1. Field of Invention
The present invention relates generally to implantable medical devices, and more particularly to vascular access devices, such as ports, and methods associated with such devices.
2. Description of the Art
As known in the art, vascular access systems are used to provide recurring access to the body of a patient when performing various therapeutic or diagnostic procedures. The vascular access system typically contains a vascular access port and an elongated, pliable catheter that is coupled to the port. The port is implanted in shallow tissue areas in the body of patient, such as subcutaneously under the skin. The entire device is located subcutaneously to enhance a patient's quality of life. Because the vascular access port is implanted subcutaneously, it cannot be seen outside the body.
The port catheter is inserted into the vascular system at the desired location in the patient and is used to infuse a desired substance to the necessary location in the body of the patient. A needle and a hypodermic syringe or other fluid source is used to deliver medication through the skin and soft tissue to a fluid reservoir in the vascular access port. The medication flows through the catheter and is discharged within the body at the distal end of the catheter.
Alternatively, the vascular access system can be used to withdraw body fluids by a reverse process. A typical vascular access port has a housing, a septum through which a needle is inserted, and a base containing a fluid reservoir, as is well understood in the art.
Because vascular access systems are implanted in the tissue of a patient for long periods of time, they are typically made as small as possible. A small profile port reduces patient discomfort, thus making any medical procedure using them as minimally invasive as possible. Shrinking the size of these systems also requires shrinking the size of the vascular access port injection site or “needle target”. As ports become smaller and smaller, or are located deeper in the tissue, it becomes more and more difficult to locate the proper insertion site or “needle target” required to infuse the desired medications through the tissue into the port reservoir. This often results in unnecessary and repetitive insertions of the needle into the patient before the correct site is located allowing the needle to enter the port reservoir. It is also difficult for the health care provider to know when the correct site has been accessed, as this is not an image-guided procedure.
In addition to above described uses of ports, these implantable medical devices may also be used as a conduit for contrast media used in Computer Tomography (CT) imaging processes. CT is a common medical imaging modality for diagnostic assessments that produces cross-sectional images or slices using X-ray technology. CT without contrast media allows imaging of bones (similar to X-ray), but will not provide adequate imaging of soft tissue structures, such as tumors, organs and vasculature. Thus, CT imaging may be enhanced by using an injection of contrast media into the body to improve visibility of soft tissue structures. Typically, contrast media is injected into the patient through a needle inserted in a peripheral vein. PICC lines or vascular access ports can also be used but these devices must be able to withstand the high pressures required for CT injections.
Contrast-enhanced CT requires high pressure, high flow rate contrast injections rates to ensure sufficient tissue uptake of the contrast agent, necessary to achieve adequate visibility of the tissue structures. Using a CT injector, a large volume of contrast media is injected under high pressures into the vascular access port. A typical CT injector may produce injection pressures of between 300-350 psi at the pump outlet.
A standard vascular access port can withstand only about 25 psi. If the injection pressure exceeds the tolerance of the septum, the septum may rupture, the catheter may fail, or the catheter tip may become displaced. Ruptures may lead to serious complications or injuries to the patient, including leaking or extravasation of the contrast media into the port pocket and surrounding tissue, resulting in clinically significant complications, caused by tissue necrosis from exposure to contrast media. Ruptures can also result in the loss of venous access requiring vascular access device replacement and potential complications from a second interventional procedure.
Vascular access ports have recently been designed to withstand the higher pressures generated by CT injections. Although these ports have successfully addressed the issues of maintaining septum and overall port integrity after repeated high-pressure injections, prior art port designs have not addressed the problem that medical practitioners have with being able to accurately identify an implantable port as CT-injectable. Unlike high-pressure PICC lines in which the external segment of the catheter can easily be labeled by the manufacturer as either a standard line or a high-pressure injectable line, a vascular access port is completely implanted within the patient and cannot be visibly labeled as CT-injectable. Accordingly, there is a need to provide a vascular port with a readily visible CT-identification feature to allow the practitioner to easily determine if high-pressure injections can be administered through the port septum.
3. Objects and Advantages
It is therefore a principal object and advantage of the present invention to provide an implantable medical device for vascular access that contains a system for non-invasively guiding treatment personnel to the access location.
It is a further object and advantage of the present invention to provide a non-invasive guidance system that can be incorporated into existing designs of the same sort of medical devices.
It is an additional object and advantage of the present invention to provide an implantable medical device for vascular access that may be used for high pressure fluid injections, and is distinctly identifiable as such.
It is another object and advantage of the present invention to provide a vascular access medical device that verifies proper access of the device.
It is another object and advantage of the present invention to provide a vascular access medical device that provides a visual indication of device malfunction.
Other objects and advantages of the present invention will in part be obvious and in part appear hereinafter.
In accordance with the foregoing objects and advantages, one aspect of the present invention provides a medical device suitable for subcutaneous implantation, such as a vascular access port, generally comprising a housing, a septum positioned within and supported by the housing, at least one light emitting element positioned in position-defining relation to the septum, and pressure actuated, light activating circuitry associated with the at least one light emitting element. The light emitting element(s) may be positioned, for instance, in at least partially surrounding relation around the septum or in aligned relation with the septum so long as when light is emitted therefrom, it is possible for the light to be observed and the position of the septum to be determined based upon that observance of light. The pressure to actuate the circuitry can be applied by medical personnel applying pressure to the device, but would preferably be actuated either by vertical compression or by pressure applied to the sides of the housing for ease of operation.
In one embodiment of the invention the light activating circuitry generally comprises a light supporting member that extends in a first plane and includes a conductive pathway formed thereon, and a first plate extending in a first plane transverse and in connected relation to the light supporting member. In this aspect of the invention, a second plate connected to the light supporting member and extending in a plane parallel to and laterally spaced from the first plate may also be included. Conductive traces formed on the first and second plates together with a conductive pathway formed on the light supporting member which is contiguous with the conductive traces form a circuit that may be selectively closed by application of pressure to the device, thereby actuating the light emitting elements that are securely positioned on the conductive pathway formed on the light supporting member.
In another embodiment of the invention, the light actuating circuitry generally comprises a first portion that extends in a first plane and that includes a conductive pathway formed thereon, a second portion that extends in a second plane parallel to said first plane; and a third portion that extends between and interconnects said first portion and said second portion. In this aspect of the invention, a power source is operably positioned on the second portion, and a circuit comprising the conductive pathways that are contiguous through the first, second and third portions is selectively closed by compressing the device along its vertical axis.
In another embodiment, the light actuating circuitry generally comprises light activating circuitry comprises a first portion that extends about the septum and includes a conductive pathway formed thereon, and a second portion connected to the first portion and that includes positive and negative terminals mounted thereon. The first portion forms a partial ring/track around the septum and includes first and second pressure switches on opposing sides thereof. The second portion contains a conductive pathway that provides a means to transport power from a power source to the first and second switches. Upon application of pressure to the sides of the device the circuit that carries power from the power source to the first and second switches is closed, thereby actuating the at least one light emitting element.
In another aspect of the present invention a medical device suitable for a predetermined use and for subcutaneous implantation is provided, such as a vascular access port that has the capacity to withstand a high pressure fluid injection. In this aspect of the invention, the medical device generally comprises a housing, a septum positioned within and supported by said housing, and having the capacity to be used for the predetermined use, at least one first light emitting element associated with said housing and adapted to identify the capacity of the medical device to be used for the predetermined use, and light activating circuitry. In this aspect of the invention, the at least one light emitting element is adapted to exhibit a predetermined characteristic, such as emitting light of a distinct color, that will provide a visible indication to medical personnel who can observe the light through the patient's skin that the device is or is not suitable for receiving a high pressure fluid injection.
Another aspect of the invention includes a method for non-invasively determining the location of a medical device implanted subcutaneously in a patient, wherein the medical device comprises a housing, a septum positioned within and supported by the housing, at least one light emitting element, and light activating circuitry associated with the at least one light emitting element, with the method comprising the step of applying pressure to the medical device that results in actuation of the at least one light emitting element. Following actuation of the light emitting elements, the location of the septum is determined by visually observing the position of the at least one light emitting element. In furtherance of the aspect of the invention that provides a visual cue that the device can be used for a predetermined purpose, such as whether it can withstand a high pressure fluid injection, after actuation of the light emitting element, the method includes determining whether the device can be used for the predetermined purpose based upon visual observation of a second light emitting element. The light emitting elements may remain on for a predetermined period of time following release of the pressure that actuated the circuit (or the lights can also be deactivated at that time), but regardless, a needle may then be assuredly passed through the septum.
In a further aspect of the present invention, a method for determining whether a medical device that is adapted for subcutaneous implantation in a patient has been impaired is provided. The medical device generally comprises a housing, a septum positioned within and supported by the housing, at least one light emitting device, and light activating circuitry operably coupled to the at least one light emitting element. The method of determining whether the device has been impaired generally comprises the steps of incorporating a predetermined sensor in the housing that is adapted to quantitatively measure a predetermined physical condition and compare the quantitative measurement to a predetermined threshold, and actuating the light activating circuitry in the event the predetermined threshold has been exceeded, thereby causing the at least one light emitting element to emit light. The sensors can be, for example, pressure based sensors (i.e., pressure transducers), or impedance-based sensors capable of measuring the impedance in the interior of and the exterior to the medical device.
The present invention will be more fully understood and appreciated by reading the following Detailed Description in conjunction with the accompanying drawings, in which:
The following description provides specific details in order to provide a thorough understanding of the invention. The skilled artisan, however, would understand that the invention can be practiced without employing these specific details. Indeed, the invention can be practiced by modifying the illustrated methods and resulting products and can be used in conjunction with apparatuses and techniques conventionally used in the industry. The invention, however, could easily be adapted for any subcutaneous medical device which requires visual confirmation of the location.
Referring now to the drawings, in which like reference numerals refer to like parts throughout, there is seen in
In the first embodiment, and in fact in each of the embodiments of the present invention, port 10 includes a guidance system that non-invasively defines the location of septum 14 for purposes of providing a well-defined target for the medical personnel who need to insert a needle through the septum. In each of the embodiments the guidance system comprises at least one light emitting element that is incorporated into port 10 and is adapted to be viewable through the skin of the patient in which the port is subcutaneously implanted. By viewing the light that defines the septum location, the medical personnel will be able to accurately insert the needle through the septum without “trial and error.” The light can also be used to identify the port type, such as a CT-injectable port.
With reference to
More specifically, upper housing 20 includes a pair of diametrically opposed light guides 35, 36 to house and support LEDs 28, 30 that are positioned on opposite sides of opening 22, and therefore opposite sides of where septum 14 is positioned when port 10 is assembled. In addition, a pair of resilient, domed buttons 38, 40 are positioned on each side of upper housing 20 and serve as the manual actuation points for closing circuit 32. By manually depressing buttons 38 and 40 through the patient's tissue, the switches (as described below) on circuit 32 which are normally in an open position (thus not providing power to LEDs 28, 30) are closed, thereby providing power to LEDs 28, 30. When buttons 38 and 40 are released, they bias back to their neutral positions which once again opens the switches on circuit 32 cutting power to LEDs 28 and 30.
With reference to FIGS. 6A-B, LED circuit 32 is formed from a flexible, die-cut (essentially T-shaped) strip of material with conductive printing etched thereon to form the circuit, as shown schematically in
The assembly of port 10 is illustrated with reference to
In another embodiment of the invention, the access port used in the systems of the invention is depicted in
Access port 100 also contains a lighting means that emits light from the access port. Any means that can emit light from the access port 100 can be used in this invention. In one aspect of the invention, the lighting means comprises light source 110 located on the upper surface of port can 106. The housing 102 may be of translucent or semi-translucent material to enhance visibility of the light source 110 when activated.
Depicted in
Lighting components 110 can be any source of light known in the art. Examples of light components that can be used include incandescent bulbs, luminescent or fluorescent materials, and light emitting diodes (LEDs). In one aspect of the invention, LEDs are used for the light component 110.
The lighting means preferably contain more than a single light component. While theoretically any number of light components can be used, the number of light components 110 is selected so that the desired amount of light is obtained given the physical dimensions of access port 100. For example, when septum 104 with a diameter of about 1 centimeter is used, the number of light components can effectively be from 1 to 10. In one preferred aspect, the two to three light components 110 were found effective.
Light components 110 are arranged so that a desired amount, and theoretically the maximum of amount of light is emitted from access port 100. Thus, the orientation of light components 110 will depend on several factors, including the number of lights used, the desired direction of light emission, the materials used in access port 100 (through which the light may need to be transmitted), housing 102, and septum 104. In one aspect of the invention, light components 110 are arranged to create a substantially circular shape around the periphery of septum 104.
Light components 110 can be mounted at any location on access port 100 that provides the desired intensity of light, whether that is bright or dim. To obtain effective light transmittance, light components 110 are located on the outer, “upper” surface of housing 102. In another aspect of the invention, the light components are located between the port can 106 and housing 102 which is manufactured from a transparent/translucent thermal plastic, which permits light components 110 and accompanying circuit 112 to be encapsulated inside housing 102 while allowing light to transmit there through and into the surrounding tissue. This arrangement allows all the electronic components of port 100 to be safely contained within the device, thereby reducing or eliminating contact of these components with tissue.
Alternatively, the light components may be placed within the port reservoir, either on the bottom or on the inner surface of the vertical side-walls. In this embodiment, the light components emit visible light through the septum, illuminating the septum itself rather than the periphery of the septum.
The light emitted from port 100 can be any desired color or combination of colors. In one aspect of the invention, the presence of light-emitting elements may be used to identify the vascular access port as a device that meets the requirements for high-pressure fluid injections, such as used in CT. In another aspect of the invention, different colors are used to signify different parts of access port 100. For example, a second color (i.e., green) could be used in addition to a first color (i.e., red) that is used to locate the injection site. The additional, second color would be located at or above exit lumen 114 to indicate the location of the outlet relative to the injection site. This configuration would allow a health care provider to angle the needle towards exit lumen 114 if desired for more effective placement of medication, and also aid in inserting a wire to clear any blockages that may be in exit lumen 114. It should be noted that different colors penetrate tissue to different depths. A red color is typically the most visible under tissue, but other colors may be used depending on skin depth, color and personal preference.
In another aspect of the invention, different colors could be used to demonstrate different port sizes, configurations including multiple injection sites (e.g., at least two septa incorporated into the port), port types (e.g., a port capable of withstanding high pressure fluid injections such as is needed for CT), port materials, or specific types of indicated medicines. For instance, a particular color, red for instance, could be used to designate the port as being one that is designed to withstand injection of contrast media used in CT imaging.
The power source 116 can be any known in the art that provides the needed amount of power, yet will meet the size limitations needed for access port 100. Examples of power supplies include both internal and external power supplies. To meet the size and portability requirements, however, an internal power supply (i.e., a battery with a voltage ranging from about 1 to about 6 volts) can be used in the invention. If desired, more than a single power supply can be used.
Circuitry 112 contains all the necessary electrical components to convey the power from power supply 116 to light component 110. Depending on the number and types of light component(s) used and type of power supply, circuitry 112 can be adapted to provide the desired electrical pathway. In one aspect of the invention, circuitry 112 is kept as simple as possible and contains only a simple conducting line between the power supply 116 and light components 110. Of course, more complex circuitry could be used in the lighting means if needed.
Circuitry 112 is configured so that when access port 100 is not being used, light is not emitted. Because of size limitations, power supply 116 has a limited amount of power. To conserve that limited amount, circuitry 112 is configured so that light is only emitted when needed, i.e., when access port 100 is actively being used. Alternatively, lights 110 can be configured to blink when activated instead of being constantly provided power. The intermittent light pattern creates a high on-off contrast for enhanced visibility relative to a continuous light beam. In one aspect of the invention, this operation is performed by providing a circuitry 112 configured with additional components well known in the art to produce the pulsing light pattern when the circuit is closed. As with other circuit configurations previously described, when in the normal mode, the circuit is open so that no power flows from power supply 116 to the light components 110. When light is needed in an operational mode, circuit 112 is closed so that the power from power supply 116 flows to the light components 110.
In another modification, the port may be designed to emit visible light for a pre-determined time period following pressure activation by use of a timing circuit commonly known in the art. Closing the switch by applying pressure activates the timing circuit which transmits power to the LED for a specified period of time after which the timing circuit deactivates the switch, causing the LED to go off. The timing circuit may be programmed to maintain the switch in an activated state for a period of time sufficient to allow the practitioner to identify the septum and insert the needle, preferably between 5 and 20 seconds. A timing circuit provides an advantage over non-time activated designs in that it allows the practitioner to use both hands if desired to insert the needle since continual pressure is not required to maintain the circuit in a closed position.
There are numerous methods for configuring circuitry 112 to form an open circuit in a normal mode and to form a closed circuit in an operational mode. One example of such a method is depicted in
With such a configuration, to close the circuit and activate light components 110, a force is exerted against access port 100 (e.g., a force applied along vector P (
The lighting means of the access port can be configured so that any type of force results in an emission of light. In one aspect of the invention, this force could be squeezing or pressing on the access port at any location. The amount of force needed to trigger the light emission can also vary from a slight tapping to a hard pressing.
In another aspect of the invention, the kinetic energy generated by the motion of normal body movement is stored in an internal holding cell such as a battery and implemented to provide a power source for the light emission. The patient's normal body movements are transformed into an electric current via a magnet and coil located within the port. The electrical current can then be stored using a capacitor or battery. Any other known means for storing and implementing the power generated from this kinetic energy can also be used.
In another aspect of the invention, the circuitry does not move as described above from an open position to a closed position. Instead, the light means is configured so that the application of an external electrical field (such as a capacitor or a wand) in effect closes the circuit and triggers the light emission. For example, a radiofrequency or microwave chip may be placed within the port which functions to activate a switch to close the circuit when an externally generated radiofrequency or microwave field is present (such as a field created by a RF or microwave wand). As well, the lighting means could be configured without a power supply and an external magnetic field could be applied to supply the necessary amount of power to actuate the light which would require use of a magnetic switch in the port. In these aspects where current is induced, obviously, batteries are not needed and the maintenance of the device is thereby enhanced. It should also be pointed out that external activation as described herein may also be used in combination with manual pressure activation to transmit power to the LEDs. In this aspect, the external activation provides a secondary means of activating the power which may be used in the event of a malfunction of the pressure activated switch or an inability to access the pressure points on the port due to port location deep within the tissue.
In one modification of the invention, structural components of the access port 100 (i.e., housing 102, septum 104, port can 106) can be made from any material that allows a greater amount of light to be emitted through it. Most materials used in access port components typically have a low degree of light transmittance. Examples of materials that can be used to improve light transmittance include translucent or transparent materials, such as glass, polyurethane, or polycarbonate. In the aspect of the invention where light components 110 are located between port can 106 and housing 102, the housing is made of such materials.
In another modification applicable to all embodiments, the light activating circuitry can be configured to turn the light emitting elements on and off at different time intervals or under different conditions as indicators. For example, the lighting means can be configured to indicate both the location of the septum and correct needle insertion into the septum. In this embodiment, the pressure-activated light component arrangement previously described may be used to indicate the precise location of the septum.
After locating the septum, the health practitioner inserts the needle through the patient's tissue and into the septum. Correct placement of the needle is indicated/verified by the illumination of an additional light emitting component, which is activated by the conductive coupling of a plate located on the bottom of the reservoir and conductive elements within the septum. The needle, which is conductive itself, acts as the switch to conductively couple the reservoir base plate and the conductive elements within the septum, thereby illuminating the light emitting component.
The septum may be made electrically conductive by the addition of a filler material such as silver, carbon or other conductive material commonly known in the art. Alternatively, a fine metallic mesh structure may be embedded within the septum body to act as the conductive element. In one embodiment, the bottom conductive plate may be eliminated by configuring a septum comprised of two horizontal planes of mesh (or other conductive filler) material. When the needle is inserted into the septum, it contacts both mesh planes thus completing the electrical circuit and allowing power to flow to the light emitting components.
The port of this invention (all embodiments) may also be configured to emit visible light when the port is impaired in some manner such as catheter occlusion or port leakage. A set of impedance-based sensors may be used to monitor and compare fluid-generated impedance within the port and externally in the tissue immediately surrounding the port. An impedance differential that is insignificant between the two locations may indicate that the port is leaking fluid to the surrounding tissue.
In another modification, the port may be configured with a pressure transducer located within the port, preferably on the bottom wall of the reservoir. The pressure transducer senses pressure levels and if a predetermined level is exceeded, the circuitry is automatically activated (the circuitry is also automatically actuated if the impedance-based sensors detect an impairment condition), causing the light emitting components to emit light as a visible alert of the impaired port. The predetermined pressure may be exceeded if for example, the catheter is partially or completely occluded or has become dislodged from the stem. The pressure transducer can also activate the circuitry in the event a medical practitioner attempts to inject fluid under high pressure into a port not designed for receiving high pressure injections. Alternatively or additionally, the impairment (impedance based or pressure transducer based) may be triggered when the medical personnel applies pressure to the port with a second light emitting element being actuated in the event an impairment is detected, with the second light emitting element having a distinct characteristic that differentiates it from the light emitting elements that define the position of the septum.
With reference to
With reference to
Referring to
When buttons 330, 332 are in their neutral (i.e., untouched) state, serpentine traces 327, 329 are not conductively coupled, thus maintaining an open circuit that will not transmit power through conductive pathway 334. The serpentine traces 327, 329 remain in a normally open state by use of either a spacer frame 337 or an air gap. As shown in
To activate the light circuit 312, buttons 330, 332 are manually depressed (e.g., by applying a force along vector T shown in
Alternatively, the serpentine traces 327, 329 may be maintained in an open state by an air gap. Referring again to
With reference to
When assembled, port 300 includes space 390 which is defined by the upper surface of housing 304 and the lower surface of cover 318. Space 390 houses the LEDs 338 and portions of the circuitry 312. Space 390 may optionally be filled with an adhesive filler material such as epoxy to enhance the overall structural integrity of port 300, and specifically the sealing characteristics of the port. By filling space 390, the circuitry 312, LEDs 338 are held in sealing arrangement with the other port components, thus preventing moisture or fluid from entering space 390 and impairing port functionality.
Septum 316, as illustrated, may be composed of two portions of distinct material durometers 316a and 316b. If port 300 is to be used for injection of contrast media as is done for CT and other forms of imaging, material durometer 316a may be lower (i.e., softer) than durometer 316b. The use of a lower (softer) durometer 316b on the bottom layer when port 300 is used for injection of contrast media allows contrast media to be injected at relatively higher pressures than other forms of septum designs. The use of the lower (softer) durometer on the bottom layer of the septum will improve its efficacy in this regard. It is possible, however, that the reverse arrangement could be used, as could an arrangement where the harder material radially surrounds the softer material.
With reference to
When injection of fluids or withdrawal of blood samples is needed, the medical practitioner activates the port light emitting elements 338 by applying manual finger pressure (step 500—see
Activation of the light emitting elements 338, which are located on the periphery of the septum 316, provides the medical practitioner with an immediate and accurate visual indicator of the septum location relative to the port 300 (step 510/510′). As illustrated in
As illustrated in
In addition to any previously indicated variation, numerous other modification and alternative arrangements may be devised by those skilled in the art without departing from the spirit and scope of the invention and appended claims are intended to cover such modifications and arrangements. Thus, while the invention has been described above with particularity and detail in connection with what is presently deemed to be the most practical and preferred aspects of the invention, it will be apparent to those of ordinary skill in the art that numerous modifications, including but not limited to, form, function, manner of operations and use may be made without departing form the principles and concepts set forth herein.
The present application claims priority to U.S. Provisional Application Ser. No. 60/722,800, filed Sep. 30, 2005, the entirety of which is hereby incorporated by reference.
Number | Date | Country | |
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60722800 | Sep 2005 | US |