The present document discloses a product and a needle insertion method in which the force and/or the depth of insertion and/or of injection can be controlled.
To deliver a substance into dermal tissue with the aid of a needle, that is to say into an area extending a few millimeters below the level of the skin, there are two main methods:
The Mantoux method is very disquieting and relatively painful since it requires a slow penetration of the needle, often accompanied by a forward and backward movement that is difficult to perform and requires considerable training. Only skilled practitioners are able to successfully perform this method. The main difficulty involves injecting to the correct depth and, in particular, in avoiding a situation where the injected liquid is located in the subcutaneous zone or escapes to the surface of the skin.
The other devices have a means for limiting the depth of insertion, either by the size of the microneedles or by the means that limit the insertion of the needle. These needles, generally called microneedles, have the advantage of limiting pain, of facilitating the work of the practitioner, and of mechanically limiting the depth of their insertion. However, on account of the shallow depth of insertion and the mechanical properties of the skin (elasticity, compressibility, etc.), these needles are often poorly inserted (incomplete insertion for example), which can lead to the injected substance leaking at the surface of the skin. Irrespective of the injection device using a needle or microneedle, a method may be needed to improve their insertion into the skin. This may involve a speed provided simply by a movement of the hand, or by a device allowing higher and better controlled speeds to be reached, or an aspiration or pulling of the skin. When the insertion is manual, the speed provided by the movement of the hand is often insufficient, as is shown, in
When the insertion is performed with the aid of an inserter (also called an insertion device), a microneedle has a greater likelihood of being correctly inserted, ideally completely inserted, into the dermal tissue. The inserter permits good control of the speed and force of the needle at the moment of penetrating the skin.
Preferably, the size of the needle thus determines the depth or location of the layer in which the substance has to be administered. The devices disclosed by the patent applications US 2011/0172639 and US 2012/0029434 comprise needles whose length determines the target layer. They are incorporated by reference into this application. In other words, the needles of these devices have a limited length, so as not to deliver the liquid at too great a depth. The length of the needle thus determines the layer to be reached.
The article “Echographic measurement of skin thickness in adults by high frequency ultrasound to assess the appropriate microneedle length for intradermal delivery of vaccines” (Laurent A., Mistretta F., Bottigioli D., Dahel K., Goujon C., Nicolas J. F., Hennino A. and Laurent P. E., Vaccine 25 (2007) 6423-6430), incorporated by reference into this document, concerned the thickness of the dermal tissue at four different sites of the human body: the thighs, waist, deltoid region and shoulder blades. According to this article, said thickness is variable depending on ethnicity, body mass index, injection site and gender. The study also concludes that the thickness of the skin (epidermis and dermis) varies between 1.66 mm and 2.77 mm. This article finally concludes that a needle with a length of 1.5 mm is universally suitable for at least the four sites studied.
Generally, after insertion of the needle, the delivery of the substance can be carried out (by an injection, the application of a substance, the dissolving of the needles, the application of a patch). However, as is shown in
The present document discloses devices and methods permitting an improvement over the prior art.
Laurent A. et al. (2007) and the devices of the prior art use needles of a given length in order to inject and/or diffuse a substance, with the length determining a target layer. However, as is shown in
One of the principles of the invention is to exert a force on compressible tissue in order to allow a needle to reach one or more layers of said tissue that could not have been reached by said needle without having compressed said tissue. Preferably, these layers are deeper, that is to say farther from the surface of the skin, than the layers that would have been reached without this compression.
More generally, one of the principles of the invention is to control the stress exerted on, or the deformation of, the target tissue(s) (that is to say the one or more tissues in which the liquid is to be injected, or tissue against which a force is exerted by the device) before, during or after the insertion of the needle or before, during or after the injection, in order to
A first aspect of the invention is to permit the creation of a cavity and/or of a channel which is larger (for example longer) than the size of the needle, in order to create a sort of (virtual) reservoir and thereby allow the substance to be better assimilated by the tissue. In other words, one of the aims of the present invention is to facilitate the diffusion of a substance within the tissue by creating a cavity (also called a reservoir), which can have the form of a channel, in the area of the end of the needle. At the start of the injection, this reservoir will be able to easily accommodate the administered substance, thus initiating the creation of a larger volume at the end of the needle, capable of ultimately receiving the entirety of the injected volume. Even before the start of the injection, this cavity can additionally permit the creation of a supplementary exchange surface needed for the diffusion of the liquid injected into the tissue. The viscoelasticity of the tissue can permit enlargement of the volume and/or of the exchange surface of the cavity as the injection proceeds. Without this reservoir being present in the area of the end of the needle at the moment of the injection, the opening of the needle risks being obstructed by the tissue, for example. In this case, a very high injection pressure is then needed to push aside the tissue obstructing the opening of the needle, in order to deliver a fluid from the needle. In this configuration (that is to say when no cavity or channel has been created), the fluid then tends to invest the needle/tissue interface, and this is manifested by the start of a leak, which will become worse as the injection proceeds. This results in partial or zero injection of liquid. Another effect associated with this pressure is the risk of causing more pronounced pain during the injection.
Conversely, when a supplementary channel or cavity is created due to deeper insertion of the needle and relaxation of the pressure, all or some of the injected substance can be at least temporarily stored in said cavity, limiting the risk of leaks and/or of withdrawal of the needle during the injection and/or of pain when the substance is injected (due to the tearing of the tissue, which tearing is necessary for the creation of a space for receiving the injected solution). In fact, the skin is endowed with a degree of elasticity that allows it to deform and thus accommodate a small volume of liquid. Beyond a certain quantity, the deformation is no longer capable of absorbing a supplementary volume, and the skin tears locally (in most cases generating a painful sensation). Moreover, by creating this cavity, the administered substance comes into contact with a larger surface area of tissue, thereby potentially improving its assimilation.
A second aspect of the invention is to compress the tissues in order to allow a microneedle to reach deeper layers than those it could have reached without compression and solely on account of its length. In other words, one of the aims of the invention is to allow the pointed end of the needle to reach (temporarily or not) a depth (of the dermal tissue at rest, that is to say when unstressed) that is greater than the length of the needle. This therefore makes it possible to produce shorter needles than those normally used to reach a given layer. For example, by exerting a force on microneedles of 300 microns, these microneedles are able to reach a depth (of the dermal tissue at rest) which is normally reached only by microneedles measuring at least 1 mm. This therefore makes it possible to limit the length of the needles, which constitutes a real gain both as regards economy and also as regards the method of producing these needles.
A third aspect of the invention is to ensure the insertion of the needle to a given depth while limiting the speed of the needle when the latter comes into contact with the skin. The speed allows the needle to pierce the biological barrier and compensate for the deformation effect of the skin associated with its elasticity while the force exerted, and therefore the pressure, allows the needles to penetrate to a given depth. It is likewise possible to pull or pinch or aspirate the skin in order to pierce the biological barrier, then to exert a force on the needle in order to permit the insertion to a given depth. Thus, the insertion in this case takes place in two stages:
A fourth aspect of the invention is to permit a sponge effect. In one possible embodiment, a compression means can exert a force on target tissue before, during or after the insertion. This compression can be effected by the base of the needle or by another element optionally independent of the base of the needle or of its support. The principle of this embodiment is to have a surface compressing a target tissue, then relaxing this force (suddenly or gradually) before, during or after the injection of the fluid.
This compression of the target tissue will allow the liquids present in this tissue to move toward “non-compressed zones”. The act of completely or partially removing this compression will create a sponge effect. In fact, the target tissue will tend to recover its original shape, thus creating an effect of suction of the displaced liquids but also of the fluid that is administered (application or injection of the substance, application of a patch, etc.). This sponge effect may be fairly long, and the assimilation of the administered substances after the removal of the needle can also be improved.
The sponge effect is also possible according to another embodiment which permits independent control of the pressure exerted by the base of the needle (P1) (or needle support) and the pressure exerted by the distal end of the inserter (P2) (preferably around the zone where the needle is positioned) on the target tissues. Preferably, for successful injection, these two pressures P1 and P2 must be different.
The pressure P1 at the base of the needle must be sufficient to ensure that the liquid is delivered:
The pressure P2 must be limited in order to allow the injected liquid to diffuse within the target tissues which are located at the periphery of the needle. An excessive pressure P2, or one exerted too close to the injection point, or a combination of these two effects could result in a very high injection pressure, which would lead to leakage, as explained previously. In other words, in such an embodiment, the device must permit control of two distinct pressures in order to improve the injection into tissue or a target layer:
The pressure P2 can be generated by a mechanism integral to the inserter via a force F2.
To do this, the distal end of the inserter can comprise three independent parts:
The force F2 can be created, for example, by an elastic element (examples: helical spring, pressurized gas), a mass subjected to gravity, the atmospheric pressure. The surface located at the periphery of the inserter and dedicated to positioning can be kept in contact with the skin by the user.
It is thus possible to generate a “sponge” effect, which allows the substance to be “aspirated” by the target tissues by controlling the pressure P2 (for example by reducing said pressure). This reduction in pressure can allow the target tissues to recover their initial shape [
The sponge effect can be increased if the pressure P2 becomes lower than the atmospheric pressure. This can be achieved if the distal part of the inserter has a cavity to which a vacuum is applied. With this architecture, it is not essential that the inserter comprises a third part dedicated to positioning and holding in place on the skin. In fact, the peripheral part of the needle to which a vacuum is applied can be sufficient to position the device and hold it in place on the skin [
In addition, the invention discloses a method comprising the following steps:
The application of the pressures P1 and P2 via the forces F1 and F2 can be effected before, during or after the partial or complete insertion of the needle.
By controlling one or both of the pressures, it is possible to reduce the injection pressure and leakages, create a sponge effect, reach one or more layers deeper than the length of the needle, distribute the substance over larger surface areas, and avoid and/or limit the effect of tearing of the tissue during the injection. With the pressure P1, it is possible to reach one or more layers deeper than the length of the needle, create a channel or a cavity, and limit the impact effect during the insertion of the needle. The withdrawl or reduction of the pressure P1 can permit a sponge effect. With the pressure P2, it is possible to control the pressure in the target tissues, or even create a sponge effect, in order to easily deliver the liquid to the target tissues.
In the present document, the detailed description of the invention includes embodiments of devices, systems and methods that are presented by way of illustration. It will be appreciated that other embodiments are conceivable and may be applied without departing from the scope or spirit of the invention. Therefore, the detailed description given below must not be taken in a restrictive sense.
To allow a better understanding of the invention, one or more embodiments will be described which are shown in the figures attached to this document. Of course, the invention is not limited to these embodiments.
The present invention is described and characterized by the independent claim(s), while the dependent claims describe other features of the invention.
Unless otherwise indicated, the scientific and technical terms used in the present document have meanings commonly used by a person skilled in the art. The definitions given in this document are mentioned in order to facilitate an understanding of the terms frequently used and are not intended to limit the scope of the invention.
The indications of direction used in the description and in the claims, such as “up”, “down”, “left”, “right”, “upper”, “lower”, and other directions or orientations are mentioned in order to afford greater clarity with reference to the figures. These indications are not intended to limit the scope of the invention.
The verbs “have”, “comprise”, “include” or equivalent are used in the present document in a broad sense and generally signify “includes, but without limitation thereto”.
In the present document:
Different types of needles are represented schematically in
The device used comprises a body defined by a proximal end and by a distal end which is intended to come into contact with tissue, and also a needle comprising a pointed distal end. The tissue to be penetrated is characterized by a greater or lesser compressibility. Said device is designed to permit control of the pressure applied to the tissue:
The device additionally comprises compression means for exerting one or more forces before, during or after the insertion of the needle, in order to compress target tissue.
In one embodiment, the compression means are neutralized suddenly or gradually after said pointed end of the needle has reached its target or a defined depth. The deactivation of the compression means can be effected manually or automatically.
In one embodiment, the device comprises a propulsion means designed to move said needle in the direction of said distal end of the device. Said propulsion means can be configured to reach a speed of between 1 meter per second and 100 meters per second. This speed may be reached only at the moment when the distal end of the needle comes into contact with the target tissue.
The sequential effect of the compression of the tissue will be understood from
The different layers (4, 5, 6, 7) or depth levels thus compress. In the present document, the layers (4, 5, 6, 7) represent different depth levels in order to better understand the effect of the compression of the tissue and the principle of the invention.
Optionally, but in a preferred manner, the action B can be totally or partially neutralized either suddenly or gradually. In
Depending on the characteristics of the tissue, the channel or reservoir (12) created by the needle (1) materializes.
In
After insertion and compression of the tissue, the action B can be neutralized and the substance can be administered. In
The embodiments disclosed below may vary. The aim of such an embodiment is to ensure that the user applies a suitable force to the inserter at different moments of the application (from the insertion of the needle to the injection of the solution). It is therefore a system for controlling the force exerted against a target tissue via the base of the needle (comprising a surface substantially parallel to the target tissue) and/or via the distal end of the body of the inserter before, during and after the insertion and injection. In other words, by virtue of this control means, the user applies a defined force to a target tissue. By virtue of indicators (for example visual, tactile or acoustic), the user knows if he is applying the correct force at the correct moment. Indeed, by virtue of this embodiment, the user is able to apply a certain force to the target tissue and can then increase or reduce this force according to the requirements.
This control means can be arranged at the interface between the inserter and the user's hand (as disclosed in
The safety system is composed of a handle (101), a spring (102) and a limit stop (103). The handle (101) slides on the body of the inserter (26). A spring (102) is inserted between the handle (101) and the limit stop (103) mounted on the body of the inserter. The spring (102) counters the movement of the handle (101) on the body of the inserter. When the user applies to the handle (101) an axial force F2 (105) above a limit value F2limit, this compresses the spring (102) in such a way that the movement of the handle (101) renders the trigger (23) accessible. The triggering and thus the insertion of the needle are then possible. When the force F2 is below the limit value F2limit, the movement of the handle (101) is not sufficient to permit triggering and, therefore, the insertion of the needle into the skin or the tissues. The spring (102) is dimensioned in such a way that the pressure P2limit corresponds to the force F2limit.
The effect can be increased by positioning or activating an adhesive (111) on the surface (109) before use of the inserter. When the handles (108) are moved closer to the tissues, the surface (109), by virtue of the adhesive, connects completely to the target tissues. After insertion, when the handles (108) are moved away from the distal part of the inserter, the tissues then remain completely connected to the surfaces (109), which tends to increase the sponge effect described above (
The vacuum can be applied in two stages. A first vacuum that is applied serves to position and maintain the inserter in place on the tissues, after which the insertion of the needle can be performed. The vacuum level can then be increased in order to generate the sponge effect. The intradermal injection of liquids having a viscosity greater than that of water presents some difficulties. In this context, applying a vacuum to the target tissues is of particular interest. This is because it can allow viscous liquid to be injected, which is otherwise too difficult, if not impossible.
It is understood here that the means for controlling the force applied to target tissue is not necessarily linked to an inserter having compression means for compressing the tissue in order to reach a layer deeper than the length of the needle. In other words, such a device may simply comprise:
These pressure control means can take different forms. They can comprise elements that slide along an axis of the inserter, at least one limit stop intended to limit the movement of this sliding element, counterforce means (an elastic blade, a spring, etc.) preferably exerting a force along an axis perpendicular to the surface of the target tissue, an indicator or a locking mechanism prohibiting insertion or injection when the force exerted by the user is not within a predefined range.
These pressure control means can be arranged either at the distal end of the inserter or at a zone where the user is intended to grip the inserter during use.
According to one embodiment, the device comprises a body defined by a distal end, intended to come into contact with said tissue, and a proximal end, at least one hollow needle of a given length intended to administer a solution, having a distal end and being mounted movably inside said body, a propulsion means designed to move said needle in the direction of the distal end of said body. Preferably, the device additionally comprises a compression means designed to temporarily compress said tissue at least in or near the insertion zone, in such a way that said pointed end of the needle, having penetrated the tissue, reaches a greater depth than the insertion of the needle without compression of said tissue. The compression means can be designed so as to no longer compress the tissue at least before the end of the administration of the solution.
The compression means can compress the target tissue for a defined duration. The compression means can be designed to compress said tissue during the insertion of said needle into the tissue. The compression means can be designed to compress said tissue after the distal end of the needle has penetrated the tissue. The compression means can be designed to no longer compress said tissue when said distal end of the needle has reached a defined depth. The compression means can be automatically or manually deactivated. Said needle can comprise a base intended to come into contact with the surface of said tissue once the needle has been inserted into the tissue. Said base can comprise a portion parallel to the surface of said tissue, intended to come into contact with said tissue. The compression means can exert a force against said base in order to compress said tissue. The compression means can also be the propulsion means. The length of said needle can be less than 3 mm. The depth of the channel resulting from the insertion with compression can be greater than or equal to 1.10 times the length of said needle. The needle can be driven at a speed in the range from 1 meter per second to 100 meters per second when said needle comes into contact with said tissue. The compression means can exert a force of 0 N to 200 N against said tissue during and/or after the insertion of said needle. The compression means can be a spring, elastic, an elastic blade, a pneumatic system, a hydraulic system or an electronic system. The needle can be fixed to a support against which the propulsion means exerts a force, at least during the driving of said needle toward said distal end. The needle can be fixed to a support designed to come into contact with said tissue in order to compress the latter in cooperation with the compression means. The needles (or at least one) can be hollow needles, coated needles or soluble needles. The device can additionally comprise an administering or sampling means designed to administer a substance into the tissue or to collect a sample. The compression means can be deactivated gradually or suddenly before or during the administration of a substance. The device can free the space needed for the formation of a papule during the administration of a substance into the tissue. The device can comprise a means for controlling the pressure exerted on the inserter by the user. The device can comprise a safety mechanism intended to authorize or trigger the insertion of the needle or the administration of the solution only when the pressure exerted on the target tissue is within a defined range. The device can comprise an indicator intended to inform the user that the pressure exerted on the target tissue is admissible for the insertion of the needle and/or the administration of the solution. The device can comprise a pressure applicator intended to generate negative or positive pressures on said target tissue or on a surface peripheral to said target tissue. The pressure applicator can compress or exerts a positive force against said target tissue or on a surface peripheral to said target tissue before, during and/or after the insertion of the needle. In other words, the pressure applicator can compress the target tissue, for example, with a force that is defined in accordance with the target tissue. The pressure applicator can exert a negative force or aspirates said target tissue or on a surface peripheral to said target tissue before, during and/or after the administration of the solution. In other words, the applicator can generate a lower pressure in the target tissue for example. This negative pressure is a pressure relative to the atmospheric pressure. It can entail an aspiration of the target tissue or entail pulling the target tissue in the direction of the proximal end of the device. The pressure applicator can exert a negative force or aspirates said target tissue or on a surface peripheral to said target tissue before, during and/or after the insertion of the needle.
According to another embodiment, the device comprises a body defined by a distal end, intended to come into contact with said tissue, and a proximal end, at least one hollow needle of a given length intended to administer a solution, having a distal end and being mounted movably inside said body, a propulsion means designed to move said needle in the direction of the distal end of said body. The device can additionally comprise a pressure applicator intended to generate negative or positive pressures on tissue. The pressure applicator can exert a first force on said target tissue before, during and/or after the insertion of the needle, then a second force on said tissue before, during and/or after the administration of the solution. Preferably, the first force and the second force can be different in terms of absolute value, relative value or the sense in which the force is exerted (for example in the direction of the proximal end or in the sense of the insertion of the needle). The first force can be positive or compels the target tissue to compress. The second force can be negative or aspirates or pulls the target tissue in the direction of the proximal end of the inserter, in which case the first force may be less than the second force.
The invention likewise discloses a method by which a needle, for example a hollow needle, is inserted into compressible tissue, which method can comprise the following steps (preferably in succession):
The method can additionally comprise the following step: gradually or suddenly withdrawing said force before or during the administration of a substance. The method can additionally comprise the following step: withdrawing said needle. The method can additionally comprise the following step: administering a substance to said perforated tissue with the aid of a patch by applying a fluid to said tissue.
Number | Date | Country | Kind |
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FR1358744 | Sep 2013 | FR | national |
Filing Document | Filing Date | Country | Kind |
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PCT/IB2014/064419 | 9/11/2014 | WO | 00 |