Patent Application
20240416077
Briefly summarized, embodiments disclosed herein are directed to a multi-function, tip confirmation adapter system for placing a distal tip of a catheter, or similar vascular access device (“VAD”) at a target location. Various multi-modal vascular access placement systems can be used to locate, track, and confirm placement of a catheter or similar VAD at a target location within a patient. Placement of the catheter distal tip can be critical for the efficacy of the treatment and to prevent undue trauma to the patient. For example, when placing a catheter within the superior vena cava (“SVC”), if the distal tip of a central venous catheter (“CVC”) falls short of the target area, the efficacy of the medication is reduced. If the distal tip is advanced too far, the distal tip can cause arrhythmia. Multi-modal, vascular access device placement systems can use various modalities to image a target area, track the catheter onto the target area, and confirm accuracy of placement of the distal tip of the catheter. Embodiments disclosed herein include a multi-function adapter configured to maintain one or more electrical communication pathways with a distal tip of the catheter during a placement procedure to confirm placement of the distal tip of the catheter.
Disclosed herein is a catheter tip confirmation system including, a catheter adapter having a housing including a first cannula defining a lumen, the first cannula formed of an electrically conductive material, a distal end of the catheter adapter housing configured to engage a proximal end of a catheter and provide fluid communication with the first cannula, a clip coupled to a first tether and engaged with a socket disposed in the catheter adapter housing to releasably engage the first cannula, the clip configured to receive a first ECG signal, a flushing adapter releasably coupled to a proximal end of the catheter adapter housing and configured to provide a saline column within the first cannula and the catheter, the flushing adapter including a second tether fixedly coupled thereto and configured to receive a second ECG signal, and an elongate medical device extending through a lumen of the first cannula, a distal tip of the elongate medical device extending to a distal tip of the catheter, the elongate medical device including a magnet disposed at a distal tip thereof.
In some embodiments, the second tether is coupled to the elongate medical device to receive the second ECG signal from the distal tip of the elongate medical device. In some embodiments, the elongate medical device includes one of a stylet, a guidewire, or a coil-over-core guidewire. In some embodiments, the second tether is coupled to a second cannula defining a lumen of the flushing adapter and in fluid communication with the first cannula, the second tether configured to receive the second ECG signal from the saline column extending to the distal tip of the catheter. In some embodiments, the clip is configured to be selectively detached from the first cannula and coupled with a proximal portion of the elongate medical device to receive the first ECG signal from the distal tip of the elongate medical device.
In some embodiments, the elongate medical device is fixedly coupled to the flushing adapter. In some embodiments, the flushing adapter further includes a flushing arm configured to provide fluid communication therewith. In some embodiments, the flushing adapter further includes a locking valve configured to transition between a locked position and an unlocked position, the locking valve in the locked position configured to inhibit longitudinal movement of the elongate medical device relative to the flushing adapter. In some embodiments, the locking valve further includes a valve member configured to control a fluid flow therethrough in both the locked position and unlocked position.
In some embodiments, the catheter tip confirmation system further includes a console configured to compare one of the first ECG signal and the second ECG signal to determine an accuracy of a location of the distal tip of the catheter. In some embodiments, the console is further configured to detect a magnetic field of the distal tip of the elongate medical device and determine a position of the distal tip of the catheter within the body of the patient. In some embodiments, the first cannula is formed of a metal, alloy, or an electrically conductive material. In some embodiments, the catheter includes one of a central venous catheter, peripherally inserted central catheter, rapidly insertable central catheter, midline catheter, single lumen catheter, multi-lumen catheter, or a dialysis catheter.
Also disclosed is a method of determining a location of a distal tip of a catheter within a body of a patient including, coupling a multi-functional adapter system to a proximal end of the catheter, the multi-functional adapter system including, a catheter adapter including a first cannula formed of a conductive material and in fluid communication with the catheter, a flushing adapter coupled to a proximal end of the catheter adapter, and a clip coupled to a first tether, establishing a saline column within the first cannula and the catheter, extending an elongate medical device through the first cannula and into a lumen of the catheter, receiving a first ECG signal by one of the saline column or the elongate medical device, and receiving a second ECG signal by one of the saline column or the elongate medical device and different from the first ECG signal and determining the location of the distal tip of the catheter using one or both of the first ECG signal and the second ECG signal.
In some embodiments, the method further includes comparing the first ECG signal with the second ECG signal to determine an accuracy of a location of the distal tip of the catheter. In some embodiments, the method further includes engaging the clip with a slot disposed in the catheter adapter housing to contact the first cannula and receive the first ECG signal. In some embodiments, the method further includes engaging the clip with the elongate medical device to receive the first ECG signal. In some embodiments, the flushing adapter includes a second cannula in fluid communication with the first cannula, and a second tether fixedly coupled thereto and configured to receive the second ECG signal.
In some embodiments, the flushing adapter includes a second tether fixedly coupled to the elongate medical device and configured to receive the second ECG signal. In some embodiments, the method further includes detecting a magnetic field strength of a magnet disposed at a distal tip of the elongate medical device to track a location of the distal tip of the catheter within the body of the patient. In some embodiments, the elongate medical device includes one of a stylet, a guidewire, or a coil-over-core guidewire.
In some embodiments, the method further includes disengaging the catheter adapter from the catheter, coupling a subcutaneous access device to the catheter, accessing the subcutaneous access device with an access needle and coupling the clip with the access needle to receive the first ECG signal. In some embodiments, the catheter includes one of a central venous catheter, peripherally inserted central catheter, rapidly insertable central catheter, midline catheter, single lumen catheter, multi-lumen catheter, or a dialysis catheter.
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 in which:
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. 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.
With respect to “proximal,” a “proximal portion” or a “proximal end portion” of, for example, a catheter disclosed herein includes a portion 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 end portion, or the proximal length of the catheter can include the proximal end of the catheter; however, the proximal portion, the proximal end portion, 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 end portion, 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 end portion” of, for example, a catheter disclosed herein includes a portion 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 end portion, or the distal length of the catheter can include the distal end of the catheter; however, the distal portion, the distal end portion, 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 end portion, or the distal length of the catheter is not a terminal portion or terminal length of the catheter.
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. 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, a distal end of the catheter adapter 110 can be coupled with a proximal end of a catheter 160, or similar VAD, and can provide fluid communication therebetween. The catheter adapter 110 can be coupled to the catheter 160 using a luer lock, twist lock, interference fit, press-fit, snap-fit engagement, or similar suitable coupling mechanism. In an embodiment, a cathlock device can further secure the catheter 160 with the catheter adapter 110. As used herein, exemplary catheters 160, or similar VAD's, can include but not limited to central venous catheters (CVC), peripherally inserted central catheters (PICC), rapidly insertable central catheters (RICC), midline catheters, single lumen or multi-lumen catheters, dialysis catheters, or the like. In an embodiment, the stylet 150 can be configured to extend through a lumen of one or more of the catheter adapter 110, flushing adapter 130, and catheter 160, as described in more detail herein.
In an embodiment, the system 100 can further include a clip 170 coupled to a first tether 172 and configured to provide electrical communication therebetween. In an embodiment, the clip 170 can be selectively coupled to one of the catheter adapter 110, flushing adapter 130, stylet 150, or catheter 160. The first tether 172 can be coupled with a multi-modal tracking system 80
, for example, the first tether 172 can include a first fin connector 174 disposed at a proximal end thereof and configured to engage a sensor 90 of a multimodal tracking system 80. As such, the clip 170, first tether 172, and fin connector 174 can be configured to provide an electrical communication pathway between the multi-modal tracking system 80 and one of the catheter adapter 110, flushing adapter 130, stylet 150, or catheter 160, as described herein. As will be appreciated, the fin connector 174 is an exemplary electrical connector and other electrical connector systems are contemplated to fall within the scope of the present invention.
In an embodiment, the flushing adapter 130 can include a second tether 176 formed integrally therewith and configured to provide a second electrical pathway between the flushing adapter 130 and the sensor 90. In an embodiment, the second tether 176 can include a second fin connector 178 disposed at a proximal end thereof and configured to communicatively couple the flushing adapter 130 with the multi-modal tracking system 80, as described herein. In an embodiment, the first tether 172 and the second tether 176 can be coupled to different fin connectors, for example the first fin connector 174 and the second fin connector 178, respectively. In an embodiment, the first tether 172 and the second tether 176 can be coupled to the same fin connector. In an embodiment, one or both of the first tether 172 and the second tether 176 can be coupled directly with a console of the multi-modal tracking system 80.
In an embodiment, the flushing adapter 130 can include a locking valve 136 disposed at a proximal end thereof and configured to selectively control a fluid communication with a lumen of the flushing adapter 130. The locking valve 136 can include a Tuohy-Borst connector, luer lock connector or similar mechanism configured to selectively provide fluid communication with the lumen of the flushing adapter 130. For example, the locking valve 136 can include a collar that can be rotated between a locked and an unlocked position. In the unlocked position, a stylet 150 or guidewire 250 can be advanced through the locking valve 136 and into lumen of the flushing adapter 130. In the locked position, the locking valve 136 can prevent movement of the stylet 150 or guidewire 250 therethrough and either lock the position of the stylet 150 or guidewire 250 relative to the flushing adapter 130, or can prevent the stylet 150 or guidewire 250 from entering the lumen of the flushing adapter 130. In an embodiment, the locking valve 136 can further include a valve member 106, e.g. a bi-leaflet valve, slit valve, duckbill valve, or the like, configured to control a fluid flow through the locking valve 136 in one or both of the locked and the unlocked position. In an embodiment, the flushing adapter 130 can include a flushing arm 140 extending therefrom and in fluid communication with the lumen of the flushing adapter 130. The flushing arm 140 can be coupled with a syringe, medical line, fluid bag, or the like and can provide a fluid to a lumen 102 of the system 100, as described in more detail herein.
As shown in
In an embodiment, the catheter adapter housing 114 can include a socket 116 configured to receive a portion of the clip 170 therein. In use, a user can insert the clip 170 into the socket 116 and engage a portion of the first cannula 112 to establish an electrical connection therebetween (
In an embodiment, as shown in
In an embodiment, the catheter adapter 110 including the clip 170 and the first tether 172 can establish a first electrical pathway, and the flushing adapter 130 including the second tether 176 can establish a second electrical pathway. Advantageously, the multi-modal tracking system 80 can use both the first electrical pathway and the second electrical pathway to cross-check the ECG signal received, and determine an accuracy of the position of the distal tip 164 of the catheter 160. For example, where a difference between the position calculated by the first pathway and the position calculated by the second pathway is relatively large, the estimated position can be averaged between the two signals and/or an accuracy rating or confidence rating can be categorized as relatively low. Alternatively, where the difference between the two pathways is relatively small, the position can be averaged and/or the accuracy rating can be relatively high. The position and accuracy rating can then be displayed to the user by the multi-modal tracking system 80.
Advantageously, the system 100 including the catheter adapter 110 and the clip 170 can provide a versatile means for establishing an electrical pathway since the clip 170 can be selectively detached from the catheter adapter 110 and coupled directly with one of the stylet 150, guidewire 250, access needle, or catheter 160, as needed depending on the specific catheter placement procedure being used, as described in more detail herein. Further, the flushing adapter 130 including the second tether 176 fixedly coupled thereto can form a reliable electrical connection and can maintain at least one electrical pathway between the catheter distal tip 164 and the multi-modal tracking system 80 while the clip 170 can be exchanged between one of the catheter adapter 110, stylet 150, guidewire 250, access needle, or catheter 160, as needed. Similarly, the clip 170 can maintain at least one electrical pathway between the catheter distal tip 164 and the multi-modal tracking system 80 while one or more of the stylet 150, guidewire 250, or flushing adapter 130 is exchanged, as described in more detail herein. Advantageously, the system 100 including both the catheter adapter 110 and the flushing adapter 130 can provide a fail-safe system to ensure the electrical communication with a distal tip of the catheter 160 remains uninterrupted and the position of the distal tip of the catheter 160 can be continually verified.
In an embodiment, the system 100 can further include one of a stylet 150 or guidewire 250, extending through the system lumen 102, into the catheter lumen 162 and to a distal tip 164 of the catheter 160. In an embodiment, as shown in
In an embodiment, the stylet 150 or guidewire 250 can be formed of a conductible material to provide an electrical pathway therethrough. In an embodiment, the clip 170 can be disengaged from the catheter adapter 110 and coupled with a proximal end of one of the stylet 150 or the guidewire 250. As such, a third electrical pathway can be established between a distal tip 154 of the stylet 150 disposed adjacent the distal tip 164 of the catheter 160, through the stylet 150, clip 170, first tether 172 and to the sensor 90 and/or multi-modal tracking system 80.
Advantageously, a user can switch the clip 170 between the socket 116 and the stylet 150 depending on reliability of the connection, strength of the electrical signal, the stage in the placement of the catheter 160, or the like, to cross-reference the accuracy of a second electrical pathway, alternate between electrical pathways to ensure a constant signal is provided to the sensor 90, combinations thereof, or the like.
In an embodiment, as shown in
As shown in
As shown in
In an embodiment, one or both of the stylet 150 or the guidewire 250 can include a magnetic element 180, coupled therewith adjacent a distal tip 154, 254 thereof. The magnetic element 180 can be a permanent magnet or an electro-magnet. Advantageously, the multi-modal tracking system 80 can detect a magnetic field strength and determine a location of the distal tip 164 of the catheter 160 disposed adjacent the magnetic element 180, as the catheter 160 is advance through the vasculature of the patient. Further details and embodiments of multi-modal tracking systems 80 using one or more of ultrasound imaging, magnetic tracking or tip confirmation, ECG tracking or tip confirmation, combinations thereof or the like, can be found in U.S. Pat. Nos. 8,971,994, 9,492,097, 9,636,031, 10,238,418, 10,966,630, 11,027,101, U.S. 2018/0116551, U.S. 2018/0304043, U.S. 2019/0069877, U.S. 2019/0099108, U.S. 2020/0054858, U.S. 2020/0237255, U.S. 2020/0345983, which are herein incorporated by reference in their entirety.
In an exemplary method of use, a multi-function adapter system (“system”) 100 is provided, as described herein. A user can couple a first cannula 112 extending from a distal tip of the catheter adapter housing 114 with a proximal end of a catheter 160 in an interference fit engagement, or the like and provide fluid communication therebetween. In an embodiment, a distal end of a flushing adapter 130 can be coupled with a proximal of the catheter adapter 110. In an embodiment, a stylet 150 or guidewire 250 can be fixedly coupled with the flushing adapter 130. As such, coupling the flushing adapter 130 can further include extending the stylet 150 or guidewire 250 through the first cannula 112 and into the catheter lumen 162. When the flushing adapter 130 is engaged with the catheter adapter 110, a distal tip of the stylet 150 or guidewire 250 can align with a distal tip 164 of the catheter 160.
In an embodiment, the stylet 150 or guidewire 250 can be formed as a separate structure from the flushing adapter 130. As such, once the flushing adapter 130 is coupled with the catheter adapter 110, the stylet 150 or the guidewire 250 can be slidably engaged with the system lumen 102. A distal tip of the stylet 150 or the guidewire 250 can extend to a distal tip 164 of the catheter 160. In an embodiment, the position of the stylet 150 or the guidewire 250 can be locked relative to the system lumen 102 using locking valve 136. In an embodiment, a syringe, medical line, or the like can be coupled with a flushing arm 140 of the flushing adapter 130 and can flush the system lumen 102 and the catheter lumen 162 with a saline solution. A second locking valve 146 can then lock the saline solution and establish a saline column.
In an embodiment, one of the stylet 150 or the guidewire 250 can include a magnetic element 180 disposed at a distal tip thereof. The distal tip of the catheter 160 can then be advanced through a vasculature of a patient towards a target location. One or both of the sensor 90 and the multi-modal tracking system 80 can detect a magnetic field strength of the magnetic element 180 to track a location of the distal tip 164 of the catheter 160 as it travels through the vasculature towards the target location. Optionally, the multi-modal tracking system 80 can further include an ultrasound imaging system configured to image a subcutaneous portion of the patient. As the distal tip 164 of the catheter 160 approaches a target location, the system 100 can detect an ECG signal at the distal tip 164 of the catheter 160 to confirm a position thereof relative to the target location with much higher accuracy that can be achieved with the magnetic tracking modality. The system 100 can provide one or more electrical pathways to provide the ECG signal to the multi-modal tracking system 80. ECG signals from two or more electrical pathways can be cross-referenced confirm accuracy of placement, and maintain a consistent ECG signal during the placement procedure.
Once the catheter 160 has been placed successfully, the stylet 150 or guidewire 250 can be withdrawn proximally. Advantageously, the catheter adapter 110 can maintain an ECG electrical pathway to confirm the distal tip of the catheter 160 has not been dislodged during withdrawal of the stylet 150 or guidewire 250. In an embodiment, the flushing adapter 130 can be disconnected from the catheter adapter 110 and can be withdrawn proximally. In an embodiment, one of the stylet 150 or the guidewire 250 can be fixedly coupled to the flushing adapter 130 as described herein. As such, disconnecting and withdrawing the flushing adapter 130 from the catheter adapter 110 can include withdrawing the stylet 150 and guidewire 250 from the catheter lumen 162. Advantageously, the clip 170 and catheter adapter 110 can maintain an ECG electrical pathway to confirm the distal tip 164 of the catheter 160 has not been dislodged during disconnection and withdrawal of the flushing adapter 130 and/or stylet 150 or guidewire 250.
In an embodiment, the catheter adapter 110 can then be detached from the catheter 160 and the stylet 150 can be reinserted into the catheter 160 with the clip 170 coupled thereto. The distal tip stylet 150 can be advanced to the distal tip of the catheter 160 and the multi-modal tracking system 80 can detect an ECG signal at the distal tip of the catheter 160 to reconfirm the distal tip of the catheter 160 has not been dislodged from the target location.
In an embodiment, a port or similar subcutaneous access device can be coupled to the catheter 160 by urging a stem of the port into a proximal end of the catheter lumen 162. During the process of coupling the port to the catheter 160, a distal tip of the catheter 160 can be dislodged. To reconfirm the distal tip of the catheter 160 is correctly placed, an access needle, e.g. a Huber needle or the like, can access the port and catheter 160 assembly and flush the assembly with a saline solution to establish a saline column. The clip 170 of the system 100 can then be coupled with the access needle to establish an electrical pathway with a distal tip of the catheter 160, through the saline column, the access needle, and the clip 170, to reconfirm the position of the distal tip 164 of the catheter 160.
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 and/or modifications can appear to those of ordinary skill in the art, and, in broader aspects, these adaptations and/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.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US21/55054 | 10/14/2021 | WO |
