In various embodiments, the invention relates to implantable drug-delivery devices and to apparatus and methods for refilling such devices.
Medical treatment often requires the administration of a therapeutic agent (e.g., medicament, drugs, etc.) to a particular part of a patient's body. Some maladies, however, are difficult to treat with currently available therapies and/or require administration of drugs to anatomical regions to which access is difficult to achieve.
A patient's eye is a prime example of a difficult-to-reach anatomical region, and many vision-threatening diseases, including retinitis pigmentosa, age-related macular degeneration (AMD), diabetic retinopathy, and glaucoma, are difficult to treat with many of the currently available therapies. For example, oral medications can have systemic side effects; topical applications may sting and engender poor patient compliance; injections generally require a medical visit, can be painful, and risk infection; and sustained-release implants must typically be removed after their supply is exhausted.
Another example is cancer, such as breast cancer or meningiomas, where large doses of highly toxic chemotherapies, such as rapamycin, bevacizumab (e.g., Avastin®), or irinotecan (CPT-11), are typically administered to the patient intravenously, which may result in numerous undesired side effects outside the targeted area.
Implantable drug-delivery devices, which may have a refillable drug reservoir, cannula, and check valve, etc., generally allow for controlled delivery of pharmaceutical solutions to a specified target. As drug within the drug reservoir depletes, the physician can refill the reservoir with, for example, a syringe, while leaving the device implanted within the patient's body.
If, however, the syringe needle is inadvertently inserted too far into the device during the refilling, the device can be damaged. Such damage may necessitate removal of the device and its replacement with another, thereby obviating some of the advantage of using the device. Even if the device is not damaged, insertion of the needle too far into the device can, for example, embed the needle tip in the bottom wall of the device's reservoir, thereby clogging the needle's lumen. Additionally, the improper insertion of the needle into the device may lead to the delivery of the drug into an improper location.
A need exists, therefore, for improved implantable drug-delivery devices, and apparatus and methods for refilling such devices.
In various embodiments, the present invention features apparatus and methods for refilling, in situ, a drug-delivery device implanted within a patient's body. The apparatus generally contain features, and the methods typically contain steps, that allow the refilling to occur in a manner that minimizes the risk of damage to the device, and thereby maximizes its effective lifetime. For example, embodiments of a refilling needle described herein employ a needle depth gauge to limit the degree to which the needle penetrates the drug-delivery device during a refilling procedure. As another example, the drug-delivery device itself may include a stop to limit the extent of the needle's penetration therein. Moreover, to aid a physician in locating a needle entry port of the drug-delivery device, and to protect the patient from inadvertent punctures by the needle, embodiments of the invention employ a visualization ring that identifies the needle entry port. These features, together with others, facilitate the rapid refilling of the drug-delivery device, while minimizing the risk of damage to the device and injury to the patient. Thus, the time spent by a physician in refilling the drug-delivery device is reduced (which may generate a cost savings), the useful life of the drug-delivery device may be lengthened, and the need to replace drug-delivery devices damaged during the course of attempts to refill them is reduced.
In general, in one aspect, embodiments of the invention feature a needle for refilling an implantable drug-delivery device. The drug-delivery device may have a needle entry port that includes a throat for receiving the needle therethrough. For its part, the needle may include a hollow shaft that terminates in a tip, a fluid exit port along the shaft proximate to the tip, and means for limiting the extent of entry of the needle into the entry port. In one embodiment, the needle tip is conically-shaped. The fluid exit port of the needle may be positioned intermediate to the tip and the limitation means.
In various embodiments, the limitation means includes a stop on the needle shaft. For example, the stop may be a ring surrounding and fixedly mounted to the shaft. The ring may have an outer diameter exceeding a width of the entry port's throat. Alternatively, the stop may be spherically-shaped, cylindrically-shaped, rectangularly-shaped, or pyramidally-shaped. In certain embodiments, the limitation means is constructed of a metal, a plastic, and/or a composite material. The limitation means may be, for example, constructed of a biocompatible material, such as polydimethylsiloxane (PDMS). (Although the ensuing discussion refers primarily to PDMS, this is for convenience, and references to PDMS are intended to connote any suitably biocompatible form of polydiorganosiloxane (i.e., silicone) polymer.) Other exemplary materials from which the limitation means may be constructed include polyimide, polypropylene, polyetheretherketone (PEEK), polycarbonate, an acetyl film, polyoxymethylene plastic, gold, stainless steel, nickel, chrome, and combinations thereof.
In general, in another aspect, embodiments of the invention feature an implantable drug-delivery device. The drug-delivery device includes a drug reservoir, a needle entry port, and a vestibule. The needle entry port may include a throat for receiving a refill needle therethrough. The throat may open into the vestibule, which may (i) be wider than the throat, (ii) include a stop on a wall opposite the throat for halting progress of a needle into the vestibule through the throat, and (iii) be in fluid communication with the drug reservoir.
In various embodiments, the drug-delivery device also includes a check valve that is located between the vestibule and the drug reservoir. For its part, the needle entry port may also include a self-sealing material (e.g., at its top surface). In one embodiment, the stop within the vestibule is sized so as to halt the progress of a needle that includes an exit port at a point at which the exit port is in fluid communication with the vestibule. A top surface of the stop may be cup-shaped. In certain embodiments, the stop is constructed of a metal, a plastic, and/or a composite material. The stop may be, for example, constructed of a biocompatible material, such as PDMS. Other exemplary materials from which the stop may be constructed include polyimide, polypropylene, PEEK, polycarbonate, an acetyl film, polyoxymethylene plastic, gold, stainless steel, nickel, chrome, and combinations thereof.
In general, in yet another aspect, embodiments of the invention feature an implantable drug-delivery device that includes a drug reservoir, a needle entry port, and a visualization ring surrounding the needle entry port. The needle entry port may include a throat for receiving a refill needle therethrough. The throat may open into a vestibule that is in fluid communication with the drug reservoir. For its part, the visualization ring may be visible through ocular tissue (e.g., a patient's conjunctiva) so as to visually indicate the position of the needle entry port.
In various embodiments, the visualization ring is constructed of a material that is biocompatible and/or withstands penetration by the refill needle. The visualization ring may include one or more fluorescent pigments, such as a luminescent aerogel, a nanoparticle, a phthalocyanine (PC) pigment, fluorescein isothiocyanate, rhodamine, coumarin, cyanine, an Alexa Fluor, a DyLight Fluor, a quantum dot, a green fluorescent protein, and/or a luciferin. In another embodiment, the visualization ring includes a light emitting diode. Alternatively, a light emitting diode present in the drug-delivery device may be located away from the visualization ring and optical fiber may be used to conduct light from the light emitting diode to and around the visualization ring. The visualization ring may also include a material that enhances surface echogenicity and acoustic shadowing. Electronics may also be present in the drug-delivery device in order to move or vibrate the visualization ring. In yet another embodiment, the visualization ring includes a magnetic material.
In general, in still another aspect, embodiments of the invention feature a method for refilling a drug-delivery device implanted within a patient. The method includes inserting, into a needle entry port of the drug-delivery device, a distal tip of a needle that includes a hollow shaft and a stop on the shaft. The needle may then be advanced into the needle entry port until the stop limits further entry of the needle into the entry port. Drug may be delivered through the hollow shaft of the needle, out a fluid exit port positioned along the shaft of the needle proximate the tip, and into the drug-delivery device. In accordance with this method, the stop may be a ring that surrounds the shaft of the needle and that has an outer diameter exceeding a width of the entry port.
In general, in a further aspect, embodiments of the invention feature another method for refilling a drug-delivery device implanted within a patient. The method includes inserting, into a needle entry port of the drug-delivery device, a distal tip of a needle. The needle may then be advanced through the needle entry port into a vestibule of the drug-delivery device until a stop positioned on a wall of the vestibule opposite the needle entry port halts further entry of the needle. Drug may be delivered through a hollow shaft of the needle, out a fluid exit port positioned along the shaft of the needle proximate the tip, and into the vestibule. The stop may halt further entry of the needle at a point at which the exit port of the needle is in fluid communication with the vestibule.
In various embodiments, these methods include locating, prior to inserting the distal tip of the needle into the needle entry port, a visualization ring that visually indicates the position of the needle entry port. The visualization ring may surround the needle entry port and be visible through the patient's conjunctiva.
These and other objects, along with advantages and features of the embodiments of the present invention herein disclosed, will become more apparent through reference to the following description, the accompanying drawings, and the claims. Furthermore, it is to be understood that the features of the various embodiments described herein are not mutually exclusive and can exist in various combinations and permutations.
In the drawings, like reference characters generally refer to the same parts throughout the different views. Also, the drawings are not necessarily to scale, emphasis instead generally being placed upon illustrating the principles of the invention. In the following description, various embodiments of the present invention are described with reference to the following drawings, in which:
In general, embodiments of the present invention pertain to drug-delivery devices implantable within a patient's body, such as, for example, within the patient's eye, and to apparatus and methods for refilling those devices. In certain embodiments, an implantable drug-delivery device combines small size and a refillable reservoir. The small size minimizes discomfort from the device to the patient, while the refillable reservoir allows the device to be refilled in situ, rather than being replaced. As such, a fluid, such as a solution of a drug, can be supplied to the patient over extended periods of time.
As also illustrated in
The visualization ring 140 may also be made with materials that enhance surface echogenicity and acoustic shadowing so that the physician may better visualize the needle entry port 116 when using certain imaging devices. Such materials include metals, semiconductors, and advanced composite materials that cause the visualization ring 140 to become more reflective or absorbent to ultrasound waves or infrared light (in contrast to the other materials on the non-ring portions of the drug-delivery device 100 that are not desired to be visualized) during such times as when the physician uses an ultrasound scanner, an optical coherence tomography (OCT) visualization tool, or other coherence scanner for visualizing the ring 140 subcutaneously. For example, if the outer shell of the drug-delivery device 100 is made of polyimide (a less reflective material), but the visualization ring 140 is lined with gold (a more reflective material), then the visualization ring 140 will be more easily visualized by the physician when using an OCT scanner or ultrasound scanner since the light, laser, or sound will be reflected differently by the gold.
In another embodiment, the visualization ring 140 includes one or more light emitting diodes (LEDs) that illuminate during the desired time of refilling. For example, the drug-delivery device 100 may include an internal power supply (e.g., a battery) and other electronics to supply power to the LEDs. Then, the physician may activate the power supply and electronics wirelessly (e.g., using a device that emits a radio-frequency (RF) signal) to turn the LEDs on just prior to refilling the drug-delivery device 100. Alternatively, where it is desired to hermetically package the electronic devices (including the LEDs) within the drug-delivery device 100, the LEDs may be located in a different part of the drug-delivery device 100 (e.g., distant from the visualization ring 140) and a conduit, such as a bundle of optical fiber, may be used to conduct the light from the LEDs to the visualization ring 140 and also around the visualization ring 140.
In yet another embodiment, the visualization ring 140 and/or the needle entry port 116 moves up and down, or vibrates, in a manner that gives the physician a tactile sensation confirming the location of the visualization ring 140 and/or needle entry port 116. Again, such movement and/or vibration may be imparted to the visualization ring 140 and/or the needle entry port 116 through the use of electronics internal to the drug-delivery device 100. Those electronics may be activated remotely through, for example, a handheld device emitting an RF signal.
In still another embodiment, the visualization ring 140 includes a magnetic material. For example, the visualization ring 140 may be made, at least in part, from a ferromagnetic material alone, or it may include a ferromagnetic material encased in a ceramic. The refill needle 120 used in combination with such a visualization ring 140 may likewise contain magnetic materials, for example on a tip 208 and/or shaft 212 thereof, and/or on a stop 224 connected thereto (see
Since the needle entry port 116 may be very small, and the physician may be injecting drugs in an invasive manner, it is often useful to add a secondary or tertiary confirmatory signal for the location of the visualization ring 140 and the needle entry port 116, such as sight, sound, tactile sensation, and/or magnetic interaction.
In one embodiment, as illustrated in
The visualization ring 140 may be an annulus and, as illustrated in
In addition to the visualization ring 140, an insertion guider (not shown) may be positioned at a top surface of, or within, the needle entry port 116 to aid in guiding the refill needle 120 along the elongate axis of the vestibule 132 (and not into the sidewall 144). The insertion guider may be cylindrical in shape, or have another shape. In addition, the insertion guider may be removable and may be placed on top of the needle entry port 116 and mechanically or magnetically locked to the needle entry port 116 just prior to the refilling procedure.
As mentioned, a physician may pierce the surface 124 of the needle entry port 116 with the refill needle 120 as he or she advances the needle 120 into the vestibule 132 of the drug-delivery device 100. In one embodiment, the material of the surface 124 is self-sealing. More specifically, the surface 124 may be formed from a soft plastic material that can be punctured with the needle 120 and that reseals itself upon removal of the needle 120. In one embodiment, the self-sealing material is able to withstand multiple punctures by the needle 120, and is biocompatible. Examples of materials that may be employed for the self-sealing material include, but are not limited to, PDMS, parylene C, parylene HT, polycarbonates, polyolefins, polyurethanes, copolymers of acrylonitrile, copolymers of polyvinyl chloride, polyamides, polysulphones, polystyrenes, polyvinyl fluorides, polyvinyl alcohols, polyvinyl esters, polyvinyl butyrate, polyvinyl acetate, polyvinylidene chlorides, polyvinylidene fluorides, polyimides, polyisoprene, polyisobutylene, polybutadiene, polyethylene, polyethers, polytetrafluoroethylene, polychloroethers, polymethylmethacrylate, polybutylmethacrylate, polyvinyl acetate, nylons, cellulose, gelatin, silicone rubbers and porous rubbers. Where the self-sealing material includes a plastic that is capable of leaching or absorbing drugs that come into contact with it (e.g., silicone), parylene may be coated over the plastic so that less drug is exposed to the plastic.
A hollow shaft 212 (i.e., a shaft having a lumen that extends therethrough) extends from the proximal end 200 of the refill needle 120 to a proximal end 216 of the tip 208. In addition, as illustrated, the refill needle 120 may include at least one fluid exit port 220 positioned along the shaft 212 (e.g., near the tip 208). For example, the refill needle 120 may include, near the proximal end 216 of the tip 208, two fluid exit ports 220 positioned approximately 180° apart around the circumference of the shaft 212. Alternatively, the fluid exit port(s) 220 may be positioned elsewhere along the shaft 212. The fluid exit port(s) 220 is/are in fluid communication with the lumen of the hollow shaft 212. In this way, when the refill needle 120 is positioned within the vestibule 132 of the device 100, as further described below, therapeutic fluid may be passed through the hollow shaft 212 of the needle 120, out its fluid exit port(s) 220, and into the vestibule 132. In addition, the fluid exit port(s) 220 are generally oriented transverse to the long axis of the refill needle 120. In this fashion, the refill needle 120 may be inserted into the needle entry port 116 of the device 100 with reduced risk of occluding the exit port(s) 220 with material cored from the walls of the throat 128.
With reference still to
In one embodiment, as illustrated in
The stop 224 may be constructed of a metal, a plastic, a composite material, or a combination thereof. The metal, plastic, and/or composite material may be biocompatible, or not. In one embodiment, the stop 224 is constructed of PDMS. Alternatively, the stop 224 may be constructed of other material, or combinations of materials, that have the requisite mechanical strength to perform the function of the stop 224 described herein. For example, the stop 224 may also be constructed of polyimide, polypropylene, PEEK, polycarbonate, acetyl film (e.g., acetyl copolymer), polyoxymethylene plastic (e.g., Delrin®), gold, stainless steel, nickel, and/or chrome. The stop 224 may also take the form of an integral, disk-like protrusion from (and extending around) the needle shaft 212, introduced during the manufacture thereof.
In practice, an exemplary refill needle 120 may be prepared by pinching closed a hollow 30-gauge needle and deburring the closure to leave a conical tip 208 of approximately 254 μm in height. Two exit ports 220, each measuring approximately 101 μm in diameter, may then drilled through refill needle 120 approximately 127 μm above the proximal end 216 of the conical tip 208. A stop 224 may then be fabricated by laser-cutting a thin PDMS membrane into an appropriately sized ring shape. As will be understood by one of ordinary skill in the art, the inner diameter of the ring-shaped stop 224 is determined by the size of the outer diameter of the refill needle 120 (i.e., approximately 305 μm for a 30-gauge needle). The PDMS ring-shaped stop 224 may then be fitted onto the shaft 212 of the needle 120 and secured by, for example, a glue. The location on the shaft 212 to which the ring-shaped stop 224 is secured is chosen as described above.
In another embodiment, rather than fixedly mounting a stop 224 on the outside of the shaft 212 of the refill needle 120, or in addition thereto, a stop may be positioned within the vestibule 132 of the drug-delivery device 100 itself. For example, as illustrated in
The stop 152 may be a rectangular prism, a cylinder, or any other shape suitable for carrying out the functions of the stop 152 described herein. As illustrated in
In addition, like the stop 224 of the refill needle 120, the stop 152 may be constructed of a metal, a hard (e.g., fully cross-linked or reinforced) plastic, a composite material, or a combination thereof. For example, the stop 152 may be constructed from a thick layer of PDMS (i.e., a thicker layer than that used for the puncturable surface 124 of the needle entry port 116), polyimide, polypropylene, PEEK, polycarbonate, acetyl film (e.g., acetyl copolymer), polyoxymethylene plastic (e.g., Delrin®), gold, stainless steel, nickel, and/or chrome. The stop 152 may be biocompatible, or not. In general, the stop 152 may be constructed of any relatively rigid and mechanically robust material, or combinations of materials, that have the requisite mechanical strength for performing the functions of the stop 152 described herein.
An operator of the drug-delivery device 100 (e.g., a physician) may refill the device 100 in situ (i.e., without having to remove the device 100 from the patient's eye). To do so, in one embodiment, the operator first locates the visualization ring 140 of the device 100. The operator may locate the visualization ring 140 by simple visual inspection because, as described above, the visualization ring 140 is constructed of a material that is visible through the patient's conjunctiva. Moreover, because the visualization ring 140 surrounds the needle entry port 116, it visually indicates the position of that needle entry port 116 to the operator.
Once the visualization ring 140 and needle entry port 116 are located, the operator inserts the distal tip 208 of the refill needle 120 into the needle entry port 116 of the drug-delivery device 100. More specifically, the operator may contact the surface 124 of the needle entry port 116 with the distal tip 208 of the refill needle 120, pierce the surface 124 by advancing the needle 120, and further advance the needle 120 into the throat 128 and then the vestibule 132 of the drug-delivery device 100. In an embodiment where the refill needle 120 includes the stop 224 fixedly mounted to (or integral with) its shaft 212, the operator may continue to advance the needle 120 into the needle entry port 116 until the stop 224 contacts the surface 124 of the needle entry port 116, thereby limiting further entry of the needle 120 into the needle entry port 116. Alternatively, in an embodiment where the vestibule 132 includes the stop 152 fixedly mounted to its bottom wall 148, the operator may continue to advance the refill needle 120 into the needle entry port 116 until the distal tip 208 of the needle 120 contacts the stop 152, which then halts further entry of the needle 120 into the vestibule 132.
At the point of the stop 224 and/or the stop 152 acting to limit further entry of the needle 120 into the vestibule 132, the operator will be assured, as described above, that the exit port(s) 220 of the refill needle 120 is/are properly placed within the vestibule 132 and in fluid communication therewith. The operator may then cause a therapeutic fluid (e.g., a drug in liquid form) to be delivered through the hollow shaft 212 of the refill needle 120, out the fluid exit port(s) 220, and into the vestibule 132 of the drug-delivery device 100. Injection of the therapeutic fluid from the needle 120 into the vestibule 132 forces the fluid through the check valve 136 and into the reservoir 108, thereby refilling the reservoir 108.
Accordingly, as described herein, the operator may rapidly refill the drug-delivery device 100 in situ, while the risk of damage to the device 100 and injury to the patient are also minimized.
Having described certain embodiments of the invention, it will be apparent to those of ordinary skill in the art that other embodiments incorporating the concepts disclosed herein may be used without departing from the spirit and scope of the invention. For example, the drug-delivery device 100 may also be implanted in other portions of a patient's body, such as in the sub-arachnoid space of the brain to provide chemotherapy or to provide another type of treatment for the brain, near a tumor in any portion of the patient's body to provide chemotherapy, or in a pancreas that does not respond well to glucose to provide agents (e.g., proteins, viral vectors, etc.) that will trigger insulin release. Accordingly, the described embodiments are to be considered in all respects as only illustrative and not restrictive.
This application claims priority to and the benefit of, and incorporates herein by reference in its entirety, U.S. Provisional Patent Application No. 61/018,747, which was filed on Jan. 3, 2008.
The U.S. Government has a paid-up license in this invention and the right in limited circumstances to require the patent owner to license others on reasonable terms as provided for by the terms of Grant Nos. ERC EEC-0310723 and EEC-0547544 awarded by the National Science Foundation.
Number | Date | Country | |
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61018747 | Jan 2008 | US |
Number | Date | Country | |
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Parent | 12348178 | Jan 2009 | US |
Child | 13868649 | US |