The invention relates to devices for delivery of intradermal injections generally, and more particularly to an adapter device combinable with a standard syringe to form an assembly for delivery of an intradermal injection.
Intradermal injections are used for delivering a variety of diagnostic and treatment compositions into a patient. Substances may be injected intradermally for diagnostic testing, such as to determine a patient's immunity status against tuberculosis and the status of allergic diseases. Vaccines, drugs and other compounds may also be delivered intradermally. In many instances, intradermal delivery is preferred because it generally requires a smaller volume dose of the diagnostic or treatment compound than other delivery techniques. An intradermal injection is made by delivering the substance into the epidermis and upper layer of the dermis. There is considerable variation in the skin thickness, both between individuals and within the same individual at different sites of the body. Generally the outer skin layer, or the epidermis, has a thickness between 500-200 microns and the dermis, the inner and thicker layer of the skin, has a thickness between 1.5-3.5 min.
Making intradermal injections is difficult and generally requires an experienced nurse or medical professional. Incorrect placement of the tip of the needle cannula leads to a failed injection. The placement of the needle tip deeper than about 3.0 mm has the potential of delivering the injection into the subcutaneous region, where the intradermal dosage may be insufficient. Incorrect placement of the needle cannula may also puncture the skin again after being inserted into dermis, with the delivered compound being lost on the surface of the skin. Injection is often followed by a jet effect, with the compound exiting the injection site through the needle puncture track. The jet effect is even more pronounced for injections through a needle placed perpendicular to the injection site and in particular for shallow delivery. The success of intradermal injections is often determined by the experience of the healthcare professional. The preferred intradermal injection technique (using a standard needle) requires the healthcare professional to stretch the skin, orient the needle bevel to face upward, and insert a short bevel needle cannula at an angle of around 10-15 degrees, assuring that 2 to 3 mm of the needle cannula are located in the skin. The needle tip ends up positioned in the dermis or close to epidermis boundary. The compound is slowly injected into the skin of the patient, forming a blister or wheal. The insertion of the needle at an incorrect angle and/or depth results in a failed intradermal injection. Intradermal (ID) injection has been considered for immunization in the past, but has generally been rejected in favor of more reliable intramuscular or subcutaneous routes of administration because of the difficulty in making a successful ID injection.
Administration into the region of the intradermal space has been routinely used in the Mantoux tuberculin test, in which a purified protein derivative is injected at a shallow angle to the skin surface using a 27 or 30 gauge needle and a standard syringe. The technique is known to be quite difficult to perform and requires specialized training. A degree of imprecision in the placement of the injection results in a significant number of false negative test results. As a result, the Mantoux approach has not led to the use of intradermal injection for systemic administration of substances, despite the advantage of requiring smaller doses of substances.
There have been attempts to develop devices that would assure a precise needle penetration depth during ID injection which tends to vary due to tissue compliance, penetration angle, skill level and other factors. These are detailed in U.S. Pat. Nos. 4,393,870 and 6,200,291 and US Published Patent Applications Numbers 2003/0093032 and 2004/0147901. These devices employ complex constructions that tension the skin by vacuum, expanding the mounting surface prior to the needle insertion.
Alchas et al. developed a unique intradermal needle assembly for the delivery of compounds into the intradermal space by penetrating the dermis perpendicularly to its surface. A limiter supporting the needle is placed on the skin, the needle inserted, and the compound delivered. The penetration depth is in the 0.5 to 3 mm range, with a device limiter setting the penetration depth. There is a broad range of patents, issued and pending, defining different features of the system. U.S. Pat. Nos. 6,494,865, 6,569,123, 6,689,118, 6,776,776, and U.S. Patent Publication Number 2003/0199822 describe such systems. The main limitation of the systems developed by Alchas et al. is the broad range of deposit depth due to assembly tolerances, needle bevel and the variations in skin properties. Another concern is back flow through the needle channel from the deposit pool to the surface of the skin due to a short direct channel formed by the needle. The jet effect further limits the performance when a shallow delivery is attempted.
Shielding and disposal of the contaminated needle cannula is a primary concern upon completion of an injection. It is preferable to cover the contaminated needle as soon as the intradermal injection is completed. A number of different approaches to shielding the contaminated needle are discussed in U.S. Pat. Nos. 4,631,057; 4,747,837; 4,801,295; 4,998,920; 5,053,018; 5,496,288; and 5,893,845.
The lack of suitable devices to accomplish reproducible delivery to the epidermal and dermal skin layers has limited the widespread use of the ID delivery route. Using conventional devices, ID injection is difficult to perform, unreliable and painful to the subject. There is thus a need for devices and methods that will enable efficient, accurate and reproducible delivery of agents to the intradermal layer of skin.
WIPO Patent Application Publication WO/2008/131440 (“the '440 publication”) discloses devices and methods for intradermal administration of diagnostic and therapeutic agents, vaccines and other compounds into the dermal layer of the skin. The '440 publication is incorporated herein by reference in its entirety. The devices and the methods simplify the ID injection process and increase the consistency of the placement of the needle tip in the dermal space close to the skin surface allowing for a shallow cannula placement in the dermis. Furthermore, the devices and methods broaden the number of sites suitable for ID injection and make successful ID injections possible with limited training.
The applicability of devices disclosed in the '440 publication would be substantially broadened with design improvements allowing for improved placement depth of the cannula in the dermis. Furthermore, a design facilitating the ease of device and syringe merger would be of a substantial benefit. The improvements facilitating the ID injection using one hand and other features would also be beneficial for the use of ID devices and methods. There is thus a need for improvements to devices and methods for efficient, accurate and reproducible delivery of agents to the intradermal layer of skin.
Briefly stated, in a first aspect the invention is an adapter device for use in combination with a syringe to form an assembly for delivering an intradermal injection. The adapter device comprises a body which is connectable to the syringe. A second primary skin contacting surface is positioned at a distal end of the body. At least one support element is connected to the body. With the assembly in an assembled condition, the at least one support element supports a needle cannula connected to the syringe. The needle cannula is supported by the at least one support element intermediate a base and a tip of the needle cannula. At least a terminal portion of the needle cannula extends axially in a direction at least substantially parallel to at least a planar portion of the second primary skin contacting surface.
Preferably, the adapter device further comprises a first primary skin contacting surface positioned at the distal end of the body. The first primary skin contacting surface is positioned at an angle to the second primary skin contacting surface between approximately 100 degrees and approximately 165 degrees.
Further preferably the adapter device body is formed in a first portion and a second portion, the portions being rotatably connectable. A first support element is connected to the first portion and a second support element connected to the second portion. The first and second support elements support the needle cannula along a plane passing through a centerline of the syringe.
Alternatively, the adapter device may preferably include a single support element connected to the body, wherein the support element supports the needle cannula at a point offset from a syringe centerline in one of a plane at least substantially perpendicular to the planar portion of the second primary skin contacting surface or a plane at least substantially parallel to the planar portion of the second primary skin contacting surface.
The foregoing summary, as well as the following detailed description of the invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, there are shown in the drawings embodiments which are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown.
In the drawings:
Certain terminology is used in the following description for convenience only and is not limiting. The words “right”, “left”, “lower”, “upper”, “horizontal” and “vertical” designate directions in the drawings to which reference is made. The words “inwardly” and “outwardly” refer to directions toward and away from, respectively, the geometric center of the adapter device and designated parts thereof. Unless specifically set forth herein, the terms “a”, “an” and “the” are not limited to one element but instead should be read as meaning “at least one”. The terminology includes the words noted above, derivatives thereof and words of similar import.
Referring to the drawings, shown in
The body 110 may be sized and shaped to accept any type of syringe 20, for example a fixed needle style syringe 30 (see
With continued reference to
Preferably, the adapter body 110 further comprises a first primary skin contacting surface 130 positioned at the distal end 126 of the body 110. With reference to
Like the second primary skin contacting surface 132, the first primary skin contacting surface is preferably planar in its entirety, as illustrated, but alternatively could comprise both a planar portion and a non-planar portion (not illustrated).
Note that the first primary skin contacting surface 130 is optional. Alternatively, the opening 136 could be enlarged to such an extent as to effectively eliminate the first primary skin contacting surface 130. This alternative configuration is not illustrated in the drawings.
With reference again to
With reference now to
The support elements 140, 150 function to align at least the terminal portion 27 of the needle cannula 24 primarily relative to the second primary skin contacting surface 132 such that at least the terminal portion 27 of the needle cannula 24 extends axially in a direction substantially parallel to at least the planar portion of the second primary skin contacting surface 132. As noted above in the background section, controlling the depth into the skin of an intradermal injection is critical to the success of the injection. It is therefore critical to properly align at least the terminal portion 27 of the needle cannula 24 relative to the second primary skin contacting surface 132, as variation of needle cannula 24 alignment relative to the second primary skin contacting surface 132 translates directly into variation of depth of the intradermal injection.
The need for alignment is driven by the normal tolerance of the angularity of the needle cannula 24 resulting, for example, from manufacturing variability or post-manufacturing deformation of the needle cannula. Any needle cannula possesses an angularity tolerance from its base to its tip. Taking the base as a reference point, this angularity tolerance forms a cone of positional uncertainty increasing in its radial extent in a linear manner from base to tip. For example, a two degree tolerance on angularity for a 1 inch long needle results in a circular zone of positional uncertainty at the tip having a radius of acrtan (2°)=0.035 inches.
Note further that providing a support intermediate the hub and tip in effect stiffens the needle cannula 24, reducing the tendency of the needle cannula 24 to deflect during the injection process (such deflection thus increasing the difficulty in ensuring the intradermal injection is delivered at the proper depth). The intermediate support thus provides an additional advantage in that a smaller diameter (and more flexible) needle cannula 24 may be used, in view of the enhanced stiffness resulting from the intermediate support.
With reference now to
With reference again to
With reference now to
With reference now to
With reference now to
Like the first embodiment body 110, the second embodiment body 210 may be sized and shaped to accept any type of syringe 20, for example a fixed needle style syringe 30 shown in
The body 210 has a body centerline 212, which, in the assembled condition, is preferably, but not necessarily, coincident with the syringe centerline 22. The body further comprises a second primary skin contacting surface 232 positioned at a distal end 226 of the body 210. Similarly to the first embodiment body 110, the second primary skin contacting surface 232 is preferably, as illustrated, in its entirety a planar surface. Alternatively, the second primary skin contacting surface 232 could comprise both a planar surface forming only a portion of the second primary skin contacting surface 232, with a remaining portion of the second skin contacting surface being non-planar. In one embodiment, as illustrated in
Preferably, the second embodiment adapter body 210 further comprises a first primary skin contacting surface 230 positioned at the distal end 226 of the body 210. As with the first embodiment adapter device 100, preferably the first and second primary skin contacting surfaces 230, 232 are positioned at an angle 234 (see
Like the second primary skin contacting surface 232, the first primary skin contacting surface 230 is preferably planar in its entirety, as illustrated, but alternatively could comprise both a planar portion and a non-planar portion (not illustrated).
Note as before with the first embodiment adapter device 100, that the first primary skin contacting surface 230 is optional. Alternatively, the opening 236 could be enlarged to such an extent as to effectively eliminate the first primary skin contacting surface 230. This alternative configuration is not illustrated in the drawings.
The second embodiment adapter body 210 is formed to receive the syringe 20 in a sideways motion. Stated otherwise, the body 210 includes side openings 214, including a syringe barrel side opening 216, a syringe hub portion side opening 218, and a needle cannula side opening 220. The syringe 20 can thus be assembled with the second embodiment adapter device 200 in a direction substantially perpendicular to body centerline 212.
With reference now to both
With continued reference to
Before proceeding further with the detailed description of the invention, it should be noted relative to the schematic representations of needle alignment techniques to be discussed herein below that the simple linear deflected shapes schematically illustrated do not accurately reflect the actual deflected shape of the needle cannula 24, which of course will vary depending on the support conditions and flexure characteristics of the actual needle cannula 24 (for example, stiffness of the needle hub, material of the needle cannula 24, and diameter of the needle cannula 24). Accordingly, the simplified linear shapes shown should be understood to be mere approximations.
With reference now to
More particularly, as illustrated schematically in
In order to appropriately control the depth of the injection, the planar portion of the second primary skin contacting surface 232 is inclined relative to the syringe centerline 22 at a non-zero angle 282 (nominally equal to angle 280), such that the planar portion of the second primary skin contacting surface 232 is oriented substantially parallel to the terminal portion 27 of the needle cannula proximate the tip 28. The support angle 280 and the non-zero angle 282 are thus formed in the vertical plane 248 (illustrated in
Recall that the simple linear deflected shape schematically illustrated does not accurately reflect the actual deflected shape of the needle. Accordingly, the actual optimal angle at which the second primary skin contacting surface should be inclined to the syringe centerline 22 to accomplish as nearly as possible parallelism between the terminal portion 27 of the needle and the planar portion of the second primary skin contacting surface 232 may not be angle 280, but rather an angle approximately equal to support angle 280. In practice, the non-zero angle 282 may exceed the support angle 280 due to the fact that the needle cannula 24 will leave the hub along the syringe centerline 22 and then be deflected at support point 290.
With reference to
Note that
With reference now to
As with the third alignment technique, it would be possible to reorient the V-groove portion 244 from a side insertion configuration (illustrated in
Rather than incorporating the V-groove portion 244 illustrated, alternatively two opposing inclined ramp portions (corresponding to opposing sides of the V-groove portion 244) could be provided, but rather than joining together at the vertex, the opposing sides could join opposing sides of a slot (not illustrated). The width of the slot could be slightly larger than the diameter of the needle cannula 24, to allow the needle cannula 24 to slide within the slot (not illustrated). The closed end of the slot would be positioned along the syringe centerline 22. Thus, the slot (not illustrated) would extend from approximately from where the vertex of the V-groove portion 244 would fall in the illustrated embodiment (see
It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but it is intended to cover modifications within the spirit and scope of the present invention as defined by the appended claims.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US2009/066960 | 12/7/2009 | WO | 00 | 2/1/2011 |
Number | Date | Country | |
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61201125 | Dec 2008 | US | |
61203274 | Dec 2008 | US |