The present disclosure relates to systems and methods for implementing a peel away hemostasis valve.
An introducer sheath is used for the percutaneous insertion of medical devices such as heart pumps, guidewires, and diagnostic catheters into an artery or vein of a patient. A hemostasis valve and a hub are parts of the introducer sheath that are designed to have medical devices inserted through and be able to be removed in-line from the inserted medical devices. During the insertion of the medical devices, hemostasis valves should resist tearing while maintaining hemostasis. In addition, the hemostasis valve may split into two pieces with acceptable force during a peel away action of the introducer sheath.
Some peel away hemostasis valve designs have a thickness that helps with sealing but requires high force to tear. Other peel away hemostasis valve designs are cut all the way through the thickness of the valve body to provide low forces for tearing but have trouble sealing around the medical devices used throughout the procedure. However, many current peel away hemostasis valves do not exhibit the performance necessary for the insertion of modern heart pump systems.
In addition to sealing performance and ease of peel away, hemostasis valves should also allow for stability during insertion of heart pump systems as well as during peel away. Some peel away hemostasis valve designs suffer from a double break during peel away, which occurs when the valve has two distinct points of resistance to tearing. For example, the double break points may be located near the edge of the valve and at the center of the valve. A double break causes movement of the heart pump system while in the artery or vein of the patient and can cause damage to the arteriotomy of the patient and/or damage to the heart pump system. There is a need for a hemostasis valve design that mitigates double breaks during peel away and improves the stability of the heart pump system placement during a procedure.
The systems, methods, and devices described herein provide for a peel away hemostasis valve designed in a manner to provide low forces for tearing, strong sealing around the medical devices, and stability during insertion of the medical devices as well as during peel away. The valve of the present disclosure has longitudinal cuts that are defined by a cylindrical surface axially aligned with the outer diameter of the hemostasis valve and an edge that aligns with the spiral path of one of the helical slits at the center of the hemostasis valve. Compared with existing valves, the design of the longitudinal cuts in the valve of the present disclosure reduces the required force to tear through the peel away hemostasis valve during a peel away action. The longitudinal cuts and the helical slits are separated by a constant distance through the thickness of the valve, which provides better hemostasis performance compared to a hemostasis valve that has longitudinal cuts all the way through the valve. The peel away hemostasis valve of the present disclosure also has through holes along its perimeter that facilitate connection of the hemostasis valve to the hub of an introducer and maintains a stretch (when posts are inserted in the through holes) in the hemostasis valve during a peel away action.
Embodiments are disclosed herein for a hemostasis valve body comprising a first surface, a second surface opposite the first surface, an edge, helical slits, and a pair of longitudinal cuts. The edge extends between the outer perimeters of the first surface and the second surface. The helical slits are positioned at a center of the valve body and traverse the first surface to the second surface. The helical slits provide a seal around a medical device during an insertion of the medical device into a blood vessel. Each respective longitudinal cut extends from the first surface partially through the valve body to a depth short of the second surface for at least part of a length of the respective longitudinal cut. The longitudinal cuts facilitate a separation of the valve body into two parts during a peel away action. The embodiments disclosed herein provide a peel away hemostasis valve that seals well to a medical device inserted therein and also allows for peeling away the hemostasis valve with low force. Additionally, the design of the peel away hemostasis valve prevents a double break and facilitates stability of medical devices or heart pump systems during procedures.
In certain implementations, the longitudinal cuts may be positioned at a distance from the helical slits. According to some implementations, the longitudinal cuts may be angled at a similar angle of rotation as the helical slits. In certain implementations, each respective longitudinal cut may be positioned on opposite sides of the valve body. According to some implementations, each respective longitudinal cut may traverse the first surface to the second surface for at least part of the length of the respective longitudinal cut near the edge.
According to one implementation, the hemostasis valve body may comprise a first group of lines formed on the first surface and a second group of lines formed on the second surface. The first group of lines may extend radially outward from the center of the valve. The second group of lines may extend radially outward from the center of the valve. In some implementations, the helical slits may traverse the first group of lines to the second group of lines. According to some implementations, the first group of lines may be angularly offset from the second group of lines.
In certain implementations, the hemostasis valve body may comprise through holes at a distance from the edge that traverse the first surface to the second surface. According to some implementations, each respective through hole may comprise one of round edges, flat edges, and non-symmetric shape. In some implementations, the through holes may be angularly spaced equally. According to certain implementations, the angle between adjacent through holes may be less than or equal to 25 degrees. In other implementations, the through holes may be sized to accommodate ports. According to some implementations, the through holes (when posts are inserted therethrough) may keep the hemostasis valve body stretched during a peel away action.
According to one implementation, the first surface may be parallel to the second surface. In some implementations, the first surface and the second surface may comprise a planar shape. According to some implementations, the first surface may comprise one of a conical, tapered, and convex shape. In certain implementations, a shallow point of the first surface may be at the center of the valve.
According to some implementations, the valve body may comprise a disc shape. According to one implementation, the valve body may comprise one of a cylindrical and cubic shape.
According to a further implementation of the present disclosure, a system is provided for inserting a blood pump into a blood vessel of a patient. The system includes a blood pump and an introducer assembly, which comprises a sheath and a hub that includes the hemostasis valve body. The sheath and the hemostasis valve body can be sized to receive the blood pump. The introducer hub includes wings and notches that facilitate the breaking of the introducer hub. A medical service professional applies force on the wings in order to break the introducer hub during a peel away action. The notches are purposefully implemented as weak points on the hub that break when sufficient force is applied on the wings. The longitudinal cuts on the hemostasis valve body can be radially aligned with the notches in order for the valve to break without much force along the longitudinal cuts.
According to a further implementation of the present disclosure, a method is provided for peeling away an introducer sheath assembly having (1) an introducer hub, the introducer hub having (a) first and second wings located opposite each other, and (b) first and second notches located at midpoints between the first and second wings, (2) a hemostasis valve within the introducer hub having first and second longitudinal cuts radially aligned with the first and second notches, and (3) a introducer sheath having longitudinal scoring aligned with the first and second notches. As described above, the wings and notches facilitate the breaking of the introducer hub. Compared with other peel away methods, this method achieves a smooth peel away along a consistent tearing path by aligning purposefully implemented weak points on the introducer hub, hemostasis valve, and introducer sheath. The method comprises applying a first force to the first wing of the introducer hub in a first direction radial from an introducer sheath and a second force to the second wing of the introducer hub in a second direction opposite the first direction. The method further comprises causing the first force and the second force to be transmitted to the first and second notches of the introducer hub, thereby breaking the first and second notches. The method further comprises causing the hemostasis valve to break along the first and second longitudinal cuts. The method further comprises separating the introducer sheath along the longitudinal scoring.
The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:
There is a need for a peel away hemostasis valve that seals well and has features allowing for peeling away the hemostasis valve with low force. The peel away hemostasis valve described herein accomplishes this by incorporating longitudinal cuts that are defined by a cylindrical surface axially aligned with the outer diameter of the hemostasis valve and an edge that aligns with the spiral path of one of the helical slits at the center of the hemostasis valve. The design of the longitudinal cuts lowers the required force to tear through the peel away hemostasis valve during a peel away action. The longitudinal cuts and the helical slits are separated by a constant distance which provides better hemostasis performance compared to a hemostasis valve that is cut all the way through. Additionally, there is a need for a peel away hemostasis valve that does not double break and facilitates stability of heart pump systems during procedures. The peel away hemostasis valve described herein accomplishes this by incorporating through holes along the perimeter of the hemostasis valve that connect the hemostasis valve to the hub of an introducer and keeps the hemostasis valve stretched (when posts are inserted through the through holes) during a peel away.
As depicted in
After the blood pump 100 has been advanced through the introducer 200, the introducer 200 may be removed and, in some implementations, replaced by a device appropriate for longer-term use. To remove the introducer 200, a healthcare professional may grasp first and second wings 218a and 218b of the hub 210, and apply a force to the wings 218a and 218b in a direction either toward the elongate sheath 202 or a direction radial to the elongate sheath 202, forcing the first wing 218a toward the second wing 218b depending on the orientations of the first and second wings 218a and 218b relative to the elongate sheath 202. In the orientation of wings 218a and 218b as shown in
As depicted in
The thickness 308 of the peel away hemostasis valve 300 may be set to achieve the specific hemostasis performance required. The hemostasis performance of the peel away hemostasis valve is improved if the thickness 308 of the peel away hemostasis valve 300 is set to a large value. In another aspect, the thickness 308 of the peel away hemostasis valve 300 may be set to require a certain amount of force during a peel away action. The amount of force required during a peel away action is small if the thickness 308 of the peel away hemostasis valve 300 is set to a small value. In some aspects, the thickness 308 of the peel away hemostasis valve 300 may be set to satisfy a tradeoff between the specific hemostasis performance and the required amount of force during a peel away action.
Peel away hemostasis valve 300 may be inserted into the vasculature by an introducer sheath. Peel away hemostasis valve 300 may have medical devices inserted through and may be able to be removed in-line from the inserted medical devices. The medical devices may include heart pumps, guidewires, diagnostic catheters, sheaths, and dilators.
As depicted in
Helical slits 316 traverse through the center of the valve from the first group of lines 314 in the first surface 302 to the second group of lines 324 in the second surface 304. The helical slits 316 follow a spiral path between first surface 302 and second surface 304. The length of the first group of lines 314 and the second group of lines 324 determines the size of the helical slits 316. The size of the helical slits 316 may be set to balance the hemostasis performance with the insertion and removal force of the medical devices inserted through the peel away hemostasis valve 300. As the length of the first group of lines 314 and the second group of lines 324 increases, the size of the helical slits 316 increases, the hemostasis performance of the peel away hemostasis valve 300 decreases, and the removal force of the medical devices inserted through the peel away hemostasis valve 300 decreases.
Each longitudinal cut 318a and 318b may extend from first surface 302 partially through the peel away hemostasis valve 300 to a depth short of second surface 304 for at least part of a length of the respective longitudinal cut 318a or 318b.
Longitudinal cuts 318a and 318b facilitate a separation of the peel away hemostasis valve 300 into two parts during a peel away action. Longitudinal cuts 318a and 318b may be positioned at a distance from helical slits 316. Each longitudinal cut 318a and 318b may be positioned on opposite sides of the peel away hemostasis valve 300. Each longitudinal cut 318a and 318b may traverse first surface 302 to second surface 304 for at least part of the length of the respective longitudinal cut 318a or 318b near edge 306. The region where the longitudinal cut 318a or 318b traverses through the entire thickness 308 of the hemostasis valve 300 is referred to herein as a through slit 322a or 322b, which may serve as an origin for tear propagation during a peel away action. The termination of the longitudinal cuts 318a and 318b at the first surface 302 of the peel away hemostasis valve 300 may be a sharp edge.
In some embodiments, longitudinal cuts 318a and 318b are angled at a similar angle of rotation as the helical slits 316. As depicted in
During a peel away action, a tear starts at the through slits 322a and 322b (located near the edge 306 of the valve) and propagates along the portion of the longitudinal cuts 318a and 318b near the second surface 304. The tear then proceeds to propagates from the second surface 304 to the first surface 302 along the distance between the longitudinal cuts 318a and 318b and the helical slits 166. The tear propagation results in splitting the peel away hemostasis valve 300 into two pieces along the path described.
In certain implementations, peel away hemostasis valve 300 is partially surrounded by the hub 210 of introducer 200 (as described further in relation to
The design depicted in
At step 1304, the first force and the second force are transmitted to the first notch 214 and the second notch of the introducer hub 210, causing the first and second notches 214 to break. For example, the applied force is transmitted from the wings 218a and 218b to a first notch 214 and second notch. The minimum thicknesses at the notches allows the introducer hub 210 to break at the first notch 214 and second notch. Additionally, the shape of the notches concentrate stress to facilitate splitting of the hub 210 along the notches. The minimum thickness and shape of the notches provide a break wall at which a crack may be initiated in the hub 210. In some implementations, the minimum thickness of the notches ranges from 0.075 mm to 0.35 mm.
At step 1306, the hemostasis valve 300 of the introducer hub 210 is broken along the first longitudinal cut 318a and the second longitudinal cut 318b. The first longitudinal cut 318a is aligned with the first notch 214 and the second longitudinal cut 318b is aligned with the second notch For example, a tear starts at the through slits 322a and 322b, located near the edge 306 of the valve and at the radial ends of the longitudinal cuts 318a and 318b, respectively. The tear then propagates radially inward along the portion of the longitudinal cuts 318a and 318b near the second surface 304. This results in the longitudinal cuts 318a and 318b being completely cut through the thickness of the valve. At this point, the valve 300 is still intact at the region between the longitudinal cuts and the helical slits. The tear then proceeds to propagate through this region between the longitudinal cuts 318a and 318b and the helical slits 166. The tear propagation in this region can occur in a radial direction, in a direction through the thickness of the valve 300, or in a vector having components in both directions. The tear propagation in this region results in splitting the peel away hemostasis valve 300 into two pieces along the path described.
At step 1308, the introducer sheath 202 is separated along longitudinal scoring 222 on the introducer sheath 202. The longitudinal scoring 222 is radially aligned with the first notch 214 and the second notch. For example, the longitudinal scoring 222 on the elongate sheath 202 allows the sheath to separate along the length of the elongate sheath 202, and the hub 210 and elongate sheath 202 is peeled away in two pieces. After the introducer is peeled away, the percutaneous pump 100 is left in place in the blood vessel 240.
Other objects, advantages and aspects of the various aspects of the present invention will be apparent to those who are skilled in the field of the invention and are within the scope of the description and the accompanying Figures. For example, but without limitation, structural or functional elements might be rearranged. Similarly, principles according to the present invention could be applied to other examples, which, even if not specifically described here in detail, would nevertheless be within the scope of the present invention.
This application claims the benefit of U.S. Provisional Application No. 62/582,075, filed on Nov. 6, 2017, the content of which is hereby incorporated herein by reference in its entirety.
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