Automated peritoneal dialysis system with drain purge

Abstract

To provide an automated peritoneal dialysis system with a suitable drain purge.SOLUTION: A peritoneal dialysis system (10) includes: a cycler (20) including pump actuators (60); a disposable unit including a pumping portion (126) operable with the pump actuators (60), a patient line (122e) disposed in fluid communication with the pumping portion (126), and a drain container (124a) disposed in fluid communication with the pumping portion (126); and a control unit (50). The control unit (50) is configured to cause the pump actuators (60) to activate the pumping portion (126) to execute peritoneal dialysis treatment in which fresh dialysate is pumped through the patient line (122e) to the patient and spent dialysate is pumped from the patient to the drain container (124a), and to pump the spent dialysate from the drain container (124a) through the patient line (122e) to a house drain at the end of the treatment.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] (Priority Claim) This application claims priority to and the benefit of U.S. Provisional Patent Application No. 63 / 185,050, filed May 6, 2021, entitled "Automated Peritoneal Dialysis Assembly," the entire contents of which are incorporated herein by reference.

[0002] FIELD OF THE DISCLOSURE The present disclosure relates generally to medical fluid treatment, and more particularly to dialysate treatment. [Background technology]

[0003] A variety of causes can cause a person's renal system to fail. Renal failure results in several physiological disturbances. It is no longer possible to balance water and minerals or excrete the daily metabolic load. Toxic end products of metabolism, such as urea, creatinine, and uric acid, can accumulate in the patient's blood and tissues.

[0004]

[0003] Reduced kidney function, particularly kidney failure, is treated by dialysis. Dialysis removes waste, toxins, and excess water from the body that normally functioning kidneys would otherwise remove. Dialysis treatment for kidney function replacement is important for many people because the treatment is lifesaving.

[0005] One type of kidney failure treatment is hemodialysis ("HD"), which generally uses diffusion to remove waste products from a patient's blood. A diffusion gradient occurs across a semipermeable dialyzer between the blood and an electrolyte solution called dialysate or dialysate, causing diffusion.

[0006] Hemofiltration ("HF") is an alternative renal replacement therapy that relies on the convective transport of toxins from the patient's blood. HF is achieved by adding substitution or replacement fluid to the extracorporeal circuit during treatment. Substitution fluid and fluids accumulated by the patient between treatments are ultrafiltered over the course of the HF treatment, providing a convective transport mechanism that is particularly beneficial in removing middle and large molecules.

[0007] Hemodiafiltration ("HDF") is a treatment that combines convective and diffusive clearance. HDF uses dialysate flowing through a dialyzer, similar to standard hemodialysis, to provide diffusive clearance. In addition, a replacement solution is delivered directly to the extracorporeal circuit to provide convective clearance.

[0008] Most HD, HF, and HDF treatments are performed in centers. There is a trend toward home hemodialysis (HHD) today because HHD can be performed daily, providing therapeutic benefits over in-center hemodialysis treatments, which are typically performed two or three times per week. Research has shown that more frequent treatments remove more toxins and waste products and result in less interdialysate fluid overload than patients undergoing less frequent, but possibly longer, treatments. Patients undergoing more frequent treatments do not experience as many downcycles (fluid and toxin fluctuations) as in-center patients who accumulate two or three days' worth of toxins before treatment. In certain regions, the nearest dialysis center may be many miles from a patient's home, causing door-to-door treatment times to consume a significant portion of a patient's day. Treatments at facilities closer to the patient's home can also consume a significant portion of a patient's day. HHD can be performed overnight or during the day while the patient relaxes, works, or is otherwise productive.

[0009] Another type of kidney failure treatment is peritoneal dialysis ("PD"), in which a dialysis solution, also called dialysate, is infused through a catheter into a patient's peritoneal cavity. The dialysate is in contact with the peritoneal membrane within the patient's peritoneal cavity. Waste, toxins, and excess water enter the dialysate from the patient's bloodstream through capillaries in the peritoneal membrane due to diffusion and osmosis (i.e., an osmotic gradient across the membrane). An osmotic agent in the PD solution provides the osmotic gradient. Spent or exhausted dialysate is drained from the patient, removing the waste, toxins, and excess water from the patient. This cycle may be repeated, for example, multiple times.

[0010] There are various types of peritoneal dialysis therapies, including continuous ambulatory peritoneal dialysis ("CAPD"), automated peritoneal dialysis ("APD"), tidal flow dialysis, and continuous flow peritoneal dialysis ("CFPD"). CAPD is a manual dialysis procedure. Here, the patient manually connects an implanted catheter to a drain, allowing used or spent dialysate to drain from the peritoneal cavity. The patient then switches the fluid connection so that the patient catheter communicates with a bag of fresh dialysate, allowing fresh dialysate to be infused through the catheter and into the patient. The patient disconnects the catheter from the fresh dialysate bag, allowing the dialysate to dwell in the peritoneal cavity, allowing waste, toxins, and excess water to be transported. After a dwell period, the patient repeats the manual dialysis procedure, for example, four times a day. Manual peritoneal dialysis requires a significant amount of time and effort from the patient, leaving ample room for improvement.

[0011] Automated peritoneal dialysis ("APD") is similar to CAPD in that the dialysis treatment involves drain, fill, and dwell cycles. However, APD devices typically perform the cycles automatically while the patient sleeps. APD devices relieve the patient from having to manually perform treatment cycles and from having to administer supplements during the day. APD devices are fluidly connected to an implanted catheter, a source or bag of fresh dialysate, and a fluid drain. APD devices pump fresh dialysate from the dialysate source through the catheter and into the patient's peritoneal cavity. APD devices also allow the dialysate to dwell in a chamber, allowing waste, toxins, and excess water to be removed. The source may contain multiple liters of dialysate, including several solution bags.

[0012] APD machines pump spent dialysate, or dialysis waste, from the patient's peritoneal cavity through a catheter to a drain. Similar to the manual process, several drain, fill, and dwell cycles occur during dialysis. A "final fill" can occur at the end of an APD treatment. The final fill fluid can remain in the patient's peritoneal cavity until the start of the next treatment, or it can be manually emptied at some point during the day.

[0013] Known APD systems include a device or cycler that accepts and actuates a pumping cassette, which has a rigid portion and a flexible portion that is deformable to perform pumping and valving. Sealing the fluid disposable cassette with a pneumatic path via a gasket to provide actuation has proven to be a potential field issue, which can delay treatment start times and affect the user experience. Pneumatic cassette systems also generate acoustic noise that can cause customer dissatisfaction.

[0014] For each of the above reasons, there is a need for improved APD devices. Summary of the Invention [Means for solving the problem]

[0015] This disclosure describes a streamlined automated peritoneal dialysis ("APD") system and associated cycler that uses a peristaltic pump and a disposable set that organizes the tubing and performs a number of functions discussed below. In one embodiment, the system's cycler includes a peristaltic pump actuator that can pump in two directions. Flow in either direction passes through a disposable cassette that is part of the overall disposable set.

[0016] The disposable cassette is mounted within the cycler housing, in one embodiment, perpendicular to the operating surface of the housing and then enclosed between the operating surface and a hinged door of the housing. A user interface that communicates with the control unit is provided next to the housing door, whereby the patient or user typically interacts with one surface of the device to input commands, receive data, and load the disposable cassette.

[0017] In one embodiment, the system also includes a bag shelf enclosure that serves multiple purposes. The bag shelf enclosure is sized so that the cycler can be stored inside the enclosure when the cycler is not in use. The bag shelf enclosure is also sized so that the bag shelf enclosure can be set on top of the cycler when the cycler is in use. The bag shelf holds multiple containers or bags, such as multiple supply containers and one or more drain containers. In one example, multiple supply containers are placed inside the bag shelf enclosure during a procedure, and a drain container and a final fill container are placed outside and above the enclosure. The bag shelf enclosure can include color-coded markers provided at locations for loading containers or bags with lines extending through apertures into the cycler, the apertures having similar color-coded markers. The matching color-coded markers make it easy for patients or caregivers to identify which bags and lines belong to which locations on the bag shelf enclosure.

[0018] It is conceivable that the supply container or bag can later be used as a drain container or bag to reduce overall disposable costs. For example, assume that a patient is full of effluent at the start of treatment. The effluent is first drained from the patient and delivered to an empty drain container. A first patient fill is then delivered to the patient from the first supply container and, after a specified dwell period, delivered to the same or a different drain container, depending on the size of the drain container. The drain container is used to receive the effluent until the first supply container is empty. The first supply container then receives the effluent after a dwell period using PD fluid delivered from a second supply container. The first supply container is used to receive the effluent, possibly over multiple patient fills, dwells, and drains, until the second supply container is empty. At that point, the patient may receive a final fill of a different formulation of peritoneal dialysis fluid, which will remain in the patient until the next night's treatment or, perhaps, until the daytime exchange.

[0019] At the end of treatment, the multiple containers or bags are filled with effluent. To prevent the patient or caregiver from having to transport the drain bag to a house drain, such as a toilet, sink, or bathtub, the cycler's control unit is programmed to prompt the user to disconnect the patient line from the patient's transfer set and carry the distal end of the patient line to the house drain. As used herein, "house drain" should be understood to mean any type of drain provided in any type of building or residence, such as a home, apartment, work building, hospital, clinic, public or private facility, etc. If necessary, a reusable extension line can be connected to the distal end of the patient line to reach the house drain. The patient or caregiver then presses the drain button on the user interface, at which time the cycler activates the peristaltic pump actuator in a direction that draws spent dialysate or effluent from each of the drain containers (one or more of which may be previous supply containers) and pumps the spent dialysate through the patient line (and extension line, if necessary) to the house drain. The cycler detects when each drain container is empty (e.g., via a weigh scale and / or pressure sensor, described in detail below) and automatically switches a valve actuator, such as a pinch valve actuator, between the drain containers in sequence until each is empty. The above sequence is repeated for any remaining fresh dialysate in the main supply container or the last fill container. It should be understood that multiple drain containers (one or more of which may be previous supply containers) can be drained in parallel or simultaneously, for example, to save time. In this way, the patient disconnects the patient line, presses the drain button, and is free to begin their day.

[0020] As described above, in one embodiment, the cycler uses peristaltic pumping. A peristaltic pump actuator under the control of a control unit is located on the operating surface of the cycler. The disposable cassette includes peristaltic pump tubing that a user guides over the peristaltic pump actuator when loading the cassette. During operation, the peristaltic pump actuator compresses the peristaltic pump tubing against a track at multiple points. The track's operative proximity to the peristaltic pump actuator makes loading the tubing difficult. Therefore, the cycler includes a movable track that translates out of the way of the peristaltic pump actuator via a linkage when a patient or caregiver opens the cycler door to load the cassette. After the cassette is loaded, closing the cycler door translates the movable track via a linkage to an operational position directly adjacent to the peristaltic pump tubing. In an alternative embodiment, a motor and lead screw assembly, or linear actuator (e.g., a linear stepper motor) is provided to automatically translate the track out of the way of the peristaltic pump actuator when the patient or caregiver opens the cycler door to load a cassette, and to automatically translate the track to an operational position when the door is closed. In a further alternative embodiment, a motor and lead screw assembly, or linear actuator (e.g., a linear stepper motor) is provided, but the patient or caregiver instead presses one or more buttons on a user interface to translate the track out of the way or into an operational position.

[0021] In an embodiment, the track is attached to a block or member that is translatable across the actuation surface toward and away from the peristaltic pump actuator. In addition to the translational movement of the member (and track), the movable track can also rotate about a pivot axis provided at one end of the track, which pivot axis is attached to the translatable member. The other end of the track is spring-loaded via a spring, e.g., a compression spring, trapped between the track end and the member. The spring urges the track about the pivot axis into a desired operating position about the peristaltic pump tubing when the member is translated toward the peristaltic pump actuator. The pivoting track can also provide a damping effect to absorb or tolerate variations due to tubing tolerances and aid in noise reduction.

[0022] As mentioned above, the cycler, in one embodiment, uses pinch valve actuators, and the disposable cassette is provided with valve seats that receive the pinch valve actuators to occlude or close the fluid paths provided by the disposable cassette, where the cassette is sealed and covered with a flexible sheet, e.g., flexible plastic, in which the pinch valve actuators are pressed into their respective valve seats to close their respective fluid paths. The pinch valve actuators retract to open their respective fluid paths.

[0023] The pinch valves are each driven by a linear actuator, which may be any suitable type of linear actuator, such as a linear stepper motor, that provides the required amount of travel (e.g., up to 10 mm) and the required amount of pressurized cassette seat closing force (e.g., 30 to 60 Newtons (“N”) or less). The linear actuator drives the valve plunger back and forth to press the cassette seat against the cassette valve seat, allowing the seat to be removed from the cassette valve seat. In one embodiment, the valve plunger includes a proximal end effector coupled to the linear actuator and a distal end effector slidably coupled to the proximal end effector. A spring, such as a wave or compression spring, may be provided on the plunger and positioned to bias the distal end effector outward relative to the proximal end effector. The variable distance provided by the spring allows the pinch valve to initially contact the cassette seat with a smaller closing force that steadily increases as the spring is compressed. In embodiments, a flexible membrane, such as a silicone membrane, is secured to the actuation surface over the end of the distal end effector so that the flexible membrane contacts the cassette seat. When the spring is fully compressed, the cassette seat experiences the full force of the linear actuator and spring. The spring therefore provides a force buffer that helps protect the flexible membrane across multiple procedures and protect the cassette seat over the course of a single procedure. The spring can help with variations due to disposable cassette tolerances and cassette loading, and may further enable smaller or less expensive linear actuators.

[0024] As described above, the disposable cassette provides multiple valve seats, which may include a patient line valve seat, first and second supply line valve seats, a final fill line valve seat, and a drain line valve seat. In one embodiment, the patient line valve seat is fluidly separated from the first peristaltic tubing port by an in-line fluid heating path, e.g., a serpentine path. When the disposable cassette is loaded for operation, the in-line fluid heating path is adjacent to a heater, such as a resistance plate heater.

[0025] In one embodiment, the first and second supply line valve seats, the final fill line valve seat, and the drain line valve seat are each disposed in a common well that is fluidly connected to the second peristaltic tubing port. In this manner, fresh dialysate can be pumped in a first direction from either the supply container for the first and second supply line valve seats or the final fill line valve seat, through the common well and in-line fluid heating path, where the fresh dialysate is heated, and then from the patient line valve seat to the patient. Spent dialysate or effluent can be pumped in a second direction from the patient through the patient line valve seat and in-line fluid heating path, where the spent dialysate is not heated, to the common well, and from the drain line valve seat to the drain container.

[0026] Any of the valve seats described herein may include a tapered sealing surface surrounded by a plurality of displacement ribs, each extending from the rigid wall of the disposable cassette, at least some of which are spaced to prevent or mitigate undesired blockage of the tapered sealing surface by the flexible sheet and allow fresh or used dialysate flow therethrough. The displacement ribs may be completely separate from one another or may extend from a common cylindrical base. The displacement ribs may be separate from the tapered sealing surface or may extend from the outer edge of the tapered sealing surface. The displacement ribs prevent the flexible sheet from penetrating the tapered sealing surface. The displacement ribs may guide each pinch valve plunger toward the center of the valve seat while providing a certain amount of resilience or play between the pinch valve plunger and the valve seat. In embodiments, the tapered sealing surface tapers to form a funnel shape that leads to an opening that allows fresh or used dialysate to flow into or out of the valve seat. In embodiments, the opening extends through a port disposed on the other side of the rigid body of the disposable cassette, the port sealably receiving (attaching to) a tube or line, such as a patient line, a supply line, or a drain line. The tapered sealing surface may also include or define one or more circular sealing rings that compress the flexible sheet when the flexible sheet is closed by the pinch valve.

[0027] In an embodiment, a first or patient pressure sensing pod is located within the disposable cassette directly adjacent to the patient line valve seat. When the disposable cassette is loaded, the patient pressure sensing pod is adjacent to the first or patient pressure sensor, which outputs to the cycler control unit. The patient pressure sensor output can be used to control the positive and negative pumping pressures experienced by the patient within safe pressure limits. A second or pumping pressure sensing pod is located within the disposable cassette between the common well and the second peristaltic tubing port. When the disposable cassette is loaded, the pumping pressure sensing pod is adjacent to the second or pumping pressure sensor, which outputs to the cycler control unit. The pumping pressure sensor output can be used to detect blockages in the supply and drain lines and / or to supply empty conditions.

[0028] The disposable cassette, when loaded for operation, may also include one or more areas adjacent to a thermocouple or other temperature sensor that outputs to the control unit. The temperature sensing area may be located, for example, at the end of the in-line fluid heating pathway directly adjacent to the patient pressure sensing pod, so that the outlet temperature of the fresh dialysate to the patient can be monitored and controlled to a desired temperature, such as body temperature or 37°C, for example, via a proportional, integral, derivative ("PID") routine executed by the control unit using feedback from the temperature sensor. A second temperature sensor may optionally be positioned to detect the temperature at the inlet to the in-line fluid heating pathway, which may also provide useful information for the PID routine.

[0029] It is contemplated that a pressure sensor may be mounted on the operating surface of the cycler so that when a disposable cassette is loaded for operation, the cassette sheet, which may be polyvinyl chloride ("PVC"), is contacted and placed under tension by the pressure sensor, generating a baseline force that is measured by the pressure sensor. Fresh or used dialysate pressure further displaces (or attempts to displace) the cassette sheet, thereby increasing or decreasing the fluid force acting on the pressure sensor relative to the baseline force. The force difference caused by the positive or negative hydraulic pressure is correlated with the actual hydraulic pressure value by the control unit, which may be used for pressure control, displayed by a user interface, and / or stored for transmission to a remote computer for evaluation.

[0030] Pretensioning the cassette sheet with a pressure sensor provides a pressure sensing regime with high sensitivity and resolution, but it can be temperature sensitive. Therefore, temperature compensation is considered. Here, the voltage output (or current output) from the pressure sensor is modified by adding a component that is a function of the measured temperature (e.g., using the thermocouple described above) multiplied by an empirically determined temperature scaling factor to form a compensated voltage output, which is then converted to or correlated with a compensated positive or negative pressure.

[0031] As described above, pretensioning the cassette seat with a pressure sensor results in a pressure sensing regime with high sensitivity and resolution, but can also be prone to mechanical creep sensitivity. To combat creep sensitivity, in one embodiment, the control unit is programmed to precondition the cassette seat prior to treatment, e.g., during setup, thereby eliminating much of the pressure signal fluctuation due to creep before the pressure measurement becomes an issue. To do so, after the disposable cassette is primed, the control unit closes all pinch valves and then activates the peristaltic pump actuator to pressurize the interior of the cassette, including the pressure pod, stretching the cassette seat. The control unit can be programmed to oscillate the cassette fluid pressure up and down multiple times over a specified period, with the upper pressure limit being, for example, 100% to 150% of the maximum operating pressure set for the treatment. While preconditioning the cassette seat helps to make uncompensated pressure readings more accurate, temperature compensation helps to make the final pressure reading more accurate.

[0032] In one embodiment, the disclosed system and cycler uses a weigh scale with multiple load cells to monitor the amount of fresh dialysate delivered to the patient, the amount of spent dialysate removed from the patient, and enable the control unit to calculate the amount of ultrafiltration ("UF") removed from the patient. The weigh scale and load cells are advantageous for several reasons. First, weigh scales are relatively accurate compared to other volume measurement techniques. Second, the weigh scales reduce pump costs because the pump actuator can be a relatively simple peristaltic pump actuator and the disposable portion of the pump can be simple peristaltic pump tubing.

[0033] One drawback of using load cells is calibration. Load cells can read inaccurately over time and therefore need to be recalibrated. The cycler and related systems of the present invention provide a weigh scale with multiple load cells and an on-board structure and methodology for calibrating the weigh scale. In one embodiment, the weigh scale includes a weight plate positioned on top of the cycler that supports the weight of the bag shelf enclosure, solution and drain containers, and associated fresh and used dialysate. The weight plate and each weighed item on the weight plate are supported by multiple, e.g., four, load cells that collectively measure the total mass (bag shelf enclosure, container, and fluid) placed on the weight plate. In one embodiment, the on-board calibration structure includes a fifth load cell and a linear actuator (which may be the same type as used for pinch valves) positioned between the fifth load cell and the weight plate.

[0034] The linear actuator includes an actuation output shaft fixed to the weight plate so that the linear actuator can apply a pulling or downward force to the weight plate. In one implementation, the pulling force is applied to the center of mass of the underside of the weight plate. An additional calibration load cell measures the total applied force, while four operating load cells each measure a portion or quarter of the total force. If each of the operating load cells is operating properly, the sum of their outputs should equal the total force measured by the calibration load cells. In one example, assume a pulling force of 1000 Newtons ("N") is applied by the linear actuator. The calibration load cell then outputs 1000 N, and the equidistant operating load cells 102a-102d should each read 250 N, combining to total 1000 N.

[0035] Because the calibration load cell is used infrequently, the calibration algorithm is applied assuming that the output of the calibration load cell is more accurate than the aggregate output of the working load cells used throughout each procedure. Thus, during calibration, if there is a discrepancy between what the calibration load cell reads and the aggregate output of the working load cells, the control unit, using the calibration algorithm, scales or offsets the aggregate output of the working load cells to match the aggregate output of the calibration load cells. In the example above, assume that the working load cells actually collectively read 995 N instead of 1000 N. Thus, the working load cell reading is 0.5% low. The control unit is thereby configured to correct the aggregate output of the working load cells during the procedure by a calibration factor of 1000 / 995, or 1.005.

[0036] Because the calibration load cell is used infrequently, the calibration algorithm assumes that its output is more accurate than the aggregate output of the working load cells used throughout each procedure. Therefore, during calibration, if there is a discrepancy between what the calibration load cell reads and the aggregate output of the working load cells, the control unit using the calibration algorithm scales or offsets the aggregate output of the working load cells to match the aggregate output of the calibration load cells. In the above example, assume that the working load cells actually collectively read 605 Newtons instead of 600 Newtons. Therefore, the working load cells only sense 395 Newtons of the applied 400 Newtons. Therefore, the working load cell reading is 1.3% low. The cycler's control unit is thereby configured to correct the aggregate output of the working sensors during the procedure by a calibration factor of 400 / 395, or 1.01.

[0037] The load cell calibration routine or algorithm may be run on any desired basis, for example, before the start of each treatment. It should also be understood that because many of the weight values ​​monitored and collected during treatment are weight differences, errors in the aggregate output of the operational load cell will tend to cancel out, assuming the errors do not change over the course of treatment. For example, the mass associated with a 2-liter patient fill volume is monitored and controlled by the aggregate output of the operational load cell, which records the decrease in mass over the course of the patient fill. The volume and mass associated with the patient drain may be preset in the control unit, e.g., multiplying the fill volume by a factor such as 1.3 to account for the patient UF removed within the drain volume. The volume and mass associated with the patient drain may alternatively be left open-ended and instead controlled by detecting a characteristic increase in negative pressure with a pumping pressure sensing pod and associated pressure sensor, which indicates that the patient is essentially fully drained and that further draining may be uncomfortable for the patient. In either case, the operational load cell will detect an increase in weight over the course of the patient drain, which should tend to cancel out the operational load cell error.

[0038] In a first aspect, which in light of the disclosure set forth herein is not intended to limit the disclosure in any way but may be combined with any other aspect or portion thereof, a peritoneal dialysis system includes: a cycler including a pump actuator; a disposable set including a pumping unit operable with the pump actuator, a patient line disposed in fluid communication with the pumping unit, and a drain container disposed in fluid communication with the pumping unit; and a control unit configured to cause the pump actuator to (i) perform a peritoneal dialysis treatment in which fresh dialysate is pumped through the patient line to a patient and spent dialysate is pumped from the patient to the drain container, and (ii) at the end of the treatment, operate the pumping unit to pump the spent dialysate from the drain container through the patient line to a house drain.

[0039] In a second aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the pump actuator is a peristaltic pump actuator, and the pumping portion of the disposable set includes a peristaltic pump tube.

[0040] In a third aspect of the present disclosure that may be combined with any other aspect or portion thereof, the peritoneal dialysis system includes an extension line configured to be connected to a patient line to reach a house drain as needed.

[0041] In a fourth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the extension line is reusable.

[0042] In a fifth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the peritoneal dialysis system includes a user interface in communication with the control unit, the user interface configured to prompt the patient at the end of treatment to disconnect the patient line and move the patient line toward a house drain.

[0043] In a sixth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the peritoneal dialysis system includes a user interface in communication with the control unit, the user interface configured to provide or enable a drain button at the end of treatment to initiate pumping of spent dialysate from the drain container to a house drain via the patient line.

[0044] In a seventh aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the user interface is further configured to require confirmation that the drain line is in fluid communication with the house drain before providing or enabling the drain button.

[0045] In an eighth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the cycler includes a patient valve actuator that operates with a patient valve seat provided by the disposable set and a drain valve actuator that operates with a drain valve seat provided by the disposable set, and the control unit is configured to cause the patient valve actuator and the drain valve actuator to enable flow through the patient valve seat and the drain valve seat and to pump spent dialysate from the drain container through the patient line to a house drain.

[0046] In a ninth aspect of the present disclosure that may be combined with any other aspect or portion thereof, at least one of the patient valve actuator or the drain valve actuator is a pinch valve actuator.

[0047] In a tenth aspect of the present disclosure that may be combined with any other aspect or portion thereof, a peritoneal dialysis system includes a supply container arranged in fluid communication with a pumping portion of a disposable set, the supply container being used during a peritoneal dialysis treatment to pump fresh dialysate through a patient line to a patient.

[0048] In an eleventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, the supply container is used later during peritoneal dialysis treatment to receive used dialysate from the patient.

[0049] In a twelfth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the cycler includes a sensor in operative communication with a control unit, and the control unit is configured to use an output from the sensor to determine whether one of the drain container or the supply container subsequently used as the drain container is empty or substantially empty after pumping the spent dialysate to the house drain, and then switch to the other of the drain container or the supply container subsequently used as the drain container for pumping the spent dialysate to the house drain.

[0050] In a thirteenth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the sensor is a weight sensor or a pressure sensor.

[0051] In a fourteenth aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, the control unit is further configured to cause the pump actuator to activate the pumping section at the end of treatment to pump remaining fresh dialysis fluid from the supply container through the patient line to the house drain.

[0052] In a fifteenth embodiment of the present disclosure that may be combined with any other embodiment or portion thereof, the drain container is a first drain container and includes a second drain container arranged to be fluidly connected to the pumping section of the disposable set, and the cycler includes a sensor in operative communication with the control unit, and the control unit is configured to use an output from the sensor to determine whether the first drain container is empty or substantially empty after pumping the spent dialysate to the house drain, and then switch to the second drain container for pumping the spent dialysate to the house drain.

[0053] In a sixteenth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the sensor of the fifteenth aspect is a weight sensor or a pressure sensor.

[0054] In a seventeenth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the drain container is a first drain container and includes a second drain container arranged to be in fluid communication with the pumping section of the disposable set, and the control unit is configured to drain the first and second drain containers simultaneously.

[0055] In an eighteenth aspect of the present disclosure that may be combined with any other aspect or portion thereof, a peritoneal dialysis system comprises: a cycler including a pump actuator; a disposable set including a pumping unit operable with the pump actuator, a patient line arranged in fluid communication with the pumping unit, and a drain line arranged in fluid communication with the pumping unit; and a control unit configured to cause the pump actuator to (i) perform a peritoneal dialysis treatment in which fresh dialysate is pumped to a patient through the patient line and spent dialysate is pumped from the patient through the drain line, and (ii) at the end of the treatment, operate the pumping unit to pump the spent dialysate through the drain line and the patient line to a house drain.

[0056] In a nineteenth aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, the drain line is fluidly connected to a drain container, which is initially provided as a drain container or supply container filled with fresh dialysis fluid.

[0057] In a twentieth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the patient line and the drain line are separated by a disposable cassette of the disposable set, and at the end of treatment, the used dialysate is pumped through the drain line, through the disposable cassette, through the patient line, and to the house drain.

[0058] In a 21st aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, the disposable cassette includes a pressure sensing pod arranged to enable detection of a pressure change indicating that a drain container in fluid communication with the drain line is empty, and thereafter the control unit switches to draining spent dialysis fluid from a different source to the house drain at the end of treatment.

[0059] In a 22nd embodiment that may be combined with any other embodiment or portion thereof of the present disclosure, the cycler includes a weighing scale, and a drain container in fluid communication with the drain line is arranged to be weighed by the weighing scale, and an output from the weighing scale indicating that the drain container is empty is used by the control unit to switch to draining spent dialysate from a different source to a house drain at the end of treatment.

[0060] In a 23rd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a peritoneal dialysis system comprises: a cycler including a pump actuator; a disposable set including a pumping unit operable with the pump actuator, a patient line arranged in fluid communication with the pumping unit, and a drain container arranged in fluid communication with the pumping unit; and a control unit configured to cause the pump actuator to (i) perform a peritoneal dialysis treatment in which fresh dialysate is pumped through the patient line to a patient and used dialysate is pumped from the patient to the drain container, and (ii) at the end of the treatment, operate the pumping unit to pump the used dialysate from the drain container through the patient line to a desired destination.

[0061] In a 24th aspect of the present disclosure that may be combined with any other aspect or portion thereof, the desired destination includes a house drain or another container disposed in fluid communication with the pumping section.

[0062] In a 25th aspect of the present disclosure that may be combined with any other aspect or portion thereof, pumping the spent dialysate from the drain container through the patient line during (ii) includes operating the pumping unit in a first direction to at least partially fill the patient line with spent dialysate, and then operating the pumping unit in a second direction to remove the spent dialysate from the patient line to a desired destination.

[0063] In a 26th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a disposable medical fluid cassette includes a pumping section, a patient line valve seat arranged in fluid communication with the pumping section, a rigid body defining a common well, the common well in fluid communication with the pumping section, at least one supply line valve seat arranged within the common well, and a drain line valve seat arranged within the common well.

[0064] In a twenty-seventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, the patient line valve seat is provided by a rigid body.

[0065] In a 28th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the pumping unit includes a peristaltic pump tube attached to a rigid body.

[0066] In a 29th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the pumping portion includes a pump chamber defined by a rigid body.

[0067] In a thirtieth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the rigid body defines an in-line fluid heating path disposed between the patient line valve seat and the pumping portion.

[0068] In a thirty-first aspect of the present disclosure that may be combined with any other aspect or a portion thereof, a disposable medical fluid cassette includes a temperature sensing region disposed between a patient line valve seat and an in-line fluid heating path.

[0069] In a thirty-second aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the in-line fluid heating path is configured so that fresh dialysate flows upward during priming to remove air through the patient line valve seat.

[0070] In a thirty-third aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the disposable medical fluid cassette includes at least one of a pumping pressure sensing pod positioned between the drain line valve seat and a first end of the inline fluid heating path, or a patient pressure sensing pod positioned between the patient line valve seat and a second end of the inline fluid heating path.

[0071] In a thirty-fourth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a disposable medical fluid cassette includes at least one of a patient line in fluid communication with a patient line valve seat, at least one supply line in fluid communication with at least one supply line valve seat, or a drain line in fluid communication with a drain line valve seat.

[0072] In a thirty-fifth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the disposable medical fluid cassette includes at least one of a pumping pressure sensing pod positioned adjacent to the patient line valve seat or a pumping pressure sensing pod positioned adjacent to the common well.

[0073] In a thirty-sixth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a disposable medical fluid cassette includes a flexible sheet sealed to a rigid body, the flexible sheet being bent to open and close at least one supply line valve seat and a drain line valve seat.

[0074] In a thirty-seventh embodiment of the present disclosure that may be combined with any other embodiment or portion thereof, the rigid body includes a rigid wall that defines a common well, and the flexible sheet is sealed to the rigid wall to surround the common well.

[0075] In a thirty-eighth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, at least one of the patient line valve seat, the at least one supply line valve seat, or the drain line valve seat includes a tapered sealing surface surrounded by a plurality of displacement ribs, at least some of which are spaced to mitigate ingress of the flexible sheet into the tapered sealing surface.

[0076] In a thirty-ninth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the common well includes a ramp configured to direct air in the common well toward the drain line valve seat.

[0077] In a fortieth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the drain line valve seat is positioned relative to at least one supply line valve seat within a common well, such that the drain line valve seat is positioned higher than the at least one supply line valve seat so as to direct air toward the drain line valve seat when the disposable medical fluid cassette is loaded for operation.

[0078] In a forty-first aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a peritoneal dialysis system comprises: a cycler including a pump actuator, a patient line valve actuator, at least one supply line valve actuator, and a drain line valve actuator; a pumping unit configured to operate with the pump actuator; a patient line valve seat configured to operate with the patient line valve actuator; and a disposable medical fluid cassette including a rigid body defining a common well, at least one supply line valve seat disposed in the common well and configured to operate with the at least one supply line valve actuator, and a drain line valve seat disposed in the common well and configured to operate with the drain line valve actuator.

[0079] In a forty-second aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the cycler is configured to perform a patient drain in which used dialysate enters a common well, followed by a patient fill in which fresh dialysate enters the common well.

[0080] In a forty-third aspect of the present disclosure, which may be combined with any other aspect or portion thereof, during patient drain, a drain line valve actuator is actuated to allow used dialysate to exit the common well through the drain line valve seat, and during patient fill, one of the at least one supply line valve actuator is actuated to allow fresh dialysate to enter the common well through one of the at least one supply line valve seats.

[0081] In a forty-fourth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, during patient drain and patient fill, the patient line valve actuator is actuated to allow used and fresh dialysis fluid to flow through the patient line valve seat, respectively.

[0082] In a forty-fifth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a valve seat for a disposable medical fluid cassette includes a rigid wall, a tapered sealing surface extending from the rigid wall, the tapered sealing surface surrounding an opening formed in the rigid wall, and a plurality of displacement ribs extending from the rigid wall or from an outer edge of the tapered sealing surface to surround the tapered sealing surface, the displacement ribs being spaced apart to mitigate undesired blockage of the tapered sealing surface.

[0083] In a forty-sixth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the displacement ribs are separate from each other or extend from a common cylindrical base.

[0084] In a forty-seventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, the tapered sealing surface is cylindrical, and the displacement ribs collectively form a cylindrical shape that surrounds the tapered sealing surface.

[0085] In a forty-eighth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the tapered sealing surface forms a funnel shape that leads to the opening.

[0086] In a forty-ninth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the opening extends through a port located on the opposite side of the rigid wall from the tapered sealing surface and the displacement rib.

[0087] In a fiftieth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the tapered sealing surface includes at least one circular sealing ring for compressing against a mating sealing member.

[0088] In a fifty-first aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a pinch valve includes a linear actuator, a proximal end effector coupled to the linear actuator, a distal end effector slidably engaged with the proximal end effector, and a spring positioned and arranged to bias the distal end effector outward relative to the proximal end effector.

[0089] In a fifty-second aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the linear actuator includes a linear stepping motor.

[0090] In a fifty-third aspect of the present disclosure that may be combined with any other aspect or portion thereof, the proximal end effector and the distal end effector form a valve plunger.

[0091] In a fifty-fourth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the proximal end effector includes a larger diameter portion and a smaller diameter portion, and the distal end effector includes a cylindrical opening that slidably receives the smaller diameter portion of the proximal end effector.

[0092] In a fifty-fifth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the spring is disposed between a step that transitions between the larger diameter portion and the smaller diameter portion and the distal end effector.

[0093] In a fifty-sixth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the spring is constrained by a smaller diameter portion of the proximal end effector.

[0094] In a fifty-seventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, an outer diameter of the distal end effector is at least substantially equal to an outer diameter of the larger diameter portion of the proximal end effector.

[0095] In a fifty-eighth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the spring is a wave spring or a compression spring.

[0096] In a fifty-ninth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, one of the proximal end effector or the distal end effector defines at least one groove, and the other of the proximal end effector or the distal end effector includes at least one spring arm that mechanically fits into the at least one groove.

[0097] In a sixtieth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, at least one groove is sized to provide a travel length of the distal end effector relative to the proximal end effector that is equal to or greater than the uncompressed length of the spring.

[0098] In a 61st aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a dialysis device includes: an actuation surface onto which a fluid transport member is loaded to perform dialysis treatment; a hole formed in the actuation surface; and a pinch valve including a linear actuator, a proximal end effector coupled to the linear actuator, a distal end effector slidably engaged with the proximal end effector, and a spring positioned and arranged to bias the distal end effector outward relative to the proximal end effector, wherein the pinch valve is mounted within the device such that the distal end effector extends through the hole to block a portion of the fluid transport member.

[0099] In a sixty-second embodiment of the present disclosure that may be combined with any other embodiment or a portion thereof, the hole is covered by a flexible membrane, and the distal end effector bends the flexible membrane to block a portion of the fluid transport member.

[0100] In a 63rd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the pinch valve is mounted within the device such that the spring is compressed before a portion of the fluid conveying member experiences a full occlusion force applied by the linear actuator.

[0101] In a 64th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the hole is a first hole, the pinch valve is a first pinch valve, the actuation surface defines a second hole adjacent to the first hole, and includes a second pinch valve mounted within the device, and a distal end effector of the second pinch valve extends through the second hole to block a second portion of the fluid conveying member.

[0102] In a sixty-fifth embodiment of the present disclosure that may be combined with any other embodiment or portion thereof, the dialysis machine includes a control unit programmed to sequence the first and second pinch valves according to a preprogrammed sequence.

[0103] In a sixty-sixth aspect of the present disclosure that may be combined with any other aspect or portion thereof, a dialysis device operable with a disposable set having a peristaltic pump tubing includes an actuation surface for receiving the disposable set, a peristaltic pump actuator extending from the actuation surface, the peristaltic pump actuator operable with the peristaltic pump tubing, a member translatable along the actuation surface, a track pivotally connected to the member at a first end via a pivot axis, and a spring biased to urge a second end of the track outward from the member about the pivot axis.

[0104] In a sixty-seventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, the dialysis device includes a stopper arranged to limit the distance that the spring can push the second end of the track outward from the member.

[0105] In a sixty-eighth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the spring is disposed around the stopper.

[0106] In a sixty-ninth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the stopper is connected to the member and moves with the member.

[0107] In a seventieth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the stopper extends through an aperture or opening formed in the second end of the member and includes a head larger than at least one dimension of the aperture or opening, and a spring is biased to press the second end of the member against the head.

[0108] In a seventy-first aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the spring is a compression or extension spring.

[0109] In a seventy-second aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the member includes a base that defines an arc having a radius that at least substantially matches the radius of the orbit.

[0110] In a seventy-third aspect of the present disclosure that may be combined with any other aspect or portion thereof, the dialysis device includes a stopper arranged to stop the rotation of the orbit caused by the spring when the radius of the orbit at least substantially reaches the radius of the arc.

[0111] In a 74th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the actuation surface defines a linear rail, the member translates along the linear rail, and the lower surface of the member includes a rail receiver sized to operate with the linear rail.

[0112] In a seventy-fifth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the linear rail and the rail receiver are configured such that the linear rail holds a member slidably relative to an actuation surface.

[0113] In a seventy-sixth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the member defines at least one slot for allowing the member to be slidably attached to the actuation surface.

[0114] In a seventy-seventh aspect of the present disclosure that may be combined with any other aspect or portion thereof, the dialysis machine includes a door configured to open and close relative to an actuation surface, and further includes a linkage positioned and arranged to translate the track away from the peristaltic pump actuator when the door is open and to translate the track to an operable position relative to the peristaltic pump actuator when the door is closed.

[0115] In a seventy-eighth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the dialysis machine includes a door configured to open and close relative to an actuation surface, and further includes a motorized assembly configured to translate the track away from the peristaltic pump actuator and to translate the track to an operable position relative to the peristaltic pump actuator at different times.

[0116] In a seventy-ninth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the motorized mechanism includes a motor operable by a lead screw or linear actuator.

[0117] In an eightieth aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the motorized mechanism is configured to (i) automatically translate the track away from the peristaltic pump actuator when the door is opened and automatically translate the track to an operable position relative to the peristaltic pump actuator when the door is closed, or (ii) translate the track away from the peristaltic pump actuator and / or translate the track to an operable position relative to the peristaltic pump actuator at different times in response to at least one user interface input.

[0118] In an eighty-first aspect of the present disclosure that may be combined with any other aspect or portion thereof, a dialysis machine operable with a disposable set having peristaltic pump tubing includes an actuation surface for receiving the disposable set, a peristaltic pump actuator extending from the actuation surface, the peristaltic pump actuator operable with the peristaltic pump tubing, a track translatable along the actuation surface, a door closable relative to the actuation surface, and a linkage or motorized mechanism configured to (i) translate a screw thread away from the peristaltic pump actuator to move the peristaltic pump tubing to a position opposite the peristaltic pump actuator, and (ii) translate the screw thread to a position operable relative to the peristaltic pump tubing.

[0119] In an 82nd aspect of the present disclosure which may be combined with any other aspect or portion thereof, there is provided a linkage mechanism, the linkage mechanism being configured and arranged such that when a door is opened, (i) is performed, and when the door is closed, (ii) is performed.

[0120] In an 83rd aspect of the present disclosure which can be combined with other aspects or portions thereof, there is provided an electric mechanism, the electric mechanism being configured and arranged to automatically perform (i) when a door is opened and to automatically perform (ii) when the door is closed.

[0121] In an 84th aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, an electric mechanism is provided, wherein at least one of (i) or (ii) is executed in response to a user interface input.

[0122] In an 85th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the motorized mechanism includes a motor operable by a lead screw or a linear actuator.

[0123] In an 86th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a medical fluid system includes a medical fluid pump actuator, a medical fluid transfer set having a flexible sheet, a temperature sensor positioned and arranged to detect the temperature of the medical fluid flowing through the medical fluid transfer set, a pressure sensor positioned and arranged to contact the flexible sheet when the medical fluid transfer set is loaded for operation by the medical fluid pump actuator, and a control unit configured to (i) precondition the flexible sheet for operation with the pressure sensor by causing the medical fluid pump actuator to apply pressure to the flexible sheet, and (ii) use output from the temperature sensor in a compensation algorithm that corrects the output from the pressure sensor.

[0124] In an eighty-seventh aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the medical fluid pump actuator is a peristaltic pump actuator.

[0125] In an 88th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the pressure sensor is positioned such that when the medical fluid transfer set is loaded for operation by the medical fluid pump actuator, the flexible sheet is placed under tension through contact with the pressure sensor.

[0126] In an eighty-ninth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the pressure sensor is operable with the pressure pod portion of the flexible sheet.

[0127] In a 90th embodiment of the present disclosure that may be combined with any other embodiment or a portion thereof, the pressure applied during (i) is a fluid pressure.

[0128] In a 91st embodiment of the present disclosure which may be combined with any other embodiment or a portion thereof, the pressure applied during (i) is a cyclic up and down pressure.

[0129] In a 92nd embodiment of the present disclosure, which may be combined with any other embodiment or portion thereof, the pressure applied during (i) is 100% to 150% of the maximum operating pressure supplied during the procedure.

[0130] In a 93rd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the medical fluid system includes a plurality of valves operable by a medical fluid transfer set, and the control unit causes the plurality of valves to be closed during (i).

[0131] In a 94th aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, the algorithm comprises: V T =V0+gT, where V0 is the output from the pressure sensor, and V T is the corrected pressure output, g is the temperature scaling factor, and T is the sensed temperature.

[0132] In a 95th aspect of the present disclosure, which can be combined with other aspects or portions thereof, the control unit is configured to update the temperature compensation algorithm (i) each time the output from the pressure sensor is read by the control unit, or (ii) periodically.

[0133] In a 96th aspect of the present disclosure, which can be combined with other aspects or portions thereof, the control unit is configured to use the corrected output from the pressure sensor (ii) for at least one of (a) controlling the medical fluid pump actuator to pump within the patient's pressure limits, (b) determining a line occlusion condition, or (c) determining a container empty condition.

[0134] In a 97th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a medical fluid system includes a medical fluid pump actuator, a medical fluid transfer set having a flexible sheet, a pressure sensor arranged so that when the medical fluid transfer set is loaded for operation by the medical fluid pump actuator, the flexible sheet is placed under tension through contact with the pressure sensor, and a control unit configured to precondition the flexible sheet for operation by the pressure sensor by applying pressure to the flexible sheet by the medical fluid pump actuator.

[0135] In a 98th embodiment of the present disclosure that may be combined with any other embodiment or portion thereof, the pressure applied during preconditioning is fluid pressure.

[0136] In a 99th embodiment of the present disclosure that may be combined with any other embodiment or portion thereof, the pressure applied during preconditioning is cyclical up and down pressure.

[0137] In a hundredth aspect of the present disclosure that may be combined with any other aspect or portion thereof, the pressure applied during preconditioning is 100% to 150% of the maximum operating pressure supplied during treatment.

[0138] In a 101st aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a medical fluid system includes a plurality of valves operable with a medical fluid transfer set, and a control unit causes the plurality of valves to be closed during preconditioning.

[0139] In a 102nd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a medical fluid system includes a medical fluid pump actuator, a medical fluid transfer set having a flexible sheet, a temperature sensor positioned and arranged to detect the temperature of the medical fluid flowing through the medical fluid transfer set, a pressure sensor arranged so that the flexible sheet is placed under tension through contact with the pressure sensor when the medical fluid transfer set is loaded for operation by the medical fluid pump actuator, and a control unit configured to use output from the temperature sensor in a compensation algorithm that corrects the output from the pressure sensor.

[0140] In a hundred and third aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to update the temperature compensation algorithm (i) each time the output from the pressure sensor is read by the control unit, or (ii) periodically.

[0141] In a 104th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to use the corrected output from the pressure sensor for at least one of (i) controlling the medical fluid pump actuator to pump within the patient's pressure limits, (ii) determining a line occlusion condition, or (iii) determining a container empty condition.

[0142] In a 105th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a dialysis device operable with a disposable set having at least one container includes a pump actuator operable to pump dialysis fluid to and / or from at least one container, a weight plate arranged to support the at least one container, a plurality of operating load cells arranged to support the weight plate, a linear actuator arranged to apply a force to the weight plate, a calibration load cell arranged to measure the force applied by the linear actuator, and a control unit in operative communication with the operating load cell, the linear actuator, and the calibration load cell, wherein the control unit is configured to cause the linear actuator to apply a force to the weight plate, compare the resulting outputs from the operating load cell and the calibration load cell, and determine a calibration coefficient from the comparison to offset future outputs from the operating load cell.

[0143] In a hundred and sixth aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the operating load cells are positioned to be at least substantially equidistant from the center of mass of the weight plate.

[0144] In a hundred and seventh aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the calibration load cell is positioned so as to be at least substantially at the center of mass of the weight plate.

[0145] In a 108th aspect of the present disclosure that may be combined with any other aspect or portion thereof, the linear actuator includes a motor and a lead screw, or a linear stepping motor.

[0146] In a 109th aspect of the present disclosure that may be combined with any other aspect or portion thereof, the linear actuator is disposed between the calibration load cell and the weight plate.

[0147] In a 110th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to sum the resulting output from the operating load cell for comparison with the resulting output from the calibration load cell.

[0148] In a 111th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, a calibration factor for offsetting future outputs from the operating load cells is applied to the sum of future outputs from the operating load cells.

[0149] In a 112th aspect of the present disclosure that may be combined with any other aspect or portion thereof, the calibration coefficient includes the resulting output from the calibration load cell divided by the sum of the resulting outputs from the operating load cells.

[0150] In a 113th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the linear actuator is in mechanical communication with the weight plate, and the control unit is configured to cause the linear actuator to apply a pulling force to the weight plate.

[0151] In a 114th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the control unit is configured to cause the linear actuator to apply a force to the weight plate before the container is placed on the weight plate.

[0152] In a 115th aspect of the present disclosure, which may be combined with any other aspect or a portion thereof, the control unit is configured to cause the linear actuator to apply a force to the weight plate during processing while the container is supported by the weight plate.

[0153] In a 116th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is in operative communication with a pump actuator, and at least the operating duration of the pump actuator is controlled using an offset output from an operating load cell.

[0154] In a 117th aspect of the present disclosure that may be combined with any other aspect or a portion thereof, the control unit is configured to prevent the linear actuator from supplying force for the duration of the operation.

[0155] In a 118th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to determine mass or volume flow during treatment using two or more offset outputs from the operating load cell.

[0156] In a 119th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a dialysis system comprises a disposable set including a pumping unit and at least one container, and a dialysis machine, the dialysis machine including a pump actuator operable with the pumping unit to pump dialysis solution to and / or from at least one supply container, a weight plate arranged to support the at least one container, a plurality of operating load cells arranged to support the weight plate, a linear actuator arranged to apply a force to the weight plate, a calibration load cell arranged to measure the force applied by the linear actuator, and a control unit operatively communicating with the operating load cell, the linear actuator, and the calibration load cell, wherein the control unit is configured to cause the linear actuator to apply a force to the weight plate, compare the resulting outputs from the operating load cell and the calibration load cell, and determine a calibration coefficient from the comparison to offset future outputs from the operating load cell.

[0157] In a 120th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to sum the resulting output from the operating load cell for comparison with the resulting output from the calibration load cell.

[0158] In a 121st aspect of the present disclosure, which may be combined with any other aspect or portion thereof, a calibration factor for offsetting the resulting output from the operating load cells is applied to the sum of the resulting outputs from the operating load cells.

[0159] In a 122nd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the at least one container includes at least one supply container, the pump actuator is operable with the pumping unit to pump fresh dialysis from the at least one supply container, and the control unit is configured to determine the amount of fresh dialysis solution to be delivered using at least two offset outputs from the operating load cell.

[0160] In a 123rd aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the at least one container includes at least one drain container, the pump actuator is operable with the pumping unit to pump used dialysis to the at least one drain container, and the control unit is configured to determine the amount of used dialysis solution to be delivered using at least two offset outputs from the operating load cell.

[0161] In a 124th aspect of the present disclosure, which may be combined with any other aspect or portion thereof, the control unit is configured to use at least two offset outputs from the operating load cells to determine the amount of fresh dialysis fluid delivered to the patient or the amount of used dialysis fluid removed from the patient.

[0162] In a 125th aspect of the present disclosure, any of the features, functions, and alternatives described in connection with any one or more of Figures 1 to 13 may be combined with any of the features, functions, and alternatives described in connection with any other of Figures 1 to 13 and / or any of the aspects enumerated herein.

[0163] Thus, an advantage of the present disclosure is that it provides an accurate APD system that uses a relatively simple and cost-effective peristaltic pump.

[0164] Another advantage of the present disclosure is that it provides an APD system that eliminates certain sealing problems present in known APD systems.

[0165] A further advantage of the present disclosure is that it provides an APD pump drive system that eliminates the bulky pneumatic equipment associated with certain APD systems.

[0166] Yet another advantage of the present disclosure is that it provides an APD pump drive system that reduces noise compared to pneumatic systems.

[0167] Yet another advantage of the present disclosure is to provide an APD system that manages peritoneal dialysis fluid flow to be within safe and comfortable patient pressure limits.

[0168] Yet another advantage of the present disclosure is to provide an APD system with a simplified disposable set.

[0169] A further advantage of the present disclosure is that it provides an APD system with accurate pressure and weight sensing.

[0170] Moreover, an advantage of the present disclosure is to provide an APD system that simplifies removal of spent dialysate to accommodate a drain for a patient.

[0171] Additional features and advantages will be described in and apparent from the following detailed description and drawings. The features and advantages described herein are not all-inclusive, and in particular, many additional features and advantages will be apparent to those skilled in the art in view of the drawings and description. Also, any particular embodiment need not possess all of the advantages listed herein, and it is expressly contemplated that each advantageous embodiment may be separately claimed. Furthermore, it should be noted that the language used herein has been chosen primarily for readability and descriptive purposes, and not to limit the scope of the inventive subject matter. The present invention further provides, for example, the following: (Item 1) A peritoneal dialysis system (10), comprising: a cycler (20) including a pump actuator (60); A disposable set (120), comprising: a pumping section (126) operable with the pump actuator (60); a patient line (122e) disposed in fluid communication with the pumping section (126); a drain container (124a) disposed in fluid communication with the pumping section (126); a disposable set (120) including: A control unit (50) and Equipped with The control unit (50) (i) performing a peritoneal dialysis treatment in which fresh dialysate is pumped to a patient through the patient line (122e) and spent dialysate is pumped from the patient to the drain container (124a); (ii) at the end of treatment, pumping the spent dialysate from the drain container (124a) through the patient line (122e) to a house drain; The peritoneal dialysis system (10) is configured to cause the pump actuator (60) to operate the pumping unit to perform the above. (Item 2) Item 1. The peritoneal dialysis system (10) of item 1, wherein the pump actuator (60) is a peristaltic pump actuator and the pumping portion (126) of the disposable set (120) includes peristaltic pump tubing. (Item 3) 2. The peritoneal dialysis system (10) of claim 1, further comprising an extension line (122f), the extension line (122f) configured to be connected to the patient line (122e) when needed to reach the house drain. (Item 4) 4. The peritoneal dialysis system (10) according to item 3, wherein the extension line (122f) is reusable. (Item 5) Item 1. The peritoneal dialysis system (10) of item 1, including a user interface (58) in communication with the control unit (50), the user interface (58) configured to prompt the patient to disconnect from the patient line (122e) and move the patient line (122e) toward the house drain at the end of treatment. (Item 6) 2. The peritoneal dialysis system of claim 1, further comprising a user interface in communication with the control unit, the user interface configured to provide or enable a drain button to initiate the pumping of the spent dialysate from the drain container through the patient line to the house drain at the end of treatment. (Item 7) 7. The peritoneal dialysis system of claim 6, wherein the user interface is further configured to require confirmation that the drain line is in fluid communication with the house drain before providing or enabling the drain button. (Item 8) Item 1. The peritoneal dialysis system of item 1, wherein the cycler includes a patient valve actuator that operates with a patient valve seat provided by the disposable set and a drain valve actuator that operates with a drain valve seat provided by the disposable set, and the control unit is configured to cause the patient valve actuator and the drain valve actuator to enable flow through the patient valve seat and the drain valve seat to pump the spent dialysate from the drain container through the patient line to the house drain. (Item 9) Item 1. The peritoneal dialysis system (10) of item 1, wherein at least one of the patient valve actuator or the drain valve actuator is a pinch valve actuator. (Item 10) Item 1. The peritoneal dialysis system (10) of item 1, further comprising a supply container (124b) arranged in fluid communication with the pumping section (126) of the disposable set (120), the supply container (124b) being used during the peritoneal dialysis treatment to pump fresh dialysate through the patient line (122e) to the patient. (Item 11) Item 11. The peritoneal dialysis system (10) of item 10, wherein the supply container (124b) is used to receive spent dialysate from the patient later during the peritoneal dialysis treatment. (Item 12) The cycler (20) includes a sensor in operative communication with the control unit (50), the control unit (50) comprising: using an output from the sensor to determine when one of the drain container (124a) or the supply container (124b), which will subsequently be used as a drain container after pumping the spent dialysate to the house drain, is empty or substantially empty; and then switching to the other of the drain container or the supply container (124b) to be subsequently used as a drain container for pumping the used dialysis fluid to the house drain. Item 12. The peritoneal dialysis system (10) according to item 11, configured to perform the following: (Item 13) Item 13. The peritoneal dialysis system (10) according to item 12, wherein the sensor is a weight sensor (102a to 102d) or a pressure sensor (36a, 36b). (Item 14) Item 11. The peritoneal dialysis system of item 10, wherein the control unit is further configured to cause the pump actuator to operate the pumping section to pump remaining fresh dialysate from the supply container through the patient line to the house drain at the end of treatment. (Item 15) The drain container (124a) is a first drain container, and the system includes a second drain container (124b) disposed in fluid communication with the pumping unit (126) of the disposable set (120), the cycler (20) includes a sensor in operative communication with the control unit (50), and the control unit (50) is configured to: using an output from the sensor to determine when the first drain (124a) container is empty or substantially empty after pumping the spent dialysate to the house drain; Thereafter, switching to the second drain container (124b) to pump the spent dialysis fluid to the house drain. Item 1. The peritoneal dialysis system (10) according to item 1, configured to perform the following: (Item 16) Item 16. The peritoneal dialysis system (10) according to item 15, wherein the sensor is a weight sensor (102a to 102d) or a pressure sensor (36a, 36b). (Item 17) Item 1. The peritoneal dialysis system (10) of item 1, wherein the drain container (124a) is a first drain container, the system includes a second drain container (124b) arranged to be in fluid communication with the pumping section (126) of the disposable set (120), and the control unit (50) is configured to drain the first and second drain containers (124a, 124b) simultaneously. (Item 18) A peritoneal dialysis system (10), comprising: a cycler (20) including a pump actuator (60); A disposable set (120), comprising: a pumping section (126) operable with the pump actuator (60); a patient line (122e) disposed in fluid communication with the pumping section (126); a drain line (122a) disposed in fluid communication with the pumping section (126); a disposable set (120) including: A control unit (50) and Equipped with The control unit (50) (i) performing a peritoneal dialysis treatment in which fresh dialysate is pumped to a patient through said patient line (122e) and spent dialysate is pumped from said patient through said drain line (122a); (ii) at the end of treatment, pumping the spent dialysate through the drain line (122a) and the patient line (122e) to a house drain; The peritoneal dialysis system (10) is configured to cause the pump actuator (60) to operate the pumping unit to perform the above. (Item 19) Item 19. The peritoneal dialysis system (10) of item 18, wherein the drain line (122a) is in fluid communication with a drain container (124a), the drain container being initially provided as a drain container or a supply container (124b) filled with fresh dialysate. (Item 20) Item 19. The peritoneal dialysis system (10) of item 18, wherein the patient line (122e) and the drain line (122a) are separated by a disposable cassette (130) of the disposable set (120), and at the end of treatment, the used dialysate is pumped through the drain line (122a), through the disposable cassette (130), and through the patient line (122e) to the house drain. (Item 21) Item 21. The peritoneal dialysis system (10) of item 20, wherein the disposable cassette (130) includes pressure sensing pods (150a, 150b) arranged to enable a pressure change indicating that a drain container (124a) in fluid communication with the drain line (122a) is empty to be detected, and thereafter the control unit (50) triggers a switch to draining spent dialysate from a different source to the house drain at the end of treatment. (Item 22) Item 19. The peritoneal dialysis system (10) of item 18, wherein the cycler (20) includes a weighing scale (100), a drain container (124a) in fluid communication with the drain line (122a) is arranged to be weighed by the weighing scale (100), and an output from the weighing scale (100) indicating that the drain container (124a) is empty is used by the control unit (50) to trigger a switch to draining spent dialysate from a different source to the house drain at the end of treatment. (Item 23) A peritoneal dialysis system (10), comprising: a cycler (20) including a pump actuator (60); A disposable set (120), comprising: a pumping section (126) operable with the pump actuator (60); a patient line (122e) disposed in fluid communication with the pumping section (126); a drain container (124a) disposed in fluid communication with the pumping section (126); a disposable set (120) including: A control unit (50) and Equipped with The control unit (50) (i) performing a peritoneal dialysis treatment in which fresh dialysate is pumped to a patient through the patient line (122e) and spent dialysate is pumped from the patient to the drain container (124a); (ii) at the end of treatment, pumping the spent dialysate from the drain container (124a) through the patient line (122e) to a desired destination; The peritoneal dialysis system (10) is configured to cause the pump actuator (60) to operate the pumping unit to perform the above. (Item 24) Item 24. The peritoneal dialysis system (10) of item 23, wherein the desired destination includes a house drain or another container disposed in fluid communication with the pumping section (126). (Item 25) Item 24. The peritoneal dialysis system of item 23, wherein pumping the used dialysate from the drain container through the patient line during (ii) comprises operating the pumping unit in a first direction to at least partially fill the patient line with the used dialysate, and then operating the pumping unit in a second direction to remove the used dialysate from the patient line to the desired destination. [Brief explanation of the drawings]

[0172] [Figure 1] FIG. 1 is a perspective view of one embodiment of the disclosed system and associated cycler and disposable set.

[0173] [Figure 2] FIG. 2 is a perspective view of one embodiment of the working surface of a cycler of the present disclosure.

[0174] [Figure 3] FIG. 3 is a perspective view of one embodiment of a peristaltic pump tubing autoloading structure and related features.

[0175] [Figure 4] FIG. 4 is an elevational view of one embodiment of a pinch valve of the present disclosure.

[0176] [Figure 5] 5A and 5B are elevation and cross-sectional views of one embodiment of a spring-loaded end effector valve plunger of the present disclosure.

[0177] [Figure 6] FIG. 6 is a side elevational view of one embodiment of a disposable cassette of the present disclosure adjacent the working surface of a cycler.

[0178] [Figure 7] FIG. 7 is a perspective view of one embodiment of a valve seat of the present disclosure taken along line VII-VII of FIG.

[0179] [Figure 8] FIG. 8 is a side elevational view of one embodiment of a disposable cassette of the present disclosure as viewed from outside the cycler when the disposable cassette is loaded for operation.

[0180] [Figure 9] FIG. 9 is a perspective view of the operating side of one embodiment of a disposable cassette of the present disclosure showing how the fluid paths and valve seats are formed.

[0181] [Figure 10] FIG. 10 is a perspective and elevational cross-sectional view illustrating several alternative embodiments of valve seats of the present disclosure.

[0182] [Figure 11]FIG. 11 is a cross-sectional elevation view illustrating one embodiment for interfacing a pressure sensor and pressure sensor pod of the present disclosure.

[0183] [Figure 12] FIG. 12 is a plot showing pressure sensor output versus temperature used to determine the temperature scaling coefficients for the pressure sensing scaling or offset equations of the present disclosure.

[0184] [Figure 13] FIG. 13 is a perspective view of one embodiment of a self-calibrating weigh scale that can be used with the systems and cyclers of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0185] (System Overview) Referring now to the drawings, and particularly to FIG. 1 , an embodiment of a system 10 includes an automated peritoneal dialysis ("APD") cycler 20 having a housing 22, which in one embodiment uses a peristaltic pump to operate a disposable set 120. All rigid and flexible tubing portions of the disposable set 120 may be made from one or more plastics (e.g., polyvinyl chloride ("PVC") or non-PVC materials such as polyethylene ("PE"), polyurethane ("PU"), or polycarbonate ("PC"). The housing 22 of the cycler 20 may be made from any of the above plastics and / or metals, such as stainless steel, steel, and / or aluminum.

[0186] In the illustrated embodiment, the housing 22 includes a hinged door 24 having a series of holes or slots 26a, 26b, 26c, 26d, and 26e, respectively, for the tubing (122a through 122e) of the disposable set 120 extending from the inside of the housing 22 to the outside of the housing. While shown as elongated slots, the apertures (26a through 26e) could alternatively be holes. However, the slots (26a through 26e) are advantageous for allowing the door 22 to hinge open without placing the tubing (122a through 122e) under undue tension. In an embodiment, the tubing (122a through 122e) is pre-connected to and sterilized with the disposable pump cassette, described below. The distal ends of the tubing (122a through 122e) are removed from the sterile caps during treatment setup and secured to containers or bags (124a through 124d) of the disposable set 120 (line 122e is the patient line). Container or bag 124a can be a drain container or bag. Containers or bags 124b and 124c can be primary fresh dialysate supply containers or bags. Container 124d can be a final fill container or bag, holding a different formulation of fresh dialysate (e.g., 2 to 3 liters of icodextrin) that is formulated to remain inside the patient's peritoneal cavity after the patient disconnects from the disposable set 120.

[0187] In the illustrated embodiment, the door 24 is positioned vertically, thus holding the set 120 of disposable cassettes within the housing 22 of the cycler 20 perpendicular to the operating surface of the housing. The door 24 is positioned adjacent to the user interface portion of the cycler 20, which includes a control unit 50 having one or more processors 52, one or more memories 54, and a video controller 56. The video controller interfaces the one or more processors 52 and the one or more memories 54 with a user interface 58. The user interface 58 may include a touchscreen and / or electromechanical buttons (such as membrane switches) for inputting user commands and providing instructions, alerts, and alarms. Providing the user interface 58 next to the door 24 of the housing 22 allows the patient or other user to interact with typically one surface of the device 20 to input commands, receive data, and load / unload disposable cassettes. The user interface 58 may alternatively or additionally be a remote user interface, for example, via a tablet or smartphone. Control unit 50 may also include a transceiver and a wired or wireless connection to a network (not shown, e.g., the Internet) to transmit treatment data to a physician or clinician server that interfaces with the physician or clinician's computer and receive prescription orders / changes from the physician or clinician's server. Data transmitted to the physician or clinician's computer may be analyzed and / or converted into or used to form other data useful for analysis. Such data conversion may alternatively or additionally be performed in control unit 50 of cycler 20.

[0188] FIG. 1 shows that in one embodiment, system 10 also includes a bag shelf enclosure 40, which serves multiple purposes. Bag shelf enclosure 40 is sized so that a cycler 20 can be stored inside the enclosure when the cycler 20 is not in use. In the illustrated embodiment, bag shelf enclosure 40 includes a rotatably hinged handle 42 that allows a user to transport the enclosure with the cycler 20 stored therein. As shown in FIG. 1 , bag shelf enclosure 40 is also sized so that the bag shelf enclosure can be set on top of the cycler 20 (on top of a weight plate, in one embodiment, as described in detail below) when the cycler 20 is in use. The bag shelf holds multiple containers or bags (124a-124d), such as multiple supply containers (124b-124d) and one or more drain containers 124a. As shown, the containers or bags are held within enclosure 40 and on the outer top surface of the enclosure.

[0189] The bag shelf enclosure 40 may include color-coded markers 44a through 44d provided at locations for loading receptacles or bags with lines extending through slots or apertures 26a through 26d into the cycler 20, with the slots or apertures having similar color-coded markers or borders. The matching color-coded markers 44a through 44d and slot borders make it easy for patients or caregivers to identify which bags and lines belong to which locations on the bag shelf enclosure 40. For example, marker 44a and the border of slot 26a may be green to indicate drain line 122a and drain receptacle 124a, and the desired location of the drain receptacle. Markers 44b and 44c and the borders of slots 26b and 26c may be blue to indicate primary supply lines 122b and 122c and supply receptacles 124b and 124c, and the desired location of the supply receptacles. The marker 44d and the border of the slot 26d may be red to indicate the last fill line 122d and the last filled container 124d, and the desired location of the last filled container.

[0190] (Drain / Purge) It is contemplated that supply containers or bags, such as primary supply containers or bags 124b and 124c, may be used later as drain containers or bags to reduce overall disposable costs. For example, assume a patient is full of effluent at the start of treatment. The effluent is first drained from the patient and delivered to the first empty drain container 124a. A first patient load is then delivered from the first primary supply container 124b to the patient and, after a designated dwell period, delivered to the same drain container 124a (or a different drain container, depending on the size of the drain container). In an embodiment, the drain container 124a and primary supply containers 124b and 124c are larger 6-liter containers designed to hold multiple cycles of fresh and used dialysate. The drain container 124a is used to receive effluent until the first supply container 124b is empty, after which the first supply container receives the effluent after a dwell period using PD fluid delivered from the second supply container 124c. The first supply container 124b is used to receive the patient effluent, possibly over multiple patient fills, dwells, and drains, until the second supply container 124c is empty. At that point, the patient can receive a final fill of a different formulation of peritoneal dialysis fluid from the last fill container 124d, which will remain in the patient until the next night's treatment, or perhaps until the daytime exchange. If the second supply container 124c is empty at the end of a treatment, it can be used as the first empty drain container at the start of the next treatment, further reducing disposable waste and costs.

[0191] In one example, the containers (124a to 124d) may be used as follows when the patient is initially full: Initial drain → Drain container 124a Supply vessel 124b → First filling → Drain vessel 124a Supply vessel 124b → Second filling → Drain vessel 124a Supply vessel 124c → third filling → supply vessel 124b Supply vessel 124c → fourth filling → supply vessel 124b Last Filled Container 124d - Last Filled

[0192] In one example, the containers (124a through 124d) may be used as follows when the patient is initially empty: Supply vessel 124b → First filling → Drain vessel 124a Supply vessel 124b → Second filling → Drain vessel 124a Supply vessel 124c → third filling → supply vessel 124b Supply vessel 124c → fourth filling → supply vessel 124b Last Filled Container 124d - Last Filled

[0193] At the end of treatment, multiple containers or bags (e.g., containers 124a, 124b) are filled with effluent. The remaining supply container 124c may also contain remaining fresh dialysate. To prevent the patient or caregiver from having to transport the complete drain bag to a house drain, such as a toilet, sink, or bathtub, the control unit 50 of the cycler 20 is programmed to prompt the user to disconnect the patient line 122e from the patient's transfer set and carry the distal end of the patient line 122e to a house drain. If necessary, a reusable extension line 122f can be connected to the distal end of the patient line 122e to reach the house drain. The patient or caregiver then presses the drain button on the user interface 58, at which time the cycler 20 activates a pump actuator, e.g., a peristaltic pump actuator, in a direction that draws spent dialysate or effluent from each of the drain containers 124a, 124b (one or more of which may be the original supply container) and pumps the spent dialysate through the patient line 122e (and extension line 122f, if necessary) to the house drain. Remaining fresh dialysate is similarly removed from the supply container 124c. In embodiments, the drain button is displayed only when needed, e.g., via a touchscreen display, at the end of treatment. Alternatively, the drain button may be a membrane switch that is enabled only when needed, e.g., at the end of treatment. Furthermore, regardless of the type of drain button, the drain button may be displayed and / or enabled only after the patient presses a confirmation button provided by the user interface 58 in response to a prompt by the user interface to confirm that the patient or caregiver has extended the patient line 122e / 122f to the house drain.

[0194] The control unit 50 of the cycler 20 detects when each drain container 124a, 124b is empty (e.g., via a weight scale and / or pressure sensor operating on a pressure pod of the disposable cassette, as described in detail below) and automatically switches valve actuators, such as pinch valve actuators, to sequence between the drain containers 124a, 124b (and, if necessary, the supply container 124c) until each is empty. In particular, the cycler 20 includes a patient valve actuator that operates with a patient valve seat provided by the disposable set 120 and a drain valve actuator that operates with a drain valve seat provided by the disposable set, and the control unit 50 is configured to cause the patient valve actuator and the drain valve actuator to enable flow through the drain valve seat and pump spent dialysate from the drain container through the patient line to the house drain. It should be understood that multiple drain containers (one or more of which may be previous supply containers) may be drained simultaneously over the same or overlapping time periods, e.g., to save time.

[0195] It is contemplated that control unit 50 may look for remaining fresh dialysate in any remaining supply containers, such as containers 124c and 124d, and cause the pump actuator to pump the remaining fresh dialysate through the patient line to receive the drain. In this manner, when the patient disconnects from patient line 122e and presses the drain button, the patient can assume that all fresh and used dialysate has been pumped to the house drain, and thus the patient is free to begin their day.

[0196] Although system 10 is described in this section as pumping effluent or remaining fresh dialysate to a house drain, it should be understood that in alternative embodiments, control unit 50 may pump any remaining fluid (fresh or spent) from any container (124a through 124d) to any other container (124a through 124d). In an embodiment, after a procedure, the patient disconnects from patient line 122e, places the distal end of the patient line in a priming holder (not shown) located in housing 22 of cycler 20, and confirms this action in user interface 58. The distal end of patient line 122e remains open to atmosphere. Control unit 50 then executes a sequence in which all fluid currently present in patient line 122e is pumped to the desired destination container (124a through 124d), resulting in patient line 122e being completely or nearly completely filled with air. The control unit 50 then causes any dialysate (fresh or spent) delivered to any container (124a-124d) to be moved via the peristaltic pump actuator 60 rotating in the patient fill direction for a known number of strokes to push the amount of fluid through the in-line fluid heating path 144 and into a safe portion of the patient line 122e so that the fluid does not spill out the end of the patient line. The control unit 50 then reverses the direction of the peristaltic pump actuator 60 to rotate in the patient drain direction for a known number of strokes and changes the valve state of the associated valve actuator to push the amount of fluid through the safe portion of the patient line 122e and the in-line fluid heating path 144 to the desired destination container (124a-124d). The control unit 50 then repeats the pumping and back-pumping actions until the desired amount of fresh or spent dialysate has been moved from the desired source container (124a-124d) to the desired destination container (124a-124d).

[0197] (Automatic loader) Referring now to FIG. 2, one embodiment of the operating surface 30 of the cycler 32 is shown. The operating surface 30 in FIG. 1 is hidden behind the door 24. When the door 24 is opened, the operating surface 30 as shown in FIG. 2 is exposed. The labels "top," "bottom," "user interface," and "patient end" are shown in FIG. 2 to indicate how the operating surface 30 is oriented in FIG. 1. The operating surface 30 in the illustrated embodiment includes a heater 32 (such as a resistive plate that heats an in-line fluid heating path provided by a disposable cassette, described below). The operating surface 30 also includes multiple valve actuators (34a through 34e), including a drain line valve actuator 34a, main supply line valve actuators 34b and 34c, a final fill line valve actuator 34d, and a patient line valve actuator 34e. Embodiments of the valve actuators (34a through 34e) are described in more detail below. The operating surface 30 also includes multiple pressure sensors (including a patient pressure sensor 36a and a pumping pressure sensor 36b). Embodiments of pressure sensors 36a and 36b are similarly described in detail below. At least one temperature sensor 38, e.g., a thermocouple or thermistor, is also provided. A control unit 50, figuratively shown in Figure 2, controls heater 32 and valve actuators (34a through 34e) and receives inputs from pressure sensors 36a, 36b and temperature sensor 38.

[0198] FIG. 2 further illustrates that a peristaltic pump actuator 60, under the control of the control unit 50, is positioned on and extends behind the operating surface 30 of the cycler 20. The pump actuator 60 may include a pump head 62 positioned on the operating surface 30 and a driver or motor 64 positioned behind the operating surface 30. The disposable cassette includes peristaltic pump tubing, and when loading the cassette, a user guides the peristaltic pump tubing over the pump head 62 of the peristaltic pump actuator 60. During operation, the peristaltic pump actuator 60 compresses the peristaltic pump tubing against the track 66 at multiple points. The operative proximity of the track 66 to the peristaltic pump actuator 60 makes loading the tubing difficult. Therefore, the present cycler 20 provides a movable track 66 that translates out of the way of the peristaltic pump actuator, e.g., via a linkage (not shown), when a patient or caregiver opens the door 24 of the cycler 20 to load the disposable cassette. After the cassette is loaded, closing the cycler door 24 translates the movable track 66, e.g., via a linkage, to an operational position directly adjacent the peristaltic pump tubing. In an alternative embodiment, a motor and lead screw assembly, or a linear actuator (e.g., a linear stepper motor, not shown) is provided to automatically translate the track 66 out of the way of the peristaltic pump actuator 60 when the patient or caregiver opens the door 24 to load the cassette, and to automatically translate the track 66 to an operational position when the door 24 is closed. In a further alternative embodiment, a motor and lead screw assembly, or a linear actuator (e.g., a linear stepper motor, not shown) is provided, but the patient or caregiver instead presses one or more buttons on the user interface 58 to translate the track 66 out of the way or to an operational position.

[0199] In the embodiment, the track 66 is mounted to a block or member 70 that is translatable across the actuation surface 30 toward and away from the peristaltic pump actuator 60. In addition to the translational movement of the member 70 (and track 66), the movable track 66 can also rotate about a pivot 72 provided at one end 66a of the track 66, which pivot 72 is mounted to the translatable member 70. The other end 66b of the track 66 is spring-loaded via a spring 74, e.g., a compression spring, trapped between the track end 66b and the member 70. In the illustrated embodiment, the spring 74 is inserted onto a threaded bolt 76 that extends through the track end 66b and is threaded into the member 70. The threaded bolt 76 includes a head 76h that sets the end of spring travel for the track 66, which can be adjusted in or out by rotating the threaded bolt 76 clockwise or counterclockwise, respectively. In the illustrated embodiment, spring 74 urges track 66 about pivot 72 into a desired operating position about the peristaltic pump tubing after member 76 is translated toward peristaltic pump actuator 60. Pivoting track 66 may absorb or tolerate variations due to tubing tolerances and provide a damping effect to aid in noise reduction.

[0200] 2 and 3 show that member 70 and track 66 slide along a linear rail 68 formed or provided along actuation surface 30. Member 70 includes a rail receiver (not visible) on its underside sized to fit within and operate with linear rail 68. The rail receiver in the embodiment interacts with linear rail 68 via, for example, a tongue and groove fit, such that linear rail 68 holds member 70 and track 66 in sliding engagement along actuation surface 30. Additionally or alternatively, FIG. 3 shows that member 70 may have an elongated slot 78 formed therein that receives a bolt that may be loosely tightened, thereby allowing member 70 and track 66 to slide along actuation surface 30 while still being held to the surface.

[0201] Section IIIA of Figure 3 shows the peristaltic pump tubing 126 of the disposable set 120 as it is about to be loaded. The member 70 and track 66 are in a fully retracted or out-of-the-way position. Section IIIB of Figure 3 shows the peristaltic pump tubing 126 extended or placed in an operable position around the pump head 62 of the peristaltic pump actuator 60. The member 70 and track 66 are again in a fully retracted or out-of-the-way position. Section IIIC of Figure 3 shows the member 70 and track 66 translated into an operable position relative to the peristaltic pump tubing 126 and pump head 62 of the peristaltic pump actuator 60.

[0202] As discussed above, a purely mechanical linkage (not shown) may be provided that pulls member 70 and track 66 to the fully retracted or out-of-the-way position of sections IIIA and IIIB of FIG. 3 , e.g., the linkage is actuated by the opening of door 24. The linkage pushes member 70 and track 66 to the operable position of section IIIC of FIG. 3 , e.g., the linkage is actuated by the closing of door 24. Alternatively, a motorized mechanism, such as a linear actuator or a motor and lead screw, may be provided that (i) automatically pulls member 70 and track 66 to the fully retracted or out-of-the-way position of sections IIIA and IIIB of FIG. 3 when door 24 is opened, and (ii) automatically pushes member 70 and track 66 to the operable position of section IIIC of FIG. 3 when door 24 is closed. Further alternatively, if it is desirable to have access to actuation surface 30 when members 70 and tracks 66 are in the operable position, a button may be provided on user interface 58 to activate the motorized mechanism, for example, to both retract and extend members 70 and tracks 66, or, in some cases, only to extend members 70 and tracks 66 to the operable position after they have automatically been pulled to the fully retracted position upon opening door 24. Control unit 50 may be programmed to perform either such sequence.

[0203] As shown in fully retracted sections IIIA and IIIB of FIG. 3, member 70 includes a base 70b defining an arc having a radius at least substantially matching the radius of track 66. It is contemplated that head 76h of bolt 76 provides a stop positioned to stop the pivoting of track 66 via spring 74 (e.g., by threading bolt 76 outwardly of member 70) when the radius of track 66 at least substantially reaches and thus matches the radius of the arc of base 70b. As noted above, track 66 is movable primarily for ease of loading. A secondary benefit of translational motion is adjustment of track position to optimize tubing variability. Pivoting via pivot 72 and spring 74 helps accommodate tubing tolerances and provides a damping effect that aids in noise reduction. While spring 74 is shown as a compression spring, it should be understood that the spring could alternatively be an extension spring or other type of spring.

[0204] (spring end effector) 4, 5A, and 5B, any or all embodiments of pinch valve actuators (34a through 34e) are shown. A disposable cassette 130 (e.g., injection-molded or blow-molded plastic) is provided with valve seats (132a through 132e), which receive pinch valve actuators (34a through 34e) for occluding or closing fluid paths 134 provided by the disposable cassette. In FIG. 4, the disposable cassette 130 is sealed (e.g., ultrasonically welded, heat-sealed, and / or solvent-bonded) and covered with a flexible sheet 136, e.g., flexible plastic, and the pinch valve actuators (34a through 34e) close the respective fluid paths 134 by pressing a portion of the flexible plastic against the respective valve seats (132a through 132e). The pinch valve actuators (34a through 34e) retract to open the respective fluid paths 134. As shown in FIG. 4, openings in valve seats 132a through 132e extend through the rigid body 138 of the disposable cassette 130 and through ports 140a through 140e, which extend in a direction away from the valve seats. Each line or tube 122a through 122e is sealably connected to each port 140a through 140e, for example, by ultrasonic welding, heat sealing, and / or solvent bonding. The lines or tubes 122a through 122e extend from the disposable cassette 130 through respective slots or apertures 26a through 26e through the door 24, as shown in FIG. 1.

[0205] As shown in FIG. 4 , each of the pinch valves (34a through 34e) is driven by a linear actuator 80, which may be any suitable type of linear actuator, such as a linear stepper motor, that provides the required amount of travel (e.g., up to 10 mm) and the required amount of pressurized cassette seat closing force (e.g., 30 to 60 Newtons (“N”) or less) under the control of the control unit 50. In the illustrated embodiment, the linear actuator 80 is mounted to an interior wall 46 or other internal structure within the housing 22 of the cycler 20 such that a valve plunger 84 connected to an output shaft 82 of the linear actuator 80 extends through a hole 30h in the actuation surface 30 just to meet a flexible valve membrane 48, e.g., flexible silicone, bolted to the actuation surface 30. The linear actuator 80 drives the valve plunger 84 to compress the flexible membrane 48 and a portion of the cassette seat 136 against a respective cassette valve seat (132a through 132e). The linear actuator 80 retracts the valve plunger 84, allowing it to be unseated from each cassette valve seat (132a to 132e), for example, via its own resilience and positive fluid pressure.

[0206] As shown in FIGS. 5A and 5B, the valve plunger 84 in one embodiment includes a proximal end effector 86 that couples to the linear actuator 80 and a distal end effector 90 that is slidably coupled to the proximal end effector 86. As shown in FIG. 5B, the proximal end effector 86 has a larger diameter portion 86a and a smaller diameter portion 86b. The distal end effector 90 includes or defines a cylindrical opening 92 that slidably receives the smaller diameter portion 86b of the proximal end effector 86. In the illustrated embodiment, a spring 98 is disposed between a step 86c that transitions between the larger diameter portion 86a and the smaller diameter portion 86b and a proximal edge 90p of the distal end effector 90. Thus, the spring 98 is constrained by the smaller diameter portion 86b of the proximal end effector 86. 5A and 5B illustrate that the outer diameter of distal end effector 90 can be at least substantially equal to the outer diameter of larger diameter portion 86 a of proximal end effector 86 .

[0207] One of the proximal end effector 86 or the distal end effector 90 defines at least one groove, and the other of the proximal end effector or the distal end effector includes at least one spring arm that mechanically fits (e.g., snaps) into the at least one groove to slidably attach the end effectors to one another. In the illustrated embodiment, the proximal end effector 86 defines at least one groove 88, and the distal end effector 90 includes or defines multiple spring arms 94a, 94b,... 94n that mechanically fit (e.g., snaps) into the at least one groove 88. If it is desired that the distal end effector 90 not spin relative to the proximal end effector 86, a separate groove 88 can be defined for each spring arm 94a, 94b,... 94n. If this is not an issue, a single annular groove 88 can be provided instead. In either case, the length of the at least one groove 88 is sized to provide a length of travel of the distal end effector 90 relative to the proximal end effector 86 that is equal to or greater than the uncompressed length of the spring 98.

[0208] Spring 98 can be a wave or compression spring. One allowable travel length of spring 98 is 2.9 mm. In an embodiment, spring 98 is configured to provide the 25 N sealing force necessary to properly seal cassette seat 136 against valve seats (132 a to 132 e) after approximately 1.4 mm of compression travel. Spring 98 can exert a maximum force of 51 N at full height, with linear actuator 80 selected to have at least a slightly higher peak force.

[0209] The spring 98 is positioned to bias the distal end effector 90 outward against the proximal end effector 86. The variable distance provided by the spring 98 allows the pinch valves (34a through 34e) to initially contact the cassette seat 136 (via the flexible membrane 48) with a smaller closing force that steadily increases as the spring 98 is compressed. The flexible membrane 48 is secured to the actuation surface 30 to cover the end of the distal end effector 90. When the spring 98 is fully compressed, the cassette seat 136 and valve seats (132a through 132e) experience the full closing force of the linear actuator 80 and spring 98. The spring 198 therefore provides a force buffer that helps protect the flexible membrane 48 across multiple procedures and the cassette seat 136 across a single procedure. The spring 98 may also account for variations due to tolerances of the disposable cassette 130 and its loading, further allowing for a smaller or less expensive linear actuator 80 .

[0210] (disposable cassette / valve seat) 6-10, the disposable cassette 130 in the illustrated embodiment provides multiple valve seats, which may include a patient line valve seat 132e, first and second supply line valve seats 132b and 132c, a final fill line valve seat 132d, and a drain line valve seat 132a. In the embodiment shown in FIGS. 6 and 9, the patient line valve seat 132e is fluidly separated from the first peristaltic tubing port 142a by an in-line fluid heating path 144, e.g., a serpentine path. When the disposable cassette 130 is installed for operation, the in-line fluid heating path 144 is adjacent to a heater 32, such as the resistive plate heater shown in FIG. 2. FIG. 9 shows that a flexible sheet 136 is sealed to a rigid body 138 over the fluid heating path 144, allowing heat to be transferred through the thin-walled sheet to fresh dialysate moving through the path.

[0211] 6 and 9 show that, in one embodiment, first and second supply line valve seats 132b, 132c, final fill line valve seat 132d, and drain line valve seat 132a are each disposed within a common well 146 that is in fluid communication with second peristaltic tubing port 142b. Peristaltic pump tubing 126 is attached (e.g., ultrasonically welded, heat sealed, and / or solvent bonded) to tubing ports 142a and 142b. Thus, fresh dialysate can be pumped in a first direction from either the supply containers (124b to 124d) for first and second supply line valve seats 132b, 132c or final fill line valve seat 132d through common well 146 and inline fluid heating pathway 144, where the fresh dialysate is heated and then delivered to the patient through patient line valve seat 132e. Spent dialysate or effluent can be pumped from the patient in a second direction through the patient line valve seat 132e and the in-line fluid heating path 144 (where the spent dialysate is not heated) into the common well 146, and from the drain line valve seat 132a to the drain container 124a.

[0212] Common well 146 simplifies the fluid path of cassette 130. Drain line valve seat 132a is located closest to peristaltic tubing port 142b, thereby causing spent dialysate to travel a minimum distance within well 146 before reaching the drain line valve seat. FIG. 8, showing the non-operating side of disposable cassette 130, shows drain port 140a, supply container ports 140b and 140c, and final fill container port 140d extending from rigid body 138 on the other side from common well 146. Again, drain port 140a, to which drain line 122a is ultrasonically welded, heat sealed, and / or solvent bonded, is located directly adjacent to peristaltic tubing port 142b, such that spent dialysate is removed from common well 146 as quickly as possible to reduce mixing with fresh dialysate remaining in the well. Supply container lines 122b, 122c, final fill container line 122d, and patient line 122e are similarly ultrasonically welded, heat sealed, and / or solvent bonded to supply container ports 140b, 140c, final fill container port 140d, and patient line port 140e, respectively.

[0213] 7 and 10 illustrate that any of the valve seats (132a through 132e) described herein may include a tapered sealing surface 152 surrounded by a plurality of displacement ribs (154a through 154f), which may extend from the rigid body 138 of the disposable cassette 130, at least some of the displacement ribs (154a through 154f) spaced apart by gaps G, which prevent or mitigate undesired blockage of the tapered sealing surface 152 by the flexible sheet 136 and allow fresh or used dialysate to flow through the gaps G. The displacement ribs (154a through 154f) may be completely separate from one another (see Examples XC through XE of FIG. 10) or may extend from a common cylindrical base (see Examples XA and XB of FIG. 10). The displacement ribs (154a through 154f) may be separate from the tapered sealing surface 152 (see examples XB, XC, and XE in FIG. 10 ), or may extend from or be connected to the outer edge of the tapered sealing surface (see examples XA and XD in FIG. 10 ). The displacement ribs (154a through 154f) help guide the pinch valve plunger 84 toward the center of the valve seats (132a through 132e) while providing a certain amount of resilience or play between the pinch valve plunger and the valve seat. In an embodiment, the tapered sealing surface 152 tapers to form a funnel shape that leads to an opening that allows fresh or used dialysate to flow into or out of the valve seats (132a through 132e). In an embodiment, the opening extends through a port (140a through 140e) located on the other side of the rigid body 138 of the disposable cassette 130 ( FIG. 8 ). The tapered sealing surface 152 may also include or define one or more circular sealing rings 156 that compress the flexible sheet 136 when the flexible sheet is closed by the pinch valves (34a through 34e).

[0214] In an embodiment, a first or patient pressure sensing pod 150a is located within the disposable cassette 130 directly adjacent to the patient line valve seat 132e. When the disposable cassette 130 is loaded, the patient pressure sensing pod 150a outputs to the first or patient pressure sensor 36a, which in turn outputs to the cycler control unit 50. The output of the patient pressure sensor 36a can be used to control the positive and negative pumping pressures experienced by the patient so that they are within safe pressure limits, for example, a positive pressure of 0.21 bar (3 psig) and a negative pressure of −0.10 bar (−1.5 psig). A second or pumping pressure sensing pod 150b is located within the disposable cassette 130 between the common well 146 and the second peristaltic tube port 142b. When the disposable cassette 130 is loaded, the pumping pressure sensing pod 150b is adjacent to the second or pumping pressure sensor 36b, which outputs to the cycler control unit 50. The output of the pumping pressure sensor 36b can be used to detect blockages in the supply and drain lines and / or empty supply and drain containers. For example, a spike in positive pressure from the pumping pressure sensor 36b can indicate a blockage in the drain line 122a or the patient line 122e. In another example, a sudden increase in negative pressure from pumping pressure sensor 36b may indicate (i) an obstruction in patient line 122e or supply lines (122b to 122d), (ii) an empty supply container 124b, 124c, or last fill container 124d during treatment, or (iii) an empty supply container 124b, 124c, last fill container 124d, or drain container 124a at the end of treatment when attempting to drain any remaining unused or used treatment fluid.

[0215] The disposable cassette 130 may also include one or more regions 148 adjacent to a thermocouple or other type of temperature sensor 38 that, when installed for operation, outputs to the control unit 50. The temperature sensing region 148 may be located, for example, at the end of the in-line fluid heating pathway 144 directly adjacent to the patient pressure sensing pod 150a, so that the outlet temperature of the fresh dialysate to the patient can be monitored and controlled to a desired temperature, e.g., body temperature or 37°C, via, for example, a proportional, integral, derivative ("PID") routine executed by the control unit 50 using feedback from the temperature sensor 38. A second temperature sensor and associated cassette temperature region (not shown) may optionally be positioned to detect the temperature at the inlet to the in-line fluid heating pathway 144, which may likewise provide useful information for the PID routine.

[0216] FIG. 6 shows the vertically positioned disposable cassette 130 as it is loaded for operation against the operating surface 30, with the cassette including several features to enhance priming and air handling. With further reference to FIG. 1, it should be understood that a key feature of the overall system 10 for preventing air from reaching the patient is the location of the fresh dialysate supply containers or bags (124b and 124c) and the last filled container or bag 124d, which are higher than the location where the disposable cassette 130 is loaded against the operating surface behind the door 24. Here, air tends to remain within the containers or bags (124b through 124d) and not be delivered to the disposable cassette 130. While not shown, it is conceivable to provide structure within and above the bag shelf enclosure 40 that elevates the rear end of each container or bag (124b through 124d) relative to the forward discharge end of the container. In this way, air tends to migrate away from the bag's connection to its respective tubing (122b through 122d) and toward the rear of the containers (124b through 124d).

[0217] It is also contemplated to place an air sensor or detector (not shown), which may be an ultrasonic sensor with an emitter pair and a receiver pair on either side of the holes or slots (26b through 26d), as shown in FIG. 1. The air sensors or detectors output their output signals to the control unit 50, which monitors them. If air is detected, the control unit 50 (i) stops the peristaltic pump actuator 60 from pumping further toward the patient, (ii) closes the corresponding supply valve seats (132b through 132d) shown in FIG. 6, (iii) opens the drain valve seat 132a, and (iv) reverses the rotation of the peristaltic pump actuator 60, forcing the dialysate with entrained air into the drain line 122a and the drain container 124a.

[0218] FIG. 6 shows that drain valve seat 132a is positioned higher than supply valve seats (132b through 132d) to help move air toward the drain valve seat. Additionally, the top of common well 146 is provided with ramp 146r to direct air upward toward drain valve seat 132a. FIG. 6 further shows that pumping pressure sensing pod 150b is provided with an inlet lower than the top of ramp 146r so that air is encouraged to float away from pumping pressure sensing pod 150b toward drain valve seat 132a. FIG. 6 also shows that the outlets of patient and pumping pressure sensing pods 150a and 150b are directed upward and relatively high, thereby tending to encourage air to leave the pods and aid in the accuracy of fresh and spent dialysate pressure measurements.

[0219] To aid in priming, the serpentine fluid heating path 144 meanders upward to help air exit the disposable cassette 130 during priming through the patient line valve seat 132e and the patient line 122e to atmosphere. The patient line valve seat 132e, like the drain line valve seat 132a, is positioned relatively high when the disposable cassette 130 is loaded for operation. During priming, the distal end of the patient line 122e is held in a priming holder (not shown) located on the housing 22 of the cycler 20. An additional air detector or sensor (not shown), such as an ultrasonic sensor, with an output to the control unit 50 may be incorporated into the priming holder to detect when the patient line 122e is fully primed with fresh dialysate. Placing an additional air sensor or detector (not shown) for the patient line is also contemplated, and may be an ultrasonic sensor with an emitter and receiver pair located on either side of the patient line hole or slot 26e shown in FIG. 1 . The additional air sensor or detector outputs its output signal to the monitoring control unit 50. If air is detected in the patient line 122e, the control unit 50 executes air purge procedures (i) through (iv), forcing the air through the fluid heating pathway 144 and into the drain container or bag 124a.

[0220] (pressure sensor) 11, in one embodiment, the cycler 20 of the system 10 mounts pressure sensors 36a, 36b on or in association with the cycler's working surface 30 such that they reside within holes 30h in the working surface 30, such that when the disposable cassette 130 is loaded for operation, the cassette sheet 136 (which may be polyvinyl chloride (“PVC”) or any of the other polymers listed herein) is contacted and placed under tension by the pressure sensors 36a, 36b, generating a baseline or preload force Fp that is measured by the pressure sensors. FIG. 11 shows a possible diameter of the contact heads of the pressure sensors 36a, 36b, i.e., 10 mm, which also provides an indication as to the size or diameter of the pressure pods 150a, 150b of the disposable cassette 130. The fresh or spent dialysate pressure P further displaces (or attempts to displace) the cassette sheet 136, thereby increasing or decreasing the counter fluid force Fr acting on the pressure sensors 36a, 36b relative to the baseline or preload force Fp. The force difference between Fr and Fp caused by the positive or negative fluid pressure P is correlated by the control unit 50 to an actual fluid pressure value, which is used for pressure control as described herein, and which may be displayed by the user interface 58 and / or stored for distribution to a remote server computer for evaluation.

[0221] Pretensioning the cassette sheet 136 by the pressure sensors 36a, 36b results in a pressure sensing area with high sensitivity and resolution, but it can tend to be temperature sensitive. Therefore, it is contemplated to program the control unit 50 to compensate the pressure readings for temperature. Here, the voltage output (or alternatively, current output) from the pressure sensors 36a, 36b is modified by adding an offset component, which is a function of the measured temperature (e.g., using the temperature sensor 38 and temperature sensing area 148 described above) multiplied by an empirically determined temperature scaling factor to form a compensated voltage output, which is then converted to or correlated to a compensated positive or negative pressure. One suitable scaling or offset algorithm stored in the control unit 50 is as follows: V T =V0+gT, where: V0 is the output from the pressure sensors 36a, 36b; V T is the corrected pressure output used by the control unit 50 going forward, g is the temperature scaling factor, T is the sensed temperature.

[0222] FIG. 12 shows the plot used to determine the temperature scaling factor g for the scaling or offset algorithm described above. For each of the four plot lines, the baseline or preload Fp of pressure sensors 36a, 36b was observed during a 30-minute fluid dwell period for fluid maintained at different temperatures ranging from 15° C. to 40° C. (typical dialysate temperatures). As shown in FIG. 12, an equation characterizing each line was determined. Each equation takes the form y=mx+b, where (i) y is the V T (ii) b is V as above, (iii) x is the measured temperature T as above, and (iv) m is the scaling factor g as above. The m values ​​from each trial were averaged to form the scaling factor g used in the scaling or offset algorithm stored in control unit 50.

[0223] In an embodiment, the control unit 50 is configured to update a compensation algorithm for adjustments in the measured temperature T (i) each time the output from the pressure sensors is read by the control unit, or (ii) periodically. The control unit 50 uses the corrected output V from the pressure sensors 36a, 36b to at least one of: (a) control the medical fluid pump actuator to pump within the patient's positive or negative pressure limits; (b) determine a line occlusion condition; and / or (c) determine the empty status of the fresh dialysate or used dialysate container during or after treatment. T It is configured to use

[0224] As described above, pretensioning the cassette seat 136 via the pressure sensors 36a, 36b results in a pressure sensing regime with high sensitivity and resolution, but it can also be prone to mechanical creep sensitivity. To combat creep sensitivity, in one embodiment, the control unit 50 is programmed to precondition the cassette seat 136 prior to treatment, e.g., during setup, thereby eliminating much of the pressure signal fluctuation due to creep before measurements from the pressure sensors 36a, 36b become significant. To do so, after the disposable cassette 130 is primed for treatment, the control unit 50 closes all pinch valves (34a through 34e) and then activates the peristaltic pump actuator 60, pressurizing the interior of the cassette 130, including the seat of the pressure pods 150a, 150b, to stretch the cassette seat. The control unit 50 can be programmed to cause the pump actuator 60 to oscillate the cassette fluid pressure up and down multiple times, possibly in different directions, over a specified period of time. The high pressure may be, for example, 100% to 150% of the maximum operating pressure set for the procedure, which may be higher than the patient's pressure limit. For example, the pressure used during the priming or drain purge described above may be higher, e.g., 0.50 bar (7.25 psig) or higher. Preconditioning the cassette seat 136 helps make the uncompensated pressure reading more accurate, while temperature compensation helps make the final pressure reading more accurate.

[0225] (Load cell calibration) 13 , the system 10 and cycler 20 of the present disclosure, in one embodiment, uses a weigh scale 100 including multiple operating load cells (102a through 102d) to monitor the volume of fresh dialysate delivered to the patient, the volume of spent dialysate removed from the patient, and from there, enable the control unit 50 to calculate the volume of ultrafiltration (“UF”) removed from the patient. The weigh scale and load cells are advantageous for several reasons. First, the weigh scale 100 is relatively accurate compared to other volume measurement technologies. Second, the weigh scale 100 reduces pump costs because the pump actuator 60 can be a relatively simple peristaltic pump actuator and the disposable portion of the pump can be simple peristaltic pump tubing 126.

[0226] One drawback to using load cells is calibration. Load cells can read inaccurately over time and therefore need to be recalibrated. The present cycler 20 and associated system 10 provide a weigh scale 100 having multiple load cells (102a through 102d) and an on-board structure 110 and associated methodology for calibrating the weigh scale 100. In one embodiment, the weigh scale 100 includes a weight plate 104 positioned on top of the cycler 20 that supports the weight of the bag shelf enclosure 40 and the solution and drain containers (124a through 124d) and associated fresh and used dialysate, respectively. The weight plate 104 and each weighed item on the weight plate are supported by multiple, e.g., four, load cells (102a through 102d) that collectively measure the total mass (bag shelf enclosure 40, containers (124a through 124d), and fluid) placed on the weight plate. The on-board calibration structure 110 in one embodiment includes a linear actuator 112 (which may be of the same type as those used in pinch valves and may include, for example, a motor and lead screw, or a linear stepper motor) and a fifth or calibration load cell 114 disposed below the linear actuator 112, which includes an actuation output shaft 116 fixed to the weight plate 104. The actuation output shaft 116 may, for example, extend through a hole formed in the weight plate 104 and be capped above the upper surface of the weight plate so as to apply a downward force to the plate. Alternatively, the actuation output shaft 116 may be bolted to the underside of the weight plate 104, slide into a groove formed in the underside of the weight plate 104, be screwed into the underside of the weight plate 104, or include a flange with some alternative mechanical connection to the weight plate 104.

[0227] The linear actuator 112 in one embodiment is actuated to apply a pulling or downward force to the weight plate 104. In one implementation, the force is applied to the center of mass CM of the weight plate 104, as shown in FIG. 13. The operating load cells (102a through 102d) in an embodiment are each at least substantially equidistant from the center of mass CM and spaced apart by equal x-coordinate distances (e.g., the distance between the contact points of load cells 102a and 102b is the same as the distance between the contact points of load cells 102d and 102c) and equal y-coordinate distances (e.g., the distance between the contact points of load cells 102a and 102d is the same as the distance between the contact points of load cells 102b and 102c).

[0228] An additional calibration load cell 114 measures the total pulling or downward force applied by the linear actuator 112, and the four operating load cells (102a through 102d) each measure a portion, or quarter, of the total force. If each of the operating load cells (102a through 102d) is operating properly, the sum of their outputs should equal the total force measured by the calibration load cell 114. In one example, assume a pulling force of 1000 Newtons ("N") is applied by the linear actuator 112. The calibration load cell 114 should output 1000 N, while the operating load cells (102a through 102d) should each read 250 Newtons, totaling 1000 N.

[0229] Because the calibration load cell 114 is used infrequently, the calibration algorithm is applied assuming that the output of the calibration load cell 114 is more accurate than the aggregate output of the operating load cells (102a-102d) used throughout each procedure. Thus, during calibration, if there is a discrepancy between what the calibration load cell 114 reads and the aggregate output of the operating load cells (102a-102d), the control unit 50, using the calibration algorithm, scales or offsets the aggregate output of the operating load cells (102a-102d) to match the aggregate output of the calibration load cell 114. In the example above, assume that the operating load cells (102a-102d) actually collectively read 995 N instead of 1000 N. Therefore, the operating load cells (102a-102d) are reading 0.5% under. Thereby, the control unit 50 of the cycler 20 is configured to correct the collective output of the operating load cells (102a through 102d) during the procedure by a calibration factor of 1000 / 995 or 1.005.

[0230] The load cell calibration routine or algorithm of the system 10 is executed at any desired interval, for example, before the start of each treatment. The control unit 50 controls the duration of the pump actuator 60 operation (patient fill or drain), for example, using offset output pressures from the operating load cells (102a through 102d). The control unit 50 is configured to prevent the linear actuator 112 from supplying force during such operation duration. In another example, the control unit 50 is configured to determine a mass or volumetric flow rate during treatment using two or more offset outputs from the operating load cells (102a through 102d). In a further example, the control unit 50 is configured to determine the amount of fresh dialysate to be delivered using at least two offset outputs from the operating load cells (102a through 102d). In yet another example, the control unit 50 is configured to determine the amount of used dialysate to be delivered using at least two offset outputs from the operating load cells (102a through 102d). In yet a further example, the control unit 50 is configured to use at least two offset outputs from the operating load cells (102a through 102d) to determine the amount of spent dialysate delivered to or removed from the patient.

[0231] It should also be understood that because many of the weight values ​​monitored and collected during treatment are weight differences, errors in the aggregate output of the operating load cells (102a-102d) tend to cancel out, assuming the errors do not change over the course of treatment. For example, the mass associated with a patient fill volume of, say, 2 liters, is monitored and controlled by the aggregate output of the operating load cells (102a-102d) by recording the drop in mass over the course of the patient fill. The volume and mass associated with the patient drain may be preset in the control unit 50, for example, multiplying the fill volume by a factor such as 1.3 to account for the patient UF removed within the drain volume. The volume and mass associated with the patient drain may alternatively be left open-ended and instead controlled by detecting a characteristic rise in negative pressure with the pumping pressure sensing pod 150b and associated pressure sensor 36b, which indicates that the patient is essentially fully drained and that further draining may be uncomfortable for the patient. In either case, the motion load cells (102a through 102d) sense an increase in weight over the course of the patient drain which should tend to offset the motion load cell error.

[0232] It should be understood that various modifications and variations of the presently preferred embodiments described herein will be apparent to those skilled in the art. Accordingly, it is intended that such modifications and variations be covered by the appended claims. For example, while system 10 discloses peristaltic pumping, membrane pumping or volumetric pumping may alternatively be used. While system 10 discloses in-line heating, batch heating may alternatively be used. Furthermore, while calibrated load sensing is disclosed in connection with supply and drain containers, calibrated load sensing may alternatively be used with a dialysate preparation unit that pumps to one or more weight containers disposed on a weight plate.

Claims

1. A peritoneal dialysis system (10), comprising: a cycler (20) including a pump actuator (60); A disposable set (120), comprising: a pumping section (126) operable with the pump actuator (60); a patient line (122e) disposed in fluid communication with the pumping section (126); a drain container (124a) disposed in fluid communication with the pumping section (126); a disposable set (120) including: a supply container (124b) disposed in fluid communication with the pumping portion (126) of the disposable set (120); a control unit (50) in operative communication with the sensor; Equipped with The control unit (i) performing a peritoneal dialysis treatment in which fresh dialysate is pumped from the supply container through the patient line (122e) to a patient and spent dialysate is pumped from the patient to the drain container (124a); (ii) pumping the spent dialysate from the drain container (124a) through the patient line (122e) to a house drain at the end of the peritoneal dialysis treatment; and causing the pump actuator (60) to operate the pumping section to perform the supply container (124b) is used to receive spent dialysate from the patient later during the peritoneal dialysis treatment; The control unit (50) using an output from the sensor to determine when one of the drain container (124a) or the supply container (124b), which will subsequently be used as a drain container after pumping the spent dialysis to the house drain, is empty or substantially empty; and then switching to the other of the drain container or the supply container (124b) to be subsequently used as a drain container for pumping the used dialysis to the house drain. A peritoneal dialysis system (10) configured to perform the following.

2. 2. The peritoneal dialysis system of claim 1, wherein the pump actuator is a peristaltic pump actuator and the pumping portion of the disposable set includes peristaltic pump tubing.

3. 2. The peritoneal dialysis system of claim 1, further comprising an extension line configured to be connected to the patient line when needed to reach the house drain.

4. The peritoneal dialysis system (10) of claim 3, wherein the extension line (122f) is reusable.

5. 2. The peritoneal dialysis system of claim 1, further comprising a user interface in communication with the control unit, the user interface configured to prompt the patient to disconnect from the patient line and move the patient line toward the house drain upon completion of the peritoneal dialysis treatment.

6. 2. The peritoneal dialysis system of claim 1, further comprising a user interface in communication with the control unit, the user interface configured to provide or enable a drain button to initiate the pumping of the spent dialysate from the drain container through the patient line to the house drain at the end of the peritoneal dialysis treatment.

7. 7. The peritoneal dialysis system of claim 6, wherein the user interface is further configured to require confirmation that a drain line is in fluid communication with the house drain before providing or enabling the drain button.

8. 2. The peritoneal dialysis system of claim 1, wherein the cycler includes a patient valve actuator that operates with a patient valve seat provided by the disposable set and a drain valve actuator that operates with a drain valve seat provided by the disposable set, and the control unit is configured to cause the patient valve actuator and the drain valve actuator to enable flow through the patient valve seat and the drain valve seat to pump the spent dialysate from the drain container through the patient line to the house drain.

9. 9. The peritoneal dialysis system of claim 8, wherein at least one of the patient valve actuator or the drain valve actuator is a pinch valve actuator.

10. The peritoneal dialysis system (10) of claim 1, wherein the sensor is a weight sensor (102a to 102d) or a pressure sensor (36a, 36b).

11. 2. The peritoneal dialysis system of claim 1, wherein the control unit is further configured to cause the pump actuator to operate the pumping section to pump remaining fresh dialysate from the supply container through the patient line to the house drain at the end of the peritoneal dialysis treatment.

12. A peritoneal dialysis system, comprising: a cycler including a pump; a patient line disposed in fluid communication with the pump; a first container disposed in fluid communication with the pump; a second container disposed in fluid communication with the pump; Control unit and Equipped with The control unit, during a peritoneal dialysis treatment, (i) pumping spent dialysate from a patient through the patient line to the first container and the second container; (ii) pumping the spent dialysate from the first container and the second container through the patient line to a house drain at the end of the peritoneal dialysis treatment; and operating the pump to perform the steps of:

13. The cycler includes a sensor in operative communication with the control unit, the control unit comprising: using an output from the sensor to determine when the first container is empty or substantially empty after pumping the spent dialysate to the house drain; thereafter, switching to the second drain container for pumping the spent dialysate to the house drain; The peritoneal dialysis system of claim 12, configured to:

14. A peritoneal dialysis system as described in claim 13, wherein the sensor is a weight sensor or a pressure sensor.

15. A peritoneal dialysis system as described in claim 12, wherein the control unit is configured to simultaneously pump the used dialysis fluid from the first and second drain containers through the patient line to the house drain.

16. The cycler includes a sensor in operative communication with the control unit, the control unit comprising: using an output from the sensor to determine when the first container is full or substantially full after pumping the spent dialysate from the patient through the patient line to the first container; thereafter, switching to the second container for pumping the spent dialysate from the patient through the patient line to the second container; The peritoneal dialysis system of claim 12, configured to:

17. A peritoneal dialysis system as described in claim 16, wherein the sensor is a weight sensor or a pressure sensor.

18. A peritoneal dialysis system as described in claim 12, wherein during (i), pumping the used dialysis fluid from the patient through the patient line to the first container and the second container includes causing the pump to pump in a first direction, and during (ii), pumping the used dialysis fluid from the first container and the second container through the patient line to a house drain includes causing the pump to pump in an opposite second direction.

19. A peritoneal dialysis system as described in claim 12, further comprising a user interface communicating with the control unit, the user interface configured to provide or enable a drain button to initiate the pumping of the used dialysis fluid from the first container and the second container through the patient line to the house drain at the end of a peritoneal dialysis treatment.

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