This invention relates to irrigation systems and tubing for delivering fluid through a patient's vasculature, in particular when a patient is undergoing catheter-based cardiac ablation procedures in which irrigation fluid is delivered to the tissue ablation site in the heart through tubing that extends through a catheter.
With irrigated EP devices, irrigation fluid, e.g., saline, is sourced from a fluid bag that is punctured by a bag spike of a drip chamber that is connected to an irrigation tubing whose distal end is typically connected to a luer hub or side port provided at or near a proximal end of a guiding sheath. For a passively-irrigated sheath where irrigation is supplied without a pump, it is desirable for the irrigation pathway to from a saline bag to the sheath to maintain positive pressure so as to ensure fluid flow for minimizing risks of blood coagulation. With the sheath inserted in a patient's vasculature and irrigated by the saline bag, the pressure in the irrigation pathway as measured, e.g., at a side port of sheath, would depend on a height differential of the saline bag relative to the height of the patient minus the cardia pressure. The pressure in the irrigation pathway is normalized but varies when a catheter is inserted into or removed from the guiding sheath. In particular, when a catheter is inserted into the sheath, a vacuum, as measured at a location proximal of the sheath, is created in the irrigation pathway trailing the catheter as it is advanced through the sheath until the catheter tip passes the distal tip of the sheath, at which stage pressure in the irrigation pathway normalizes again. And, when the catheter is retracted from the sheath, a pressure rise occurs in the irrigation pathway as measured from the location proximal of the sheath. This variance is depicted in
Accordingly, there is a desire for a device that is responsive to changes in irrigation flow pressure and self-adjusts to normalize the fluid flow rate in an irrigation pathway between a saline bag and a sheath or other electrophysiology device such as a catheter.
In some embodiments, an inline flow control device for passive irrigation tubing to be used with electrophysiology devices, includes a proximal lumen, a distal lumen, and a diaphragm having a first surface and a second surface. The diaphragm is housed in a chamber having first and second opposing sidewalls. The first sidewall has a first opening in communication with the proximal lumen and the second sidewall has a second opening in communication with the distal lumen. Advantageously, the diaphragm is elastically flexible and unfixed at least at is peripheral edge to the chamber so as to assume configurations, including a neutral configuration that allows a predetermined fluid flow through the device, a first flexed configuration that allows greater fluid flow through the device and a second flexed configuration that generally ceases fluid flow through the device.
In some embodiments, the device defines a fluid path that includes through the proximal lumen, over the first surface of the diaphragm, around a circumferential outer edge of the diaphragm, under the second surface of the diaphragm and through the distal lumen.
In some embodiments, the side sidewall of the chamber has a plurality of fins configured to support the diaphragm on its second surface.
In some embodiments, the fins have a tapered profile.
In some embodiments, each fin has a greater inner edge and a lesser outer edge to provide the tapered profile.
In some embodiments, the diaphragm in the neutral configuration is generally planar.
In some embodiments, the diaphragm in the first flexed configuration is flexed toward the second sidewall.
In some embodiments, the diaphragm in the second flexed configuration is flexed toward the first sidewall.
In some embodiments, the second sidewall includes raised projections.
In some embodiments, the raised projections or fins are configured to support a lesser portion of the diaphragm in the neutral configuration and a greater portion of the diaphragm in the first flexed configuration.
In some embodiments, the raised projections or fins are configured to support a lesser portion of the diaphragm in the second flexed configuration and a greater portion of the diaphragm in the first flexed configuration.
In an alternate embodiment of an inline flow control device for passive irrigation tubing to be used with electrophysiology devices, the device includes a housing, an elastically deformable diaphragm and a hollow piston. The housing has a proximal chamber and a distal passage. The diaphragm is fixed to the chamber solely along its peripheral edge and the diaphragm is otherwise free to assume a neutral configuration, a first flexed configuration and a second flexed configuration. The hollow piston extends through the diaphragm and into the distal passage. The piston is configured for movement with the diaphragm with a neutral position when the diaphragm is in the neutral configuration, an extended position relative to the housing when the diaphragm is in the first flexed configuration and a retracted position relative to the housing when the diaphragm is in the second flexed configuration. Advantageously, the piston has a slot opening with a proximal portion proximal of the diaphragm and configured to pass fluid from the chamber into an interior of the piston and a distal portion distal of the diaphragm and configured to pass the fluid from the interior to the outlet, where the distal portion has a variable exposed segment outside of the housing that is greater when the piston is in the extended position and lesser when the piston is in the retracted position.
In some embodiments, the slot opening has a proximal portion proximal of the diaphragm and a distal portion distal of the diaphragm.
In some embodiments, the diaphragm has a peripheral edge that is fixed to an inner surface of the chamber.
In some embodiments, the diaphragm is generally planar in the neutral configuration.
In some embodiments, the diaphragm has a convex flexure in the first flexed configuration.
In some embodiments, the diaphragm has a concave flexure in the second flexed configuration.
In some embodiments, the piston includes a first slot opening and a second slot opening.
In some embodiments, the piston includes a first member on its outer surface proximal of the diaphragm and a second member on its outer surface distal of the diaphragm, the first and second members configured to secure the piston to the diaphragm.
These and other features and advantages of the present invention will be better understood by reference to the following detailed description when considered in conjunction with the accompanying drawings. It is understood that selected structures and features have not been shown in certain drawings so as to provide better viewing of the remaining structures and features.
In some embodiments, as shown in
With further reference to
The diaphragm 20 is supported in the chamber 22 such that its first surface S1 faces the proximal lumen 21 so the fluid (liquid or air) of the upstream path 30 can encounter the first surface S1 and act on the diaphragm 20, and its second surface S2 faces the distal lumen 23 so that any backflow of fluid (liquid or air) in the opposite direction downstream of the diaphragm 20 in the distal lumen 23 can encounter the second surface S2 and act on the diaphragm 20. Notably, the diaphragm is not affixed to any surface or feature inside the chamber (or at least its peripheral edge remains unaffixed and unattached inside the chamber) but rather rests under its own weight with its second surface S2 supported on raised projections or fins 24 that extend upwardly from the second sidewall W2 into the diaphragm chamber 22.
In some embodiments, each fin 24 lies on a radial line of the second sidewall W2, evenly spaced from its adjacent fins about the longitudinal axis L. In some embodiments, there are eight fins, each spaced at 45 degrees from the adjacent fin about the longitudinal axis L. Each fin 24 has an outer edge 25 and an inner edge 26. The outer edge 25 is configured and sized to provide a gap space SGX between it and radial wall W3. The inner edge 26 is separated from an inner edge 26 of a diametrically opposing fin 24 by a gap space about equal to a diameter D of the distal lumen 23 of the downstream path 32. Each fin 24 has a length LX that is less than the chamber radius RC, and a tapered profile such that it has a taller axial dimension at its inner edge 26 and a shorter axial dimension at its outer edge 25. Between the inner edges 26 of the fins is a proximal opening 29 of the distal lumen 23.
The diaphragm 20 in its neutral configuration is generally planar and therefore rests under its own weight on the fins 24 at or near the inner edges 26, with the outer edge E and adjacent portion thereof to extend free from contact with either the fins 24 and the first sidewall W1 of the chamber 22, best shown in
Where the fluid entering the proximal lumen 21 surpasses a predetermined threshold flow (e.g., a threshold flow rate), the fluid distorts and depresses the diaphragm 20 toward or into a first flexed configuration with the outer edge E and adjacent portion thereof flexed toward the fins 24, as shown in
Where the fluid entering the proximal lumen 21 subsequently decreases and falls below the predetermined threshold flow, the diaphragm 20 being subjected to lesser fluid pressure from the proximal lumen 21 elastically rebounds and returns toward its neutral (unflexed) configuration with the space gaps returning to their original dimensions, as shown in
Where fluid enters the chamber 22 from the distal lumen 23, such as from backflow of irrigation fluid or when the catheter is retracted partially or fully from the sheath and creates a trailing vacuum in the distal lumen 23 that surpasses the predetermined threshold flow, the diaphragm 20 distorts and is depressed into a second flexed configuration, as shown in
Where the backflow fluid subsequently decreases and falls below the predetermined threshold flow, the diaphragm 20 being subjected to lesser fluid pressure from the distal lumen 23 elastically rebounds and returns toward its neutral (unflexed) configuration with the space gap SG2 returning to its original dimension, as shown in
With reference to
In use, the device 10 may be assembled by laying the diaphragm 20 on the raised projections or fins 24 of the second member 41 of the housing 17 with the diaphragm 20 centered relative to the distal lumen 23, as shown in
When the pressure between the distal lumen 23 and the proximal lumen 21 generally equalizes, the diaphragm 20 returns to its neutral configuration with at least the space gap SG2 decreasing to allow a medium flow through the chamber 22, as shown in
With the diaphragm in the neutral configuration (
When the EP device 14 is retracted from the patient's vasculature, sufficient positive pressure in the distal lumen 23, causes the diaphragm 20 to flex away from the fins 24 (
It is understood that the device 10 may be placed anywhere along the irrigation pathway between the fluid source and the side port 19 (see
Advantageously, the device 10 responds to changes in pressure in the fluid path upstream or downstream of the diaphragm in self-adjusting the fluid flow through the device to normalize the pressure change. It is understood that different fluid dynamics within the device allow for both changes in pressure and fluid flow upstream or downstream to affect and effectuate movement of the diaphragm and/or for movement of the diaphragm to affect and effectuate changes in pressure and fluid flow upstream and downstream, as needed or appropriate.
In alternate embodiments as shown in
The piston 114 is hollow with an interior enclosed by a sidewall 118, a proximal end wall 120P and a distal end wall. 120D. In some embodiments, the sidewall 118 is cylindrical and the end walls 120P, 120D are circular. The sidewall is configured with one or more elongated openings or slots 124 that extend longitudinally between the end walls 120P, 120D and allow fluid to enter into and exit from the interior of the piston. Each elongated slot 124 can be divided into a proximal opening 124P that is proximal of the diaphragm 108 and a distal opening 124D that is distal of the diaphragm 108. In some embodiments, the proximal opening 124P is relatively smaller/shorter and the distal opening 124D is relatively larger/longer. The sidewall 118 has an outer diameter D3 that is no greater and generally equal to the diameter D2 of the distal passage 105 so that the piston can slide freely in the distal passage 105 relative to the housing 101, along the longitudinal axis L, with generally a fluid-tight seal between the outer surface of the piston 114 and the side wall 118 of the distal passage 105.
The diaphragm 108 is constructed of an elastically flexible material so that it can assume different configurations, including: a neutral or planar configuration when the diaphragm is subjected to generally equal fluid pressures (liquid or air) on its first or proximal surface and its second or distal surface (
Fluid can pass between the subchambers 103A, 103B only via the slot openings 124 and the interior of the piston 114. Fluid can pass between the proximal irrigation tubing 130 and the distal irrigating tubing 132 via the fluid pathway defined by the slot openings 124, the interior of the piston 114 and the exposed segment 124X.
In use, the device 100 is situated between a proximal irrigation tubing 130 and a distal irrigation tubing 132. In some embodiments, the device 100 is configured with an outer diameter that allows the device to fit within the lumens of the tubing 130 and 132. As fluid passes from the proximal irrigation tubing 130 into the inlet 109 and the chamber 103, the fluid enters the proximal subchamber 103A and enters the interior of the piston 114 via each proximal slot opening 124P upstream of the diaphragm 108. The fluid then passes through the interior of the piston 114 moving downstream of the diaphragm 108, and exits the piston 114 and the housing 101 and into the distal irrigation tubing 132 solely through the exposed segment 124E of the distal portion 124D of each slot opening 124. The diaphragm 108 remains in the neutral configuration of
Where there is less pressure acting on the distal surface 108D of the diaphragm 108 relative to the pressure acting on the proximal surface 180P of the diaphragm, for example, when a catheter is advanced distally within a guiding sheath and creates a vacuum downstream or distal of the diaphragm, the diaphragm flexes convexly which pushes the piston distally and increases the size of the exposed segment 124E allowing a greater flow of fluid to pass into the distal irrigation tubing 132 compared to when the diaphragm is in its neutral/unflexed configuration. When the pressures distal and proximal of the diaphragm equalizes, the diaphragm returns to its neutral configuration, drawing the piston which decreases the size of the exposed segment 124E back to the initial predetermined size.
Where there is less pressure acting on the proximal surface 180P of the diaphragm 108 relative to the pressure acting on the distal surface 180D of the diaphragm, for example, when a catheter is retracted proximally within a guiding sheath and creates a vacuum upstream or proximal of the diaphragm, the diaphragm flexes concavely which retracts the piston proximally and decreases the size of the exposed segment 124E allowing a lesser flow of fluid to pass into the distal irrigation tubing 132 compared to when the diaphragm is in its neutral/unflexed configuration. When the pressures distal and proximal of the diaphragm equalizes, the diaphragm returns to its neutral configuration, advancing the piston which increases the size of the exposed segment 124E back to its initial predetermined size.
Accordingly, the device 101 automatically self-adjusts fluid flow passing through in accordance with pressure differences upstream and downstream of the diaphragm 108 to achieve pressure equilibrium in the chamber 103. It is understood that different fluid dynamics within the device allow for fluid flow in the piston to affect and effectuate changes the diaphragm and/or for changes in the diaphragm to affect and effectuate movement of the piston, as needed or appropriate.
In some embodiment, the proximal end wall 120P has a size or diameter greater than the sidewall 118 of the piston 114 as a safety feature in minimizing the risk of the piston dislodging from the diaphragm 197 and exiting the device 101.
The preceding description has been presented with reference to presently preferred embodiments of the invention. Workers skilled in the art and technology to which this invention pertains will appreciate that alterations and changes in the described structure may be practiced without meaningfully departing from the principal, spirit and scope of this invention. Any feature or structure disclosed in one embodiment may be incorporated in lieu of or in addition to other features of any other embodiments, as needed or appropriate. As understood by one of ordinary skill in the art, the drawings are not necessarily to scale. Accordingly, the foregoing description should not be read as pertaining only to the precise structures described and illustrated in the accompanying drawings, but rather should be read consistent with and as support to the following claims which are to have their fullest and fair scope.