and the "patient discharge and system discharge position" and between the pump chamber fill position and the patient fill position. These positions are driven by a unique rotational position on the overall cam profile (ie, the overlap of the individual cams as seen from the end of the camshaft).</p><p> The disposable units of the present invention are provided in a variety of different formats. In some embodiments, the portion of the disposable unit that forms the heating path is formed of the same membrane that seals the rigid member or manifold that forms the valve chamber. The same membrane also forms the pump receiver. In a separate embodiment, the disposable unit includes a first set of membranes that form a pump receiver and valve manifold via a rigid member. The disposable unit also includes a second membrane that is different from the first membrane that forms the fluid heating path. In one embodiment, medical grade piping connects the first set of membranes to the second set of membranes. Specifically, the fluid heating path is connected to the valve manifold through the fluid by piping.</p><p> Disposable units of other embodiments include a first flexible membrane and a second flexible membrane that house the pump receiver, fluid heating path and valve manifold. The disposable unit also includes a rigid frame attached to the first and second flexible membranes. The rigid frame allows the patient or operator to install the frame and disposable unit within the exterior of the hardware unit of the dialysis system. The rigid frame is sized to fit exactly in the space provided inside the exterior. The rigid frame also holds the disposable unit in a stable position when the patient or operator connects the tubes. For example, the valve manifold provides a connection port or other type of connector for connecting to supply lines, drain lines and patient lines. In some embodiments, the rigid frame extends or bypasses the membrane, including the pump receiver, fluid heating path and valve manifold. In some embodiments, the rigid frame is plastic. In one embodiment, the rigid frame is bowed along both sides to increase the rigidity of the disposable unit and prevent the disposable unit from deforming during the heat seal of its manufacture.</p><p> In certain embodiments, the rigid member or manifold of the disposable unit includes an interface in which the membrane can be easily sealed by the manifold. The edges of the manifold are tapered to reduce the heat required to bond between the membrane and the plastic valve manifold. The knife-shaped tapered edge also reduces or eliminates the air gap between the tip and bottom membranes, minimizing the potential for leaks in the disposable unit. The squared edges also reduce the likelihood of burning off the film during the heat sealing process.</p><p> The above hardware unit also includes a display device that provides display system information. The display device allows the patient or operator to enter information and instructions into the controller. For example, the display device also includes an attached touch screen that allows the patient or operator to initiate automatic fluid delivery through the disposable unit. The system initiates the delivery of dialysate into the patient's peritoneal cavity, either pneumatically or mechanically, through a pump chamber and through an in-line heater. The system then automatically performs other cycles of dialysis treatment, eg, while the patient is asleep or at night. The automated system not only moves the dialysate from the supply vessel to the patient, but also allows the dialysate to stay inside the patient for a period of time and automatically transfer the dialysate from the patient to the drain vessel.</p><p> The system provides a graphic user interface (GUI). The GUI in one embodiment uses an embedded web browser and an embedded web server. Web browsers and servers run the system's main microprocessor. The GUI also uses device access and control software that runs on the main system processor and a dedicated processor. This device access and controller controls low-level devices such as heaters and pumps. The GUI also provides intermediate software for the web browser to communicate with the device access and control software.</p><p> The GUI displays some treatment setup screens and some dialysis treatment screens. The setup screen generally allows the patient to preview the setup part of the treatment. The system is waiting for operator input before proceeding to the next setup screen. The setup screen provides the patient with an actual image of the device and a video of the actions required to connect the system to the patient.</p><p> Treatment The treatment screen presents the patient with various treatment cycles in real time or substantially in real time. Treatment The treatment screen displays information such as cycle time in both graphs and numbers. Treatment The treatment screen does not require input from a patient who may be asleep while these screens are displayed. At the end of the procedure, the system redisplays some removal screens, which, like the setup screens, wait for input from the patient before performing any action.</p><p> The treatment screen is in color and is illuminated to be seen at night, easily visible from a distance of about 10 to 15 feet, but not to wake up the sleeping patient. In some embodiments, the screen background is black, while the graph is ruby red. In contrast, the setup screen is proven and colored for daytime viewing.</p><p> In the above embodiments, one of the advantages of the present invention is to provide an improved system and method for performing dialysis.</p><p> Another advantage of the present invention is to provide an improved system and method for performing peritoneal dialysis.</p><p> Another distinct advantage of the present invention is to provide an automated peritoneal dialysis system and method of operation thereof.</p><p> A further distinct advantage of the present invention is to provide an automated dialysis system that is convenient for dialysis treatment.</p><p> A further separate advantage of the present invention is to provide an economically advantageous automated dialysis system.</p><p> A further distinct advantage of the present invention is to provide an automated dialysis system that favors quality of life.</p><p> A further distinct advantage of the present invention is to provide a disposable unit with a bow-shaped curved side that increases and reduces the rigidity of the disposable unit.</p><p> Further, an advantage of the present invention is to provide a disposable unit with a tapered interface to reduce the heat storage of the semi-rigid manifold and provide a stronger seal.</p><p> Various features and advantages of the present invention can be clarified by reading the present disclosure, including the appended claims, with reference to the accompanying drawings. This advantage is desirable but not necessary for the practice of the present invention.</p><p> (Detailed description of the invention) The present invention relates to a dialysis system and a method of performing dialysis. Specifically, the present invention relates to a system and method for automatically performing peritoneal dialysis in a patient. The present invention provides a method of automatically exchanging a dialysis fluid in and out of a patient's peritoneal cavity multiple times. Automatic replacement of dialysate includes drainage, filling and retention periods, usually during the patient's sleep. Specific treatments include 3-5 dialysis fluid changes. In certain embodiments, the present invention provides a single-pass system in which the dialysate passes through the peritoneal cavity only once prior to excretion. Although the present invention provides peritoneal dialysis, it is also suitable for other types of dialysis and other medical fluid transfer manipulations.</p><p> (I. System overview) With reference to the drawings, in particular FIG. 1, the specific treatment performed in the system 10 of the present invention begins with draining the dialysis solution that is already in the patient's peritoneal cavity 12. System 10 delivers fresh dialysate from one of a plurality of bags 14 through an in-line heater 16 to the patient or peritoneal cavity 12. After a period of residence in the peritoneal cavity 12, the used dialysate in the peritoneal cavity is pumped from the patient or peritoneal cavity 12 to the drain vessel 18 or other disposal means. System 10 then pumps fresh dialysate from the supply bag 14 into the patient or peritoneal cavity 12 and repeats this procedure as determined by the treatment protocol. In system 10 of one embodiment, the last bag of dialysate (usually a dialysate with a different formulation than that in other feed bags) is placed in the peritoneal cavity 12 due to retention extension such as daytime retention. Pumped.</p><p> In one embodiment, the system 10 includes a mechanically operated diaphragm pump 20. The mechanically operated diaphragm pump 20 uses a pump motor 22 and a linear pump actuator 24. Vacuum can also be used in the mechanical actuator for the diaphragm pump 20, as detailed below. In another embodiment shown in FIG. 2, the pump is fully fluid operated.</p><p> In FIG. 1, system 10 also includes a valve actuator 26 that mechanically activates valves V1 through V5. The controller 30 controls the valve actuator 26 and, if necessary, opens valves V1 to V5 to allow dialysate to flow in a predetermined direction. In one embodiment, the valve actuator 26 includes a valve motor 28 and a camshaft (shown below) that opens at least one of V1 to V5 to allow dialysate to flow in a predetermined direction.</p><p> Controller 30 includes multiple processors and memory for each processor. Processors include the main microprocessor and some dedicated processors. The main microprocessor performs high-level tasks such as the graphic user interface (GUI) described below. Dedicated processors perform low-level tasks such as valve movement, sensor reading, and repeated heater cycles. A separate processor is provided solely for the purpose of tracking safety parameters such as heater plate and medical fluid temperature. In the object of the present invention, unless otherwise specified, "processor 34" is a general term for all processors, and "memory 32" is a general term for all corresponding memories.</p><p> The controller 30 also includes an input / output (I / O) module 36. The memory 32 stores a computer program including a stepwise sequence for the system 10 and is formed to output a certain output when there is a specific input. Processor 34 executes the program in memory 32. The I / O module receives signal lines from various sensors. The I / O module 36 is also connected to a power line that includes an input power line (including battery power) and a power line that outputs to various electrical components.</p><p> In some embodiments, the controller 30 includes a video controller 38, such as a video card. The controller 30 also includes a display device or video monitor 40 that displays medical procedure or dialysis information to the patient or operator. In one embodiment, the controller 30 also includes a touch screen 42 that mediates the video monitor 40 and electrically communicates with the I / O module 36. The touch screen 42 allows the patient or operator to enter medical procedure or dialysis information into the controller 30.</p><p> The controller 30 controls the heater 16, the pump 20, and the valve actuator 26 in several different phases that form a single medical or dialysis procedure. In the first pump filling phase, controller 30 activates pump 20 to pump medical fluid or dialysate from one of the supply bags 14. In FIG. 1, the controller 30 instructs the vacuum source 44, including the air pump 46, to evacuate both sides of the pump 20 through the first vacuum line 48 and the second vacuum line 50. Vacuum lines 48 and 50 pass through the walls of the first and second pump chambers, respectively, and suck one of the pair of membranes facing the inside of the pump chamber inside the pump chamber to create a vacuum. The other membrane is held facing the piston head in the pump 20. The other membrane is alternately and temporarily or permanently mechanically attached to the piston head without the need to evacuate the piston side of the pump 20.</p><p> Attaching the membrane inside the pump chamber and facing the piston head, the controller 30 commands the linear actuator 24 to aspirate inside the pump 20. The suction further pulls the membrane in the pump chamber apart. At this point, the controller 30 controls the valve actuator 26 to open only valve V1. The filling line 52 is made negative pressure by pulling the membrane apart, and the negative pressure draws the medical fluid or dialysate from the supply bag 14 into the receiver formed by opening the membrane in the pump chamber of the pump 20.</p><p> In the patient-filling phase, the controller 30 moves the linear pump actuator 24 upwards within the pump 20 when the vacuum source 44 maintains a negative pressure on the internal membrane through the pump chamber wall. The upward movement of the actuator 24 and the attached piston head create a mechanical positive pressure that closes the membrane receiver and pumps the medical fluid out of the pump 20. At this point, the controller 30 controls the valve actuator 26 and only valves V2 and V3 open. Thus, all fluid coming out of the pump 20 is pumped through the in-line heater 16, through the heater line 54 and the catheter line 56, into the patient, eg, into the patient's peritoneal cavity 12. In one embodiment the catheter line 56 is connected to a single lumen catheter implanted within patient 12, while in other embodiments the system 10 can use multiple lumen catheters.</p><p> The heater 16 in one embodiment includes at least one electric heating plate that heats the medical fluid to near body temperature. The controller 30 turns the heater 16 on and off as needed to obtain an appropriate fluid temperature. If the medical fluid is too hot or too cold, the controller 30 closes valve V1 and valve V2 located on the opposite side of the heater line 54 from the heater. If heating is inadequate, dialysate will not enter the peritoneal cavity.</p><p> The controller 20 repeats the pump filling phase and the heater filling phase to fill the patient's peritoneal cavity 12 with fluid according to the treatment protocol. In one embodiment, the volume inside the pump is about 30-50 milliliters, and an adult patient uses, for example, about 2 liters of dialysate. Therefore, the pump charge phase and the heater charge phase are repeated about 50 times. In one embodiment, the pump actuator 24 keeps the fluid pressure at the pump 20 at about 3 pounds per square inch (psi).</p><p> System 10 includes a fluid volume sensor 60 that measures the actual volume of medical fluid delivered through pump 20. By aggregating multiple individual pump volumes, the controller knows exactly how much medical fluid or dialysate was delivered to patient 12. In one embodiment, the system 10 repeats a pump filling phase and a heater filling phase, with the pump 20 delivering a predetermined volume of medical fluid. The predetermined volume is input to the controller 30 by the patient or operator.</p><p> In the retention phase, the controller 30 retains the medical fluid or dialysate in the patient 12 for a period of time, which time is controlled by the controller by the patient 12 or the operator. In one embodiment, the controller 30 determines the dwell time, but the patient 12 or operator can ignore the system 10 and instruct the system 10 to remove the medical fluid from the patient 12.</p><p> In the second pump filling phase, medical effluent is removed from patient 12. Controller 30 and Actuator 26 open valve V4 and close the remaining valves. While the vacuum source maintains the negative pressure inside the pump 20, the linear actuator 24 pulls the pump piston into the chamber of the pump 20 and reopens the intermembrane receiver. The negative pressure generated by opening the receiver draws the medical fluid from the patient 12 through the catheter line 56 and sends it into the membrane receiver formed inside the pump 20.</p><p> In the drain phase, the controller 30 moves the linear pump actuator 24 upwards within the pump 20 while maintaining a negative pressure on the inner membrane by the vacuum source 44 through the pump chamber wall. The upward movement of the actuator 24 creates a mechanical positive pressure that closes the membrane receiver and expels the medical fluid out of the pump 20. At this point, controller 30 controls valve actuator 26 to open only valve V5. As a result, all the fluid existing in the pump 20 is discharged to the drain container 18 through the drain line 58. The drain container 18 is a drain bag or a drain pipe for homes, hospitals and the like.</p><p> An embodiment of the fluid volume sensor 60 will be described in more detail below along with a description of the diaphragm pump 20. In addition to the fluid volume sensor 60, the system 10 includes a variety of other desired types of sensors.</p><p> System 10 includes temperature sensors 62, such as sensors T1 and T2, at relevant locations within System 10. In some embodiments, the sensor 62 is non-invasive, but any other type of temperature sensor can be used. As shown in FIG. 1, the sensors T1 and T2 provide feedback of the fluid temperature after the excess heater by the controller 30. Sensor T3 measures the temperature of the medical fluid before heating. Sensor T4 provides ambient temperature.</p><p> System 10 also includes a temperature sensor 62 that monitors the temperature of the heater 16. In one embodiment, the heater 16 is an in-line plate heater. The in-line plate heater 16 has at least one heater plate, eg, two heater plates with a disposable unit placed between them. Separate temperature sensors PT1 and PT2 are provided to measure the temperature of each plate heater. The system 10 can thereby control each plate heater individually.</p><p> The system 10 includes at least one air sensor 64, such as the sensor AS1, which is installed directly in the throat of the pump 20 inlet and outlet. A separate air sensor AS2 monitors the air in the medical fluid just before the last shutoff valve V13 leading to the catheter line 56 after leaving the non-other. The controller 30 monitors the air content detected by the air sensor 64 and controls the system 10 to perform the necessary air bleeding. The system 10 can separate the air and expel the air from the fluid, or simply carry the air to the drain vessel 18. System 10 also includes an exhaust solenoid 66 operated by controller 30. The exhaust solenoid 66 allows the system 10 to release the vacuum applied to one or both membranes in the pump 20.</p><p> System 10 can accumulate air for a variety of reasons. For example, valves V1 to V5 and fluid lines such as lines 52, 54, 56 and 58 may contain air before starting system 10. The supply bag 14 also introduces air into the pump 20. Patient 20 can also produce some gas, accompany the dialysate and enter pump 20. In addition, if there is a leak in the disposable fluid or supply bag 12, the connection to the patient's catheter or drain bag, the pump 20 may draw air through the leak.</p><p> System 10 is equipped with various fluid pressure sensors 68. The fluid pressure sensors FP1 and FP2 measure the excess pressure of the fluid in the filling line 52 leading to the pump 60. The fluid pressure sensor 68 provides the controller 30 with a signal indicating the individual fluid pressure at that location. Based on the signals from the pressure sensors FP1 and FP2, the controller 30 operates the fluid pump and valve to obtain and maintain the desired fluid pressure. As mentioned earlier, system 10 keeps the pump pressure at, for example, 3 psi.</p><p> System 10 also has 70 different valve pressure sensors. The valve pressure sensors VP1 to VP2 detect the fluid pressure in valves V1 to V5. System 10 is further equipped with at least one vacuum pressure sensor 72, eg, at vacuum source 44, to ensure that proper pressure is maintained on the membrane in pump 20.</p><p> In a separate embodiment, the fluid pressure sensor 68, the valve pressure sensor 70 and the vacuum sensor 72 are non-penetrating sensors, respectively. That is, the sensor does not physically contact (and can contaminate) the medical fluid or dialysate. Of course, the system 10 includes other fluid and pressure equipment such as flow rate sensors, pressure gauges, flow meters or pressure regulators at any location with any quality.</p><p> System 10 also includes various position sensors. In one embodiment, the position sensor includes a linear encoder 74 that monitors the position of the linear pump actuator 24 and a rotary encoder 76 that monitors the angular position of the valve actuator 26 or camshaft. Encoders are one type of positioning feedback device that can be used. One type of positioning feedback device includes a proximity sensor and a magnetic pickup that detect a pulse, eg, the teeth of a gear mounted on a camshaft, and output the pulse to a computer or microprocessor.</p><p> Encoders 74 and 76 provide, for example, a pulse output sent to controller 30. The pulse output tells controller 30 how far the linear pump actuator 24 or valve actuator 26 is from the home position or home index 78, or how far it is. For example, home position 78 is the position where the pump is fully open or closed on the linear encoder 74 and the angle 0 degree position on the rotary encoder 76.</p><p> In one embodiment, encoders 74 and 76 are absolute encoders that detect home position 78 even after power loss. In another embodiment, the encoders 74 and 76 are augmentable encoders, backed up by a battery so that the system 10 can remember the location of the home position 78 even when no external power is applied. Alternatively, the system 10 can be programmed to automatically move the pump actuator 24 and the valve actuator 26 until it detects the home position when the power is turned on, in which case the system 10 will perform the main sequence.</p><p> Figure 2 illustrates a separate system 100. System 100 includes the same parts with the same functionality (and the same reference number) as described above. Therefore, these components need not be described again unless the mechanism of the new components in System 100 is different. The main difference between system 100 and system 10 is that the pump 120 of system 100 is entirely fluid started and does not use the linear actuator 24 of system 10.</p><p> In the pump filling phase described above, controller 30 activates pump 120 to pump medical fluid or dialysate from one of the supply bags 14. To that end, the controller 30 vacuums the vacuum source 44, including the vacuum pump motor 46 (shown away from the motor 46 in FIG. 2), on both sides of the pump 120, i.e. on the two pump membranes, through vacuum lines 148 and 149. Order to pull. The vacuum pump motor 46 of this embodiment includes a rotary encoder 76 and a home position or home index 78. The rotary encoder 76 provides feedback on the position of the member 150 within the vacuum source 44. Thus, the system 100 can know if the vacuum source 44 further aspirates or if the member 150 is at the bottom within the vacuum source 44.</p><p> To draw the medical fluid, the vacuum line 148 evacuates a pair of facing membranes in the pump chamber through the walls of the first and second pump chambers. The vacuum draws the membrane in the opposite direction of the pump chamber. At this point, the controller 30 controls the valve actuator 26 to open only valve V1. By pulling the membrane apart, a negative pressure is created on the filling line 52, allowing the medical fluid or dialysate to pass through the filling line 52 and into the receiver formed between the membranes in the pump chamber of the pump 120. Pull in from the supply bag 14.</p><p> Also in a separate embodiment, the pump 120 maintains a constant vacuum on one of the membranes, but the other membrane does not pump suction. A vacuum is released on one of the two membranes to pump the fluid out. The separated membrane elastically returns to its closed position. This operation is described in detail below.</p><p> System 100 also includes a valve manifold that is slightly different than System 10. System 100 has one less valve than System 10, but System 100 does not have an additional valve (Valve V3 for System 10) immediately after the fluid heater 16. Obviously, those skilled in the art need to understand that there are a number of ways to form valves and fluid delivery lines for System 10 and System 100. Therefore, the shapes of the valves and fluid delivery lines of System 10 and System 100 shown are merely exemplary, and the present invention is not limited thereto.</p><p> (II. Hardware unit and disposable unit) With reference to Figures 3A, 3B, 4A and 4B, systems 10 and 100 include a hardware unit 110 and a disposable unit 160. The hardware unit 110 of one embodiment is portable and can be carried to and from the patient's home. The hardware unit 110 includes a housing 112 that includes a base 114 and a lid 116. In one embodiment, the lid 116 is hinged to the base 114. Alternatively, the lid 116 can be completely removed from the base. In either case, the lid 116 can be opened to touch the interior of the housing 112 so that the patient or operator can install and remove the disposable unit 160 into and out of hardware 110. The hardware unit 110 is made of any protective, hard and elastic or elastic material, such as a plastic or metal sheet, and the surface can be modified or finished.</p><p> When the disposable unit 160 is installed inside the hardware unit 110, the operator closes the lid 116 and uses at least one lock or latch mechanism 118 (FIG. 3B) to safely place the disposable unit 160 inside the hardware unit 110. Store. FIG. 4A shows member 119 of housing 112 to which the latch mechanism of lid 116 is attached. The hardware unit 110 displays a video monitor 40 and has an associated touch screen 42 for inputting instructions as described above. Separately, or in addition to the touch screen 42, the hardware unit 110 is equipped with at least one electromechanical switch or touch buttons 43, 124, 125 and 127, as well as control members 122 and / or illuminated. Equipped with a display. Pushbuttons or switches 43, 124, 125 and 127, and knob 122 allow the patient or operator to enter commands and information into systems 10 and 100. The video monitor 40 provides the patient or operator with medical procedure information 126.</p><p> FIG. 3B shows the dimensions of a set of hardware units 110 of the present invention. The dimensions and weight of the present invention are smaller than previous automated dialysis systems. This feature demonstrates the portability and ease of use of the systems 10 and 100 of the present invention. The size and weight allow the hardware unit 110 to be shipped by standard overnight express delivery. If the systems 10 and 100 of the present invention fail, the replacement unit can be economically shipped to the patient in time for the next treatment.</p><p> The hardware unit 110 in one embodiment has a height and depth of about 23-30 cm, and the preferred embodiment shown in FIG. 25 has a height and depth of about 25 cm. The hardware unit in one embodiment is about 32-40 cm wide and in one preferred embodiment is about 34 cm wide as shown in the figure. Therefore, the internal volume of the unit 110 is about 17,000 cm.³~ 36,000 cm³And in one preferred embodiment about 21,250 cm³(1310in³). Section 4B skillfully illustrates the many parts housed in this compact space and their efficient use. These components and the hardware unit 110 weigh about 9 kilograms (kg) and in a preferred embodiment weigh about 7 kilograms.</p><p> Figures 3A and 4B provide an easy-to-use automation system due to the type, shape and layout of the hardware unit 110. The parts of systems 10 and 100 that the patient must be concerned with are installed on the top, front and sides of the unit. The liquid feed control component is installed under the heater 116 and under the disposable unit mounting station. Monitors and controls 43, 122, 124, 125 and 127 are located on the entire surface of unit 110.</p><p> Hardware unit 110 includes pump 20 or 120, and linear pump actuator 24 if system 10 is used. The hardware unit 110 also includes a valve motor 28, an in-line heater 16, various sensors, a vacuum source 44 including an air pump motor 46, a valve actuator 26 and a controller 30, as well as the other hardware described above. FIG. 4B illustrates that the pump chamber wall of pump 20 or 120 is located within the lid 116 of the housing. In FIG. 4B, the heater 16 is located at the base 114 of the housing 112. Alternatively, or in addition, a heater can be installed on the lid 116. Base 114 also includes facing pump chamber walls.</p><p> With reference to FIGS. 3A, 4A, 4B, 5 and 6, various embodiments of the disposable unit 160 are shown. In each embodiment, the disposable unit 160 includes a pair of flexible membranes including an upper flexible membrane 162 and a lower flexible membrane 164. The disposable unit 160 of FIG. 6 contains two flexible membranes, namely membrane pair 166 and membrane pair 168. Each of the membrane pairs 166 and 168 includes an upper flexible membrane 162 and a lower flexible membrane 164.</p><p> The flexible membrane 162 and the flexible membrane 164 can be made of any sterile and inert material such as sterile and inert plastic or rubber. For example, membranes 162 and 164 are buna-N, butyl, hyparon, kel-F, kynar, neoprene, nylon, polyethylene, polystyrene, polypropylene, polyvinyl chloride, silicone, vinyl. , Viton or any combination thereof. One of the preferred embodiments of the flexible membrane is described below in connection with FIGS. 13 and 14.</p><p> Membranes 162 and 164 are sealed to each other at various locations to form a receiver between the fluid delivery pathway and the membranes 162 and 164. The seal is a heat seal, an adhesive seal, or a combination thereof. Figures 3A, 4A, 5 and 6 show that the nearly circular seal 170 forms a fluid pump receiver 172 between the substantially circular membranes 162 and 164. The pump receiver 172 operates with the fluid pump. Instead of the seal 170, in one embodiment the base 114 and lid 116 compress the membrane to form a seal. Figures 4A and 5B show that in one embodiment the disposable unit 160 becomes the second seal 174 and protects the systems 10 and 100 if the primary seal 170 leaks or deteriorates during use.</p><p> Figures 3A, 3B and 4B show that the fluid pump receiver 172 fits between the clamshell pumps 20 and 120 and the lid 116. The clamshell shape, which forms the fluid pump receiver 172 with the base 114 and lid 116 of the hardware unit 110, forms the pump chambers of the pumps 20 and 120 of the present invention. The clamshell shape in the base 114 and lid 116 includes at least one port that evacuates on membranes 162 and 164. In this way, the membranes 162 and 164 are pulled towards the clamshell shape, forming a clamshell shape in the base 114 and lid 116, creating a negative pressure inside the receiver 172, resulting in the outside of the hardware unit 110. The medical fluid is drawn into the receiver 172 from the supply bag 14 located at.</p><p> Figures 3A, 4A, 5 and 6 show that a normally rectangular spiral seal 178 creates a spiral heating path 180 between windings 162 and 164. The fluid heating path 180 passes from the valve manifold 190 through the spiral portion and returns to the valve manifold. FIG. 4A illustrates that the fluid heating path 180 is fitted between the base 114 of the hardware unit 110 and the heating plate of the heater 16 installed on the lid 116. By providing a heat source in either one of the fluid heating paths 180, the medical fluid can be heated quickly and efficiently. However, in a separate embodiment, the heater 16 may include only one heater on one side of the fluid heating path 180 formed by the disposable unit 160, or may include multiple heaters on each side of the disposable unit 160. it can.</p><p> The upper and lower membranes 162, 164 are attached to the disposable unit 160 using the thermal sealing techniques described herein. Membranes 162, 164 are stretchable, and when the disposable unit 160 is placed between the predetermined gaps between the upper and lower plates of the heater 16, the membranes 162, 164 stretch and come into contact with the heater plate. As a result, conduction heating is performed between the heater plate 16 and the membranes 162 and 164, and the membrane and the medical fluid. The predetermined gap is slightly larger than the thickness of the disposable unit 160. Specifically, as the dialysate moves through the fluid heating path 180 of the disposable unit 160, the spirally wound membranes 162, 164 of the fluid heating path 180 extend between the spiral seals 178 and the heater plate 16 Touch.</p><p> (A. Separate membrane set) The disposable unit 160 in FIG. 6 is similar to the disposable unit 160 in FIGS. 3A-5. However, the in-line fluid heating path 180 is installed in a different membrane pair 166 than the fluid pump receiver 172 and the valve manifold 190, which are installed in separate membrane pairs 168. A pair of elastic tubes 182 and 184, which are any suitable medical grade pipes, fluidly connect the valve manifold 190 to the fluid heating path 180. The tubes 182 and 184 can be connected to the membrane pairs 166, 168 in any desired manner, such as heat sealing, bonding, pressure bonding or other permanent or path value removable fluid connections. When installed in the hardware unit 110, the heater 16 heats each side of the heater membrane pair 166 as in other embodiments.</p><p> By separating the fluid heating path 180 from the fluid pump receiver 172 and the valve manifold 190, the membranes of each membrane pair can be made of different materials. It is desirable that the membranes 162 and 164 of the heating pair 166 effectively conduct or radiate heat. On the other hand, the membranes 162 and 164 of the fluid delivery pair 166 should withstand the forces of suction and mechanical activation. Therefore, it is desirable to use different materials for the membrane pair 166 and the membrane pair 168.</p><p> The membrane pair 166 forming the heater fluid flow path 180 also forms an alignment hole 176 along a protrusion protruding from the base 114 or lid 116 of the hardware unit 110. Each embodiment of the disposable unit 160 disclosed herein includes an alignment hole 176 to facilitate the patient or operator to install the disposable unit 160 within the housing 112 of the hardware unit 110. There is.</p><p> (B. Rigid frame and bowed sides) As shown in FIGS. 3A, 4A and 5, embodiments of the disposable unit 160 disclosed herein also surround or substantially surround rigid or semi-rigid members or, in some embodiments, the membranes 162 and 164 of the disposable unit 160. Formed to provide a surrounding frame 186. In some embodiments, the rigid member of the frame 186 is formed of sterile rigid or semi-rigid plastic, such as one or a combination of the plastics listed above for membranes 162 and 164. The frame 186 facilitates the patient or operator to install the disposable unit 160 within the housing 112 of the hardware unit 110.</p><p> In one embodiment, the housing 112 is provided with a pin or guide into which the frame 186 of the disposable unit 160 fits comfortably. FIG. 5 shows that the frame 186 is provided with pores 161 that fit into the pins or guides of the housing 112. The frame 186 may provide multiple openings that fit into approximately the same number of pins or guides provided by the housing 112. FIG. 5 also shows that the frame 186 contains an asymmetric number of chamfers 163. The chamfered portion 163 has an angle such as 5 ° with respect to the other side surface of the frame 186. Housing 112 has or provides a surface on which the disposable unit 160 is installed. This surface is asymmetrical or provides a guide that allows the unit 160 to be installed in the housing 112 from one direction. With the chamfer 163 and the corresponding housing 112, if the patient installs the disposable unit 160 inside the housing 112, the bottom of the disposable unit 160 is installed inside the housing and the fluid inlet / outlet 196 points in the proper direction. Is guaranteed.</p><p> As mentioned above, the disposable unit 160 includes the valve manifold 190. In some embodiments, the valve manifold 190 is made of rigid or semi-rigid plastic, such as one or a combination of those listed above for membranes 162 and 164. The valve manifold 190 is covered with upper and lower membranes 162 and 164 on either side, resulting in the formation of a sealed and inert logical flow path for systems 10 and 100.</p><p> In FIG. 5, the manifold 190 is provided with a hole 192 and a slot 194. Hole 192 positions valves such as valves V1 and V5 of system 10 for example. Slot 194 serves as a fluid delivery path from the valve to the fluid pump receiver 172, the fluid heating path 180 or the fluid inlet / outlet 196. Fluid inlets / outlets 196 are led to supply bag 14, catheter line 56, patient 12 and drain vessel 18, respectively. The fluid inlet / outlet 196 can have various shapes and orientations as illustrated in FIG. 3A. The drain container 196 is connected to an external elastic tube by a method known to those skilled in the art.</p><p> In certain embodiments, the rigid or semi-rigid frame 186 includes arched sides 187 and 189 as illustrated in FIG. The bowed sides 187 and 189 are formed on the frame 186 before the membranes 162 and 164 are heat-sealed or adhesively sealed on the frame 186 and manifold 190. The frame 186 and the bowed sides 187 and 189 are extruded plastic or injection molded plastic. The frame 186 may contain only one, less than all or all bowed sides.</p><p> In the illustrated implementation, the sides 187 and 189 are either outwardly bowed or alternately inwardly curved. In a preferred embodiment, the sides are bowed in the plane direction of the frame 186 of the disposable unit 160. The bowed sides 187 and 189 increase the rigidity of the frame 186 and the disposable unit 169. Therefore, the disposable unit can be more easily installed in the housing 112 of the hardware unit 110. The bow-shaped curved sides 187 and 189 reduce the degree of bending or distortion of the frame 186 by heat sealing or mechanical pressing the membranes 162 and 164 onto the frame 186 and manifold 190.</p><p> (C. Thermal seal interface) With reference to FIG. 7, thermal seals of membranes 162 and 164 to manifold 190 are illustrated. In certain embodiments, the manifold 190 is made of a rigid or semi-rigid plastic material as described above. In an embodiment, thermal sealing of membranes 162 and 164, which are injection molded parts, to manifold 190 requires different machining parameters than, for example, thermal sealing of individual membranes 162 and 164 with each other in seal 170 of fluid pump receiver 172. Is. For example, thermal sealing of membranes 162 and 164 to manifold 190 requires more heat, pressure and heating time. Semi-rigid or rigid manifold 190 significantly thicker than the films 162 and 164, respectively. Therefore, the thicker manifold 190 acts as a heat reservoir compared to the thinner membrane. Therefore, the bond between the thin film and the thick manifold 190 requires more heat or energy than the bond seal between the thin films 162 and 164.</p><p> As shown in Figures 3A, 4A, 5 and 6, the disposable unit 160 requires a membrane to manifold and a membrane to membrane seal. Obviously, it is necessary to heat seal the entire disposable unit 160 in one step or process. It is also clear that the heat sealing process must be carried out to avoid burning or melting of the thin films 162 and 164.</p><p> FIG. 7 shows an embodiment for resolving the thermal imbalance between different materials. FIG. 7 shows a portion of the manifold 190, the entire of which is shown in FIG. In FIG. 5, the manifold 190 shows the portion connected to the fluid pump receiver 172. This part is shown in FIG. 7 as part 205. FIG. 5 also shows two ports extending from the manifold 190 fluidly connected to the fluid heating path 180. These ports are illustrated as ports 201 and 203 in FIG. Both FIGS. 5 and 7 show that the injection molded manifold 190 forms a plurality of holes 192 and 194. Hole 192 operates in a valve actuator and slot 194 to form a fluid path when surrounded by membranes 162 and 164.</p><p> To reduce the amount of heat required to seal the membranes 162 and 164 to the manifold 190, the manifold 190 has sides 193 that are thinner than the rest of the manifold 190. The thinner side 193 has a smaller mass and therefore absorbs less local heat if the manifold is of uniform thickness. The side surface 193 also disregards or includes the taper portion 195. The taper portion 195 seals the membranes 162 and 164 and has a flat portion on which the membranes 162 and 164 are placed together, and in some embodiments the membrane and membrane seals are made in addition to the membrane and manifold 190 seals.</p><p> The tapered edge 195 provides an interface that seals the membranes 162 and 164 to the manifold 190. This edge is formed by continuously stretching the side surface 193 of the manifold 190 that requires sealing and, if not sealed, comes into contact with the medical fluid. Therefore, as shown in FIG. 5, it is not necessary to taper the side surface of the manifold 190 forming the inlet / outlet port 196 as shown in FIG. Also, as shown in FIG. 7, the tapered edge 195 on the thin side 193 is discontinuous where ports 201, 203 and 205 extend from the manifold 190.</p><p> Ports 201, 203 and 205 also form a tapered edge 207. The tapered edge 207 forms an interface for heat sealing the portion to the membranes 162 and 164. As described above, the tapered edges 207 of ports 201, 203 and 205 allow for direct membrane-to-membrane sealing following the membrane-to-tapered edge 207 seal. The tapered edges 195 and 207 in the preferred embodiment gradually taper toward the upper edge of the knife. In other embodiments, the tapered edges 195 and 207 may be of a different form or shape, such as rounded edges, blunted edges, or may simply be further reduced in thickness from the side surface 193 of the manifold 190. As shown, the ports 201, 203 and 205 of certain embodiments form an egg-shaped opening. The tapered oval opening allows for a smoother transition than the circular outer diameter. The egg-shaped opening functions like a round opening from the standpoint of fluid delivery, unless the internal egg-shaped opening area is less than or equal to the opening area of an appropriate circular port. Ports 201, 203 and 205 also form a rising portion 209. The rise 209 forms a ball of polymer material along the tips and tapered edges 207 of ports 201, 203 and 205. Balls can be added along the tapered edges 195 and / or side 193, or placed in place of the rise. The riser or bead 209 provides a very thin area of plastic that can be melted or deformed to provide a flux-like seal that can seal the films 162 and 164 to the manifold 190. The beads are flakes of agglomerated plastic that is hotter than the plastic that surrounds the manifold 190. Membranes 162 and 164 are sealed to the manifold 190 without heating a larger area of the manifold 190. The risers or beads 209 facilitate sealing of the bends and / or corners formed by the manifold 190.</p><p> (D. Integrated Chip Protector Organizer and Breathable Chip Pro) Protector HOME CHOICE® Peritoneal Dialysis System With reference to FIG. 8, certain embodiments of the Integrated Chip Protector Organizer 270 are illustrated. In the HOME CHOICE® peritoneal dialysis system provided by the assignee of the invention, the disposable set is prepacked and provided to the patient. When the patient opens the bag, each part is sterilized and held in a disposable set. The disposable set includes a disposable unit and some tubes coming out of the disposable unit. Similar to the present invention, the HOME CHOICE® disposable unit includes a drain line tube that connects to at least one bag-filling tube and a tube that connects to the patient infusion set. Each of these requires a separate chip protector. That is, after sterilizing the inside of the disposable unit and the tube using, for example, ethylene oxide, the end of the tube must be sealed with a cap so that the sterilized state inside the system is maintained. The HOME CHOICE® system provides an independent chip protector for each tube.</p><p> The integrated chip protector organizer 270 of the present invention provides an integral member 272 (which may actually be made of multiple components) formed of or provided by a plurality of chip protectors 274, 276, 278 and 280. In addition to the breathable chip protector 270 accommodating and protecting the connector at the end of the tube extending from the disposable unit 160, the integrated chip protector 270 also bundles and aligns the tubes according to dialysis treatment procedures. In the illustrated embodiment, the chip protector 274 is a chip protector for the drain line connector 284 connected to a drain line 285 leading to a suitable port on the disposable unit 160. Chip protectors 276 and 278 protect the supply bag protectors, connectors 286 and 288 that connect the ends of tubes 287 and 289 that extend to Y connection 287/289, while the legs of Y connection 287/289 are disposable units 160. Extends to a suitable port. The chip protector 280 is a patient fluid line protector. The chip protector 280 houses and protects a connector 290 that connects to a patient tube that extends to a suitable port on the disposable unit 160.</p><p> Each of the tubes 285, Y connection 287/289 and / or patient fluid tube 292 of certain embodiments is made of polyvinylpyrrolidone (PVC) having an inner diameter of 4 mm and an outer diameter of 5 mm. As shown, the Integrated Chip Protector Organizer 270 is formed to receive and protect various types of fluid connectors. The fluid connector 284 extending through the tube 285 to the drain line port of the disposable unit 160 is, in some embodiments, exactly the same as the port exiting the supply bag 14. The port exiting the feed bag 14 also includes a membrane pierced by the sharp trunk of the feed bag connectors 286 and 288. The drainline connector 284 does not include the unnecessary supply bag 14 membrane. The tip protector 290 that connects to the end of the patient fluid tube 292 is discussed in detail below.</p><p> In one preferred embodiment, the systems 10 and 100 of the present invention include two 6 liter supply bags 14. The two 6-liter bags feature an economical amount of peritoneal dialysis and are sufficient fluid to perform several filling, retention and drain cycles at night while the patient is asleep. Therefore, the integrated organizer 270 includes chip protectors 276 and 278 that accommodate and protect the two supply connectors 286 and 288. In a separate embodiment, the integrated organizer 270 can form or comprise any number of feed bag chip protectors. Any number of supply bags can be further connected via Y or T-shaped pipe couplings.</p><p> The Integrated Organizer 270 can be equipped with a separate chip protector, such as a protector for the last bag that holds a sufficient amount of the patient to fill last during the day, eg, 2 liters of peritoneal dialysis. In this case, a separate last bag tube (not shown) is connected to the connector, which is the same or similar bag perforation connector as the filled bag connectors 286 and 288.</p><p> The body 272 of the protector organizer 270 is an embodiment made of PVC. Chip protectors 274, 276, 278 and 280 are injection molded or blow molded. Alternatively, the chip protector is attached to the main body 272 separately. As seen in FIG. 8, at least one chip protector includes flutes, threads or other protrusions that make it easier to grab and hold each tube connector. Further, although the organizer 270 is commonly referred to herein as an "integrated" organizer, the organizer 270 itself can consist of any number of parts. Integrated refers to a form in which one unit accommodates a plurality of chip protectors.</p><p> The integrated organizer 270 includes a rim 294 that extends outward from the main part of the main body 272 and surrounds the main part of the main body 272. FIG. 9 shows a cross-sectional view of the integrated organizer 270 in which the rim 294 tapers downward from the drain line tip protector 274 to the patient fluid tip protector 280. That is, the rim 294 is higher or thicker at the end of the drain line than at the end of the patient fluid line. This allows the integrated chip protector organizer 270 to be mounted on the hardware unit 110 in only one direction.</p><p> FIG. 3A illustrates that the integrated chip protector organizer 270 slides vertically into the hardware unit 110 in some embodiments. The hardware unit 110 includes or comprises a pair of films 296 extending outward from the side wall of the hardware unit 110. Although FIGS. 3B and 4A show other embodiments, the rim 294 of the organizer 270 is illustrated to slide vertically into the notch 297 formed or provided at the base 114 of the housing 112 of the hardware unit 110. ing. Organizer 270 rim 294 slides between membrane 296 and hardware unit 110. When the member 296 extends toward the tip of the hardware unit 110, it extends further outward. The details of the membrane 296 correspond to the details of the rim 294 of the organizer 270, and the organizer 270 slides into the hardware unit 110 from only one direction.</p><p> FIG. 9 also shows that the chip protectors 274, 276, 278 and 280 can have various cross-sectional shapes. Each of the chip protectors includes a hard bottom and sides that seal around the respective connectors 284, 286, 288 and 290, and the integrated organizer 270 even after the patient removes the disposable set from the sealed sterile container. Maintain the sterilization of the system. The integrated organizer 270 illustrated in FIGS. 8 and 9 is mounted on the side of the hardware unit 110 in a rugged manner. Via a tight connection, patients can often remove tubes 285, 287, 289 and 292 with only one hand. The interface between the hardware unit 110 and the organizer 270 simplifies the patient's procedure and provides a rigid and sterile environment for the tube and associated connector unit.</p><p> FIG. 3A also shows a separate possible embodiment in which another integrated organizer 298 is incorporated into or provided in frame 186 of the disposable unit 160. The commonly shown tube 196 is grouped horizontally as opposed to the vertical arrangement of the chip protector 270 in the housing 112. The Horizontal Integrated Organizer 298 shows that the idea of protecting and organizing tubes prior to specification can be applied at various locations and orientations in System 10.</p><p> In one embodiment, the chip protector and organizer 270 are configured with tubes 285, 287, 289 and 292 in parallel vertically perpendicular to each other, with a first tube on top that the patient will pull when initiating dialysis treatment. As a result, the next tube that the patient is likely to pull is provided in the middle, and the last tube is provided at the bottom of the vertically bee integrated organizer 270. According to one embodiment, the patient first removes the drain connector 284 from the chip protector 274 and guides the drain line 285 to a toilet, drain bag or other drain. The patient then removes the supply connectors 286 and 288 and breaks the supply bag 14 (Figures 1 and 2). At this point, the dialysate can be delivered to the disposable unit 160 and the entire system 10. Controllers 30 in systems 10 and 100 begin to cycle, which will be described in more detail below.</p><p> Once started, systems 10 and 100 prompt the patient to take the started patient line 292 and connect it to the moving set embedded in the patient. The moving set (not shown) includes a catheter located within the patient's peritoneal cavity and a tube extending into the catheter. The tube contains a connector that connects to connector 290. At this point, systems 10 and 100 can either drain the used peritoneal fluid from the patient 12 to the drain 18 or draw fresh fluid from at least one supply bag 14 to fill the patient's peritoneal cavity 12.</p><p> Figures 10 and 12 illustrate embodiments of the patient line chip protector 280. The HOME CHOICE® system manufactured by the assignee of the present invention initiates the patient fluid line by holding the patient connector perpendicular to approximately flush with the feed bag. In this way, when the HOMECHOICE® system initiates the disposable unit, gravity feeds the peritoneal fluid to the patient's fluid line to the end of the patient's fluid connector. The patient fluid connector is opened and air is free to escape as the peritoneal fluid is gravitationally supplied through the patient line. The HOME CHOICE® system allows the patient fluid line to be activated without counting pump strokes or with a fixed volume of dialysate of known volume, a technique that tends to fail with wiping pressure.</p><p> Systems 10, 100 of the present invention provide different devices and methods of initiation that do not require the calculation of the amount of fluid that reaches the patient connector of the patient fluid line accurately but does not exceed it. FIG. 10 shows a cross section of the patient fluid connector 290 inserted into the vent tip protector 280. FIG. 11 shows a cross section of the patient fluid connector 290 alone. FIG. 12 shows a cross section of the chip protector 280 alone. A hydrophobic membrane 300 is installed on the outer edge of the chip connector 280. The chip protector 280 forms a fluid lumen 302 extending over the entire length of the chip protector 280. The hydrophobic membrane 300 covers the fluid lumen 302. The hydrophobic membrane 300 drains air from the patient fluid line, but does not allow water or ascitic fluid to flow through the membrane.</p><p> It should be understood that the breathable chip protector 280 containing the hydrophobic membrane 300 is not limited to being installed in the integrated chip protector organizer 270. FIG. 9 shows that the integrated organizer 270 includes a patient chip protector 280 with a hydrophobic membrane 300 and a fluid lumen 302. However, in a separate embodiment, the breathable chip protector 280 is provided as a separate or isolated chip protector similar to that used in the HOMECHOICE® system provided by the assignee of the invention.</p><p> Hydrophobic membranes such as the hydrophobic membrane 300 used herein are commercially available. One of the suitable hydrophobic membranes is manufactured by Millipore (Millipore, 80Ashby Road, Bedford, MA01730). FIG. 12 best illustrates that the hydrophobic membrane is heat-sealed or ultrasonically sealed to the chip protector 280. The fluid lumen 302 in one embodiment has a relatively small diameter (1.25 to 1.75 mm), which is 1 / 50,000 to 70,000 of an inch.</p><p> If the breathable chip protector 280 and the patient fluid connector 290 work together to fully start the systems 10 and 100, the chip protector 280 and the patient fluid connector 290 will leak even if the patient removes the patient fluid connector 290 from the chip protector 280. Minimize the amount of fluid. As best seen in FIG. 10, the connector 290 contains or provides a male lure 304 that matches the female lure 306. The fitted lures 304 and 306 prevent peritoneal fluid, which must be wide enough to accommodate the flange 308 of the patient fluid connector 290, from filling the cavity of the chip protector 280. In Figure 12, the sealing interface between the male lure 304 on the connector 290 and the female lure 306 on the breathable tip protector 280 reduces the internal volume 310 around the male lure 304 to 50,000 to 70,000 times the volume of the lumen 302. It shows a significant reduction.</p><p> To start systems 10, 100, the patient removes the drain line 285 from the chip protector 274 and puts it in a tub, toilet or drain 18. The patient removes at least two feed bag connectors 286 and 288 and breaks the seal membrane (not shown) of feed bag 14. Systems 10 and 100 will then automatically start the pump or at the patient's input. In each case, systems 10 and 100 pump fluid from at least one supply bag 14 through connectors 286 and 288, and tubes 287 and 289 into the disposable unit 160, and an integrated organizer from patient fluid line 292. Drain to the patient fluid connector 290 as it is housed in the 270 breathable chip protector 280. As shown in FIGS. 3 and 3B, the organizer 270 is housed vertically in the hardware unit 110.</p><p> When the peritoneal fluid reaches the patient fluid connector 290, most of the air in the system 10 is extruded through the hydrophobic membrane 300 attached to the end of the chip protector 280 housed in the integrated chip protector 270. The property of the hydrophobic membrane 300 is that it allows air to pass but not water or peritoneal fluid. Therefore, when the fluid finally reaches the hydrophobic membrane 300, the pressure rises in the systems 10 and 100 because there is little extra space for the fluid to flow in. Systems 10 and 100 are equipped with at least one pressure sensor, eg, a pressure sensor 68 (denoted as FP1, FP2 and FPT in FIGS. 1 and 2).</p><p> At least one pressure sensor 68 detects a pressure increase due to the peritoneal fluid pushing up the hydrophobic filter 300. The pressure sensor sends a signal to the I / O module of controller 30. The controller 30 receives the signal, but the controller is programmed to stop the diaphragm pumps 20 and 120 in memory 32. In this way, the system 10 automatically self-starts the filling lines 287 and 289, the disposable unit 160, and the patient fluid line 292, respectively, without the need for control volume calculation or gravity starting.</p><p> Systems 10 and 100 include at least one safety measure based on volumetric calculations. That is, in normal operation, systems 10 and 100 do not control the start using the volume calculation. However, if, for example, the patient removes the connector 290 from the breathable chip protector 280 of the integrated organizer 270 before the patient fluid systems 10, 100 detect a pressure rise and stop the pumps 10, 100, the systems 10, 100 will alarm. Adopt the calculation. Systems 10 and 100 are informed that the peritoneal fluid has been pumped too much (for example, if the volume is set to be greater than the initial volume of the system) and the pumps 20 and 120 are stopped.</p><p> (III. Membrane material for disposable units) With reference to FIGS. 13 and 14, the upper and lower films 162, 164 can be made with a single layer film structure 312 (FIG. 13) or a multilayer film structure 312 (FIG. 14). Film 312 is made of PVC-free polymeric material and must meet many physical property requirements. The film 312 has a low modulus of elasticity and must deform at low pressure to function as a pump element. Low modulus means that the modulus of elasticity measured according to ASTM D882 is about 10,000 psi or less, more preferably about 8,000 psi or less, still more preferably about 5,000 psi or less, and finally 3,000 psi or less, or these. It means that it is a combination of stomach in the range defined by the number. In order to allow in-line heating, the film must have a moderate thermal conductivity. Mathis Instruments As measured using HotDisk manufactured by Ltd., the film has a thermal conductivity of 0.13 W / meter ° K or higher. The film 312 must be heat sealable to the cassette 160. The film 312 must be sterilizable by gamma irradiation, vapor exposure for a period of time (eg 1 hour), and ethylene oxide exposure without significant deterioration of the film or adverse effects on the dialysate. Finally, the film 312 needs to be stretchable at high speeds of 50 ft / min and above.</p><p> The monolayer structure 312 is formed from a blend of about 90 to about 99% by weight of the first component containing styrene and hydrocarbons, about 10 to 1% by weight of melt strength increasing polymer, and more preferably cavity melt strength polypropylene. ..</p><p> The term "styrene" includes various substituted styrenes, including styrene and alkyl-substituted styrenes and halogen-substituted styrenes. Alkyl groups contain 1 to 6 carbon atoms. Specific examples of substituted styrene include α-methylstyrene, β-methylstyrene, vinyltoluene, 3-methylstyrene, 4-methylstyrene, 4-isopropylstyrene, 2,4-dimethylstyrene, o-chlorostyrene, and p-chloro. Includes styrene, o-bromostyrene, 2-chloro-4-methylstyrene and the like. Styrene is most preferred.</p><p> Hydrocarbon moieties and hydrocarbon polymers of styrene contain conjugated diene. The conjugated diene used is one containing 4 to 10 carbon atoms, specifically 4 to 6 carbon atoms. Examples thereof include 1,3-butadiene, 2-methyl-1,3-butadiene (isoprene), 2,3-dimethyl-1,3-butadiene, proloprene, 1,3-pentadiene, 1,3-hexadiene, etc. Is included. Mixtures of these conjugated diene, such as mixtures of butadiene and isoprene, are also used. Preferred conjugated diene are isoprene and 1,3-butadiene.</p><p> Copolymers of styrene and hydrocarbons are block copolymers containing diblocks, triblocks, multiple blocks and star blocks. Specific examples of diblock copolymers include styrene-butadiene, styrene-isoprene, and selective hydrogenated derivatives thereof. Examples of triblock copolymers are styrene-butadiene-styrene, styrene-isoprene-styrene, α-methylstyrene-butadiene-α-methylstyrene and α-methylstyrene-isoprene-α-methylstyrene, and their selective hydrogenation. Included under the derivative.</p><p> Selective hydrogenation of steam block copolymers is carried out by various known processes such as catalysts for precious metals such as Raney nickel, platinum or palladium, hydrogenation in the presence of soluble transition metal catalysts and the like. In a suitable hydrogenation process that can be used, the diene-containing polymer or copolymer is dissolved in an inert hydrocarbon diluent such as cyclohexane and hydrogenated by reaction with hydrogen in the presence of a soluble hydrogenation catalyst. Such a process is described in US Pat. Nos. 3,113,986 and 4,226,952, the disclosure of which is incorporated herein by reference and is incorporated herein by reference.</p><p> Particularly useful hydrogenated block copolymers are styrene-isoprene-styrene hydrogenated block copolymers such as polystyrene- (ethylene / propylene) styrene block copolymers. When a polystyrene-polybutadiene-polystyrene block copolymer is hydrogenated, the resulting product is similar to a regular copolymer block of polyethylene and 1-butadiene. This hydrogenated copolymer is often called SEBS. If the conjugated diene used is isoprene, the resulting hydrogenation product is similar to a regular block copolymer (EP) of ethylene and propylene. This hydrogenated block copolymer has many children called SEPS. If the conjugated diene is a mixture of isoprene and butadiene, the selective hydrogenation product is called SEEPS. Suitable SEBS, SEPS and SEEPS copolymers are sold under the trademarks KRANTON from Shell Oil and under the trademarks SEPTON® and HYBPAR® from KURARY.</p><p> Block copolymers of conjugated diene and vinyl aromatic compounds can be grafted with α, β-unsaturated monocarboxylic acid or dicarboxylic acid reagents. Carboxylic acid reagents include the carboxylic acid itself and functional derivatives such as anhydrides, imides, metal salts, esters, etc., which can be grafted onto selective hydrogenated block copolymers. The graft polymer usually contains 0.1 to 20% by weight, preferably 0.1 to 10% by weight of graft carboxylic acid, based on the total weight of the block copolymer and the carboxylic acid reagent. Specific examples of useful monobasic carboxylic acids include acrylic acid, methacrylic acid, cinnamic acid, crotonic acid, anhydrous acrylic acid, sodium acrylate, calcium acrylate, magnesium acrylate and the like. Dicarboxylic acids and useful derivatives thereof include maleic acid, maleic anhydride, fumaric acid, mesaconic acid, itaconic acid, citraconic acid, monomethyl maleate, monosodium maleic acid and the like.</p><p> The first component containing styrene and a hydrocarbon block copolymer can be modified by adding mineral oil, paraffin oil, polybutene oil or the like. The amount of oil added to the styrene and hydrocarbon block copolymer is 5-40%. The first component may contain polypropylene in about 20% by weight of the first component. One of the first ingredients that is particularly suitable is the oil-modified SEBS sold by Shell Chemical Company under the product name KRANTON G2705.</p><p> The melt strength increasing polymer is preferably polypropylene with high melt strength. Suitable high melt strength polypropylenes are homopolymers or copolymers of polypropylene and may or may not have free-ended long chain branches. In one of the preferred embodiments of the invention, the high melt strength polypropylene is in the range of 10 grams / 10 minutes to 800 grams / 10 minutes, more preferably in the range of 10 grams / 10 minutes to 200 grams / 10 minutes, or any within this range. Has a fusion strength of the combination of. High melt strength polypropylene is known to have free-ended long chain branches of polypropylene units. Methods for preparing polypropylene exhibiting high melt strength properties are described in US Pat. Nos. 4,916,198, 5,047,485 and 5,605,936, which are incorporated herein by reference. It is a part. One such method is to use a chain propylene polymer with 1 × 10 high-energy ionizing radiation in an environment with an active oxygen concentration of about 15%.⁴There are methods of irradiation where a dose of megarad / min is sufficient to produce a significant amount of chain breaks in the chain propylene polymer, but insufficient to gelatinize the material. The chain is cut by irradiation. Subsequent rearrangement of the strands results in the formation of new strands and at the same time the fragments of the strands combine with the strands to form branches. This results in a high molecular weight, non-chain propylene polymer material with the desired free-ended long chain branches. Radiation is maintained until a significant amount of long chain branches are produced. The material is then treated until all free radicals present in the irradiated material are substantially inactivated.</p><p> High melt strength polypropylene can also be obtained as described in US Pat. Nos. 5, 416, 169, which is incorporated herein by reference in its entirety, but is specifically induced by that method. Peroxide (di-2-ethylhexyl peroxydicarbonate) is reacted with polypropylene under specific conditions and then melt extruded. Such polypropylenes are chain crystalline polypropylenes with a branch count of substantially 1 and therefore do not have free-ended long chain branches and have an intrinsic viscosity of about 2.5 dl / g to 10 dl / g. ..</p><p> A suitable copolymer of polypropylene is obtained by polymerizing a propylene monomer having an α-olefin having 2 to 20 carbon atoms. In a more preferred form of the invention, propylene is copolymerized with ethylene in a proportion of about 1-20% by weight, more preferably about 1-10% by weight, most preferably about 2-5% by weight of the copolymer. Copolymers of propylene and ethylene are random or block copolymers. In the preferred form of the invention, the propylene copolymer is obtained using a single-locus catalyst.</p><p> The components of the blend are blended and extruded using known techniques. The film 312 has a thickness of about 3-12 mils, more preferably about 5-9 mils.</p><p> FIG. 14 shows a multi-layer film having a first layer 314 and a second layer 316. Although FIG. 14 shows the use of two layers, the present invention also assumes the use of two or more layers if the requirements for the properties of the vapor material are met. The first layer 314 may be the same polymer blend as the monolayer used to fabricate the monolayer structure, but in a more preferred form of the invention it is a sealing layer for adhering the film to the cassette 160. The second layer 316 is made of a PVC-free material and is preferably selected from polyolefins, polybutadienes, polyesters, polyester ethers, polyester elastomers, polyimides and the like, and blends thereof. The binding layer (s) need to be adhered to the first layer 314.</p><p> Suitable polyolefins include homopolymers and copolymers obtained by polymerizing α-olefins containing 2 to 20, more preferably 2 to 10 carbon atoms. Therefore, suitable polyolefins include polymers and copolymers of propylene, ethylene, butene-1, penten-1, 4-methyl-pentene-1, hexene-1, heptene-1, octene-1, nonene-1 and decene-1. Is included. Most preferably, the polyolefin is a propylene polymer and copolymer, or a polyethylene polymer and copolymer.</p><p> Suitable homopolymers of polypropylene have a stereochemical structure of non-crystalline, isotactic, syndiotactic, atactic or stereoblock. In one of the preferred forms of the invention, polypropylene homopolymers are obtained using single-locus catalysts.</p><p> Although it is also preferred to use a blend of polypropylene and α-olefin, the propylene copolymer can vary with the carbon number of the α-olefin. For example, the present invention envisions a blend of propylene and α-olefin in which one copolymer has a 2 carbon α-olefin and the other copolymer has a 4 carbon α-olefin. It is also possible to use any combination of α-olefins having 2 to 20 carbon atoms, more preferably 2 to 8 carbon atoms. Therefore, the present invention envisions blends of propylene and α-olefins in which the first and second α-olefins have a combination of 2 and 6, 2 and 8, 4 and 6, 4 and 8 carbon atoms. It is also envisioned that more than one polypropylene and α-olefin will be used in the blend. Suitable polymers are obtained using the catalloy process.</p><p> It is preferable to use the high melt strength polypropylene defined for steam.</p><p> Suitable homopolymers of ethylene include those having a density of 0.915 g / cc or higher, including low density polyethylene (LDPE), medium density polyethylene (MDPE) and high density polyethylene (HDPE).</p><p> Suitable copolymers of ethylene are obtained by polymerization of ethylene monomers and α-olefins having 3 to 20 carbon atoms, more preferably 3 to 10, and most preferably 4 to 8 carbon atoms. It is desirable that the ethylene copolymer has a density of 0.915 g / cc or less, more preferably 0.910 g / cc, even more preferably 0.900 or less as measured by ASTM D-792. Such polymers are often referred to as VLDPE (Ultra Low Density Polyethylene) or ULDPE (Ultra Low Density Polyethylene). The ethylene α-olefin copolymer is preferably produced using a single-locust catalyst, and more preferably produced using a meta-line catalyst system. Single-locus catalysts are believed to have a single steric and electronically equivalent catalyst position, in contrast to Ziegler-Natta-type catalysts, which are known to have mixed catalyst sites. There is. Alpha-olefins catalyzed by single-locust catalysts are Dow chemicals It is sold under the trade name AFFINITY from Chemical, the trademark ENGAGE (registered trademark) from DuPont, and the trade name EXACT from Exxon. These copolymers are sometimes referred to herein as ULDPE.</p><p> Suitable copolymers of ethylene include ethylene and lower alkyl acrylate copolymers, ethylene and lower alkyl substituted alkyl acrylates, and ethylene vinyl acetate copolymers with a vinyl acetate content of about 5-40% by weight relative to the copolymers. The term "lower alkyl acrylate" refers to a comonomer having the formula shown in Diagram 1.</p><p><chemistry num="1"><img file="JP4902117B2_D0001.tif" /></chemistry> Diagram 1 The R group is an alkyl having 1 to 17 carbon atoms. Therefore, the term "lower alkyl acrylate" is not limited to methyl acrylates, ethyl acrylates and butyl acrylates.</p><p> The term "alkyl-substituted alkyl acrylate" is a comonomer with the formula shown in Figure 2.</p><p><chemistry num="2"><img file="JP4902117B2_D0002.tif" /></chemistry> Diagram 2 R₁And R₂Is an alkyl having 1 to 17 carbon atoms, and may have the same or different fractional prime numbers. Therefore, the term "alkyl-substituted alkyl acrylate" includes, but is not limited to, methyl methacrylate, ethyl methacrylate, methyl etacrilate, ethyl etacrylate, butyl methacrylate, butyl ethanecrylate and the like.</p><p> Suitable polybutadienes include 1,2- and 1,4-addition products of 1,3-butadiene (collectively referred to as polybutadiene). In a more preferred form of the invention, the polymer is a 1,2-addition product of 1,3-butadiene (these are referred to as 1,2-polybutadiene). In an even more preferred form of the invention, the polymer of interest is syndiotactic 1,2-polybutadiene, even more preferably low crystalline syndiotactic 1,2-polybutadiene. In the preferred form of the invention, low crystalline syndiotactic 1,2-polybutadiene is 50% or less, more preferably about 45% or less, even more preferably about 40% or less, even more preferably about 13-40%. Most preferably, it has about 15-30% crystallinity. In the preferred form of the invention, syndiotactic 1,2-polybutadiene has a melting point of about 70-120 ° C as measured according to ASTM D3418. Suitable resins include grades JSR RB 810, JSR RB 820, JSR from JSR (Japan Synthetic Rubber). Includes what is sold as the RB 830.</p><p> Suitable polyesters include di- or polycarboxylic acids and di- or polyhydroxy alcohols or alkylene oxides. In the preferred form of the invention, the polyester is a polyester ether. Suitable polyester ethers are obtained by reacting 1,4-cyclohexanedimethanol, 1,4-cyclohexanedicarboxylic acid and polytetramethylene glycol ethers and are commonly referred to as PCCE. Suitable PCCEs are sold by Eastman under the trade name ECDEL. Suitable polyesters further include a hard negotiating segment of polybutylene terephthalate and a polyester elastomer which is a block copolymer of soft (amorphous) polyether glycol. Such polyester elastomers are sold by DuPont Chemical under the trade name HYTREL®.</p><p> Suitable polyamides include those obtained by ring-opening reaction of lactam having 4-12 carbon atoms. Therefore, this group of polyamides includes Nylon 6, Nylon 10 and Nylon 12. Acceptable polyamides include aliphatic polyamides obtained by the condensation reaction of diamines having a carbon number in the range of 2 to 13 and aliphatics obtained by the condensation reaction of diic acids having a carbon number in the range of 2 to 13. Also included are polyamides, polyamides obtained by the condensation reaction of fatty acid diamines, and polyamides containing copolymers. Thus, suitable polyamides include, for example, nylon 66, nylons 6, 10, and fatty acid dimer polyamides.</p><p> In the preferred form of the invention, the cassette 160 is made of a material that can adhere to the upper and lower membranes 162 and 164. The term adhesiveable means that the membrane can be adhered to the cassette using standard heat sealing techniques. One of the suitable materials is a polymer blend of polyolefin, polystyrene and hydrocarbon copolymers. Specifically, the polymer blended polyolefin is polypropylene, more preferably a copolymer of ethylene and polypropylene having an ethylene content of about 1-6% by weight of the copolymer. The styrene and hydrocarbon copolymers are more preferably SEBS triblock copolymers as defined above. Polypropylene copolymers should be composed of a blend of about 70-95%, preferably about 80-90%, SEBS is composed of about 5% -30%, more preferably about 10% -20% SENBS. To. In the preferred form of the invention, the polypropylene used to make the cassette has a lower melting point than the high melt strength polypropylene used to make the film. In the preferred form of the invention, the polypropylene of the cassette 160 has a melting point of about 120-140 ° C and the membrane has a melting point of about 145-160 ° C. Cassette 160 can be injection molded from these polymer blends.</p><p> The upper and lower membranes 162, 164 are adhered to the cassette 160 using heat sealing technology. The film has a tear strength of 5.0 lb / inch or more when tested using a tensile strength tester until the film tears or the bond breaks. Also, when the membrane is attached to a cassette, the membrane can be deformed at a pressure of 5 psi. The membrane retains its low modulus and deformability even after continued sterilization and meets pumping conditions. The membrane has a long shelf life. The membrane retains pumping performance even after storage for 2 years.</p><p> (IV. Valve actuator) With reference to FIG. 15, an embodiment of the interface between the valve actuator 26 and the valve manifold 190 is illustrated. A valve motor 28 (not shown) of the valve actuator 26 drives the camshaft 200 with a mechanical coupling that can be determined by one of ordinary skill in the art. In one embodiment, a single camshaft 200 is attached to each valve in a series of cams 202, eg, system 10 or 100. The cam 202 is fixed to the cam shaft 200 and rotates in a 1: 1 relationship with it.</p><p> The cam 202 drives the piston 204, which meshes with the cam via a method of reducing friction with the cam, such as the roller 206. The cam 202 drives the piston 204 up and down (only two of the five cams are connected to the piston to show other features of the actuator 26). When the cam 202 drives the piston 204 connected to it upwards, the piston 204 meshes with one of the membranes 162 or 164 (specifically the lower membrane 164, not shown in FIG. 15 for clarity) and engages the membrane. Push into each hole 192 formed by the rigid manifold 190. This operation stops the flow of medical fluid or dialysate at each valve.</p><p> The piston 204 is also spring mounted inside the receiver housing 208. When the camshaft 200 rotates and the shape of the lower part of the cam appears below the piston 204, a spring inside the housing 208 pushes the piston 208 and the roller 206 keeps in contact with each cam 202. As a result, the piston 204 is removed from the respective holes 192 formed by the rigid manifold 190, and the films 162 and 164 stretched upward by the piston 204 are springed back into their normal shape. This action begins to flow the medical fluid or dialysate through their respective valves.</p><p> The motor 28 is, for example, a step motor or a servo motor type, and can rotate at a constant rate of rotation and stay for an arbitrary predetermined time. Therefore, the motor 28 can keep the valve open or closed for the required time. Cam 202 has its own combination of peaks and valleys for each flow condition. In some situations with the valves V2 and V3 of System 10, the valves are always open or closed together, using the same cam 200 with both valves pointing in the same direction on the camshaft 200.</p><p> With reference to FIGS. 16A and 16B, the camshaft 200 and cam 202 are symbolically illustrated. FIG. 16A illustrates the composite cam profile 370, i.e. the combination of cams 202a-202f of FIG. 16B. FIG. 16B shows that the cams 202a to 202f are mounted on the camshaft 200 via the hub 384. Hub 384 may employ a set screen as is known. The camshaft 200 also has a notch or the like for aligning the hub 384. In a separate embodiment, at least one cam 202a-202f is formed integrally with the camshaft 200. In one embodiment, the camshaft 200 is an integrally molded part that prevents the cams 202a-202f from rotating with each other. The integrally molded camshaft 200 supports or mounts a plurality or all cams 202a to 202f.</p><p> As illustrated in FIG. 15, each cam 202a-202f of FIG. 16B drives one piston 204 and one roller 206 to operate one valve head 192 of the rigid manifold 190. The cams 202a to 202f open or close the valve head 192 according to the shape of each cam. FIG. 16B shows that the camshaft 200 supports six cams 202a to 202f. FIG. 15 shows 5 this cam 200. The cam provided in the embodiment of FIG. 16B is for opening the last bag indicated by the "open last bag valve" position 382. Either System 10 or 100 contains the last bag. The final bag is intended to fill the patient with approximately 2 liters of the final dialysate before the patient leaves the system and returns to normal activities of daily living.</p><p> The valve motor 28 and valve actuator 26 (FIGS. 1 and 2) rotate the camshaft 200 to open and close the valve head 192 to create the desired solution flow path. The arrangement of cams 202a-202f on the camshaft 200 is made so that at least one fluid pathway is open at any given time at any time during treatment. Further, when the valve actuator 26 rotates the camshaft 200 from a position where a certain flow path is open to the next, the cam series 202a to 202f temporarily close all valves. Closing each valve prevents dialysate from regurgitating or flowing in the wrong direction. Further, the cams 202a to 202f are arranged so that only one valve head 192 of the valve manifold 190 of the disposable unit 160 is open at a certain time. In addition, there are no open channels in case of system failure or ill-conditioned power outage. This safety measure prevents the dialysate from freely flowing to patient 12 or overfilling patient 12.</p><p> Since the disposable unit 160 is mounted on the hardware unit, the operator or the patient can freely open the lid 116 of the housing 112 for the hardware unit 110. In this case, the controller 30 commands the camshaft to rotate automatically so that the "all valves open" position 372 is below the rollers 206 and piston 204, as illustrated in composite profile 370. To do. At the "all valves open" position 372, the camshaft 200 rotates and is pressed under the roller 206 associated with each piston 204. Thus, when the operator or patient mounts the disposable unit 160 and the valve manifold 190 on the hardware unit 110, the piston 204 is in a relatively low position, i.e. out of the path. This allows the patient or operator to install the disposable unit 160 in the hardware unit 110 without being disturbed or squeezed by at least one piston 206.</p><p> After the patient or operator mounts the disposable unit on the hardware unit 110 and closes the lid 116, the controller 30 automatically rotates the camshaft 200 and the "all valves closed" position 386a is the piston 204 and rollers. Make it come to 206. As shown, the "all valves closed" position 386a is adjacent to the "all valves open" position 372. When the camshaft 200 rotates to the "all valves closed" position 386a, the fluid is system 10, 100. Cannot flow through. As the camshaft 200 rotates from the "all valves open" position 372 to the first "all valves closed" position 386a, a mechanical interlock (not shown) is released on the camshaft 200. It moves in and prevents the camshaft 200 from rotating backwards to the "all valves open" position 372, which opens each valve head 192 if the operator attempts to open the lid 116 during treatment. Prevents the uncontrolled flow of dialysate that occurs in the case of.</p><p> In a separate embodiment, the interlock is provided in software. The encoder feeds back the position and speed to the controller 30. Therefore, the controller 30 recognizes the position of the camshaft 200 and prevents the controller 30 from rotating the camshaft 200 in the reverse direction to the "all valves open" position 372.</p><p> When the patient closes the lid 116, a second mechanical interlock (not shown) locks the lid in its position and the patient is unable to open the lid 116 during treatment. Systems 10 and 100 detect when the patient removed the patient fluid line 292 and connector 290 from the infusion set implanted in patient 12. Only then will systems 10, 100 allow the patient to open the lid 116. Mechanical interlocks prevent free filling, overfilling, and patient interference with the system while it is in operation. The shape of the valve provides a fail-safe system that stops the feed in the event of a failure or power outage.</p><p> In many cases when a patient initiates dialysis treatment, the patient is already filled with dialysis. Thus, in the wet embodiment of FIG. 16, the composite profile 370 comprises a "all valves open" position 372 next to a "valve open from patient" position 374. The "valve open from patient" position is next to the "drain valve open" position 376. In this way, when treatment is initiated, the camshaft 200 easily drains the used dialysate from the patient in collaboration with the pumps 20 and 120. It should be understood that any cam of cams 202a-202f can be a cam that provides a "valve open" position 374 from the patient, a "drain valve open" position 376, and the like.</p><p> There is a second "all valve closed" position 386b between the "valve open from patient" position 374 and the "drain valve open" position 376. Each valve is momentarily closed while opening a new valve and closing the previously opened valve. Controller 30 puts camshaft 200 to motor (eg step motor, servo motor or DC motor) and actuator 26 through "all valve closed" position 386b to "drain valve open" position 376 "valve open from patient" position Switch back and forth between 374. In this way, pumps 20 and 120 can draw fluid from patient 12 and dump it into drain 18.</p><p> When systems 10 and 100 complete the drain cycle from the initial patient, controller 30 rotates camshaft 200 to actuator 26 of motor 28 through "all valves closed" position 386c to "supply valve open" position 378. Let me. To fill the patient with fresh dialysate, the controller 30 causes the camshaft 200 to switch back and forth between the "supply valve open" position 378 and the "patient valve open" position 380, each time "all valves open". Pass the closed "position 386d. Again, in the drain and fill cycle, only one valve head 192 is open at any given time. The switch always includes a "all valves closed" position between the activation of one valve head 192 and the opening of the other valve. One pump sequentially draws the fluid into the disposable unit 160 and pushes the fluid out of the bottom.</p><p> After the initial filling, the camshaft 200 can switch back and forth again between the "drain valve open" position 376 and the "valve open from the patient" position 374 through the intermediate "all valves closed" position 386b. It is in a similar position. When the patient is emptied again, the camshaft 200 is positioned to switch back and forth between the "supply valve open" position 378 and the "valve open to patient" position 380. Systems 10 and 100 repeat this series of cycles as many times as necessary. Specifically, the patient receives about 2 to 2.5 liters of dialysate in a single filling cycle. In one embodiment, the two supply bags 14 carry 6 liters of dialysate. This allows systems 10 and 100 to have 4-6 fill, retention and drain cycles, which are provided overnight while the patient is asleep.</p><p> Often, the patient is filled with the last bag at the end of treatment and the patient carries the fluid that day. To perform this procedure, the camshaft 200 switches between the "valve open from the patient" position 374 and the "drain valve open" position 376 back and forth, dumping the previously filled peritoneal fluid into the drain 18. Therefore, the camshaft 200 is in a position to switch back and forth between the "last bag valve open" position 382 and the "patient valve open" position 380. In that case, the camshaft 200 rotates through one of all valve closed positions, i.e., one of the "all valve closed" positions 386e.</p><p> To start the system, the camshaft 200 positions and switches in several different ways. In one embodiment, the camshaft 200 switches back and forth between the "supply valve open" position 378 and the "drain valve open" position 376 past the "all valve closed" position 386c. This switch, in collaboration with pump 20 or 120, allows dialysate to be pumped through disposable unit 160 from supply bag 14 to drain 18. In another embodiment, the camshaft 200 is moved back and forth between the "supply valve open" position 378 and the "patient valve open" position 380 using the breathable tip protector 280 illustrated in connection with FIGS. 8-12. Can be switched to. This causes dialysate to flow from the bag 14 through the disposable unit 160 to the patient fluid line 292 at the end of the breathable chip protector 280. When the dialysate reaches the hydrophobic membrane 300 of the breathable tip protector 28, the pressure in the systems 10 and 100 rises, the controller 30 receives the signal, stops the pump feed of the pumps 20 and 120 and switches the camshaft 200. To stop.</p><p> (V. Medical fluid pump) (A. Pump hardware and operation) The 17A and 17B is shown an embodiment of the pump 20 Ru. The lid 116 of the hardware unit 110 serves as the upper chamber wall 216. The lower channel-wall 218 is located within the housing 112 of the hardware unit 110 (FIGS. 3A and 4B). The chamber walls 216 and 218 form the inner chamber 210. The chamber 210 can be of any shape, for example a clam shell shape as illustrated in FIGS. 17A and 17B.</p><p> The lower chamber wall 218 forms or provides a sealed opening 219 that moves the pump piston 212 back and forth within the chamber 210. The piston 212 is attached to or integrally formed with the piston head 214. The piston head 214 in the figure has an outer shape similar to or the same internal shape as the upper chamber wall 216.</p><p> The pump piston 212 is connected to or integrally formed with the linear actuator 24. The linear actuator 24 in the figure is a device that converts the rotational motion of the motor 22 into the transmitted motion of the piston 212. In one preferred embodiment, the motor 22 is a linear step motor that projects a shaft that carries out transmission motion. The actuator 24 simply connects the motor shaft to the piston 212. Linear or step rotation motors allow for extremely quiet motion and high position resolution, accuracy and reproducibility. Step motors are commercially available, for example, from Haydn Switch and Instrument Inc. (Waterbury, CT) and the like.</p><p> As mentioned above, the elastic fluid receiver 172 (described in 17A but not in 17B) is formed by the extendable upper and lower membranes 162 and 164 of the disposable unit 160, respectively. In FIG. 17A, when the pump 20 is filled with medical fluid, the pump chamber 210 and the membrane receiver 172 have substantially the same shape. In FIG. 17B, when the pump 20 discharges all or most of the medical fluid, the pump channel 0210 maintains the same volume, but the membranes 162 and 164 of the fluid receiver 172 are on the inner surface of the upper chamber wall 216. It is crushed along with it, and the volume becomes virtually zero.</p><p> The vacuum source 44 of pump 22 is shown in FIG. The vacuum source 44 evacuates the top membrane 162 through the pores or ports 222. The pores or ports 222 extend through the upper chamber wall 216. The vacuum source 44 evacuates the lower membrane 164 through the openings 221 formed by or provided by the housing 223, and the ports of the openings 220. The port or opening 220 extends through the piston 212, including the piston head 214. When vacuum is applied, the lower membrane 164 is sealed against the piston head 214. The upper membrane 162 is also sealed against the upper chamber wall.</p><p> Port 222 is fluid connected to a channel (not shown) formed in the inner wall of the upper chamber wall 216. Channels extend radially outward from port 222 in various directions. The channels facilitate the distribution of negative pressure applied through port 222, allowing the top membrane 162 to substantially conform to the internal shape of the top chamber wall 216. In a similar manner, the outer surface of the piston head 214 also has channels that extend radially, and a vacuum can be applied to align the lower membrane 164 with the outer surface of the piston head 214.</p><p> Pump 20 includes diaphragm 232 stretched between the upper and lower walls 216 and 218, respectively. The diaphragm 232, along with the upper chamber wall 218, determines the maximum volume of known, predictable and reproducible dialysate, which is drawn from at least one feed bag 14 and delivered to patient 12. The diaphragm 232 can also characterize partial strokes, thus allowing accurate and reproducible volume measurements.</p><p> The diaphragm 232 is arranged around the lower piston 212 of the piston head 214. When a vacuum is applied to the port or opening 220, the diaphragm 232 and bottom membrane 164 are attracted to the opposite side of the piston head 214. When a vacuum is applied through the opening 220 and the piston head 214 is launched upward from the lower chamber wall 218, the membrane 164 and diaphragm 232 remain lowered with respect to the piston head 214. The inside of the membrane 164 follows the shape of the outer surface of the piston head 214. The remaining outer portion of membrane 164 follows the shape of the exposed surface of diaphragm 232.</p><p> The diaphragm 232 in one embodiment includes an elastic molded cup-shaped elastomer and reinforcing fibers such as fiber reinforced ethylene propylene diemethylene (EPDM). It is possible to mold the fiber integrally with the elastomer. The fibers prevent unwanted deformation of the diaphragm under pressure. The diaphragm 232 extends as the piston 212 and head 214 move downward toward the lower chamber wall 218 and pull the diaphragm 232 along the edges of the upper and lower walls 216 and 218. The diaphragm 232 also moves and remains sealed of the piston head 214 as the piston 212 and head 214 move downward toward the upper chamber wall 216.</p><p> When the pump 20 is activated, a negative pressure is applied through the port 222 to hold the upper membrane 162 on the upper chamber wall. The manifold 190 of the disposable unit 160 (see FIGS. 3A and 5) forms the fluid port opening 230 for the membrane receiver 172. The fluid port opening 230 allows medical fluid or dialysate to enter and exit the membrane receiver 172. Membrane receivers 172 are fitted into the bent edges of the upper and lower chamber walls 216 and 218. The seal 170 of the receiver 172 is actually slightly inside the bent edges of the upper and lower chamber walls 216 and 218 (see Figure 4A).</p><p> The motor 22 / actuator 24 pushes the piston head 214 to the lower chamber wall 218 during the pump filling stroke, where the upper membrane 162 is evacuated against the upper chamber wall and the lower membrane 164 and diaphragm 232 are evacuated against the piston head 214. It moves downward toward, increasing the volume in the elastic receiver 172 and creating a negative pressure in it. As described in the valve arrangement herein, the negative pressure draws dialysate from the feed bag 14 or patient 12. The open receiver 172 is filled with fluid. This process occurs when the pump moves from position in Figure 17B to position in Figure 17A. Figure 17A shows the pump at the end of the stroke with the receiver 172 fully open (ie, filled with fluid).</p><p> During the patient filling or drain stroke, the upper membrane 162 is again evacuated against the upper chamber wall 216, the lower membrane 164 and diaphragm 232 are evacuated against the piston head 214, and the motor 22 / actuator 24 pushes the piston head 214 up. It is moved upward toward the chamber wall 216 to reduce the volume in the elastic receiver 172 and generate positive pressure in it. As the valve arrangement herein shows, positive pressure pushes dialysate from receiver 172 to patient 12 or drain 18. When the lower membrane 164 moves upward toward the upper membrane 162, the receiver 172 closes. This process occurs when the pump moves from position in Figure 17A to position in Figure 17B. FIG. 17B shows the pump 20 at the end of the stroke when the receiver 172 is empty or actually above.</p><p> To maintain accuracy when air (for the purposes of the present invention, "air" includes air as well as any possible gas, especially gas expelled from the patient's peritoneal cavity) enters the fluid receiver 172. Must be kicked out. It should be understood that if air enters between the membranes 162 and 164, the preferred systems 10, 100 of the present invention do not have the ability to evacuate between the membranes 162 and 164. However, the elasticity of the membranes 62 and 164 naturally tends to expel air from it. In a separate embodiment, systems 10, 100 can be used to provide a vacuum source that evacuates between membranes 162 and 164 and expels air from it.</p><p> Systems 10 and 100 are also equipped with a positive pressure source to expel air from between the membranes. For example, in systems 10 and 100, the pump motor 46 can be operated in the reverse of normal operation to generate positive pressure instead of creating a vacuum source 44 (FIGS. 1 and 2). If air is detected between the membranes 162 and 164, or anywhere in the disposable unit 160 or piping, system 10 exerts positive pressure through the pores or port 222 of the upper chamber wall 216. In one eviction procedure, the controller 30 moves the piston head 214 to the motor 22 / actuator 24 to approximately midpoint with a positive or negative stroke. When the upper membrane 162 is pressed against the upper chamber wall 216 in a vacuum and the lower membrane 164 and the diaphragm 232 are pressed against the piston head 214 held at the midpoint, the controller introduces a negative pressure source through the pores 222. Turn it into a positive pressure source. As a result, the upper membrane 162 is pressed along the lower membrane supported by the piston head 214 and the diaphragm 232. Any air or fluid that resides in the receiver 172 is expelled as well as the air between the receiver 172 and the drain 18.</p><p> (B. Capacitive volume sensor) Figures 17A and 17B also show that pump 20 is co-located with a capacitive fluid volume sensor 60 embodiment of system 10. One embodiment of the capacitive sensor 60 is described in detail in the patent application for the title "Capacitance Fluid Volume Measurement" submitted on January 22, 2002, reference number 10/054487. Refer to the specification. The capacitance type sensor 60 uses capacitance measurement technology to measure the volume of fluid in the chamber. When the volume of the fluid changes, the detected voltage changes in proportion to the change in the amount of capacitance. Thus, the sensor 60 can determine, for example, whether the chamber is empty, 80% full, 1/4 full, half full, or any other percentage filled. .. Each of these measurements can be made accurately, for example on the order of accuracy achieved with a known weight balance or pressure / volume measurement. However, the method of the present invention is simple and non-invasive and does not require the medical operation to be a batch operation.</p><p> In general, the capacitance C between two capacitor plates changes according to the equation C = k × (S / d). Where k is the permittivity, S is the surface area of the individual plates, and d is the distance to the play. The capacitance between play and play changes in proportion to Equation 1 / (R × V). Where R is the known resistance and V is the voltage measured across the capacitor plate.</p><p> The permittivity k of the medical fluid or dialysate is much greater than the value of air filling the pump chamber 210 when the piston head 214 is bottomed against the upper chamber wall 216, for example as shown in FIG. 17B. .. Therefore, a change in the distance Δd of the low dielectric displacement fluid between the telescopic container 172 and the lower chamber wall 218 may have some effect on the capacitance between the grounded capacitor plate 224 and the anodic capacitor plate 226. Similarly, the surface area S of the capacitor plate and the moving film 164 also appear to have some effect on capacitance. Indeed, the varying overall permittivity from a high permittivity dialysate (or vice versa) that replaces the low permittivity air affects the overall capacitance between the electrodes 224.</p><p> As the membranes 162 and 164 expand and fill with the medical fluid, the overall capacitance changes, or increases. Sensor 60 generates a high impedance potential across ground and anode capacitor plates 224 and 226. The high impedance potential indicates the amount of fluid in the receiver 172. If a change is expected but the potential does not change over time, the sensor 60 indicates that there is a certain amount of air in the receiver 172.</p><p> The capacitance detection circuit amplifies the high impedance signal to generate a low impedance potential. The low impedance potential is fed back to a protective plate 228 that protects sensitive signals from external electrical influences. The amplified potential is converted to a digital signal and fed to processor 34, where the signal is filtered and / or summed. The video monitor 40 is then used to provide an image to the patient or operator with volume or flow velocity indications. In addition, the total output of the processor 34 is used to control the pump 20 of system 10, for example determining the flow rate of dialysate reaching a predetermined total volume.</p><p> With reference to FIG. 18, the pump 120 of the system 100 operated by the capacitor sensor 60 of the present invention is illustrated. The pump 120 forms a clam shell shape with first and second parts 246 and 248 forming the pump chamber 250. Parts 246 and 248 are rigid fixed volume disc-shaped notches in the base 114 and lid 116 of the hardware unit 110. The clamshell first and second parts 246 and 248 are closed and sealed on the pump receiver 172, which includes the inflatable membranes 162 and 164 of the disposable unit 110.</p><p> The openings or pores 252 are formed between the first and second clamshell portions 246 and 248 and the flexible membranes 162 and 164. The opening allows medical fluid, such as dialysate, to enter and exit chamber 250 between membranes 162 and 164 of the receiver 172. The receiver portion 172 communicates with the valve manifold 190 by fluid.</p><p> FIG. 18 shows an empty pump chamber 250 with the two membranes 162 and 164 in loose positions and the elastic receiver portion 172 closed. The empty volume state is achieved when the membranes 162 and 164 are crushed and virtually all are removed from the sterile receiver 172 and similarly from the pump chamber 250.</p><p> The empty volume state is achieved, for example, by bringing the flexible membranes 162, 164 into their loose, unexpanded state, as shown in FIG. Also, the two membranes 162 and 164 can be pressed against each other or against either 246 or 248 of the pump chamber 250. When the pump chamber 250 is filled, the medical fluid resides between the membranes 162 and 164 and the membranes are aspirated against the inner walls of parts 246 and 248.</p><p> It should be understood that either one or both of the membranes 162 and 164 can be moved in and away from the clamshell sections 246 and 248 by any suitable fluid activity device. In various embodiments, the diaphragm pump is aerodynamically or hydraulically activated.</p><p> The system 100 diaphragm pump 120 does not require a separate piston or mechanical actuator like the system 10 pump 20. Clamshells 246 and 248 form ports 254 and 256, respectively, causing the displacement fluid (eg, aerodynamic or hydraulic fluid) to move in and out of the chamber region outside the receiver 172 to operate the diaphragm pump.</p><p> In one embodiment, a medical fluid, such as dialysate, is aspirated into a receiver 172 in chamber 250. Negative pressure may be applied to at least one of the chamber ports 254 and 256 to fill the receiver 172 formed by the membranes 162 and 164 with medical fluid. Positive pressure can be applied to at least one of the ports 254 and 256, or the membranes 162 and 164 can be springed back into the shape to draw the medical fluid out of the receiver 172. In a separate embodiment, a medical fluid, such as a dialysate, can be externally pressured in and out of the pump chamber 250 between the membranes 162 and 164.</p><p> The clam shell portions 246 and 248 form and hold the capacitor plate of the capacitor sensor 60. In some embodiments, the upper clamshell portion 246 includes an active metal or conductive capacitor plate 258 between electrical insulation or plastic layers. A metal protective plate 260 is provided on top of the outer plastic layer of the upper clam shell portion 246. The protection plate 260 provides noise protection against high impedance signals sent from the anode capacitor plate.</p><p> Like pump 20 in system 10, the anodic capacitor plate in the upper clam shell portion 246 of pump 120 in system 100 is coupled to the capacitance detection circuit. The protective plate 260 is also electrically coupled to the fade back loop of the capacitance detection circuit.</p><p> In one embodiment, the lower clamshell portion 248 is also made of inert plastic and a metal capacitor plate 262 is attached to the outer surface of the lower clamshell portion 248. The metal capacitor plate 262 arranged outside the clam shell portion 248 is grounded.</p><p> In one embodiment, negative pressure is constantly maintained in the lower port 256 and is heard so that the lower membrane 164 follows the internal surface of the grounded clamshell portion 248 during repeated filling and empty cycles. In this aspect, the top membrane 162 acts as a pump. That is, when a negative pressure is applied to the upper port 254 of the upper clam shell 246, the upper membrane 162 is sucked up against the inner surface of the upper clam shell 246 and follows the inner surface of the upper clam shell 246. This action draws fluid from the supply bag 14 through the manifold 190 into the receiver 172. To drain the fluid, negative pressure is released from the upper port 254 and the upper membrane collapses, pushing the fluid out of the receiver 172. Alternatively, positive pressure is applied through at least one port.</p><p> When operated, the capacitance sensor 60 operates as described in FIGS. 17A and 17B. The receiver 172 extends between the clam shells 246 and 248. The change in the distance of the low dielectric displacement fluid between the expansion / contraction receiver 172 and the clam shells 246 and 248 Δd seems to have some effect on the capacitance between the ground plate 262 and the anode plate 258. Similar to the surface area S determined by the ground plate and the anode capacitor plate, the expanding film seems to have some effect on the overall capacitance. Indeed, the overall permittivity that changes with a high permittivity dialysate that replaces the low permittivity air (or vice versa) affects the capacitance between plates 258 and 162.</p><p> As the membranes 162 and 164 expand and fill with medical fluid, the capacitance changes, or increases. Each time the amount of medical liquid in the chamber is different, it becomes a unique total capacitance. Thus, the unique capacitance can be associated with each particular fluid volume in the chamber, eg, being substantially empty, partially filled or substantially full.</p><p> As an alternative to the capacitance sensor 60 described above, the volume of dialysate flowing through automation systems 10 and 100 can be measured using other methods such as electronic balances. In such cases, the electronic balance tracks the amount of dialysate delivered to the system during system startup. The electronic balance also monitors any additional dialysate added to the system during dialysis treatment.</p><p> In other embodiments, any system described herein can be detected with other types of current meters or devices using Boyle's law known to those of skill in the art. In addition, various other types of fluid volume and current meters can be used in automation systems 10 and 100, such as orifice plates, mass flow meters or other flow measuring devices known to those of skill in the art.</p><p> (VI. Precision pressure control) As discussed above, system 10 uses a valve actuator 24 and a pump motor 22. In one embodiment, the pump motor 22 is a step motor. In another embodiment, the motor 22 is a DC motor or other type of reproducible and accurately positionable motor. Each of these types of motors allows the system 10 to position the piston 212 and piston head 214 very accurately within the pump chamber 210. In the case of the high precision rotary motor 22, the actuator 24 accurately converts the rotary motion into a moving motion, moving the piston 212 back and forth in the chamber within the accuracy and reproducibility required by the system. The accuracy of the linear step motor in the embodiment is about 0.00012 to 0.00192 inches per step.</p><p> The pump motor 22 is also capable of inputting acceleration, speed and position data to the controller 30 due to the programmable nature of the pump motor 22 which is programmable. The controller 30 uses the information to position the piston 212 and the piston head 214 in the pump chamber 210 within an appropriate time to generate a predetermined force or fluid pressure. Pre-setting the acceleration, velocity and position of the piston head 214 has the advantage of responding relatively slowly compared to a simple air system.</p><p> For example, the flexible properties of PVC medical piping described in connection with FIG. 8 and the membrane materials described in connection with FIGS. 13 and 14 allow the system 10 to have so-called compliance. If the system 10 is trying to generate fluid pressure, for example by moving the pump piston 212 and head 214, compliance is achieved, but at the cost of flexible piping and membrane swelling. Compliance is inevitable with flexible membranes and piping. In fact, when the pipe and membrane expand to their elastic limits, the pressure in the pump chamber 210 (ie, in the receiver 172) and through the pipe rise sharply. In order to increase the pressure and drive the fluid, it is desirable to overcome the compliance of the piping and membranes 162 and 164 as quickly as possible.</p><p> The present invention uses a hybrid pressure control system that combines the ability to preset the acceleration and speed of a pump piston with an adaptive pressure control scheme, thereby adjusting the pressure to a desired pressure set for a given stroke and adjusting the pressure. It can be fine-tuned over time, i.e. over repeated strokes. In other words, the present invention uses a method of controlling pressure within a system that overcomes system compliance and seeks the desired pressure setting. The method of the present invention in which the pressure is controlled within the pump chamber 210 is shown by the velocity-pressure curve in FIG.</p><p> Generally, the system 10 controls the pressure in the receiver 172 in the pump chamber 210 by controlling the speeds of the piston 212 and the piston head 214. Velocity profile 390 in FIG. 19 shows one pump stroke made over time t starting at the start of stroke position 392. At the beginning of the stroke, the speed goes out of control beyond the preset acceleration 394. The preset acceleration 394 is programmed in controller 30. When the preset speed of acceleration 394 reaches the maximum speed 396, the acceleration 394 changes to zero and the piston 212 moves at a constant maximum speed 396.</p><p> During the acceleration 394 and maximum velocity 396 shown by the vertical dotted line 398, the corresponding pressure shown by the pressure curve 401 of the pressure profile 400 is very slow at first and increases seriesally as the time reaches the dashed line 398. Runaway. Immediately after the first part of the pressure curve, that is, immediately after the start of the stroke position, system compliance is activated and the pressure gradually increases. When compliance works, pressure rises at an ever-increasing rate.</p><p> When the pressure reaches near the pressure threshold 402 set in the software, the software in the controller 30 converts from the previous motion (acceleration, speed, position) control to adaptive control. It is necessary to understand that the pressure control method in the fluid pump of the present invention is a hybrid type control using a combination of techniques.</p><p> The motion control unit, which emphasizes acceleration 394 and maximum velocity 396, represents the period during which the control method forces the system to overcome pressure compliance. When a force approaches the threshold, the controller 30 rapidly decelerates the speed with a deceleration 404. The deceleration 404 reduces the speed of the piston 212 and piston head 214 to speed 406, which gives the adaptive control part of the pressure control system the ability to achieve the pressure set value 408. That is, without a programmed deceleration 404, the time it takes for the adaptive control part to control the pressure to reach or substantially reach the pressure set value becomes more difficult (ie, longer). Seem.</p><p> As described in more detail below, acceleration 394 is controlled to be more adaptive in some embodiments because it reduces the degree of initial overshot. The adaptive control for acceleration 394 is fine-tuned over time to further reduce the initial overshot amount. Each of these measures affects the amount of deceleration control required.</p><p> After the controlled deceleration 404 reaches speed 406, and by the time of the second dashed line 410, system 10 activates adaptive mode. The second vertical line 410 occurs at the end of the stroke. As shown, the adaptive portion of the stroke is decomposed into several regions, namely regions 412 and 414. Region 412 is characterized by overshots or undershots 394 brought about by programmed acceleration 394. When applying adaptive techniques, the adjustments or parameters that overcome the error in region 414 are preset in the software and face bar shots or undershots. Region 414 is intended to attempt to minimize errors between the actual pressure curve 401 and the pressure set value 408. During region 414, parameters and adaptive means are preset in the software to reduce the vibration of the pressure curve 401 and achieve the pressure set value 408 as much as possible and as fast as possible.</p><p> When the time indicated by the dashed line 410 is reached, the pressure control method repeats motion control again, decelerating to the final speed 418 with a predetermined speed-controlled deceleration 416, which is the initial speed at the start of stroke 392. But also. In a separate embodiment, the method simply continues adaptive control past timeline 410 in an attempt to achieve a final movement speed of 418. After time leprosy 410, the pressure along the pressure curve 401 drops towards zero pressure as shown in pressure profile 400. Comparing the pressure profile 400 with the velocity profile 390, it should be understood that the pressure is maintained in the receiver 172 of the pump chamber 210 after the stroke at time t. In some cases, the pressure overshoots when the piston suddenly stops, but the inertia of the liquid causes a pressure overshoot after a time "t".</p><p> Referring to FIG. 20, algorithm 420 which employs adaptive pressure control in regions 412 and 414 of pressure profile 400 is shown. In some embodiments, the adaptive control portion of the pressure control method employs proportional, integral and derivative (PID) adaptive parameters. In this method, as illustrated in Algorithm 420, the pressure measurement is obtained from a pressure sensor that detects the pressure inside the receiver 172 of the pump chamber 210 and provides the controller 30 with a pressure sensor input 422. The pressure sensor input 422 is sent through the digital filter 424 and becomes the measured variable 426. The measured variable 426 is compared to the desired variable, ie the pressure set value 408 shown in FIG. 19, causing an error between the measured variable 426 and the pressure set value 408.</p><p> The error 428 is then entered into the PID calculation 430 using the proportionality factor 432, the integral count 434 and the derivative count 436. The output of PID calculation 430 is adaptive pressure change 438. Next, the controller 30 increases or decreases the speed to change it, and generates a pressure change 438.</p><p> With the pressure profile 400 of FIG. 19, the algorithm 420 of FIG. 20 is routinely performed during the adaptive regions 412 and 414. As discussed below, the correction parameters, counts 432, 434 and 436, are used differently in regions 412 and 414 because the correction in region 412 minimizes overshoots and undershoots. However, the purpose of the correction in the region 414 is to make the difference in the vicinity of the pressure set value 408 zero.</p><p> As mentioned above, the system 10 uses one pump 20. A single pump 20 applies positive pressure during the patient filling and pumping strokes. The pump 20 applies negative pressure during the suction stroke from the supply bag 14 and the suction stroke from the patient 12. Precise control of pressure during the patient filling and draining strokes of the four strokes is of utmost importance. For fluid delivery from the feed bag 14, or for fluid delivery from the receiver 172 of the pump chamber 210 to the drain 18, controlling the pressure is less important. With two positive pressure strokes, one stroke, the patient filling stroke, it is important to properly control the pressure. In one of the two negative pressure strokes, the patient-to-suction stroke, it is important to properly control the pressure. The other two strokes control the pressure without unnecessarily loading the controller, motor 22 and disposable unit 160.</p><p> With reference to FIG. 21, pressure-velocity curves during several strokes of the patient filling cycle are shown. Top profile 440 shows the actual pressure 444 / given pressure 442 expressed in millilbs per square inch (mPSI). The lower profile 450 shows the corresponding velocity curve. In the pressure profile 440, the black line 442 corresponds to the desired pressure represented by mPSI. Curve 444 shows the actual pressure expressed in mPSI. Curves 452a, 452b and 452c in velocity profile 450 indicate piston speeds along pressure curve 444 in pressure profile 440. If the motor 22 used is a step motor, the speed is measured with a slight increase in steps per second, such as millisteps per second or microsteps. The different step motors used in the present invention can also be programmed with different step increments. Therefore, the actual speed is a function of the resolution of the step motor.</p><p> At zero time, the desired pressure 442 changes to 2000 mPSI almost instantaneously. The desired pressure 442 maintains this constant 2000 mPSI until about 1.6 seconds, at which point the desired pressure momentarily returns to almost zero. This step with the desired pressure curve represents a complete patient filling stroke of one worth, with one complete positive upward stroke of the piston 212 and piston head 214 in the pump chamber 220. Controlling the pressure is important in this step as the dialysate is pumped into the patient's peritoneal cavity 12. The actual pressure curve 444 runs out exponentially and oscillates at a set value of about 2000 mPSI by the method described in connection with FIG. It should be noted that the velocity curve 452a follows a pattern similar to that shown in Figure 19.</p><p> In about 1.6 seconds, i.e., when the piston head reaches the upper chamber 216 of the valve chamber 210, the controller 30 stops guiding the piston 212. The speed of the piston head remains zero until about 3.4 seconds. At this point, the valve is closed via one of the "all valve closed" positions illustrated in connection with FIG. 16A. As shown by the pressure curve 444, the remaining fluid pressure remains in the pump chamber 210 even if the piston head 214 is not moving.</p><p> In about 3.4 seconds, the desired pressure curve switches to -2000 mPSI almost instantaneously. The pump 20 is then asked to inflate and generate a negative pressure that draws the fluid from the supply bag 14. During this stroke, the pressure does not need to be controlled as accurately as in patient fluid filling. Therefore, it is programmed to bypass the motion control section of the pressure regulation method and simply adapt and find the pressure set value along line 442. During the patient filling stroke, dialysate is delivered through the fluid heating path 180 of the disposable unit 160 (see Figures 3A, 5, etc.). When the fluid passes through path 180, a lot of compliance, i.e. pulling the system, occurs. However, the pumping fluid from the feed bag 14 does not require the fluid to pass through the heating path 180. Therefore, System 10 does not experience the same level of compliance during this stroke. Since the reduced compliance does not require the "strong force" supplied by the controlled acceleration, it is possible to pump from the bag 14 without using the motion control section illustrated in connection with FIG.</p><p> In Figure 21, the pump assumes a stroke that pulls dialysate out of the supply bag in about 5 seconds. Therefore, the required pressure along curve 442 returns to zero. Next, the valves are all switched to the closed position, the controller 30 sets the piston to zero, and the piston head stops along the lower chamber wall 218 with the receiver 172 filled with fluid until about 6.8 seconds have passed. , System 10 repeats the patient filling stroke as described above.</p><p> With reference to FIG. 22, the patient is shown a pressure profile 452 and a velocity profile 460 for the patient drain stroke and pump feed stroke to the drain of the drain cycle. In pressure profile 452, the required pressure curve 454 indicates that the controller requires a negative pressure of 2500 mPSI to draw dialysate from the patient. The controller 30 requires a positive pressure of 2500 mPSI to push the fluid from the receiver 172 of the pump chamber 210 into the drain bag 18. The velocity profile 460, shown below the pressure profile 452, shows the actual velocity 462 with a slight increase in steps per second. It should be understood that both velocity profiles 450 and 460 in FIGS. 21 and 22 are absolute velocities and do not indicate that the pump piston 212 moves in the positive and negative directions.</p><p> The actual pressure curve 456 of profile 452 shows that the pressure is controlled so that it is closer to the required pressure line 454 in the suction section from the patient than in the pump to drain section of profile 452. In one embodiment, a motion-controlled velocity of 464 is provided for the suction portion from the patient, and the time t._adapt"Inside, the controller 30 is programmed to use adaptive control. In some embodiments, the method also uses a controlled deceleration at the end of suction from the patient, or the method is to find zero pressure. Similarly, the controller 30 can be switched to PID control only during the drain stroke from the pump.</p><p> Referring to FIG. 23, "fine-tuning" adaptive control of the PID portion of the pressure control method of the present invention is shown. Similar to FIG. 20, FIG. 23 contains the measured pressure variable 426 and the desired pressure set value 408. Pressure error 472 indicates an error in either the overshoot region 412 or the vibration region 414 illustrated in the pressure-velocity profile 400 of FIG. In each region, algorithm 470 focuses on two error components: error 474 measured at the current stroke and error 476 stored at the previous stroke. Controller 30 compares the two errors 476 and 478 and makes the decision shown in decision block 478.</p><p> If the current stroke error 474 is less than the previous stroke error 476 in block 476, then the previous count has the desired result and this method uses the previous count. If the current stroke error 474 is greater than the previous stroke error 476, there are two possibilities. First, counting or compensating means are not sufficient to overcome the increase in errors. Here either the counting or correction settings are increased or a separate strategy is taken. Second, the previous correction procedure may have an adverse effect, in which case the parameter relationships are reversed or a separate strategy is used. Obviously, in order to use algorithm 470, the method assumes that controller 30 remembers the method of the previous correction attempt and the result. Based on what happened before, the controller decides to increase or decrease at least one of the parameters. Apply the increase / decrease to at least one rotten count in Incremental Table 480. Adjusted or unadjusted increments are summed to at least one currently used count 482 to produce at least one adjusted count 484.</p><p> With reference to FIG. 24, Table 500 shows a variety of different counts and adaptive boundaries for the pressure control method of the present invention. Certain counts and parameters are applied by the motion control part of the profile, i.e. the set of acceleration, deceleration and velocity parts of the profile. However, motion control parameters cause errors, which affect the adaptive parameters in the PID portion of pressure control. Other parameters also apply to the adaptive control section of the profile. Adjusting the starting stroke acceleration parameter 486 (indicated by acceleration 394 in velocity profile 390 in FIG. 19) affects the motion control part of the method. The acceleration shown affects the efficient use of overshoot and stroke time. In other words, high acceleration is desirable to quickly overcome compliance, but the price is increased overshoot. Lower acceleration, on the other hand, reduces overshoot, but requires more time to overcome system compliance.</p><p> Proximity threshold parameter 488 (indicated by pressure line 402 in pressure profile 400 in FIG. 19) also affects overshoot and undershoot. Here, if the pressure threshold value 488 is set too low, an undershoot will occur, and if the pressure threshold value 488 is set too high, an overshoot will occur. The DP / dt parameter 490 is the pressure change within a given time. This parameter is for seeking to achieve a certain slope of the pressure curve 401, for example in FIG.</p><p> The maximum velocity parameter 492, shown in line 396 of velocity profile 390 in FIG. 19, also affects overshoot and subsequent resonance. Another compensating factor is the conversion to pressure deceleration 494 corresponding to line 410 in FIG. This method involves not returning to motor control, activating the system, and instead leaving the system in adaptive PID control. The conversion to deceleration can have a significant effect on the residual pressure remaining in the pump chamber 210 after the valve is closed.</p><p> The PID factors Kp, Kd and Ki, labeled 496, 498 and 502, respectively, affect the adaptive control part of the method, but less influentially on the controlled deceleration at the end of the stroke. Each of the PID factors or parameters changes and adapts with an intermediate stroke. As shown in FIG. 23, these factors can change to optimize the system over time.</p><p> Each of the above factors is used so that the fluid pressure does not change easily in the environment outside the system 10. For example, the factor can overcome changes due to physiological and chemical changes in the patient's abdomen. The height of the patient supply bag 14 also affects the initial load of the fluid pump 20. The parameters shown in Figure 24 automatically overcome height changes. In addition, when the patient is sleeping at night, the bag 14 becomes more and more empty, while the drain bag 18 becomes more full, both of which affect the pump pressure. The parameters shown in Figure 24 can automatically adjust and compensate for these changes, keeping the system running smoothly.</p><p> Some of the above factors are further varied and used in the overshoot region illustrated in the presence of pressure profile 400 in FIG. Other factors and parameters are used in the vibrating part 414 of profile 400 and vary further.</p><p> (VII. In-line heater) In certain embodiments, the in-line heater 16 includes two electric plate heaters known to those of skill in the art. The plate heater of the heater 16 has a smooth, flat surface facing the disposable unit 160. In a separate embodiment, automation systems 10 and 100 include an in-line heater 16 with a plate heater in combination with an infrared heater or other convection heater.</p><p> In a separate dual-mode heater, both the plate heater and, for example, an infrared heater are in-line heaters that heat the medical fluid through the fluid heating path 180 of the disposable unit 160. The radiant energy of the infrared heater is directed to the fluid in the fluid heating path 180 and is absorbed by the fluid. The radiant energy or infrared heater of the embodiment is a primary or high capacity heater, which can heat a relatively large volume of cold fluid to a predetermined temperature in a short time.</p><p> The plate heater of the dual mode heater of one embodiment is a secondary or maintenance heater having a relatively low heating capacity as compared to an infrared heater. As mentioned above, the plate heater uses electrical resistance to raise the temperature of the plate and heats the fluid flowing through the path 180 adjacent to the plate.</p><p> Dual-mode heaters are practically useful for quickly heating cold (high thermal energy-requiring) dialysate supplied from one of the supply bags 14 to the automation system 10 or 100. The initial system charge is colder than the later charge and the system loses heat during the convection phase. Therefore, when the supply bag 14 is stored in a cold ambient temperature, the temperature of the dialysate at the initial system charge is extremely low, 5 ° C to 10 ° C.</p><p> The plate heater and the infrared heater of the dual mode heater embodiment of the heater 16 can be arranged with each other in various forms. The dual mode heaters in certain embodiments are arranged such that the fluid passes sequentially through the side of the heater (eg, first a plate heater, then a radiant or infrared heater). In another embodiment, the fluid passes by the side of the heater at the same time (at the same time the heater). The fluid flow path passing through the heaters may be a common flow path for both heaters, such as in the fluid heating path 180, or may include an independent flow path for each heater.</p><p> (VIII. Fuzzy logic for heater control) Like fluid pressure control, control of the plate heater 16 is one of several environment variables. For example, the ambient temperature of a patient's home also affects the amount of heat required to raise the temperature of the medical fluid to the desired temperature. Obviously, the temperature of the dialysate in the feed bag 14 also affects the amount of heat required to raise the temperature of the fluid to the desired temperature. The efficiency of the plate heater also affects the amount of heat required. In addition, the voltage provided at the patient's home is also a separate factor. Specifically, the doctor or nurse prescribes the temperature of the dialysate for the patient, which is controlled to a temperature near 37 ° C. Therefore, it is desirable to have a method of compensating the heater 16 for an external temperature gradient to maintain an appropriate patient fluid temperature.</p><p> FIG. 25 illustrates an embodiment of the heating control method 510. Method 510 includes two independently executed algorithms 520 and 530 that operate in parallel to generate an overall output of 544. Algorithm 520 is called a "knowledge base" control algorithm. Knowledge-based algorithms are based on knowledge of empirical data, flow mechanisms, physical laws and experimental data.</p><p> Knowledge-based algorithms require many constant settings with many inputs. For example, control algorithm 520 requires an input pulsatile flow velocity. As illustrated below, the pulsatile flow velocity is actually calculated from several variables. Systems 10 and 100 of the present invention provide patient 12 with fluid in pulses rather than in a continuous stream. It can be easily understood from the discussion based on FIGS. 16A and 16B that fluid cannot flow from the fluid heating path to the patient if all valve heads in the disposable unit are closed. Therefore, the flow velocity of the fluid to the patient is the pulsatile flow velocity, and the patient receives the dialysate in a squirt or pulse. It is difficult to control the temperature of the fluid with this type of flow velocity. After all, the heating control method 510 provides dual algorithms 520 and 530.</p><p> In addition to the pulsatile flow velocity, the knowledge-based control algorithm 520 receives a measured, i.e., actual fluid inflow temperature signal. In addition, algorithm 520 stores plate heater efficiency based on empirical data. In some embodiments, the efficiency of the upper and lower plates of the plate heater 16 is about 95%. Algorithm 520 also inputs the total heater power derived from the input voltage into systems 10 and 100. Residential voltage varies from day to day, over the course of a day, or from place to place.</p><p> Algorithm 520 also inputs the desired outflow fluid temperature, which is a constant setting but can be changed by the patient's doctor or nurse. As shown in FIG. 25, the desired outflow fluid temperature is input to both the knowledge-based control algorithm 520 and the fuzzy logic-based control algorithm 530. As discussed in more detail below, the knowledge base control algorithm 520 outputs the knowledge base operation cycle to a total point 544.</p><p> In the fuzzy logic-based control algorithm 530, the desired fluid temperature is input to the comparison point 514. Comparison point 514 outputs the difference between the desired fluid temperature and the measured fluid temperature that excites the heating system 548. Therefore, the fuzzy logic-based control algorithm 530 receives the temperature change ΔT as an input. As described below, the fuzzy logic-based control algorithm 530 adopts the concept and strategy of fuzzy logic control to output the fuzzy logic operation cycle.</p><p> In the heating control method 510, the knowledge-based operation cycle is weighted and applied to the fuzzy logic-based operation cycle. In a separate embodiment, the system predetermines relative weights. In the heating control method 510, the fuzzy logic-based operating cycle is weighted, i.e. has a weight factor as shown in block 542. For example, if a fuzzy logic-based operation cycle is given a weight factor of 1, the fuzzy logic-based operation cycle is equally weighted by the knowledge-based operation cycle. When a weight factor 2 is given to the fuzzy logic-based operation cycle, the fuzzy logic-based operation cycle is weighted twice as much as the knowledge-based operation cycle. The severity factor of block 542 changes over time and / or can be optimized over time.</p><p> It should be understood that the weighted block 542 can also be placed in the knowledge base operation cycle output. However, as discussed below, the update rate of the fuzzy logic control loop is substantially higher than the update rate of the input signal input to the knowledge base control algorithm 520. Therefore, it is advantageous to weight the fuzzy logic-based operation cycle more than the epistemic logic-based operation cycle.</p><p> The weighted fuzzy logic-based and knowledge-based operating cycles are summed at a total point of 544 to create the overall heater operating cycle. The operating cycle is one way to control the power input and thus the plate temperature of the heater. Controlling the operating cycle means controlling the percentage of time that total power is applied to the heater, eg, plate heater 16. In a separate embodiment, the outputs of parallel control algorithms 520 and 530 may be a percentage of the total power applied at all times. Furthermore, the outputs of the parallel control algorithms 520 and 530 may be the percentage of the total power applied at a given time. For the purposes illustrated, the heating control method 510 is described with operation cycle output, which is the percentage of time that total power is applied to the heater.</p><p> As described herein, the heating system 548 (ie, heater 16) of the preferred embodiment is a plate heater, with upper and lower plates arranged around the fluid heating path of the disposable unit 160. However, the heating control method 510 can be similarly applied to the infrared heater described above. Further, the heating control method 510 can be similarly applied to a combination of different types of heaters such as a combination of a plate heater and an infrared heater.</p><p> The heating control method 510 uses multiple temperature sensors, such as the sensors 62 shown in FIGS. 1 and 2, but these sensors detect temperatures at different times within the heating control method 510 and within the systems 10 and 100. Be placed. One sensor detects the flow rate outlet temperature and feeds back the result from the heating system 548 to the comparison point 514. The other two sensors detect the temperature of the upper play and the lower plate and feed it back to the temperature limit controller 546 placed in the software.</p><p> As shown, the system determines if the upper and lower heating plates are already at the maximum permissible temperature before the total heater operating cycle is input to the heating system 548. Above that there are temperatures where it is not safe to maintain the plate of the plate heater. If at least one plate is currently reaching the temperature limit, the heating control method 510 outputs zero operating cycles regardless of the calculations of the knowledge-based control system 520 and the fuzzy-based algorithm 530. Finally, the temperatures of the upper and lower plates are fed back to block 546, and the software adds a heater operating cycle to the heating system 548 only if the current temperatures of the upper and lower plates are below the temperature limit.</p><p> In one embodiment, if one of the plates has reached the temperature limit, the heating control method 510 provides the two plate heaters with zero operating cycles even if the other plate heater is below the temperature limit. Further, if the actual temperature of the plate heater is very close to the temperature limit, the heating control method 510 may apply software to bring the operating cycle to a predetermined set value or less. In this way, if the actual temperature is very close to the temperature limit, the heating control method 510 becomes a failure type condition and uses a safe operation cycle.</p><p> Assuming the actual plate temperature is below the safe temperature limit, the heating control method 510 applies a combined operation cycle from the parallel control algorithm at total point 544. In the heater operation cycle, the total power is applied at a certain rate for a predetermined time. The predetermined time is the updated speed of the fuzzy logic control loop. In one embodiment, the heating control method 510, which includes the fuzzy control algorithm 530, updates the fuzzy logic control loop about 9 times per second. It should be understood that the update rate of the heating control method 510 is an important parameter and that simply increasing the update rate to a certain value will reduce the accuracy of the system. The range of update speeds that give good results is about 8.5 to about 9.5 times per second.</p><p> It is not possible to divide the update speed evenly into the frequency of the input power. For example, an update rate of 9 times per second works when the frequency is kept stable at 50 or 60Hz. However, in some countries the frequency is 63 hertz. In such cases, 9 update speeds will be inaccurate. Therefore, in a preferred embodiment, a frequency that is a fraction of 1 hertz, such as 9.1 hertz, is preferred. Assuming that the update speed is 9 times per second, the time per update is 110 milliseconds. Therefore, if the operating cycle is 0.5, that is, half the on / off time, the total power applied time is 55 milliseconds. Power is applied during the next 55 ms. If the operating cycle is 90%, 90% of the total power is applied for 110 milliseconds.</p><p> The update speed of the knowledge-based control algorithm 520 is not as important as the update speed of the fuzzy logic control loop. For some reason, the signal input to Algorithm 520 changes over time and does not need to be checked as often as a comparison between the desired fluid temperature and the actual fluid temperature. An update speed of about 2 seconds is sufficient for signal input. The input of control algorithm 520 can be updated once every 1/2 to 4 seconds. The knowledge base control algorithm 520 can be run on the main processors of systems 10 and 100, such as the Intel StrongARM processor. A Motorola digital signal processor is used to speed up the update of fuzzy logic control loops. In one embodiment, the fuzzy logic-based control algorithm 530 is run on a typical processor, such as a Motorola digital processor.</p><p> Figure 26 shows the knowledge base control algorithm 520 in more detail. As discussed above, in the first stage the knowledge base control algorithm receives some signal inputs as shown in block 522. Some of these inputs are updated at the main processor level twice per second. Other inputs are set in the software as constants. One of the input signals that changes over time is the number of stroke intervals (N) per millisecond. The pump piston moves for a certain period of time, stops and stays, and then moves for a certain period of time. The pump makes N strokes per millisecond, which is input to the knowledge base control algorithm.</p><p> The other input that changes over time is the input voltage (V)_ac). Input voltage V_acChanges over time in one house or in different locations. Also, a separate time-varying input signal is the measured fluid inlet temperature (T)._in). Fluid temperature T_inIs measured by one of the various sensors of method 510 described above. The input that does not easily change over time is the plate heater efficiency (E). Heater efficiency E is empirically determined. The heater efficiency E can vary depending on the pressure inside the disposable unit during heating, the material of the disposable unit and the gap tolerance of the top and bottom plates. The heater efficiency E for a particular dialysis device is substantially constant. As mentioned above, the desired fluid temperature (T_desired) Can change according to the doctor's order. However, T in any given treatment session_desiredIs constant.</p><p> The knowledge-based control algorithm 520 calculates the pulsatile flow velocity (Q) in millimeters per minute according to the equation in block 524. The equation for Q varies based on the desired unit for flow velocity. In the illustrated embodiment, it is obtained by multiplying the chamber volume in milliliters by 60,000 and dividing the product by T in milliseconds. Again, chamber volume is a function of the geometry of the pump chamber wall.</p><p> The knowledge-based control algorithm 520 calculates the total heater power in watts as shown in block 526. In the illustrated embodiment, the heating control method 510 uses the above calculation to calculate the knowledge base operation cycle as shown in block 528. In some embodiments, the knowledge base operation cycle is T._desired-T_inA factor that is multiplied by a temperature equal to, for example 0.07. Next, this product is multiplied by the pulsatile flow velocity Q. Next, the product of the latter is divided by (total heater power W x heater efficiency E). As shown in FIG. 26, the knowledge base operation cycle is then combined with the fuzzy logic base operation cycle output and supplied to the total point 544.</p><p> FIG. 27 shows an embodiment of the fuzzy logic control algorithm 530. It must be understood that fuzzy logic is generally known in the field of system engineers and systems and process control. The fuzzy logic algorithm described in the present invention is one that performs the task of receiving an error input, which is the difference between the desired fluid temperature and the actual fluid temperature, and executes fuzzy logic to make this number stand out. It's just a method. Regardless of the method using fuzzy logic, the method inputs the temperature and outputs the power limiter such as the operation cycle. Therefore, the first step of the fuzzy logic control algorithm is T as shown in block 532._desired-T_inIs to calculate the difference between.</p><p> Then execute some membership functions as shown in block 534. In this embodiment, algorithm 530 executes five measurement functions. Two of the measurement functions, namely n and p, are trapezoidal membership functions. As is known in the technique of phage logic, the trapezoidal membership function is composed of four nodes. The other membership functions, namely n small, medium and p small, are set as triangular membership functions and consist of three nodes. After setting the membership function as shown in block 534, the fuzzy logic control algorithm 530 performs a fuzzy interface as shown in block 536. In the fuzzy interface, control algorithm 530 transforms the temperature difference ΔT between Tdesired and Tin into several fuzzy sets based on the membership function set as shown in block 534.</p><p> The control algorithm 530 then applies some fuzzy logic heating rules, as shown in block 538. In one embodiment, control algorithm 530 employs five fuzzy logic rules. One rule indicates that if ΔT is large, the output must be reduced at a large rate. A separate rule indicates that if ΔT is small, the output must be reduced at a small rate. The third rule tells us that if ΔT is in the middle, the output must be zero. Other rules indicate that if ΔT is small p, the output must be increased at a small rate. The last rule tells us that if ΔT is greater than p, the output must be increased at a large rate.</p><p> The next step in the fuzzy logic control algorithm 530 is to provide a defuzzy interface as shown in block 540. The dephagy interface translates the output of the rule into a real or "crisp" output, which is then converted into an operating cycle. The defuzzy step shown in block 590 transforms the output of a fuzzy logic rule into a "crisp" or an exact number. This number is then converted to the appropriate output for the heater, which in individual embodiments is the fuzzy heater operating cycle.</p><p> As shown in block 542, the next step is how much weight should be placed on the fuzzy logic cycle for the knowledge base cycle. Weighting factors are determined by both fuzzy logic rules and knowledge-based and fuzzy logic-based control algorithms. Next, the weighted fuzzy logic operation cycle is summed at the total point 544 using the knowledge base operation cycle generated by the knowledge base control algorithm 520.</p><p> (IX. Electrical insulation of the system) Medical devices, especially those in close contact with the patient's needs, must be adequately insulated from leakage currents. Class I devices are equipped with basic insulation and a means of connecting to a ground conductor in the building where the device enters, allowing dangerous voltage to escape if the device insulation breaks. However, the main use of the systems 10 and 100 of the present invention is in the patient's home. This presents two problems for Class I devices, especially dialysis devices. First, in many countries and older homes, the grounding is defective and unreliable or completely ungrounded. Second, many people bypass existing grounding systems. The present invention overcomes this problem by providing automated dialysis systems 10, 100 that do not require grounding. Systems 10 and 100 do not rely on the basic grounding provided in Class I equipment and provide double or reinforced insulation.</p><p> Double insulation includes two layers of insulation. One layer of insulation is basic insulation. At 240VAC, basic insulation specifically requires 4mm "creeping" or 2.5mm "air clearance". Creepage is the shortest distance between two conductive parts when they are placed along the insulating surface. Creepage is also the shortest distance between the conductive part and the surrounding surface of the device body, where the conductive part and the device are in contact with the insulator. Air clearance is the distance between the two conductive parts measured through the air, or the shortest distance between the conductive part and the device body.</p><p> The additional layer of insulation is called replenishment insulation. Replenishment insulation is an independent insulation provided in addition to the basic insulation, which compensates for protection against electric shock if the basic insulation is broken. Replenishment insulation may be in the form of creep pages and clearances.</p><p> Reinforced insulation, on the other hand, is a layer of insulation that provides the same degree of protection as double insulation. Reinforced insulation provides electrical insulation equal to double insulation for the rated voltage for double insulation. At 240 VAC, which is used as the power supply voltage for systems 10 and 100, basic insulation can withstand 1500 VAC and supplemental insulation can withstand 2500 VAC. Therefore, a single layer of reinforced insulation must withstand at least 4000 VAC.</p><p> FIG. 28 shows an embodiment of the electrical insulation system 550 of the present invention. Although the system 550 is illustrated, the parts of the system 550 may be designated as the parts illustrated in the hardware discussed above. For example, the system 550 includes a housing or container 112 illustrated in FIGS. 3A-4B above, including a base 114 and a lid 116 of the hardware unit 110. The system 550 also includes a heater 16 including upper and lower heating plates shown in FIG. 3A in certain embodiments and discussed in connection with FIGS. 25-27. In addition, the system 550 also includes a display device 40 and a temperature sensor 62 that are shown and discussed in connection with FIGS. 1 and 2.</p><p> In FIG. 28, the numbers in parentheses indicate the operating or operating voltage of the case component. As shown, the wiring 552 and the neutral line 554 provide a single-phase principal voltage of 240 VAC, which is the standard voltage used for residential use in many countries around the world. Alternatively, the wiring 552 and the neutral wire 554 can also supply a single-phase 120 VAC, which is the standard voltage for home use in the United States, and can actually supply any voltage of 90 to 260 VAC. The wiring 552 and the neutral line 554 supply 240 VAC to the main power supply 556. It is noteworthy that System 550 does not include or provide protective ground conductors.</p><p> The main power supply 556 supplies 240 VAC to the power printed circuit board (PCB) 558. The power supply PCB558 includes a main part 562 and a live part 564. For the purposes of the present invention, the "main part" is the entire part of the component that should be electrically connected to the mains voltage. A "live part" is any part that, when connected, can generate current that exceeds the permissible leakage current, such as current flowing from that part to ground or from that part to a touchable part of the same device. ..</p><p> As shown, the live sections 560 and 564 gradually reduce the voltage from the mains 556 and 562, respectively, to 24 VDC. Obviously, it is also possible to step down the voltage to other desired levels. The live part 560 passes an electric current through the live part 566. Live part 566 is 1200V_peakIt is an inverter with a setting transformer that outputs the voltage of. The inverter 566 powers several cathode ray fluorescent lamps and serves as the backlight for the display device 40.</p><p> The live portion 560 is electrically isolated from the application portion 568, which is kept at zero potential. For the purposes of the present invention, an "application portion" is (i) in physical contact with a patient or operator undergoing dialysis treatment, (ii) capable of contact with a patient or operator, or (iii). Any part of the system 550 that the patient needs to touch. For example, the patient can touch the top or bottom of the plate heater 16, the temperature sensor 62 and the container or housing 112. Application 568 illustrates the casing or insulation around the temperature sensor 62.</p><p> In some embodiments that include only the display device 40 and not the touch screen 42 (discussed in FIGS. 1 and 2), the housing 112 includes a window 570, such as a glass or plastic window. The glass or plastic window is insulated at the same level as other parts, such as the plastic housing or exterior 112. In embodiments that include the touch screen 42, it is preferred that the touch screen is adequately insulated by its manufacturer. Alternatively, at least one layer discussed below is added to the system to properly insulate the touch screen.</p><p> The system 550 has an input / output port 572, even if it is a serial port or an Ethernet (Ethernet®) port for connecting the system 550 to an external computer, a network within a specific area, a wide area network, the Internet, etc. Good. To electrically insulate the I / O port 572, the system is equipped with a protective cover or casing.</p><p> The main power supply 556 powers the heater elements 576, which are located and arranged to heat the upper and lower plates of the plate heater 16. In a separate embodiment (not shown), the mains 556 powers the infrared heater described above. As shown, the heater elements 576 and the heater plates 16 are double insulated. Double insulation includes basic insulation B (240) for a rating of 250 VAC and supplemental insulation S (240) for a rating of 240 VAC.</p><p> At least in the heater plate 16 and the heater element 576, the basic and supplemental insulation must be electrically insulated but not thermally insulated. Polyimides such as Kapton (registered trademark) are excellent for that purpose. Therefore, in some embodiments, Kapton tape or sheet with a thickness of about 0.3 mm is used for each of the B (240) and C (240) layers. As further illustrated, another layer of insulation B (240) for a rating of 240 V is placed between the temperature sensor 62 and the heater plate 16. In this way the heater plate 16 is completely double insulated from the rest of the system 550. Alternatively, any of the insulating bilayers can be replaced with a reinforced insulation single layer.</p><p> Wiring 552 and Neutral wire 554 are insulated with basic working insulation BOP (240) for a rating of 240VAC, which is the electrical insulation that wraps or projects around each wire. The basic working insulation BOP (240) for the rated 240 VAC is provided between the main power supply 556 and the exterior 112 and between the power supply PCB 558 and the exterior. The basic insulation B (240) may be a properly separated air layer. Exterior 122 itself is a replenishment insulation S (240) for 240VAC. Therefore, the main power supply unit 556 is doubly insulated from the outside of the exterior 112.</p><p> Since the application part 568 is kept at zero working voltage, a separate insulation placed between the application part 568 and the housing 112 is required. Therefore, only the working insulation represented by OP in the figure exists between the application portion 568 and the housing 112. However, a double or reinforced insulation D / R (24) for 24VDC is provided between the live portion 560 and the application portion 568. "The application portion 568 maintains its zero potential. A basic insulation B (24) for the 24VDC is provided between the live portion 560 and the application portion 112. The basic insulation B (24) may be an air layer separated into a target sweat zone. As mentioned above, the exterior 112 itself is a replenishment insulation S (240) for 240VAC. Therefore, the live portion 560 is doubly insulated from the outside of the exterior 112.</p><p> No additional separate insulation is required between the live portion 560 and the live portion 566, only an operational insulation OP is provided. Live part 566 is 1200V_peakShould not rely on the replenishment insulation S (240) dedicated to the 240 VAC rating of the exterior 112, as it will increase in stages. Therefore, 1200V between the live part 566 and the housing 112_peakDouble insulation or reinforced insulation D / R (1200) for use is provided.</p><p> Double insulation or reinforced insulation D / R (240) for 240VAC is provided between the main power supply 556 and the live section 560. Double or reinforced insulation D / R (240) for 240VAC is also provided between the wiring and neutral wire 554 and the upper and lower plates of the plate heater 16. In addition, a double or reinforced insulation D / R (240) for 240VAC is also provided between the mains 562 and the live portion 564 of the power supply PCB558. For double insulation, either basic or supplemental insulation is the surface leakage distance on the PCB 558, which is reasonably distant.</p><p> A double or reinforced insulation D / R (240) for 24VDC is provided between the housing 112 and the display device 40. Display devices 40 and 1200V kept at 24VDC_peakThe insulation between the inverters kept in is only required to be operable. The live part 566 must be insulated from the outside of the housing 112 with a D / R (1200), but not with the LP (24). The reason is that the LP (1200) is on the second side of the live part 566, and even if it is short-circuited with the LP (24) due to poor operational insulation, the LP (1200) is at most 24VDC, which is a safety issue. Because it does not become.</p><p> (X. Graphic user interface) FIG. 29 shows an embodiment of a graphic user interface (GUI) system 600. The GUI system 600 of the embodiment is web-type software or other type of software. As discussed earlier in the context of FIG. 28, the systems 10 and 100 of the present invention are provided with input / output (eg Ethernet serial) ports 572, usually isolated from the patient by a cover 574. Port 572 allows controller 30 of systems 10, 100 to connect to the Internet and various other networks. The GUI system 600 of the present invention utilizes this capability when the controller 30 connects to software on the Internet or other networks.</p><p> With the GUI system 600, it is necessary to understand that the patient does not need to connect to the Internet or other networks in his home. Instead, port 572 is for the maintenance technician or the technician to install to access controller 30 in hardware 110. In this way, the patient can connect the unit to the internet or other network and update the patient's software. The patient can then take the unit home and operate it without connecting to the internet or other networks.</p><p> Web-based software Based on established standards, it is advantageous to use web-based software because the interface screen consists of existing software rather than handmade software. Web software enables communication with the outside and multiple connection points. The software is portable. For this reason, software built using existing software components reduces development time and costs.</p><p> The present invention includes the construction of a GUI using the embedded web browser 602. In one embodiment, the embedded web browser 602 is third party software. The embedded web browser 602 includes any third-party browser that runs on the platform of interest, including the latest versions of software support such as HTML4.0, ECMAScript and video GIFs. The web browser 602 provides the video monitor 40 with various GUI screens. Web browser 602 also processes patient input. When an operator operates the system (eg, press buttons 43, 124, 125 and 127 shown in Figure 3B, or turn knob 122), web browser 602 provides information about its relationship with the embedded web server 604. ..</p><p> Web server 604, on the other hand, uses web server extension software 606 to handle relationships. The embedded web server 604 is also any third party web server running on the platform of interest, including assistance for the web server extension software 606, sending dynamic definitions of information to the embedded web server 604. Can be done.</p><p> The extended web server is developed using the web server extension software 606 and meets the specifications of the mechanism such as SELBRET (Servlet) that operates in association with the selected embedded web server 604. The web server extension software 606 allows the web server 604 to go back and search and retrieve real-time information from the device access and control software 608. Different existing webs that can be used with embedded web browser 602, embedded web server 604 and server extension software 606, such as CGI, ASP, Servlets or Java (Java®) Server Pages (JSP). There are many server extension technologies.</p><p> Web server extension software 606 interacts with device access and control software 608. Device access and control software 608 is an operating environment for controlling various low level components such as valve motors / actuators, pump motors / actuators and heaters.</p><p> Depending on the operator's input and the state of the automated dialysis systems 10 and 100, the web server extension software 606 interacts with the device access and control software 608 to obtain information from it, and one of the devices in the systems 190 and 100. Activate. The web server extension software 606 then sends information to the embedded web browser 602, which is displayed on the display device. In one embodiment, the web server extension software 606 uses the CORBA standard to communicate with device access and control software 608. However, this communication is carried out using various protocols known to those of skill in the art.</p><p> It may require the operator to display high priority information, such as alarms and related messages, on the display device 40 or on an independent dedicated alarm display device while the systems 10 and 100 are in operation. obtain. In the event of a high priority event, the device access and control software 608 will be processed by the in-house developed emergency handling software 610. Meanwhile, the emergency handling software 610 uses a plug-in from the web server 604 or a renewal request simulation to update the embedded web browser 602 with any display currently displayed on the display device 40. And notify.</p><p> The emergency handling software 610 allows information to be streamed from the device access and control software 608 to the web browser 602 without a request from the web browser 602, after which the web browser requests an update. Web server 604 then sends the bill to web server extension software 606. The web server extension software 606 determines what information should be displayed on the display device 40 according to the state of the systems 10 and 100. The web server extension software 606 then sends that information back to the live web server 602, which updates the display device, for example to indicate alarm conditions.</p><p> In an embodiment of GUI system 600, the web user is inside the hardware unit 110 of systems 10, 100. As discussed above in the context of FIG. 1, controller 10 includes multiple processors (collectively referred to herein as processor 34). The main microprocessor takes precedence over some outsourced processors. Each of the embedded web browser 602, web server 604, web server extension software 606 and emergency handling software 610 runs on the main microprocessor. The device access and control software 608 runs on the main microprocessor and at least one entrusted processor.</p><p> It is also possible that several different web users also need access to the information contained within systems 10, 100. Therefore, it is preferred that HTTP does not instruct the embedded web server 604 to require a given password and instead uses a stronger and more flexible secure system.</p><p> Figures 30A-30M show some screen scenes of the GUI 600 showing the overall look and feel of the systems 10 and 100 viewed by the operator or patient. In addition, these drawings illustrate various features provided by the GUI system 100. An object of the automation system of the present invention is a simple and easy-to-operate system. The device requires two supply bags weighing less than 10 kg and can be driven virtually anywhere in the world without the risk of patient electric shock. Similarly, the GUI system 600 is designed to be simple, intuitive, effective and reliable.</p><p> As illustrated in Figure 3B, systems 10 and 100 have a display device 40, a knob 122 that allows the user to operate the GUI system 600, and the patient to three different screens: parameter change screen, recording screen and treatment screen. Includes several dedicated pushbuttons 43 to guide. In one embodiment, the display device 40 is provided and the input devices 43, 122, 124, 125 and 127 are electromechanical, respectively. In a separate embodiment, at least one input device is provided as a touch screen 42 operated by a display device and a video controller 38.</p><p> It also has a simulated or electromechanical "stop" input 124, an "OK" button 125 and a "back" button 127. The OK button allows the operator to exit a specific part of the setup procedure and prompt the GUI600 to move to the next step in the setup or treatment phase. The stop button allows the operator or patient to stop the setup or treatment phase. System 600 also includes handshake-type responses such as "Do you want to stop setup?" Other parts of the entire procedure, such as patient filling or drain cycle, also stop immediately without further input from the operator. At some point in the procedure, the system allows the operator or patient to return to at least one screen using the back button 127.</p><p> In FIG. 30A, the display device 40 and the video controller 38 can also be dispersed into a video display that provides information and instructions 612 in a patient-friendly format. After waiting for the patient to read and understand everything displayed on the display device 40, as shown on the screen, the GUI system 600 moves on to the next step or stage. Figure 3A shows that the GUI system 600 is waiting for the patient to be ready before starting treatment. System 600 prompts the user to press the "OK" button before starting treatment. FIG. 30A also shows that the treatment of reference number 614 is brightened to display the treatment screen.</p><p> In FIG. 30B, the display device 40 of the GUI system 600 prompts the patient to collect the therapeutic fluid, such as the supply bag 14. Figures 3B and 3C show that the system 600 uses still images such as still image 616 and moving images such as moving image 618, but these images are similar to the actual corresponding feeds and components and are easy for the patient. In addition, it makes it easy to connect systems 10 and 100 effectively and safely. For example, video 618 in Figure 30C resembles the actual hose fasteners in systems 10 and 100, which makes it easier for the patient to find the correct part of the device and treat it. The arrows in video 618 show the behavior that the patient is expected to perform, reducing the risk of the patient handling the stopper improperly or breaking the stopper.</p><p> Figures 30D and 30E show the patient (i) taking steps to cover the patient's mouth and nose at the appropriate time, (ii) the patient's hand before contacting critical fluid connectors such as the patient fluid connector and supply bag connector. Prompt to wash and show that GUI system 600 promotes sterile operation of systems 10 and 100. The GUI system 600 finishes the operation in each step, waits for the OK button to be input, and then moves to the next step. As shown in Figures 30D and 30E, the software LDE620 at the top of the display device 40 shows where the patient is in the setup procedure.</p><p> Screen scenes Figures 30A-30E and 30H-30M show treatment setup procedures, respectively. Therefore, the colors of the screen scenes in FIGS. 30A-30E and 30H-30M are chosen to be more visible during the day or when lit. In some embodiments, the screen is shaded differently in blue, the still images and moving images, and the internal text are white, and the external text and borders are black. However, as shown in FIGS. 30F and 30G, screen scenes showing the active stage of treatment are chosen to be easier to see at night or when turned off. In one embodiment, the screen scene of FIGS. 30A-30F is black with ruby-colored letters, charts, drawings, and the like. The red text does not indicate to sleeping patients, but it is visible at distances of 10 to 25 feet (3 to 7.6 meters).</p><p> Figures 30F and 30G show that treatment status information is displayed on the screen scene in the form of both graph 622 and numerical data 624 during the active phase of treatment. Treatment status information is displayed in real time, or substantially in real time with a slight time delay. FIG. 30F shows a screen scene during the filling portion of the treatment. In particular, Figure 30F shows the first filling stage of a fully filled household. Clock 622 on the graph shows that the charge cycle time has passed about 1/8 hour. Arrow 622 on the graph indicates that the treatment is in the filling cycle. Also, the graph display of body 622 shows that the proportion of dialysate is very low. Numeric data 624 indicates that Systems 10, 100 pumped 150 ml of dialysate to the patient.</p><p> Figure 3G shows that the patient is currently performing the first drain cycle of three drain cycles. The graph display on the clock shows that the drain cycle has passed about 1/8 hour. The graph of the arrow points down and indicates the drain cycle. Indicates that the body is substantially filled with dialysate. Numerical data 624 indicates that 50 ml of dialysate was removed from the patient.</p><p> Figures 30H and 30I show that treatment ended in the morning and the screen returned to daytime colors or colors that were more visible in an illuminated room. Figure 30H contains information and instructions that encourage the patient to disconnect from systems 10, 100. The system is waiting for the patient to select OK button 125 (Figure 3B) before proceeding. Figure 30I includes video 618, showing the behavior and device of the patient leaving the system. For each action in the removal procedure, the system 600 waits for the patient to select the OK button 125 (Figure 3B) before proceeding.</p><p> 30J-30M show that in one embodiment the dedicated input 43 shown in FIG. 3B is selected to guide the user between treatments, parameter changes and recorded information. FIG. 30J shows that the patient chose input 43 associated with the parameter change information. It is shown that screen 40 of FIG. 30J replaces the term treatment and brightens the term change.</p><p> The parameter screen shows the parameter information to the patient in a hierarchical format. First, as shown in FIG. 30J, the system 600 shows the classification of parameters such as patient preference, daily patient data, treatment parameters, nursing parameters and service parameters. The patient can use the adjustment knob 122 of FIG. 3B to scroll through the various classifications 625 to display the desired classification in the brightened display area 626. FIG. 30H shows that the patient preference classification 625 is currently displayed in the brightened display area 626.</p><p> When the user presses the OK button 125 (Fig. 3B) to select the once brightened classification 625, the first door 628 slides open and the user-selected classification 625 (eg patient preference) as shown in screen 40 of FIG. 30K. Classification) parameter 627 list is shown. In FIG. 30K, the patient preference classification 625 is displayed above the door 628, allowing the patient to know which classification of parameter 627 is displayed. At the same time, the brightened display area 626 displays one of the selection groups of parameter 627 belonging to the patient preference classification 625.</p><p> Parameter 627, shown in FIG. 30K, which belongs to patient preference classification 625, includes the percentage of display brightness, the percentage of speaker volume and the temperature of the dialysate in degrees Celsius. Obviously, patient preference classification 625 may include other parameters as well. The other classification 625 shown in Figure 30J also includes a parameter 627 different from that shown in Figure 30K.</p><p> The patient turns the knob 122 to scroll to select one of the parameters for patient preference classification 625. It is necessary to understand that the signal knob is used repeatedly in this way. This method is intended to provide a simple system, where the patient only has to turn one knob instead of remembering which of the multiple knobs applies to a particular method. If the patient wants to further select a letter that is not possessed when the door 628 is first opened, the patient can scroll the knob and the letter 122 can be enlarged. That is, the knob function gives the GUI 600 the freedom to not have to display all possible parameters at the same time. It should be understood that this advantage also applies to the classification selection screen of FIG. 30J, since it is not necessary to display each classification 625 at the same time.</p><p> Once the patient selects one of the patient preference classification parameters, for example by pressing the OK button 125, the second door slides open and the display device 40 selects the patient preference classification 625 bright display parameter 627. This classification is still displayed on the first door 628 in Figure 30L. The bright area 626 now displays one of a range of possible values 632 for the selected parameter 627 in the classification.</p><p> In the display device 40 of FIG. 30L, it is shown that the bright display area 626 currently shows a value of 80 632 for the display luminance parameter 627 of the patient preference classification. Again, the patient changes the value 632 of the selected parameter 627 by turning the knob 122. If the patient selects a value 632 for the parameters of the selected classification (by pressing the OK button 125 shown in Figure 3B while the desired value is displayed), the GUI system 600 will display the display device in Figure 30M. Remember the value as indicated by 40. FIG. 30M shows that the system 600 provides a feedback message to the patient whose selected value is memorized.</p><p> A system 600 of one embodiment presents information and commands to the operator through the various visual devices discussed above. In a separate embodiment, in addition to visual information and instruction 612, at least one or all of the above communication methods, such as still video 616, video 618, parameter information, etc., are speakers in collaboration with controller 30 of systems 10, 100. Indicated to the patient or operator by voice by 129 (Fig. 3B) or voice card (not shown).</p><p> The various programs running on the main microprocessor include at least one program that activates an audio file at some point during treatment, or at some event, such as an alarm starting with system 600, or at the input of a patient or operator. Is included. Audio files include human voice and any other type of voice. In some embodiments, the audio file guides the patient to the setup part. The audio file can warn the patient who made an inappropriate input to GUI600 or the like. In a preferred embodiment, the system does not activate voice during cycles, such as when the patient is asleep.</p><p> If the operator selects a dedicated input 43 that corresponds to the recorded information (not shown), the GUI 600 will display one or more screens showing the treatment data, and the treatment data will be displayed in a record that can be selected by several operators. Will be done. One of the recordings is the default recording that is displayed first, and knob 122 allows the operator to switch to a separate recording. Records are relevant to the latest treatment and / or can store data over several treatments over several days. The record can store any type of operational parameter information such as cycle time, number of cycles, delivery fluid volume, fluid temperature information, fluid pressure information, dialysate concentration, and any warning type event.</p><p> It should be understood that various changes and changes to the currently preferred embodiments described herein will be obvious to those skilled in the art. Such changes and changes can be made without departing from the gist and scope of the invention and without diminishing its intended benefits. Therefore, the present invention intends to cover such changes and changes within the scope of the appended claims.</p>

<figref num="1">FIG. 1 illustrates an embodiment of an automated dialysis system of the present invention having a mechanically activated fluid pump.</figref><figref num="2">FIG. 2 illustrates an embodiment of an automated dialysis system of the present invention having a fluid pump initiated by fluid.</figref><figref num="3">3A and 3B illustrate perspective views of the hardware unit and disposable unit of the present invention.</figref><figref num="4A">FIG. 4A is a plan view of an embodiment of the hardware unit and the disposable unit of the present invention.</figref><figref num="4B">FIG. 4B is a cross-sectional view taken along line 4B-4B of FIG. 4A, showing one of the possible configurations of system components within a hardware unit.</figref><figref num="5">FIG. 5 shows another embodiment of the disposable unit of the present invention.</figref><figref num="6">FIG. 6 shows another embodiment of the disposable unit of the present invention.</figref><figref num="7">FIG. 7 is a perspective view of an embodiment of a valve manifold that includes a reduced thickness interface that seals with the membrane of a disposable dialysis unit.</figref><figref num="8">FIG. 8 is a perspective view of an embodiment of the plurality of chip protector organizers of the present invention.</figref><figref num="9">FIG. 9 is a front sectional view of the plurality of chip protector organizers illustrated in FIG.</figref><figref num="10">FIG. 10 is a front sectional view of an embodiment of the breathable chip protector of the present invention showing a chip protector accommodating a patient fluid line connector.</figref><figref num="11">FIG. 11 is a front sectional view of an embodiment of a patient-style tie-line connector coupled with the breathable chip protector of the present invention.</figref><figref num="12">FIG. 12 is a front sectional view of an embodiment of the breathable chip protector of the present invention.</figref><figref num="13">FIG. 13 is a cross-sectional view of an embodiment of a single-layer film structure of the disposable unit membrane of the present invention.</figref><figref num="14">FIG. 14 is a cross-sectional view of an embodiment of a multi-layer film structure of the disposable unit membrane of the present invention.</figref><figref num="15">FIG. 15 is a perspective view of an embodiment of a valve actuator combined with the fluid manifold of the present invention.</figref><figref num="16A">FIG. 16A illustrates the features of the camshaft and cam arrangement of the present invention.</figref><figref num="16B">FIG. 16B illustrates the features of the camshaft and cam arrangement of the present invention.</figref><figref num="17A">FIG. 17A illustrates embodiments of the mechanically operated fluid pump and capacitive fluid volume sensor of the present invention.</figref><figref num="17B">FIG. 17B illustrates embodiments of the mechanically operated fluid pump and capacitive fluid volume sensor of the present invention.</figref><figref num="18">FIG. 18 illustrates another embodiment of the fluid pump and capacitance sensor operated by the fluid of the present invention.</figref><figref num="19">FIG. 19 is a graph display of an embodiment of the present invention for controlling the pressure inside the pump by accurate speed control of the pump piston.</figref><figref num="20">FIG. 20 illustrates embodiments of the algorithm of the invention for performing proportional, integral and differential adaptive pressure control.</figref><figref num="21">FIG. 21 is a graphical representation of an embodiment of the invention for controlling pressure inside a fluid pump during repeated filling and suction from a patient from a feed bag stroke.</figref><figref num="22">FIG. 22 is a graphical representation of an embodiment of the invention for pressure control in a fluid pump while the patient repeatedly drains and pumps into the drain stroke.</figref><figref num="23">FIG. 23 illustrates an embodiment of the algorithm of the present invention for applying pressure error correction parameters over time to optimize pressure control efficiency.</figref><figref num="24">FIG. 24 is a table showing the correction parameter set illustrated in FIG.</figref><figref num="25">FIG. 25 illustrates an embodiment of the heating control method of the present invention.</figref><figref num="26">FIG. 26 is a flow diagram of the knowledge base algorithm of the method discussed in connection with FIG. 25.</figref><figref num="27">FIG. 27 is a flow diagram of the fuzzy based algorithm of the method discussed in connection with FIG. 25.</figref><figref num="28">FIG. 28 is an electrical insulation diagram showing an embodiment of providing double electrical insulation in the medical fluid unit of the present invention.</figref><figref num="29">FIG. 29 illustrates an embodiment of the web-based graphic user interface of the present invention.</figref><figref num="30">30A-30M are screen scenes from a display device using the chart user interface of the present invention.</figref>