Central venous catheter (“CVCs”) are commonly introduced into patients and advanced through their vasculatures for placement by way of the Seldinger technique. The Seldinger technique utilizes a number of steps and medical devices (e.g., a needle, a scalpel, a guidewire, an introducer sheath, a dilator, a CVC, etc.). While the Seldinger technique is effective, the number of steps are time consuming, handling the number of medical devices is awkward, and both of the foregoing can lead to patient trauma. In addition, there is a relatively high potential for touch contamination due to the number of medical devices that need to be interchanged during the Seldinger technique. As such, there is a need to reduce the number of steps and medical devices involved in introducing a catheter such as a CVC into a patient and advancing the catheter through a vasculature thereof.
Disclosed herein are rapidly insertable central catheter (“RICC”) insertion assemblies, introducer-needle assemblies, and methods that address the foregoing. Notably such RICC insertion assemblies, introducer-needle assemblies, and methods include needle-stick-injury protection, as set forth below.
Disclosed herein is a catheter placement system including, a catheter, a needle supported by a needle hub and extending distally to a needle tip, the needle defining lumen, a guidewire, a seal housing including a tip shield transitionable between a locked position and an unlocked position, a tether extending between the needle hub and the seal housing, a handle defining a recess and configured to slidably receive the seal housing therein, wherein the handle and the seal housing co-operate to define a handle needle lumen and a handle guidewire lumen, and a detent configured to retain the seal housing within the recess when a first force is applied to the needle, and configured to deflect radially outwards to allow the seal housing to disengage the handle when a second force is applied.
In some embodiments, the first force is less than a threshold force required to deflect the detent, and the second force is equal to or greater than the threshold force.
In some embodiments, one or both of the first force and the second force urges the needle in a proximal direction.
In some embodiments, the tip shield in the locked position prevents distal movement of the tip of the needle relative to the seal housing, the tip shield being biased towards the locked position.
In some embodiments, the seal housing further includes a slot extending between an outer surface of the seal housing and one or both of the handle needle lumen and the handle guidewire lumen and configured to allow the portion of the guidewire to pass therethrough as the seal housing disengages the handle.
In some embodiments, the handle needle lumen extends between a distal end and a proximal end of the handle and seal housing assembly and is configured to slidably receive a portion of the needle therein, and the handle guidewire lumen communicates with the handle needle lumen and extends at an angle therefrom.
In some embodiments, the seal housing includes a seal formed of a compliant material and defining a fluid tight seal extending about a junction between the handle needle lumen and the handle guidewire lumen.
In some embodiments, the needle includes a guidewire aperture communicating with the needle lumen and configured to align with the handle guidewire lumen when the needle hub engages a proximal end of the handle.
In some embodiments, the needle further includes a slot extending between the guidewire aperture and the needle tip.
In some embodiments, the catheter is a RICC and further includes a blood flash system coupled to the needle hub.
In some embodiments, the catheter placement system further includes a support pin disposed within the handle and abutting against a portion of the guidewire to support the guidewire. The support pin causes the guidewire to automatically disengage the seal housing when the seal housing is urged proximally.
In some embodiments, the tether is configured to allow the needle hub to be withdrawn proximally up until a predetermined distance (d) where the tether prevents further proximal movement relative to the seal housing beyond the predetermined distance (d).
Also disclosed is a method of placing a catheter including, forming an insertion site using a needle supported by a needle hub, advancing a guidewire through a handle guidewire lumen of a handle, to a target location, withdrawing the needle proximally through a handle needle lumen until a distal tip is located within a seal housing, the seal housing defining a junction between the handle needle lumen and the handle guidewire lumen, transitioning a tip shield to a locked position to prevent further distal movement of the needle tip relative to the seal housing, and urging the needle proximally to deflect a detent radially outwards and disengage the seal housing from the handle.
In some embodiments, withdrawing the needle proximally further includes applying a first proximal force, and urging the needle proximally to deflect the detent includes a second proximal force, the second proximal force being greater than the first proximal force and equal to or greater than a threshold force required to deflect the detent.
In some embodiments, the seal housing is slidably engaged within a recess defined by the handle, the detent abutting against a portion of the seal housing to retain the seal housing within the recess when the first proximal force is applied.
In some embodiments, the step of urging the needle proximally urges a portion of the guidewire, disposed within the handle guidewire lumen, through a slot extending between the handle guidewire lumen and an outer surface of the seal housing.
In some embodiments, the method further includes a tether extending between the needle hub and the seal housing and configured to prevent further proximal movement of the needle hub relative to the seal housing beyond a predetermined distance (d).
Also disclosed is a catheter placement system including, a needle defining a needle lumen extending between a needle hub and a needle tip, a guidewire, a seal housing, a tether extending between the needle hub and the seal housing, a handle defining a recess and configured to slidably receive the seal housing therein, wherein the handle and the seal housing co-operate to define a handle needle lumen and a handle guidewire lumen, a tip shield transitionable between an unlocked position and a locked position, and a timing lock disposed within the seal housing and transitionable between a first position and a second position, wherein, in the first position, the timing lock is configured prevent movement of the seal housing relative to the handle, and wherein, in the second position, the timing lock is configured to allow the seal housing to slide relative to the handle.
In some embodiments, the timing lock is biased towards the second position and is retained in the first position by a portion of the needle disposed in a distal portion of the handle needle lumen.
In some embodiments, the timing lock is configured to transition from the first position to the second position when the needle tip is disposed within the seal housing.
In some embodiments, the timing lock in the second position allows the needle and seal housing assembly to disengage from the guidewire and handle assembly.
In some embodiments, the catheter placement system further includes a support pin coupled with the handle and configured to support the guidewire as the seal housing slides proximally relative to the handle. The support pin causes the guidewire to automatically disengage the seal housing when the seal housing is urged proximally.
A more particular description of the present disclosure will be rendered by reference to specific embodiments thereof that are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. Example embodiments of the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings.
Before some particular embodiments are disclosed in greater detail, it should be understood that the particular embodiments disclosed herein do not limit the scope of the concepts provided herein. It should also be understood that a particular embodiment disclosed herein can have features that can be readily separated from the particular embodiment and optionally combined with or substituted for features of any of a number of other embodiments disclosed herein.
Regarding terms used herein, it should also be understood the terms are for the purpose of describing some particular embodiments, and the terms do not limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps in a group of features or steps, and do not supply a serial or numerical limitation. For example, “first,” “second,” and “third” features or steps need not necessarily appear in that order, and the particular embodiments including such features or steps need not necessarily be limited to the three features or steps. In addition, any of the foregoing features or steps can, in turn, further include one or more features or steps unless indicated otherwise. Labels such as “left,” “right,” “top,” “bottom,” “front,” “back,” and the like are used for convenience and are not intended to imply, for example, any particular fixed location, orientation, or direction. Instead, such labels are used to reflect, for example, relative location, orientation, or directions. Singular forms of “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise.
In the following description, the terms “or” and “and/or” as used herein are to be interpreted as inclusive or meaning any one or any combination. As an example, “A, B or C” or “A, B and/or C” mean “any of the following, A, B, C, A and B, A and C, B and C, A, B and C.” An exception to this definition will occur only when a combination of elements, components, functions, steps or acts are in some way inherently mutually exclusive.
With respect to “proximal,” a “proximal portion” or “proximal section” of, for example, a catheter includes a portion or section of the catheter intended to be near a clinician when the catheter is used on a patient. Likewise, a “proximal length” of, for example, the catheter includes a length of the catheter intended to be near the clinician when the catheter is used on the patient. A “proximal end” of, for example, the catheter includes an end of the catheter intended to be near the clinician when the catheter is used on the patient. The proximal portion, the proximal section, or the proximal length of the catheter can include the proximal end of the catheter; however, the proximal portion, the proximal section, or the proximal length of the catheter need not include the proximal end of the catheter. That is, unless context suggests otherwise, the proximal portion, the proximal section, or the proximal length of the catheter is not a terminal portion or terminal length of the catheter.
With respect to “distal,” a “distal portion” or a “distal section” of, for example, a catheter includes a portion or section of the catheter intended to be near or in a patient when the catheter is used on the patient. Likewise, a “distal length” of, for example, the catheter includes a length of the catheter intended to be near or in the patient when the catheter is used on the patient. A “distal end” of, for example, the catheter includes an end of the catheter intended to be near or in the patient when the catheter is used on the patient. The distal portion, the distal section, or the distal length of the catheter can include the distal end of the catheter; however, the distal portion, the distal section, or the distal length of the catheter need not include the distal end of the catheter. That is, unless context suggests otherwise, the distal portion, the distal section, or the distal length of the catheter is not a terminal portion or terminal length of the catheter.
To assist in the description of embodiments described herein, as shown in
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art.
In an embodiment, the catheter 150 generally includes a catheter body 152 supported at a proximal end by a catheter hub (“hub”) 160. The hub 160 includes one or more extension legs 162 extending proximally therefrom and includes a fluid coupling device, such as a luer lock 164, disposed at a proximal end of one of the one or more extension legs 162. The Luer lock 164 is configured to couple the extension leg 162 with a medical fluid line, syringe, or the like. Each extension leg of the one or more extension legs 162 is in fluid communication with a lumen of the catheter body 152. For example, a first extension leg 162A is in fluid communication with a proximal lumen 114A, a second extension leg 162B is in fluid communication with a medial lumen 114B, and a third extension leg 162C is in fluid communication with a distal lumen 114C. The catheter body 152 includes an access section 154 disposed distally, a catheter section 156 disposed proximally, and a dilation section 158 disposed therebetween. The access section 154 defines a single lumen and has a first outer diameter, the catheter section 156 defines two or more lumen and has a second diameter larger than the first diameter. The dilation section 158 disposed between the access section 154 and the catheter section 156 defines a tapered outer profile extending from the first diameter of the access section 154 to the second diameter of the catheter section 156. A guidewire 130 extends through a lumen of the catheter 150 from a proximal end of an extension leg 162, to a distal tip of the access section 154.
Details on the catheter body, distal tip of the catheter, and methods of forming the catheter body and distal tip of the catheter can be found in U.S. Pat. No. 11,890,429, in U.S. Publication Nos.: US 2022/0001138, US 2023/0126869, US 2023/0132903, US 2023/0233796, US 2023/0233800, and US 2024/0091501, and in U.S. patent application Ser. No. 18/076,169, each of which is incorporated by reference in its entirety into this application. Further detail regarding catheter materials can be found, for example, in PCT/US2024/011269, filed Jan. 11, 2024, which is incorporated by reference in its entirety into this application.
Further details of catheter placement systems 100 in accordance with the embodiments described herein can be found, for example, in U.S. Pat. Nos. 11,517,719, 10,376,675, U.S. 2019/0255294, U.S. 2021/0069471, U.S. 2021/0113809, U.S. 2021/0113810, U.S. 2021/0121667, U.S. 2021/0121661, U.S. 2021/0228843, U.S. 2021/0283381, U.S. 2021/0322729, U.S. 2021/0361915, U.S. 2021/0330941, U.S. 2021/0330942, U.S. 2021/0402149, U.S. 2021/0402142, U.S. 2022/0032013, U.S. 2021/0402153, U.S. 2021/0379336, U.S. 2021/0283368, U.S. 2022/0062528, U.S. 2022/0032014, U.S. 2022/0126064, U.S. 2022/0193378, U.S. 2022/0176081, U.S. 2022/0193376, U.S. 2022/0193377, U.S. 2022/0152368, U.S. 2022/0176082, U.S. 2022/0193379, U.S. 2022/0296862, U.S. 2022/0323723, U.S. 2022/0370762, U.S. 2022/0362524, U.S. 2023/0043989, U.S. 2023/0041261, U.S. 2023/0039733, U.S. 2023/0042898, each of which is incorporated by reference in its entirety into this application.
In an embodiment, the handle 170 defines a recess 176 extending distally from a proximal end of the handle 170 and configured to receive a seal housing 180 therein. With the seal housing 180 located within the recess 176, the seal housing 180 co-operates with the handle 170 to define a handle needle lumen 172 and a handle guidewire lumen 174. The seal housing 180 is slidably engaged with the recess 176 such that it can be removed proximally from the recess 176 as described in more detail herein.
In an embodiment, the handle 170 and seal housing 180 co-operate to define a handle needle lumen 172 extending between a distal end and a proximal end of the handle 170 and configured to receive a portion of the needle 120 therethrough. The needle 120 is slidably engaged with the handle needle lumen 172 between a distal position (e.g.,
In an embodiment, the handle 170 further includes a support pin 168 extending laterally and disposed below a portion of the guidewire 130. The support pin 168 is positioned above a top-most surface of the seal housing 180. As such, the support pin 168 does not obstruct the path of the seal housing 180 as the seal housing 180 is retracted from the recess 176. The support pin 168 is configured to support a portion of the guidewire 130 as the seal housing 180 is urged proximally.
In an embodiment, the seal housing 180 further includes a seal 182 formed of a compliant material and forming a seal extending about the junction 166 where the handle guidewire lumen 174 communicates with the handle needle lumen 172. The seal 182 is formed from a polymer, elastomer, rubber, silicone rubber, self-sealing silicone, or the like. As such, as one or both of the needle 120 and the guidewire 130 is withdrawn from the seal 182, the seal 182 self-seals providing a fluid tight seal and preventing any fluids disposed therein from escaping.
In an embodiment, the seal housing 180 further includes a tip shield mechanism (“tip shield”) 188 configured to transition between a first, or unlocked, position and a second, or locked, position. In the unlocked position, the tip shield 188 allows the needle 120 to slide relative to the seal housing 180, through the handle needle lumen 172. In the locked position, the tip shield 188 extends between the needle tip 124 and the distal end of the seal housing 180 to prevent any distal movement of the needle 120 relative to the seal housing 180. In an embodiment, the tip shield 188 is biased towards the locked position and is held in the unlocked position by the presence of a portion of the needle 120 in a distal end of the handle needle lumen 172. As the needle tip 124 is withdrawn into the seal housing 180 and thereby removed from a distal portion of the handle needle lumen 172, the tip shield 188 is allowed to transition to the locked position, preventing the needle tip 124 from extending distally from the seal housing 180.
In an embodiment, the system 100 further includes a tether 192 extending between the needle hub 122 and the seal housing 180. The tether 192 can be coupled to one or both of the needle hub 122 and the seal housing 180 using an adhesive, welding, ultrasonic welding, bonding, mechanical attachment (e.g., eyelet engaging a protrusion or hook), combinations thereof, or the like. The tether 192 can be formed from an organic or synthetic flexible material with a relatively high tensile strength. Exemplary materials can include metals, alloys, plastics, polymers, composites, wires, ropes, strings, tapes, combinations thereof, or the like. As shown, the tether 192 includes a pleated material that includes one or more apertures, allowing the needle 120 to extend therethrough. However, this is not intended to be limiting.
The tether 192 can transition between a folded position (
In an embodiment, the handle 170 includes a detent 178 extending into the recess 176 and configured to retain the seal housing 180 within the recess 176. The detent 178 is supported by a flexible portion of the handle 170. As such, when the seal housing 180 is urged proximally using a first force, the detent 178 prevents the proximal movement of the seal housing 180 up until a second force, which is equal to or greater than a threshold force, is applied. When the proximal force exceeds the threshold force, the detent 178 deflects radially outwards with respect to a central longitudinal axis 70. With the detent 178 deflected outwards, the seal housing 180 can slide proximally and disengage the handle 170.
In an embodiment, the seal housing 180 includes a slot 184 extending longitudinally along a vertical plane and communicating between an outer surface of the seal housing 180 and the handle guidewire lumen 174. When the second force is applied and the seal housing 180 is urged proximally relative to the handle 170, a portion of the guidewire 130 that is disposed within the handle guidewire lumen 174 automatically disengages the handle guidewire lumen 174 and passes through the slot 184 to disengage the seal housing 180. To note, the support pin 168 supports the portion of the guidewire 130, as the portion of the guidewire 130 is urged through the slot 184, and mitigates any movement or kinking of the guidewire 130. As such, as the seal housing 180 disengages the handle 170, the guidewire 130 is automatically disengaged from the seal housing 180 but otherwise remains in place in the handle 170 and, optionally, a vessel of a patient if the distal end of the guidewire is disposed therein.
Initially, the user advances the needle tip 124 to form an insertion site and access a vessel. The guidewire 130 is then advanced through the needle lumen 126 into the vessel to anchor the insertion site. As shown in
As shown in
With the needle tip 124 within the seal housing 180, a second force is applied to the needle 120, urging the needle 120, and seal housing 180, proximally. The second force is greater than the first force and is greater than a threshold force that is required to deflect the detent 178 radially outwards. As such, as shown in
Advantageously, the support pin 168 stabilizes the guidewire 130 as the portion of the guidewire 130 is urged through the slot 184, thereby mitigating kinking or movement of the guidewire 130. As such, the guidewire 130 is automatically disengaged from the seal housing 180 as the needle 120 is removed from the vasculature and disengaged from the handle 170. Advantageously, the guidewire 130 is separated from the seal housing 180 while the user controls and manipulates the handle 170, allowing for greater control over the process.
Advantageously, the needle 120, tether 192, seal housing 180, needle hub 122 and blood flash system 140 assembly can be disengaged from the handle 170, guidewire 130, and catheter 150 assembly once vascular access is achieved, mitigating any obstruction to the advancement of the catheter 150 over the guidewire 130. Advantageously, the seal housing 180 encloses the needle tip 124 preventing any needle stick injuries once the needle 120 is disengaged from the handle 170.
In an embodiment, the threshold force required to disengage the seal housing 180 from the handle 170 can be significantly greater than the first force required to disengage the needle hub 122 from the handle 170 and withdraw the needle 120 proximally.
Advantageously, this ensures the seal housing 180 does not disengage the handle 170 until the needle tip 124 is disposed within the seal housing 180 and the tip shield 188 is deployed to the locked position, mitigating needle stick injuries. Further, the tether 192 allows the user to apply greater proximal forces to the needle hub 122 that is then transferred to the seal housing 180 by way of the tether 192.
As shown in
In an embodiment, the timing lock 190 is disposed distally within the seal housing 180 and is aligned with a distal portion of the handle needle lumen 172. As shown in
As shown in
In an embodiment, the timing lock 190 is operably coupled to the tip shield 188. As such in a first position the tip shield 188 is unlocked allowing the needle 120 to slide relative to the seal housing 180, and the timing lock 190 is locked, preventing seal housing 180 from sliding relative to the handle 170. As the needle tip 124 is withdrawn into the seal housing 180, the tip shield 188/timing lock 190 assembly is released and transitions towards a second position. In an embodiment, the tip shield 188/timing lock 190 assembly is biased towards the second position. In the second position, the tip shield 188 is locked preventing any distal movement of the needle 120 relative to the seal housing 180, and the timing lock 190 is unlocked allowing the seal housing 180 to slide relative to the handle 170. The needle 120 and seal housing 180 can disengage the handle 170 and guidewire 130 assembly, as described herein. In an embodiment, the timing lock 190 and the tip shield 188 can be the same mechanism. In an embodiment, the timing lock 190 and the tip shield 188 can be separate mechanisms that operate co-currently. In an embodiment, the timing lock 190 and the tip shield 188 can be separate mechanisms that operate independently of each other and can operate based on the movement and/or position of the needle 120. Advantageously, the timing lock 190 in the first position prevents the seal housing 180 from disengaging the handle 170 irrespective of how much proximal force is applied to the needle hub 122. As such, the timing lock 190 can further mitigate premature disengagement of the seal housing 180 from the handle 170.
While some particular embodiments have been disclosed herein, and while the particular embodiments have been disclosed in some detail, it is not the intention for the particular embodiments to limit the scope of the concepts provided herein. Additional adaptations or modifications can appear to those of ordinary skill in the art, and, in broader aspects, these adaptations or modifications are encompassed as well. Accordingly, departures may be made from the particular embodiments disclosed herein without departing from the scope of the concepts provided herein.
This application claims the benefit of priority to U.S. Provisional Patent Application No. 63/465,942, filed May 12, 2023, which is incorporated by reference in its entirety into this application.
Number | Date | Country | |
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63465942 | May 2023 | US |