The present invention relates to peristaltic pumps and cassettes which may be used in peristaltic pumps to selectively control fluid flow and prevent free-flow situations.
There are numerous environments in which peristaltic pumps are used to deliver fluids. Peristaltic pumps are often advantageous because of their ability to deliver relatively accurate doses and to deliver metered doses over a prolonged period of time. Peristaltic pumps may be used to dispense liquids in laboratories, to regulate fluid flow in automobiles, and are frequently used in the medical field to deliver fluids to a patient. These fluids may be those which are delivered to the digestive tract, commonly referred to as “enteral” applications, or to into the venous system, commonly referred to as “parenteral” applications.
There are many different types of enteral feeding devices, including nasogastric, esophagastric, and abdominal feeding apparatus for supplying nutritional products to patients. These nutritional products, which are almost always flowable, are available for a variety of supplanting and supplemental feeding requirements.
Likewise, there are many different types of parenteral infusion devices which deliver IV solutions, medication and some forms of nutrition to patients. Each system has relative advantages and disadvantages depending on the context.
Conventional infusion and feeding apparatuses, whether for enteral or parenteral applications, typically include a pump and various components and/or accessories for transferring the nutritional product or IV solution from a container (e.g., a bottle or bag) into the digestive tract or venous system, respectively, of a patient. These components, which may be reusable or disposable, typically include various tubing and connectors. All of the components (e.g., tubing and connectors) necessary for transferring the nutritional product or IV solution to a patient using a specific pump, are often collectively referred to as a “feeding set” or an “infusion set.” For ease of references, infusion sets and feeding sets will be referred to herein as a “feeding set” or “feeding sets” and it shall be understood that such covers enteral and/or parenteral applications.
In many embodiments, the feeding set has an inflow tubing line which connects to the container and an outflow tubing line which attaches to the patient. Between the inflow tubing line and the outflow tubing line is a piece of tubing which is more resilient and made according to more specific tolerances. This pump tubing segment engages the pump to deliver precise quantities of a desired fluid to the patient. The pump tubing segment is generally made of silicone and is more expensive, while the inflow tubing line and the outflow line can be made from less expensive tubing material which need not meet the more specific tolerances and performance characteristics of the pump tubing segment. Connectors are typically used to attach the pump tubing segment to the inflow tubing line and the outflow tubing line. The connectors may be disposed at opposing ends of a pump tubing segment for use in a linear or curvilinear peristaltic pump, or may be formed as one piece with the pump tubing segment being formed into a loop for engaging a rotor of a peristaltic pump. For ease of reference, both configurations may be referred to as a “cassette.” Thus, as used herein, the cassette is the portion of the feeding set that engages the pump to control fluid flow.
One concern with feeding sets is controlling free flow situations. When a fluid is being infused into a patient, it is usually desirable for the rate of flow to be regulated. It is disadvantageous in many circumstances to have a condition, commonly referred to as free-flow, in which flow into the patient is controlled solely by the force of gravity. Such conditions can result in a large volume of solution being infused into a patient over a very short period of time. Due to medical conditions or medication contained in the infused solution, a free-flow condition can pose health concerns to a patient. In some situations it can even result in death of the patient.
Because of these concerns, numerous devices have been developed to regulate free-flow in medical pumps. One challenge with the use of anti-free-flow devices is retrofitting presently existing pumps. While newer pump models are typically designed to accommodate anti-free-flow devices, pumps that are already in existence may lack such structures. One concern with occluders used with some existing pumps is that a free-flow condition can occur if the infusion set is not properly mounted in the pump. For example, if the occluder is mounted in a mounting structure and moved into an open position to allow flow but the infusion set is not properly wrapped around the rotor of the pump, there is nothing to control the rate of flow through the infusion set.
One solution to prevent free flow in feeding sets is the use of an in-line occluder. In such devices, an occluder or stop is disposed inside the tubing of the infusion set, typically in the pump tubing segment. The stop prevents flow through the tubing unless a flow channel is formed between the tubing and the stop. In-line occluders are advantageous because they are relatively inexpensive and lower the risk of accidentally creating a free-flow condition.
One problem with in-line occluders is that many older enteral feeding pumps develop relatively low pumping pressures. Because of this, the pumping pressure is occasionally inadequate to overcome the occluder or requires sufficient force that the pump inaccurately determines that there is an undesired occlusion downstream from the pumping mechanism. This causes the generation of an alarm which requires the response of medical personnel to determine that the tubing is in fact not occluded. These nuisance alarms waste the time and effort of medical personnel and unnecessarily disrupt the infusion process.
For example, as shown in
The occluder 1 is advantageous over many other occluders because it will prevent flow through the infusion tubing if the tubing is inadvertently removed from the pump rotor. Other occluders, such as some pinch clip or sliding occluders, are opened when the tubing 2 is mounted on the pump and will not close if the tubing becomes loose.
One issue with the occluder 1 configuration is nuisance occlusion alarms on older pump models. Many older pumps, such as the pump 3, have relatively low pumping power and will detect on undesired occlusion downstream based simply on the pressure needed to bypass the in-line occluder. Thus, it is desirable to have an occluder mechanism which will allow flow without nuisance alarms when the infusion set is properly mounted on the pump, and which will prevent a free-flow condition through the line if the tubing comes off the pump rotor or is otherwise not properly engaging the rotor.
While consideration has been given to simply opening the occluder when the infusion set is mounted on the pump, this still leaves open the risk of a free-flow situation. If the infusion line were inadvertently removed from around the rotor, the rotor would no longer act on the infusion line to control fluid flow. Thus, a free-flow situation could develop, potentially injuring the patient. Thus, there is a need for an apparatus and method for providing protection against a free-flow condition while avoiding nuisance alarms.
While in-line occluders and the like have made marked improvements in the control of free-flow situations, the prevalent use of peristaltic pumps in the medical industry has led to new inquiries seeking improved manufacturing techniques, lower costs, and easier use for care providers and consumers alike. Many attempts have been made to improve the state of the art of such technology, but room for improvement remains in the current technology. There are several areas for improvement associated with the use of peristaltic pumps and feeding sets.
One issue of concern is how to improve control of fluid flow when the feeding set is not mounted in and controlled by the pump. On one hand, it is disadvantageous to allow free-flow conditions. Likewise, it is disadvantageous to allow the solution to leak out of the feeding set. On the other hand, those loading the cassettes need to be able to allow flow through the feeding set to allow for priming of the cassette prior to use. While valves have been used to control fluid flow, they often make priming more difficult. In fact, some prior technology requires multiple hands to actuate a valve to prime the feeding set.
While the need remains to prevent free-flow and leakage in the feeding sets when not being used to deliver solutions under control of the pumping mechanism, there is also a need to establish, maintain, and increase ease-of-use and convenience for users and providers. Further, it is also desirable to meet these needs while reducing material and fabrication costs.
The technology improvements offered by the various aspects of the invention described herein enable new ways to meet improve usability and lower costs due to improved designs.
An anti-free-flow mechanism for use with a medical pump and associated methods of use is disclosed. Embodiments of an anti-free-flow mechanism may include an occluder mechanism mounted on or in the infusion line which is biased into a closed position and which, when mounted on the pump, is opened as the infusion set is wrapped in tension around the rotor of the pump. The occluder mechanism may be configured to allow flow through the infusion tube as long as the tubing around the pump is in tension. In the event that tension is no longer present in the infusion pump around the tube, the occluder mechanism closes once again and prevents fluid from flowing through the tubing. Thus, flow through the tubing is not prevented as long as the tubing is properly mounted on the pump, but is terminated in the event that the tubing becomes loose.
According to some embodiments, the safety occluder is formed as a pinch clip which is biased so that the exterior of the tubing is pinched closed to prevent flow. Mounting the infusion set on the pump causes the pinching mechanism to be moved open. However, if the tubing is somehow removed from the rotor so that the infusion set is no longer in tension, the biasing element will return the pinching mechanism to an occluding orientation and thereby prevent fluid flow.
In other embodiments, a pinching mechanism is used to apply force to the tubing and thereby open a flow path past an in-line occluder when the infusion set is properly mounted in an infusion pump. However, when tension is released from the infusion set, the force on the tubing is released and flow through the infusion set is again stopped.
In accordance with another aspect of the present invention, an improved peristaltic delivery system is provided. Various aspects of the invention improve usability and/or lower cost for the delivery of fluids with a peristaltic pump. Thus, the various embodiments and aspects of the invention provide an improvement over the prior art.
In accordance with one aspect of the invention, a peristaltic pump system is contemplated. The pump system preferably includes a pump body having a mounting plate with a peristaltic pumping mechanism (e.g., a rotor) which is configured to receive and removably capture a cassette of a feeding set. The cassette may include a pump tubing segment disposed to engage the pumping mechanism, and a valve formed by the pump tubing segment and an inline occluder to form a valve which selectively prevents flow through the lumen in the tubing.
The cassette may include a deflectable primer or actuator formed with an actuation pad disposed adjacent the pump tubing segment and occluder. The primer has a first position wherein it is disposed away from the tubing segment and occluder such that the tubing segment and occluder form a valve which is in a biased closed orientation, and a second position wherein the actuator is moved into contact with the tubing segment to distend or deform the tubing segment adjacent the occluder and open a flow channel between the occluder and the tubing segment.
In accordance with one aspect of the invention, the actuator may have a pad configured to deform the pump tubing segment adjacent the occluder to open flow in the lumen past the occluder, thereby opening the valve to allow flow through the feeding set. In some embodiments, the pad may have an tapering channel which engages the tubing segment to stretch or deform the pump tubing segment adjacent the occluder.
In accordance with another aspect of the invention, the actuator and occluder may be positioned on the cassette adjacent the inflow line or the outflow line to enable priming of the lumen from a location upstream or downstream from where the pumping mechanism will engage the cassette.
In accordance with another aspect of the invention, the actuator may include a flex joint integrally formed with the carrier or connector and extending therefrom. A flexible or bendable arm may also extend from the flex joint to an extent proximate the location of the occluder in the tubing segment.
In accordance with still yet another aspect of the invention, the actuator may have an engagement member which may include projections forming a channel which includes a radius similar to that of the tubing wall which defines the lumen, or similar to the outer diameter of the occluder stop.
In accordance with another aspect of the invention, the actuator may include one or more load distributors along the arm.
In accordance with another aspect of the invention, at least one reinforcement may also be incorporated about the actuator either alone or in combination with any of the configurations described herein. The at least one reinforcement may be included about the flex joint and/or flexure arm to establish a pre-established and or predetermined preload to the actuator so that a predetermined amount of force must be imparted to deflect the actuator into engagement with the tubing segment adjacent the occluder.
In yet another aspect of the invention, the flex joint, the arm, and the at least one flexure reinforcement may be employed alone or in combination and may form the entire actuator, or may be incorporated as a part of the actuator.
In accordance with yet another aspect of the invention any of the embodiments of the innovative fluid delivery sets may also include an actuator arm that can depend or extend from the carrier or connector to an extent of the actuator.
In accordance with another aspect of the invention, an engagement member (which may also be referred to as an actuation pad or deformation anvil) may be carried on the actuator and may be urged against the tubing segment proximate the inline valve formed by the occluder and tubing segment. When so deflected and urged, the engagement member engages and deforms a portion of the tubing segment to form one or more flow channels between the tubing segment and the occluder.
In accordance with yet another aspect of the invention, the mounting plate of the pump and/or the cassette may include one or more walls or elements that can capture the cassette on the mounting plate when the pump tubing segment is placed in tension on the mounting plate. The walls or elements may include complementary surfaces and/or recesses and projections to hold the cassette in place on the mounting plate. Additionally, the recesses and projections may be configured to provide a human perceptible signal to verify that the cassette has been properly mounted on the mounting plate.
In yet another aspect of the invention, the cassette body and the pump mounting structure each have complementary engagement members which have complementary engagement surfaces. The engagement members are configured so that the engagement surfaces will suddenly align as the engagement surfaces slide with respect to one another, thereby providing a sound or other human perceptible signal that the engagement surfaces of the cassette body and the mounting structure are properly aligned and that the cassette body is properly held in place on the pump.
The various aspects of the invention may be made and used either alone or in combination with one another and with the features and elements already known in the prior art. Such embodiments can be better understood by those with relevant skills in the art with reference to the following detailed description of the preferred embodiments and the accompanying figures and drawings.
Various embodiments are shown and described in reference to the numbered drawings wherein:
It will be appreciated that the drawings are illustrative and not limiting of the scope of the invention which is defined by the appended claims. The various elements in the illustrated embodiments are exemplary and not comprehensive of all possible variations and embodiments. It is appreciated that not every element can be clearly displayed in a single drawing, and as such every drawing may not show each and every element of each embodiment.
The drawings will now be discussed in reference to the numerals provided therein so as to enable one skilled in the art to practice the present invention. The drawings and descriptions are exemplary of various aspects of the invention and are not intended to narrow the scope of the appended claims.
Turning now to
The occluder mechanism 10 may include a plunger or slider 24 which engages the tubing 14. A biasing element 28, such as a spring, band, etc., may bias the slider 24 into engagement with the tubing 14 so as to pinch the tubing closed and thereby occlude the tube and prevent flow therethrough. Thus, the occluder mechanism 10 may be biased in a closed position which prevents flow.
An actuator 32, typically in the form of a pivot clip, may be disposed in engagement with the slider 24. Movement of the actuator 32, e.g. rotation of the pivot clip about an axis 34 (
The occluder mechanism 10 has at least one sloped sidewall 36 which is configured to allow the occluder mechanism to nest in the mounting structure 20 so that the sloped sidewall 36 engages a sloped sidewall 40 of the mounting structure 20 or some other structure in the sidewall. As the tapered occluder mechanism 10 slides into the tapered opening in the mounting structure 20, the wall 40 helps to center the occluder mechanism.
The wall 40 or a portion thereof may also engage the actuator 32 and push it inwardly into the occluder mechanism 10. This causes the slider 24 to move out of the closed, pinching position and into an open, non-occluding position where flow through the tubing 14 is enabled. Thus, mounting the occluder mechanism 10 in the mounting structure 20 opens flow through the tubing, as shown in
The engagement of actuator 32 and the sidewall 40 of the mounting structure 20, however, prevents the occluder mechanism 10 from remaining in the mounting structure in the event that the tubing 14 is not properly loaded. The biasing element 28 provides a force against the slider 24, and thus against inward movement of the actuator 32. If an external force is not applied to the occluder mechanism 10, the biasing element 28 will cause the occluder mechanism (via the slider 24 and actuator 32) to push against the mounting structure 20 to move upwardly, thereby returning the slider 24 into the occluding position. To overcome this biasing, the tubing 14 is placed in tension when it is wrapped around the rotor of the pump as represented by the arrow 50 in
If the tension on the tubing 14 is relieved, i.e., if the tubing inadvertently comes off the pump rotor, the downward pull on the tubing represented by arrow 50 disappears and the bias of the biasing element 28 on the slider 24 and actuator 32 overcomes the effect of gravity on the occluder mechanism 10 and the pushes the occluder mechanism 10 upwardly in the mounting structure 20. This returns the actuator 32 to its original position and allows the slider 24 to occlude flow. It will be appreciated that the actuator 32 need not return the occluder mechanism 10 to the top of the mounting structure. Rather, the actuator 32 need only push the occluder mechanism upwardly sufficiently for the slider 24 to occlude flow through the tubing. This can be assisted by a void 48 in the sidewall 40 of the mounting structure 20.
It will be appreciated that the mounting structure 20 may be mounted on any number of different pumps in a variety of ways. Some pumps, such as that shown in
Turning now to
The mounting structure 20′ includes a sloped wall 40′ which interacts with a sloped wall 32a′ on the actuator 32′. As the occluder mechanism 10′ is drawn down into the mounting structure 20′, the wall 32a′ interacts with wall 40′ and pushes against the biasing element 28 to move the slider 24 into the open position. Due to the force of the biasing element 28, however, a downward force must be placed on the occluder mechanism 10′ to overcome the bias. This is done by the tension on the tubing 14. If the tension is released, the biasing element 28 will push against the slider 24, which will force the actuator 32 outwardly. The sloped interaction between the mounting structure 20′ and the wall 32a′ of the actuator 32 will cause the occluder mechanism 10′ to rise sufficiently that tubing 14 is pinched closed by the slider 24′.
It will be appreciated that the housing 12 of the occluder mechanism 10 or 10′ need not be sloped. Likewise, the entire wall 40, 40′ need not be sloped. Rather, only portions may be needed on the mounting structure 20 or 20′ and the actuator 32 or 32′, which interact to allow for conversion of the force of the biasing element 28 into movement of the occluder mechanism 10, 10′ when the tubing 14′ is not in tension.
It will be appreciated that the interior of the occluder mechanism 10 or 10′ may include a wall disposed on one side of the tubing 14 to aid the slider 24 to pinch closed the tubing. In other words, one side of the tubing 14 is held by the wall and the opposing side is engaged by the slider 24 to pinch the tubing closed.
Turning now to
The occluder mechanism 110 also includes a base 118. The base 118 may be configured to nest in a mounting structure, such as mounting structure 20′ in
The base 118 may include an actuator 132 which pivotably extends from the base. As shown in
Because of the slope presented by the far end of the actuator 132 when it is extended, extending the actuator will tend to lift the base out of the mounting structure (e.g. mounting structure 20′ in
Such a configuration may be highly advantageous in the context of a medical pump. If the infusion set is not properly loaded, the occluder mechanism 110 will remain with the plunger or slider 124 in the first, occluding position, thereby preventing a free-flow situation which could cause injury to the patient. Once the infusion set is properly loaded, the occluder mechanism 110 is moved into the second, open position where it will not interfere with the pump's operation and will be less susceptible to causing false occlusion alarms. In the event the tubing 14 is accidentally removed from proper placement on the pump (e.g., the tubing is inadvertently pulled off the rotor), the occluder mechanism is lifted or otherwise moved sufficiently to enable it to return to the occluding position. Thus, free-flow is avoided even when the tubing 14 is inadvertently removed from its proper position.
The mounts 174 and 178 include a receiving portion 180 which is tapered or generally frusto-conical (excepting the openings). The receiving portions can receive the occluder mechanism 10, 10′ etc. and facilitate lifting of the occluder mechanism if tension is not maintained on the tubing. It will be appreciated that other pumps may have receiving portions which are not tapered. However, the actuator 32 or 32′ can be configured to still engage the receiving portion and lift the occluder mechanism to thereby occlude flow.
Turning now to
Opening a flow channel past the stop 230 can be accomplished in several ways. One common method is to simply provide sufficient pressure to radially expand the tubing 14 so that a flow path opens around the tubing. As mentioned in the background section, however, this method can create false alarms suggestion that the tubing is occluded downstream.
Another method to open a flow channel may be to apply force to the tubing adjacent the stop 230. When force is applied, the tubing tends to deform and open a flow channel around the stop 230. By controlling where the force is applied to the stop, the configuration of the openings can also be controlled as discussed in the '727 patent. Applying force on one side can create a single channel, while applying force on opposing sides will create a flow channel on each side perpendicular to the application of force.
In
While it operates with an in-line occluder rather than a pinch occluder, the occluder mechanism 210 can function similarly to those discussed above in that when the occluder mechanism 210 is disposed in the mounting structure 170 or 220 and tension is applied, the tubing is opened for fluid flow controlled by the pump. If, however, tension is not present on the tubing, the biasing of the arms 214 (like the biasing element 128) will allow the tubing to be returned to an occluded orientation. Alternatively, the occluder mechanism 210 can be configured so it nests in the mounting structure 170, 220 and remains open regardless of tension on the tubing—thereby forgoing automatic closure if the tubing 14 is not loaded properly. Whether the occluder mechanism 210 provides automatic closure will depend on the engagement between the occluder mechanism and the mounting structure.
If medical personnel need to temporarily open the occluder mechanism 10, 10′, 110, 110′, 110″, 110′″ or 210, he or she need only apply force to the actuator 32, 32′, 132, 132′, 132″, 132′″ or 232 to open flow through the tubing. As soon as the pressure is released, however, the flow past the occluder is terminated. Thus, the risk that medical personnel accidentally leave the tubing in a free-flow state is eliminated.
Turning now to
It will be appreciated in light of the disclosure that the body of the occluder which forms the actuator 214, 214′ and the body 236 of the occluder which extends from the stop may be a single body or may be attached to one another in a variety of methods including snap-fit, pressure fit, bonding or other adhesives, etc.
Turning now to
The stop 330 has a plurality of projections 336 which are spaced apart to leave channels 340. The ends of the projections 336 are configured to remain in contact with the tubing 14, while the channels 340 allow fluid to flow along the stop for the distance for which the projections engage the tubing.
When the tubing 14 is placed in tension by mounting on a pump, a portion of the tubing 14 distal from the connector 316 is pulled away from the connector. The elastomeric tubing will stretch and the stop 330 is pulled at least partially out of the connector 316 as shown in
Turning now to
The first body 518 also includes a channel 530 configured for receiving a projection 534 on the second body 522. The second body 522 is configured to nest in and travel helically in the first body 518 under a bias from the by the torsional spring 526. As the second body 522 moves upwardly, the projection 534 travels in the channel 530, causing the second body to rotate as shown by arrow 540 in
When the tubing 14 is mounted in a pump under tension, the downward force on the tubing 14 pulls against the bias of the torsional spring 526 (
It will be appreciated that the various types of fluid control devices contained herein can be used with a variety of types of peristaltic pumps. Such pumps may include linear, curvilinear and rotary peristaltic pumps. Additionally, each may be incorporated into cassettes which have additional features.
Turning now to
Preferably, the enteral delivery system may include a peristaltic pump system 610 (
The mounting plate 630 may also include a mounting structure 650 that incorporates one or more capture walls or retainers 655 (
The enteral delivery system 600 also typically may include a mounting plate door 660 and releasable latch 665, which is shown in
In variations of any of the embodiments of a fluid delivery system 600, a pump controller subsystem 670 may also be included that can be remotely operated using Wi-Fi, Bluetooth®, and other types of wireless computer communications capabilities. The fluid delivery system 600 may also include a user display interface 680 that may incorporate a touch-sensitive screen to enable user interaction and control of the subsystem 670. The pump controller subsystem may also include actuators, rotary switches, buttons, and switches 690 as depicted in
The fluid delivery system 600 may include a pump which is compatible with or specifically designed to receive part or all of a fluid delivery set, such as an infusion set or feeding set (collectively referred to as a feeding set). As shown in
A grip 707 may also be incorporated as part of the cassette body 703 to enable manipulation of the cassette 700 of the feeding set 698. The cassette body 703 may also be adapted to have a retention lip 708 (
The cassette body 703 is preferably formed from a durable polymeric material that may be selected from the group that includes, for purposes of example but not for purposes of limitation, polypropylenes, polystyrenes, nylons, high-density polyethylenes, polycarbonates, acrylics, and similar polymeric materials. More preferably, the carrier or cassette body 703 is formed from such polymeric materials to have a hardness rating on the Shore durometer scales that is approximately about or approximately greater than about 85-95 on the Shore A-scale and/or about 40 to about 50 on the Shore D-scale.
With continued reference to the preceding illustrations, and with reference now also specifically to
In addition, such polymeric materials, when used to fabricate the pump tubing segment 710, will preferably and typically be selected to have a substantially flexible Shore durometer rating of approximately about 10 to about 50 Shore D-scale, and or about 10 to about 85 Shore A-scale.
More preferably, for purposes of operation and in cooperation with peristaltic pump system 610, the material of the pump tubing segment 710 may have a durometer rating suitable for the present application, including a range of at least about 30, including from about 45 to about 85, and also including from about 45 to about 65, and also including from about 60 to about 80, on the Shore A-scale. Of course, the flexibility of the pump tubing segment 710 will depend upon the specific material selected, the viscosity of enteral products to be pumped through the tubing, the geometric and physical configuration of and relationship between the pump tubing segment 710 and the rollers 645 of the rotor 640, and many other considerations and variables.
The pump tubing segment 710 includes a generally medial portion 715 positioned between the two ends attached to the cassette body 703 so that the pump tubing segment forms a substantially extensible peristalsis loop 720. The connector portion 705 of the cassette body 703 also connects the pump tubing segment 710 to the inflow line 725 and outflow line 730.
Although the pump tubing segment 710 is removed for illustration purposes from many of the figures described herein, the extensible or stretchable loop 720 is typically stretched about the rollers 645 of the rotor 640 and positively biased when the carrier or cassette body 703 is captured on the mounting plate 630 by the capture wall 655 of the mounting structure 650.
With continued reference to the various figures and illustrations and now also with specific reference to
Selecting materials for the pump tubing segment 710 that are more flexible, more stretchable, or more ductile than the material selected for the inline occluder creates a relative material hardness, rigidity, or deformability differential between the tubing 710 and the occluder 740. In this way, the walls of the tubing segment 710 may be easily stretched, flexed, or deformed without a corresponding and or comparable deflection, deformation, and/or flexure of the inline occluder 740. Deformation of the tubing 710 allows a channel to open between the inner wall of the tubing and the stop or occluder 740. By selectively controlling the interaction of the tubing 710 and the occluder, a valve 735 is formed.
The various figures depict the interaction of the tubing 710 and the occluder 740 which form the valve 735. The connector portion 705 of the cassette body includes a connector 737 with a bore or lumen therethrough which opens in a port 745 adjacent the stop or occluder 740. The pump tubing segment 710 adjacent the occluder 740 prevents flow past the stop and into the port 745 unless the tubing is expanded away from the stop sufficiently to form a flow channel. This may be accomplished by an increase in pressure in the tubing sufficient to expand the tubing radially, or by pressing on the tubing to open a flow path around the stop or occluder 740. As shown in
The enteral feeding set 698 also preferably includes a deflectable primer or actuator 750. The actuator 750 may be formed and/or included about the mounting plate 630 of the pump system 610, and may also preferably be formed on or about the cassette body 703. In the variations where incorporated on or about the cassette body 703, the primer or actuator 750 may include at least one actuation pad or engagement member 755 and may extend from a flex joint 760 of the cassette body 703. The flex joint 760 may further preferably include a flexible arm or deflection stanchion 765 that projects to an extent 770 adjacent the occluder.
At least one engagement member 755 may further incorporate a pair of projections 780 extend and form an arcuate recess defining a channel for receiving a portion of the tubing segment. The recess may be formed to define a radius, R, 785 (
The flex joint 760 may be fabricated using a number of different configurations. In one arrangement, the flex joint 760 is made with at least one load distributor 800 adapted to withstand and distribute the dynamic stress and loading experienced during flexure of the actuator arm 765. In this exemplary variation, the at least one load distributor 800 is formed to have varying thicknesses t1, 801, and t2, 802 (
In this configuration, a constant force applied to the actuator arm 765, enables the portion having thickness t1, 801, to bend less than the portion having thickness t2, 802. As the thickness varies and increases between these portions from t2, 802, to t1, 801, the additional material available in a cross-sectional area better distributes the load force and material stress and strain into the structure of the cassette body 703.
Additionally, the configuration of the thicknesses and geometry of the one or more load distributors 800 or flexure reinforcements may enable or impart a threshold load requirement upon and to the deflectable primer or priming actuator 750. In this way, the priming actuator or deflectable primer 750 will not deflect and enable priming of the lumen 713 without imposition of possibly desirable, threshold or pre-established or predetermined load conditions. This capability can prevent undesired and or inadvertent actuation, as well as inadvertent priming of the lumen 713. All of these modifications to the configuration of the flex joint 760 may be further benefited by minimization of stress and strain concentrations around the joint 760 by use of wide, generous, or large radii 810 that connect the contemplated load distributors or reinforcement 800 to the cassette body 703.
The at least one actuation pad or engagement member 755 of the priming actuator 750 is also preferably positioned about the cassette 700 to be cooperatively positioned proximate the inline valve 735 formed by the occluder 740 and the pump tubing segment 710. With continued reference to the aforementioned figures, reference is also now specifically made to
In these figures, those with an understanding of the technical field of art may further appreciate that the primer or actuator 750 can be actuated from a nominal at rest position shown in
The portion of the pump tubing segment 710 adjacent the occluder 740 is thereby sandwiched between the projections of the engagement member and occluder and deforms to establish at least one flow channel 820. Establishment or formation of the at least one flow channel 820 enables fluid communication between the opposite inflow and outflow lines 725, 730 and through the lumen of the pump tubing segment 710 and the valve port 745.
In one exemplary configuration of the at least one flow channel 820, the walls of the tubing 710 defining the lumen are stretched against the exterior of the occluder 740 or annular ribs 747 by the channel and projections 780 of the engagement member 755, which forms at least one deformed or flexed or deflected or stretched portion 825 of the tubing wall. As a result, at least one complementary relaxed, bunched, or distended portion 830 of the wall of the pump tubing segment 710 also forms proximate thereto (
The inline valve 735 formed by the tubing segment 710 and occluder 740 is shown for exemplary purposes in the various illustrations to be along the cassette 700 adjacent the connection with the outflow line 730. The primer or actuator 750 is also shown to be cooperatively proximate to the valve 735. However, the valve 735 and the primer 750 may also be disposed adjacent the connection to the inflow line 725.
The actuator 750 may or may not be included about or on the cassette body 703 of the cassette 700, and may also and/or instead be incorporated about the mounting plate 630. In this alternative adaptation, the actuator 750 may actuate the inline valve 735 upon insertion of the enteral feeding set 698 on the mounting plate 630.
While the principles of the present invention have been discussed above generally relating to rotary peristaltic pumps, it will be appreciated that the various aspects of the present invention can also be used with other peristaltic delivery systems including linear and curvilinear peristaltic pumps. Turning to
Each of the cassette bodies 1003 includes a connector. Cassette body 1003a includes a standard connector 1038, while cassette body 1003b includes a connector 1037 which has an occluder 1040 which may be attached thereto by a pair of arms 1042 or other attachment structure, similar to the configuration shown in
Also shown in
The actuator 1050 may include a recess 1075 for engagement by a user and at least one actuation pad or engagement member 1055 may further incorporate one or more projections 1090 which form a channel with a changing width. While not shown in
The flex joint 1060 may be fabricated using a number of different configurations. In one arrangement, the flex joint 1060 is made with at least one load distributor 1070 adapted to withstand and distribute the dynamic stress and loading experienced during flexure of the arm 1065. In this exemplary variation, the at least one load distributor 1070 is formed to have varying thicknesses t1, 1071, and t2, 1072, wherein t1 is approximately thicker than t2. Other flex joints are known and their application will be apparent in light of the present disclosure.
This configuration, for a constant force applied to the flexible arm 1065, enables the portion having the greater thickness to bend less than the portion which is thinner. As the thickness varies and increases between t11071 and t21072, the additional material available in cross-sectional area better distributes the load force and material stress and strain into the structure of the cassette body 703b.
In other variations, the at least one load distributor 1080 may also be formed as or with, incorporate, or be augmented by, at least one flexure reinforcement 1085. This other type of load distributor 1070 and or flexure reinforcement 1085 may be formed with a thickness, a length, and a width that enables a further stress/strain load path between the flexure arm or deflection stanchion 1065 and other portions of the structure of the cassette body 1003b.
Additionally, the configuration of the thicknesses and geometry of the one or more load distributors and/or flexure reinforcements 1070 may enable or impart a threshold load requirement upon and to the deflectable primer or priming actuator 1050. In this way, the priming actuator 1050 will not deflect and enable priming of the lumen 1013 without imposition of a desired threshold force in order to prevent undesired and or inadvertent actuation, as well as inadvertent priming of the cassette 1000.
While not shown in
Turning now to
The cassette body 1103 also shows a pair of retainers 1141. The retainers can be used to hold the inflow and outflow lines (not show) attached to the cassette.
One issue which is present in the mounting of a cassette body in a peristaltic feeding pump is ensuring that the cassette is properly positioned within the mounting structure
With reference to
Likewise, the front of the connector or the cassette body 703 is provided with a multi-angled engagement surface 709′. The first, upper portion 709a may be vertical or substantially vertical and is preferably angled complementary to the upper portion 655a of the capture wall 655′. A second, lower portion 709c is sloped at an angle which is generally complementary to the lower portion 655c of the capture wall 655. The third, middle portion 709b is sloped slightly above horizontal, i.e. 0-15 degrees and typically between about 3 and 10, and most typically 5 degrees, i.e. generally perpendicular to the other two portions.
In an ideal situation, a person loading a peristaltic pump would push the cassette 703 all the way into the pump so that the engagement surface of the cassette engaged the engagement surface of the mounting structure 650 on the pump 610 and thereby ensured that the cassette 703 would not come out. However, it is not uncommon for medical personnel or a patient to fail to completely load the cassette 703 into the pump 610. The engagement surfaces 655a, 655b 655c, 709a, 709b and 709c interact with one another under tension to encourage the cassette body 703 to slide downwardly relative to the capture wall 655′ until an engagement member defined by the lower portion 709c and middle portion 709b of the engagement surface snaps into place in the angled void defined by the lower portion 655c and middle portion 655b of the capture wall 655′.
With reference to
One or both of the connectors 1410 of the cassette 1400 have an engagement member 1424 or projection which engages engagement surfaces on the mounting structure 1420 on the pump body 1404. The engagement member 1424 includes projection which has a first, lower engagement surface 1424a disposed at the lower portion end of the connector 1410. The lower engagement surface is angled between 0 and 15 degrees, and more typically between about 3 and 5 degrees. The projection also includes a second angled face which forms a middle engagement surface on the connector 1410. The middle engagement surface 1424b may be disposed between 0 and 45 degrees relative to horizontal, typically between about 3 and 15 degrees, and often about 5 degrees. The bottom of the projection 1424c is generally flat and engages the bottom of the mounting structure into which the connectors 1410 are placed.
The connectors 1410 may also include an upper portion 1424d of an engagement surface extending from the projection 1424. The engagement surface may be vertical, or may be sloped from vertical, typically between 3 and 10 degrees. The upper surface 1424d and the engagement surfaces 1424a and 1424b of the projection, are preferably complementary to an upper engagement surface 1420a, a middle engagement surface 1420b and a lower engagement surface 1420c, respectively, which are formed on the mounting structures 1420. The complementary engagement surfaces urge the connectors 1410 downwardly when placed under tension by the stretched pump tubing segment 1408. Thus, the connectors tend to slide down along the mounting structures 1420 and then snap in place when the void formed by the middle and lower engagement surfaces toward the bottom of the mounting structures aligns with the projection 1424 extending from the bottom portion of the connectors 1410.
Turning now to
The second connector 1537, which is typically disposed downstream from the pumping mechanism, but which may be disposed operationally on either side of the pumping mechanism, includes an occluder 1540. When the tubing segment 1510 is disposed on the connector 1537, the occluder 1540, and in particular a stop of the occluder, is disposed within the lumen 1513 of the tubing segment. The stop is larger than the interior diameter of the tubing segment 1510 so as to block flow through the lumen 1513 of the tubing segment unless the tubing segment is deformed by pressure within the tubing or an outside pressure is placed on the tubing segment to deform it and thereby form a flow channel between the stop and the wall of the tubing segment.
The description regarding the prior embodiments relating to the materials and interactions of the tubing segment, occluder and an actuator of the other embodiments are equally applicable in the present embodiment and are incorporated herein by reference.
The embodiment shown in
Disposed along the arm 1565 is an engagement member 1555 which is configured to engage the tubing segment 1510 to deform or distend the tubing segment and thereby open the flow channel.
As shown in
The actuator 1550 works by forcefully engaging the tubing segment 1550 with the engagement member 1555 adjacent the occluder 1540 and deforming the tubing segment so that a flow channel 1520 forms between the occluder 1540 and the tubing segment 1510 opposite the actuator as discussed above and shown with respect to
The interaction between the tubing segment 1510 and the occluder 1540 forms a valve 1535 which is biased closed until opened by the application of force on the actuator 1550. As soon as the force is released, the resilient tubing segment 1510 will return to its normal shape and engage the occluder 1540 to stop flow through the lumen.
It will be appreciated that the arm 1565 of the actuator 1550 may be made from a flexible material such as plastic. The flexible material is able to flex at a joint 1552 so as to deflect from a first position, wherein it is positioned away from the tubing segment 1510, into a second position wherein it forcefully engages the tubing 1510 and opens the flow channel past the occluder 1540.
The tubing segment 1510 adjacent the occluder 1540 is presented in shadow in order to show the connector 1537 in additional detail. The connector 1537 has a bore or lumen therethrough which opens in a port 1545 adjacent the stop or occluder 1540. The pump tubing segment 1510 adjacent the occluder 1540 prevents flow past the stop and into the port 1545 unless the tubing is expanded away from the stop sufficiently to form the flow channel. This may be accomplished by an increase in pressure in the tubing sufficient to expand the tubing radially, or by pressing on the tubing to open a flow path around the stop or occluder 1540. As shown in
The recess 1585 in the engagement member 1555 may be formed to define a radius, R, (
Those skilled in the art will appreciate that the actuator 1550 can be actuated from a rest position to a deflected or actuated position similar to that shown in
When introducing elements of the present invention or the preferred embodiment(s) thereof, the articles “a”, “an”, “the”, and “said” are intended to mean that there are one or more of the elements. The terms “comprising,” “including”, and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements.
As various changes could be made in the above constructions without departing from the scope of the invention, it is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
In use, the various embodiments discussed above have an inflow end of the tubing segment which is connected to a liquid source, typically by an inflow tube. The liquid source may be a chemical solution when used in a laboratory, or an enteral feeding solution or an IV solution in a medical context. The outflow tubing extends to a point of delivery which may be a test tube in a laboratory context or a patient in the context of enteral or parenteral solution delivery. A user typically then primes the enteral feeding set by depressing the actuator and then mounts the cassette body or carrier of the feeding set on the mounting plate or similar structure of a pump system. Thereafter the pump controller subsystem is actuated to effect feeding of the enteral liquid to the patient.
When used with a rotary pump, the peristalsis loop is pulled over the rotor prior to mounting the cassette body in the mounting structure. In contrast, in a linear or curvilinear pump, one of the cassette bodies is mounted on one side of the pumping mechanism and the tubing segment is drawn across the pumping mechanism. The other cassette body is then mounted on the mounting structure of the pump so that the tube is in tension adjacent the pumping mechanism.
The embodiments of the present invention are suitable for use in many applications that involve manufacture, sale, and use of peristaltic pumping systems generally and which may have particularly beneficial applications in enteral and parenteral solution delivery to patients in a medical context. The embodiments can be used to provide delivery sets and/or to allow flow with the delivery set attached to a pump.
The configurations of the inventive enteral delivery systems may be modified to accommodate many types of enteral feeding sets and the like that are suitable for use in healthcare facilities as well as in home care environments. Such feeding sets may be adapted with various types of tubing to accommodate a variety of enterally deliverable, liquid nutritional products, parenterally deliverable hydration or medication, etc., which may have various viscosities and consistencies.
Such modifications and alternative arrangements may be configured to establish compatibility with the wide variety of possible applications that are susceptible for use with the inventive and improved delivery sets and feeding sets 698 for delivering the contemplated liquid nutritional products. Accordingly, even though only few such embodiments, alternatives, variations, and modifications of the present invention are described and illustrated herein, it should be understood that the practice of such additional modifications and variations, and the equivalents thereof, are within the spirit and scope of the invention as defined in the following claims.
Thus there are disclosed embodiments of anti-free-flow mechanisms, cassettes embodying anti-free-flow mechanisms and associated methods of use, and other enhancements to a cassette used with a peristaltic pump. Those skilled in the art will appreciate numerous modifications which can be made in light of the present disclosure that do not depart from the scope of the invention. The appended claims are intended to cover such modifications.
This application is a continuation-in-part of U.S. patent application Ser. No. 12/416,041, filed Mar. 31, 2009, which is incorporated in its entirety, and claims priority to U.S. Provisional Patent Application No. 61/041,561, filed Apr. 1, 2008, which is incorporated herein by reference in its entirety.
Number | Name | Date | Kind |
---|---|---|---|
584091 | Leidich | Jun 1897 | A |
1238521 | Janish, Jr. | Aug 1917 | A |
2471623 | Hubbell | May 1949 | A |
2518165 | Millard | Aug 1950 | A |
2858095 | Harris et al. | Oct 1958 | A |
2999499 | Willet | Nov 1961 | A |
3213882 | Beatty | Oct 1965 | A |
3329391 | Deane | Jul 1967 | A |
D208753 | Curry | Sep 1967 | S |
3497175 | Koland | Feb 1970 | A |
3707972 | Villari et al. | Jan 1973 | A |
3985140 | Harris | Oct 1976 | A |
3998364 | Hollander | Dec 1976 | A |
4037596 | LeFevre et al. | Jul 1977 | A |
4063555 | Ulinder | Dec 1977 | A |
4065093 | Phillips | Dec 1977 | A |
4106675 | Taylor | Aug 1978 | A |
4142645 | Walton | Mar 1979 | A |
4160383 | Rauschenberger | Jul 1979 | A |
4230151 | Jonsson | Oct 1980 | A |
4236880 | Archibald | Dec 1980 | A |
4300571 | Waldbillig | Nov 1981 | A |
4373524 | Leibinsohn | Feb 1983 | A |
4381591 | Barger et al. | May 1983 | A |
4382453 | Bujan et al. | May 1983 | A |
4425116 | Bilstad et al. | Jan 1984 | A |
4430073 | Bemis et al. | Feb 1984 | A |
4453295 | Laszczower | Jun 1984 | A |
4498843 | Schneider et al. | Feb 1985 | A |
4524802 | Lawrence et al. | Jun 1985 | A |
4527588 | Tseo et al. | Jul 1985 | A |
4559036 | Wunsch | Dec 1985 | A |
4559045 | Danby et al. | Dec 1985 | A |
4579553 | Urquhart et al. | Apr 1986 | A |
4596557 | Pexa | Jun 1986 | A |
4624663 | Danby et al. | Nov 1986 | A |
4634092 | Daniell et al. | Jan 1987 | A |
4645489 | Krumme et al. | Feb 1987 | A |
4689043 | Bisha | Aug 1987 | A |
4728324 | Steigerwald et al. | Mar 1988 | A |
4730635 | Linden | Mar 1988 | A |
4787406 | Edwards et al. | Nov 1988 | A |
4913401 | Handke | Apr 1990 | A |
4932629 | Rodomista et al. | Jun 1990 | A |
4932938 | Goldberg et al. | Jun 1990 | A |
4935010 | Cox et al. | Jun 1990 | A |
4960259 | Sunnanvader et al. | Oct 1990 | A |
5017192 | Dodge et al. | May 1991 | A |
5020562 | Richmond et al. | Jun 1991 | A |
5022422 | di Palma | Jun 1991 | A |
5029621 | Lewis | Jul 1991 | A |
5083561 | Russo | Jan 1992 | A |
5098406 | Sawyer | Mar 1992 | A |
5151019 | Danby et al. | Sep 1992 | A |
5219327 | Okada | Jun 1993 | A |
5232193 | Skakoon | Aug 1993 | A |
5238218 | Mackal | Aug 1993 | A |
5254083 | Gentelia et al. | Oct 1993 | A |
5257978 | Haber et al. | Nov 1993 | A |
5265847 | Vorhis | Nov 1993 | A |
5336174 | Daoud et al. | Aug 1994 | A |
5351932 | Von Herrmann | Oct 1994 | A |
5391144 | Sakurai et al. | Feb 1995 | A |
5395351 | Munsch | Mar 1995 | A |
5396925 | Poli | Mar 1995 | A |
5437642 | Thill et al. | Aug 1995 | A |
5438868 | Holden et al. | Aug 1995 | A |
5456887 | Calvo et al. | Oct 1995 | A |
5474544 | Lynn | Dec 1995 | A |
5482446 | Williamson et al. | Jan 1996 | A |
5514102 | Winterer et al. | May 1996 | A |
5531680 | Dumas et al. | Jul 1996 | A |
5531713 | Mastronardi et al. | Jul 1996 | A |
5556386 | Todd | Sep 1996 | A |
5578070 | Utterberg | Nov 1996 | A |
D389228 | Winterer et al. | Jan 1998 | S |
5704584 | Winterer et al. | Jan 1998 | A |
5720721 | Dumas et al. | Feb 1998 | A |
5733061 | Child | Mar 1998 | A |
5746756 | Bromfield et al. | May 1998 | A |
5789675 | Blaine et al. | Aug 1998 | A |
5807312 | Dzwonkiewicz | Sep 1998 | A |
5810323 | Winterer et al. | Sep 1998 | A |
5826621 | Jemmott | Oct 1998 | A |
5971357 | Denton et al. | Oct 1999 | A |
6017332 | Urrutia | Jan 2000 | A |
6023970 | Blaine | Feb 2000 | A |
6048331 | Tsugita et al. | Apr 2000 | A |
6092695 | Loeffler | Jul 2000 | A |
6129699 | Haight et al. | Oct 2000 | A |
6142979 | McNally et al. | Nov 2000 | A |
RE37074 | Danby et al. | Feb 2001 | E |
6183447 | Urrutia | Feb 2001 | B1 |
6192752 | Blaine | Feb 2001 | B1 |
6196922 | Hantschk et al. | Mar 2001 | B1 |
6196992 | Keilman et al. | Mar 2001 | B1 |
6209538 | Casper et al. | Apr 2001 | B1 |
6261262 | Briggs et al. | Jul 2001 | B1 |
6328720 | McNally | Dec 2001 | B1 |
D455489 | Beck et al. | Apr 2002 | S |
6398758 | Jacobsen et al. | Jun 2002 | B1 |
6398780 | Farley et al. | Jun 2002 | B1 |
6461335 | Noecker | Oct 2002 | B1 |
6494864 | Kerwin et al. | Dec 2002 | B1 |
6506035 | Beck et al. | Jan 2003 | B1 |
6523414 | Malmstrom et al. | Feb 2003 | B1 |
6531708 | Malmstrom et al. | Mar 2003 | B1 |
RE38145 | Lynn | Jun 2003 | E |
6595950 | Miles et al. | Jul 2003 | B1 |
6623447 | Miles et al. | Sep 2003 | B2 |
6636010 | Malmstrom et al. | Oct 2003 | B1 |
H2090 | Walker | Nov 2003 | H |
6659976 | Beck et al. | Dec 2003 | B2 |
6685670 | Miles et al. | Feb 2004 | B2 |
6749591 | McNally et al. | Jun 2004 | B1 |
6750468 | Malmstrom et al. | Jun 2004 | B2 |
D501924 | Cise et al. | Feb 2005 | S |
6852094 | Beck et al. | Feb 2005 | B2 |
D503799 | Beck | Apr 2005 | S |
D503978 | Beck | Apr 2005 | S |
D504506 | Beck et al. | Apr 2005 | S |
D505199 | Beck et al. | May 2005 | S |
6902541 | McNally et al. | Jun 2005 | B2 |
6907788 | Malmstrom et al. | Jun 2005 | B2 |
D507647 | Beck et al. | Jul 2005 | S |
6923785 | Miles et al. | Aug 2005 | B2 |
6949376 | Kluttz et al. | Sep 2005 | B2 |
6979311 | Miles et al. | Dec 2005 | B2 |
7037302 | Vaillancourt | May 2006 | B2 |
D523553 | Beck et al. | Jun 2006 | S |
7070575 | Beck et al. | Jul 2006 | B2 |
7121143 | Malmstrom et al. | Oct 2006 | B2 |
7150727 | Cise et al. | Dec 2006 | B2 |
D536783 | Cise et al. | Feb 2007 | S |
7367963 | Cise et al. | May 2008 | B2 |
20020169424 | Miles et al. | Nov 2002 | A1 |
20040097885 | Beck et al. | May 2004 | A1 |
20040220542 | Cise et al. | Nov 2004 | A1 |
20040260332 | Dubrul et al. | Dec 2004 | A1 |
20050004540 | McNally et al. | Jan 2005 | A1 |
20050119625 | Miles et al. | Jun 2005 | A1 |
20060058740 | Cise | Mar 2006 | A1 |
20070118078 | McNally | May 2007 | A1 |
20070151346 | Malmstrom et al. | Jul 2007 | A1 |
20080065008 | Barbut et al. | Mar 2008 | A1 |
20080098798 | Riley | May 2008 | A1 |
20080103445 | Blaine et al. | May 2008 | A1 |
20080119782 | Steinman | May 2008 | A1 |
20080134750 | Riley | Jun 2008 | A1 |
20080208117 | Steinman | Aug 2008 | A1 |
20080276911 | Woody | Nov 2008 | A1 |
20090049919 | Hills | Feb 2009 | A1 |
20090149801 | Crandall | Jun 2009 | A1 |
20090254034 | Beck | Oct 2009 | A1 |
20100082001 | Beck et al. | Apr 2010 | A1 |
20110028899 | Beck et al. | Feb 2011 | A1 |
Number | Date | Country |
---|---|---|
0 150 666 | Sep 1984 | EP |
0 276 356 | Aug 1988 | EP |
0 423 978 | Oct 1990 | EP |
0 483 794 | Oct 1991 | EP |
2 338 759 | Dec 1999 | GB |
WO 9608666 | Mar 1996 | WO |
WO 96-17636 | Jun 1996 | WO |
Entry |
---|
WIPO, International Searching Authority ISA/KR, International Search Report issued May 4, 2012 in International Application No. PCT/US2011/054077. |
Number | Date | Country | |
---|---|---|---|
20110082438 A1 | Apr 2011 | US |
Number | Date | Country | |
---|---|---|---|
61041561 | Apr 2008 | US |
Number | Date | Country | |
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Parent | 12416041 | Mar 2009 | US |
Child | 12896729 | US |