The present disclosure relates to syringe assemblies, and particularly to syringe assemblies comprising a disinfecting cap for use in flush procedures for vascular access devices (VAD's).
VAD's are commonly used therapeutic devices and include intravenous (IV) catheters. There are two general classifications of VAD's, peripheral catheters and central venous catheters. To ensure VAD's are used and maintained correctly, standards of practice have been developed, which include a cleaning procedure, commonly referred to as flushing a catheter.
VAD standards of practice usually recommend that flush procedures be performed after catheter placement, before fluid infusion, and before and after drug administration, blood sampling, transfusions and parenteral nutrition. The goal of these flush procedures is to confirm catheter patency, avoid drug incompatibilities, ensure complete drug dose administration, prevent thrombus formation and minimize the risk of blood stream infections. Flush procedures require different types and amounts of flush solutions. The most commonly used flush solutions are saline and/or heparin lock solution. The type of flush solution and amount vary depending on the specific type of catheter. Flush solution volumes between 5 and 10 ml are most common but can range from 1 ml to 20 ml.
For flush procedures, an IV line refers to a system that can include a VAD, a tubing set with clamp and a VAD connector as a termination. Common types of VAD connectors are covered by pierceable septums or pre-slit septums made of rubber or another elastomeric material, which permits insertion of a sharp needle cannula in order to infuse fluids into or to withdraw fluids from the catheter. Upon withdrawal of the needle cannula, the septum seals itself. Ports having pre-slit septums are used with blunt plastic cannula or the frusto-conically shaped tip of a syringe barrel. The syringe tip or the blunt plastic cannula (which is usually attached to a syringe) is gently pushed through the pre-slit septum to establish fluid communication.
IV valves, which are another type of VAD connector that do not require a needle having a sharp tip, are activated by the frusto-conically shaped tip of a syringe barrel to allow fluid communication between the interior of the syringe and the catheter. These valves may contain features for delivering fluid from a storage compartment in the valve to the catheter, and are referred to in the art as positive displacement valves. An example of such a valve is disclosed in U.S. Pat. No. 6,206,861.
Bacteria and other microorganisms may gain entry into a patient's vascular system from access hubs and ports/valves upon connection to the VAD to deliver the fluid or pharmaceutical. Each access hub (or port/valve or connection) is associated with some risk of transmitting a catheter related bloodstream infection (CRBSI), which can be costly and potentially lethal. Contamination can occur during drug mixing, attachment of a cannula, and insertion into the access hub. Presently, the risk to hospitals and patients is a substantial function of the diligence of the clinician performing the connection, and this diligence is largely uncontrollable.
A product currently available that aims to combat the problems associated with contaminated VAD connectors is the SwabCap®. This device disinfects a VAD connector by covering the connector and protecting it from touch and airborne contamination after the cap has been applied. As the SwabCap® is twisted onto a VAD connector, a foam pad inside the cap is compressed, releasing the isopropyl alcohol that passively disinfects the top and threads of the VAD connector while the cap is in place. Because the SwabCap® is a separate component, room for error exists so the cap may not be utilized after every step of the flush process. Thus, the cap does not ensure compliance with aseptic technique.
There is a need, therefore, for a flush syringe assembly that promotes compliance with aseptic technique by eliminating the additional swabbing and disinfecting steps.
Aspects of the present disclosure are directed to a syringe assembly for use in flush applications and methods of disinfecting syringes. Syringe assemblies, for example, a flush syringe assembly according to a first aspect of the present disclosure comprise a barrel including a side wall having an outside surface, an inside surface defining a chamber for retaining fluid, an open proximal end, and a distal end including a distal wall with a distal tip extending distally therefrom having a first passageway therethrough in fluid communication with said chamber; a removable seal disposed on the peripheral distal surface; and a cap and an absorbent pad containing disinfectant disposed between the removable seal and the distal tip, the cap rotatable from a first position in which the distal tip is covered by the cap and a second position in which the distal tip of the barrel is exposed through the open distal end of the outer sleeve. In some embodiments, the assembly further comprises an outer sleeve slidably engaged with the outside surface of the barrel, the outer sleeve comprising an inner surface, an outer surface, and an open distal end comprising a peripheral distal surface, wherein relative sliding movement of the outer sleeve and the barrel to move distal tip of the barrel and the distal end of the outer sleeve closer together causes the distal tip to rotate the cap from the first position to the second position.
In as a second embodiment, a syringe assembly, for example, a flush syringe assembly comprises a barrel including a side wall having an outside surface, an inside surface defining a chamber for retaining fluid, an open proximal end, and a distal end including a distal wall with a distal tip extending distally therefrom having a first passageway therethrough in fluid communication with said chamber; and a cap covering the distal tip, the cap comprising a proximal side that covers the distal dip and a distal side including an absorbent pad mounted thereon, the cap pivotally movable from a first position in which the cap covers the distal tip to a second position in which the cap is moved away from the distal tip
A second aspect of the present disclosure pertains to method of disinfecting a vascular access device. The method according to one embodiment comprises exposing an absorbent pad containing disinfectant at a distal end of a flush syringe assembly comprising a barrel having a distal tip covered by a cap, contacting the vascular access device with absorbent pad, and rotating the cap to expose the distal tip of the barrel.
Before describing several exemplary embodiments of the disclosure, it is to be understood that the disclosure is not limited to the details of construction or process steps set forth in the following description. The disclosure is capable of other embodiments and of being practiced or being carried out in various ways.
With respect to terms used in this disclosure, the following definitions are provided.
Reference to “flush syringe assembly” includes syringes that are indicated for use in the flushing of VADs. The practice of flushing ensures and maintains catheter patency and helps prevent the mixing of incompatible pharmaceuticals.
As used herein, the use of “a,” “an,” and “the” includes the singular and plural. As used herein, the term “catheter related bloodstream infection” or “CRBSI” refers to any infection which results from the presence of a catheter or IV line. As used herein, the term “microorganism” refers to a microbe or organism that is unicellular or lives in a colony of cellular organisms. Microorganisms are very diverse; they include, but are not limited to bacteria, fungi, archaea, and protozoans. Microorganisms are often the cause of CRBSIs. The most common microorganisms associated with CRBSIs include, but are not limited to, Staphylococcus aureus and epidermis, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans.
As used herein, the terms “antimicrobial agent” or “antimicrobial” refers to substances that kill or inhibit the growth of microorganisms such as bacteria, fungi, archaea, or protozoans. Antimicrobial agents either kill microbes, or prevent the growth of microbes. As used herein, the term “disinfectant” refers to antimicrobial substances that are used on non-living objects or outside the body, e.g., on the skin. In one or more embodiments, disinfectants or antimicrobial agent include, but are not limited to, ethanol, 2-propanol, butanol, methylparaben, ethylparaben, propylparaben, propyl gallate, butylated hydroxyanisole (BHA), butylated hydroxytoluene, t-butyl-hydroquinone, chloroxylenol, chlorohexidine, dichlorobenzyl alcohol, dehydroacetic acid, hexetidine, triclosan, hydrogen peroxide, colloidal silver, and mixtures thereof.
As used herein, the terms “absorbent material” and “absorbent pad” refer to a material having capacity or tendency to absorb or soak up another substance. In one or more embodiments, the absorbent material or absorbent pad has a tendency to absorb a disinfectant or antimicrobial. Absorbent materials and absorbent pads may include sponges, absorbent cottons, foam, other absorbent fabrics, and synthetic polymer matrices.
As used herein, the term “Luer connector” refers to a connection collar that is the standard way of attaching syringes, catheters, hubbed needles, IV tubes, etc. to each other. The Luer connector consists of male and female interlocking tubes, slightly tapered to hold together better with even just a simple pressure/twist fit. Luer connectors can optionally include an additional outer rim of threading, allowing them to be more secure. The Luer connector male end is generally associated with a flush syringe and can interlock and connect to the female end located on the VAD. A Luer connector comprises a distal end, a proximal end, an irregularly shaped outer wall, a profiled center passageway for fluid communication from the chamber of the barrel of a syringe to the hub of a VAD. A Luer connector also has a distal end channel that releasably attaches the Luer connector to the hub of a VAD, and a proximal end channel that releasably attaches the Luer connector to the barrel of a syringe.
According to one or more embodiments, a syringe assembly is provided that includes an absorbent material or an absorbent pad containing disinfectant or antimicrobial material that is moved away from the distal end of the syringe to expose the syringe distal tip. In one or more embodiments, the absorbent material is positioned such that there are minimal obstructions to the syringe distal tip, which allows the syringe distal tip to access ports that are typically difficult to access, such as Y-connectors. According to one or more embodiments, device activation so that the disinfectant is exposed is achieved by squeezing two parts of the syringe assembly together. This allows a user of the assembly to activate the device with one hand, which prevents interruption of workflow.
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The syringe assembly 100 is further shown as comprising a connection collar 170 surrounding the distal tip 118 and an alignment collar 172 coaxial with the connection collar 170, the alignment collar 172 comprising a peripheral tab 174 that engages the outer sleeve 132. The outer sleeve 132 comprises a slot 135 that cooperates with the peripheral tab 174 to align the cap 152 with the open distal end 138 of the outer sleeve 132 and to guide relative sliding movement between the barrel 102 and the outer sleeve 132. In the embodiment shown and as best seen in
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The syringe assembly 200 is further shown as comprising a connection collar 270 surrounding the distal tip 218 and an alignment collar 272 coaxial with the connection collar 270, the alignment collar 272 comprising a peripheral tab 274 that engages the outer sleeve 232. The outer sleeve 232 comprises a slot 235 that cooperates with the peripheral tab 274 to align the cap 252 with the open distal end 238 of the outer sleeve 232 and to guide relative sliding movement between the barrel 202 and the outer sleeve 232. In the embodiment shown and as best seen in
In the embodiment shown in
In use, when a user of the syringe assembly 200 peels away the removable seal 250, the absorbent pad 254 is exposed and can be used to clean or swap a VAD. During cleaning, the cap 252 is in the first position, the absorbent pad 254 is exposed through the open distal end of the outer sleeve 232. When the cleaning is completed by the user, the user can activate the device as described above to place the cap 252 is in the second position, and the cap 252 is rotated through the open distal end 238 of the outer sleeve 232 to expose the distal tip 218 of the barrel 202.
According to one or more embodiments, the removable seal of the embodiments described herein comprises an aluminum or multi-layer polymer film peel back top. The removable seal provides a liquid tight seal by a suitable adhesive that adheres the removable seal to the peripheral distal surface of the outer sleeve. The removable seal prevents the disinfectant from dissipating too quickly and facilitates long shelf life. The removable seal can be chemically-resistant, light-blocking, non-permeable, or sterile. In one or more embodiments, the connection collar comprises a Luer connector.
While not shown in the Figures, the syringe assembly according to one or more embodiments can further comprise a plunger rod comprising a distal end including a stopper slidably positioned in fluid-tight engagement with the inside surface of the barrel for drawing fluid into and driving fluid out of the chamber by movement of the stopper relative to the barrel. The plunger rod extends outwardly from the open proximal end of the barrel
The absorbent pad according to one or more embodiments soaks up the disinfectant or antimicrobial agent. The disinfectant or antimicrobial agent can be a fluid or a gel selected from the group consisting of selected from the group consisting of ethanol, 2-propanol, butanol, methylparaben, ethylparaben, propylparaben, propyl gallate, butylated hydroxyanisole (BHA), butylated hydroxytoluene, t-butyl-hydroquinone, chloroxylenol, chlorohexidine, dichlorobenzyl alcohol, dehydroacetic acid, hexetidine, triclosan, hydrogen peroxide, colloidal silver, and mixtures thereof.
The syringe assemblies described herein can be filled with flush solution using known methods. Additionally, the syringe assemblies may be provided pre-filled from the manufacturer or supplier. The flush solution may be any solution intended for flushing or maintaining performance of VAD's. The flush solution can be selected from suitable flush solutions such as saline flush solution and heparin lock flush solution. These solutions are known in the art and are readily available. An example of a saline flush solution includes, but is not limited to, 0.9% sodium chloride USP for injection. An example of a heparin lock flush solution includes but is not limited to 0.9% sodium chloride with 100 USP units of heparin sodium per mL or 10 USP units of heparin sodium per mL.
The syringe assemblies can be used in flushing a vascular access device such as a catheter or IV set. IV sets can be very complex and may include multiple injection ports, valves, and/or other components.
There are two general classifications of VAD's, peripheral catheters and central venous catheters. Peripheral catheters are used to access veins in the peripheral extremities such as the hand and arm. Peripheral catheters are relatively short in length ranging from about 14 mm to 48 mm in length, and are available in gauge sizes from about 16 to 24. It is believed that the most commonly used peripheral catheters are 20 gauge having an ID of about 0.81 mm (0.032 inch) and 22 gauge having an ID of about 0.66 mm (0.026 inch), and having a length of about 25 mm to 32 mm. As used herein, the term “peripheral catheter” is intended to refer to a 20 or 22 gauge catheter having a length of about 25 mm Central venous catheters are substantially longer than peripheral catheters and are inserted in the patient and terminate near the heart.
Another aspect of the disclosure pertains to a method of disinfecting a vascular access device. The method includes exposing an absorbent pad containing disinfectant at a distal end of a flush syringe assembly comprising a barrel having a distal tip covered by a cap, contacting the vascular access device with absorbent pad, and then rotating the cap to expose the distal tip of the barrel. The method can further comprise utilizing embodiments of the syringe assemblies described herein, for example, a syringe assembly which comprises an outer sleeve having and open distal end and a distal end face slidably engaged with the syringe barrel and the method further comprises sliding the syringe barrel and the outer sleeve with respect to each other, causing the cap to rotate away from the distal tip. Sliding the syringe barrel and the outer sleeve with respect to each other causes the cap to rotate away from the distal tip. Prior to sliding the outer sleeve and the barrel with respect to each other, a user removes a removable seal from the distal end face of the outer sleeve to expose the absorbent pad. Prior to (or after) removing the removable seal, a user can break the stopper free. After scrubbing the VAD connector, the user slides the outer sleeve to expose the syringe tip, the syringe tip is attached to the VAD connector, and the VAD is flushed. The syringe assembly is then removed after the flushing procedure and discarded.
Although the disclosure herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present disclosure. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present disclosure as disclosed.
Filing Document | Filing Date | Country | Kind |
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PCT/US2020/018760 | 2/19/2020 | WO | 00 |
Number | Date | Country | |
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62808485 | Feb 2019 | US |