AU658067B2 - A tonometric catheter apparatus, an analyzing apparatus and methods - Google Patents

Description

AUSTRALIA 0 0 7 PATENTS ACT 1990 COMPLETE SPECIFICATION FOR A STANDARD PATENT (Original) Name of Applicant/Nominated Person: Mountpelier Investments SA.

Actual Inventor(s): Richard, FIDDIAN-GREEN Address for Service: DAVIES COLLISON CAVE, Patent Attorneys, 1 Little Collins Street, Melbourne, 3000.

Invention Title: "A tonometric catheter apparatus, an analyzing apparatus and methods" The following statement is a full description of this invention, including the best method of performing it known to us: -1- 930609,qoper\kay42086.div,1 -la- A TONOMETRIC CATHETER APPARATUS, AN ANALYZTNG APPARATUS AND METHODS This invention relates to medical diagnostic equipment and methods and is particularly concerned with hollow viscus tonometry and remote electronic and optical sensing.

The prior art (see U.S. Patent No. 4,643,192)- has recognized' that intestinal ischemia, and to a lesser degree, stress ulceration, are two problems that plague physicians involved in the management of patients in intensive care units.

Intestinal ischemia, in particular, has an insidious onset and may not be detected until days after the intestine has become completely and irreversibly compromised. A delay in the diagnosis of intestinal ischemia may have devastating consequences for a patient. The availability of means for early diagnosis and management of patients with these problems would have immediate applicability in all intensive care units, especially where the procedure can be conveniently conducted with reasonable safety and reliability.

It has been established that a fall in the intramucosal 20 pH may precede the development of intestinal ischemia and stress ulceration. As I reported in my prior U.S. Patent No. 4,643,192, expressly incorporated herein by reference, entitled "Hollow Viscus Tonometry" a fall in intramucosal pH also occurs within minutes of inducing intestinal ischemia in dogs. The fall in pH in intestinal mucosa, and hence the likelihood of ischemia or stress ulceration, can be reliably calculated from a pCO 2 S (partial pressure of CO 2 or other indicia of pH, in luminal fluid and the bicarbonate concentration in arterial blood. The method of calculating the pH in intestinal mucosal tissue, pursuant to principles of my prior patent, has been validated by directed measurements under a variety of conditions simulating clinical problems. A correlation coefficient in the order of 0.92 to 0.95 has been obtained in each of 16 dogs. The validity of the procedure is inherently extensible to humans, and indeed may also be useful in assessing the vitality of other hollow organs and tissue. See R.G. Fiddian-Green et al. "Splanchnic Ischemia and Multiple Organ Failure".

To measure the pCO in the lumen of the gut it has heretofore been.necessary to obtain and remove a sample of fluid that has been in contact with the wall of the gut for a certain ti=e period, usually at least half an hour. It has now been observed that it is somewhat difficult to manually aspirate the sampling fluid or medium from a tonometric catheter located in the gut or other internal focus with any consistency. It is much easier to obtain such samples from the stomach, but samples obtained from the stomach frequently contain foreign material that can damage a gas analyzer.

As taught in my prior patent, the desired sample or samples can be obtained from the gut using a catheter tube (called a tonometric catheter) having a walled sampling chamber on the tube with the sampling chamber being in sample-specific communication with the hollow interior of the tube. The wall of the sampling chamber comprises a material which is substantially inpermeable to liquid yet is highly permeable to gas. One suitable material is polydimethylsiloxane elastomer.

In use the catheter is introduced into a patient to place the sampling chamber at a desired site within the gut. An aspirating liquid or medium is employed to fill tne interior of S. the sampling chamber. The sampling chamber is left in place at the desired sampling site long enough to allow the gases present to diffuse through the wall of the sampling chamber into the aspirating liquid. The time should be long enough for the gases S: to equilibrate. The liquid impermeable nature of the sample chamber wall material prevents both the aspirating liquid from leaking out of the chamber and also the intrusion of any liquids into the aspirating liquid. After the appropriate or desired arount of placement time has elapsed the aspirating liquid is Saspirated along with the gases which have diffused into it. The sample thus obtained is analyzed for gas content, in particular for pCO 2 In this way the pCO 2 within the lumen of the gut can be reliably measured with the fluid being free from lumenal debris.

In carrying out the diagnostic method taught in my prior patent the pCO 2 measurement is utilized in conjunction with a measurement of the bicarbonate ion concentration (HC0 3 in an arterial blood sample of the patient for determining the pH of the tract wall.

Depending upon the particular condition of a given patient, the catheter may be left in place and samples may be taken at periodic intervals so that pH values may be periodically calculated. The procedure has a high reliability in accurately determining the adequacy of organ tissue oxygenation, and diagnosing intestinal ischemia in its incipient stages. Such determination or detection can be useful in treating the patient so that the potentially devastating consequences resulting from less timely detection may often be avoided.

While the sam7 ng techniques taught in my prior patent have provided highly accurate and reliable results, it has now been observed that there are instances (in the care of the critically ill in intensive care units, for example) in which remote sensing of the organ or organ-wall condition and automatic calculation of the organ or organ-wall pH would be advantageous and easier to effectuate. This method would thus partially or totally eliminate the need for the somewhat cumbersome aspiration of the sampling fluid or medium which fills the sampling chamber; it may also eliminate the need for the sampling chamber to be in sampling-medium communication with any other part of the device. There is also a need to extend the benefits of tonometric sampling and sensing to other internal hollow viscous organs.

To this end, there is a need for new and different tonometric devices specifically adapted to allow my sensing and sampling techniques to be performed with ease in a clinical environment, and in combination with other procedures.

According to a first aspect of the present invention there is provided a tonometric catheter apparatus for measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising: a) an elongated tonometric catheter tube hzving at least one lumen extending longitudinally therethrough; b) at least one walled sampling chamber on said catheter tube in fluid communication with the interior of said lumen, said walleu sampling chamber 93060,p:oper\kay,tonometdiv.3 -4generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, at least a portion of the wall of said sampling chamber being composed of a wall material that is freely and selectively permeable to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids, and said sampling chamber forming an interior space with said catheter tube in order to allow said one or more liquid fluids or gaseous fluids of interest from the tissue of the wall portion of the internal organ to permeate into said sampling chamber, with said catheter tube extending to a position outside of the body of the human or other mammal, and with said lumen providing fluid communication between said sampling chamber and the outside of the body of the human or other mammal for a sampling medium to flow therebetween; and c) analyzing sensor means positioned outside of the body of the human or other mammal and in communication with said lumen, for sensing the level of at least one of said liquid fluids or gaseous fluids of interest permeated from the tissue of the wall portion of the internal organ with said sampling medium in sampling chamber.

According to a second aspect of the present invention there is provided a \tonometric catheter apparatus for measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising: a) an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough; b) at least one walled sampling chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber being defined by a balloon member generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, at least a portion of the wall of said balloon member being composed of a wall material being substantially impermeable to other liquid fluids or gaseous fluids, and said balloon member being inflated for forming an interior space between said balloon member and said catheter tube in order to allow said one or more liquid fluids or gaseous fluids of interest from the tissue of the wall portion of the internal organ to permeate into said sampling 930609,p:\oper\kay,tonometdiv.4 chamber, with said catheter tube extending to a position outside of the body of the human or other mammal, and with said lumen providing fluid communication between said sampling chamber and the outside of the body of the human or other mammal for a sampling medium to flow therebetween; and c) analyzing sensor means positioned outside of the body of the human or other mammal in communication with said lumen, for sensing the level of at least one of said liquid fluids or gaseous fluids of interest permeated from the tissue of the wall portion of the internal organ into said sampling medium in said sampling chamber.

According to a third aspect of the present invention there is provided a method of measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising the steps of: a) providing an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough with at least one walled sampling chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, the wall of said sampling chamber being composed of a wall material that is freely and selectively permeable 20 to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids said sampling chamber defining an interior space between said sampling chamber and said catheter •tube; b) providing a gas analyzing apparatus for sensing the level of at least one of said liquid fluids or gaseous fluids of interest; c) introducing the catheter tube into the organ of interest so that said walled sampling chamber is disposed at a desired sampling site, said catheter tube extending to a position outside the body of the human or other mammal so that said i lumen provides fluid communication between said sampling chamber and the outside of the body of the human or other mammal; d) introducing a sampling medium into said catheter tube and into said interior space between said sampling chamber and said catheter tube; 930609,p:oper\kaytonomediv.5 -6e) leaving said sampling chamber disposed a: said sampling site for a length of time sufficient to allow said liquid fluid or gaseous fluids of interest that are present at said sampling site to diffuse across the wall of the sampling chamber into said sampling medium contained within said sampling chamber; f) withdrawing at least a portion of said sampling medium through said catheter tube; and g) analyzing the sample thus withdrawn using said gas analyzer means to determine the level present of said liquid fluid or gaseous fluid in said withdrawn sampling medium.

According to a fourth aspect of the present invention there is provided a method of measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising the steps of: a) providing an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough with at least one walled sampling chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber being defined by a balloon member generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, the wall of said balloon member being composed of a wall material that 20 is freely and selectively permeable to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids, said balloon member defining an interior space between said sampling chamber and said catheter tube; b) providing a gas analyzing apparatus for sensing the level of at least one of said liquid fluids or gaseous fluids of interest; c) introducing the catheter tube into the organ of interest so that said balloon member is disposed at a desired sampling site, said catheter tube extending to a position outside the body of the human or other mammal so that said lumen provides fluid communication between said balloon member and the outside of the body of the human or other mammal; d) introducing a sampling medium into said catheter tube and into said interior space between said balloon member and said catheter tube; 9306G9,p:\oper\kayjonometdiv,6 -7e) leaving said sampling chamber disposed at said sampling site for a length of time sufficient to allow said liquid fluids or gaseous fluids of interest that are present at said sampling site to diffuse across the wall of the balloon member into said sampling medium contained within said balloon member; f) withdrawing at least a portion of said sampling medium through said catheter tube; and g) analyzing the sample thus withdrawn using said gas analyzer means to determine the level present of said liquid fluid or gaseous fluid in said withdrawn sampling medium.

In one embodiment of the present invention a new apparatus and method is provided for remotely sensing organ condition and conveying an electromagnetic 15 signal, e.g. an electrical current or optical signal, to an electronic or optical apparatus located outside the organ under investigation. In one preferred embodiment, a chemically sensitive electronic transducer (or plurality of transducers), such as a field 7 o 941223,p:\oper\kay,tonomeLdiv,7 -8effect transistor, is attached to a tonometric catheter for introduction into the organ along with the tonometric catheter. The first electronic sensor, preferably nontemperature, generates and conveys an electromagnetic signal indicative of some desired aspect of organ condition, indicative of the pCO 2 pH and/or P 0 2 level of the organ or organ-wall. For example, in ore preferred embodiment, mean ambient pCO 2 pH and/or P 0 2 of lumenal fluid or the like is measured or monitored via wire or other suitable electromagnetic energy conveying means to an electronic circuit which interprets the electromagnetic signal and produces a report of the organ condition. The electronic circuit may include an input for receiving a separately determined signal indicative of the blood pH of the patient. Using this pCO 2 pH and/or P 0 2 measurement along with blood (preferably arterial) pH data, the electronic circuit determines the pH of the organ wall under test and thereby provides information for determining the organ's current condition or perhaps predicting the organ's future condition. The electronic circuit may be suitably constructed from analog components, digital components or both.

In another embodiment, a pH, pCO 2 or P 0 2 senitive colorimetric substance is injected into an area adjacent to the organ, into the sampling chamber of the tonometric catheter, and an optical sensor is employed to detect color change in order to determine the pH of the wall of that organ. The optical sensor can either be disposed in or on the tonometric catheter for introduction into the area adjacent the organ or it may be disposed outside the organ with fiber optic cable optically coupling the sensor to the tonometric catheter site at which the pH sensitive substance has been injected.

In another embodiment of the present invention there is provided a variety of new and different tonometric catheter devices for sensing and/or sampling a fluid or gas property (such as pH, P 0 2 pCO 2 and the like) which is indicative of the condition of an internal organ, in conjunction or combination with a walled catheter tube adapted for delivery or draining fluids, such as nasogastric tubes, urinary catheters, ureteric catheters, intestinal feeding tubes, wound or abdominal drains (suction or regular) and biliary tubes, catheters and stents, with or without remote sensing means for pH, pCO 2 and/or P 0 2,.

In still another embodiment, the device employs two separate walled catheter 930609,p:\oper\kaytonomet -9tubes, one tonometric catheter tube for the measurement of a fluid or gas property, that is in communication with the sampling chamber; and a second walled catheter tube adapted for delivering or draining fluids.

In yet another embodiment, the device employs a walled sampling chamber in communication with a sensing means, and a second walled catheter tube adapted for delivering or draining fluids.

Optionally, when a non-temperature sensing-means is employed, a second sensing-means may be employed as well.

For a more complete understanding of embodiments of the invention, its objects and advantages, reference may be had to the following specification and to the accompanying drawings. Also, see my co-pending and commonly assigned applications filed of even date herewith entitled "Tonometric Catheter Combination" and "Hollow Viscus and Solid Organ Tonometry", bearing respective serial numbers WO 90/01893 and WO 90/01896, both of which are completely and expressly incorporated herein by reference.

Embodiments of the invention will now be described, byway of example only, with reference to the accompanying drawings, in which: *e 930610,p:\oper\kay,tonome'Ldiv.5 Figure 1 is a plan view of a first embodiment of the tcnometric catheter; Figure 2A is a partial cross-sectional view of the tonometric catheter illustrating a first means for attachment of an electronic field effect transistor sensor; Figure 2B is a partial cross-sectional view of the tonometric catheter illustrating a second means of attachment of the field effect transistor sensor; Figure 3 illustrates the method of use of the tonometric catheter in measurement of the pH of the colon and also of the stomach, the specific embodiment illustrated for colonic measurement being that of Figure 5 and the specific tonometric catheter for gastric measurement being that of Figure 4; Figure 4 is another embodiment of the tonometric catheter with nasogastric tube; Figure 4A is a cross-sectional view of the tonometric catheter of Figure 4 taken substantially along the line 4A-4A of Figure 4; .Figure 4B is a cross-sectional view of the tonometric catheter of Figure 4 taken substantially along the line 4B-4B of Figure 4; 'Figure 5 is yet another embodiment of the tonometric 25 catheter having multiple sensing/sampling portions; Figure 5A is a cross-sectional view of the tonometric catheter of Figure 5, taken substantially along the line 5A-5A of Figure Figure 6 is a detailed view illustrating the tonometric catheter of Figure 4 in use within the stomach; Figure 7 is a detailed view illustrating the tonometric catheter of Figure 5 in use within the colon; Figure 8 is a similar View illustrating the tonometric catheter of Figure 1 in use within the colon; Figure 9 is an electrical schematic diagram illustrating one embodiment of electronic circuit in accordance with the invention; Figure 10 is an electrical schematic diagram illustrating another embodiment of the optical measurement of pH in accordance with the invention; Figure 11 is another embodiment of a tonometric catheter with a urinary catheter; Figure 11A is a cross-sectional view of the tonometric catheter/urinary catheter of Figure 11, taken substantially along the line 11A-11A of Figure 11.

Figure 1 illustrates a first embodiment of tonometric catheter 20. The tonometric catheter comprises a length of suitable tubing 22, one end 32 of which is closed, and the opposite end of which has a connector such as a luer-lock 24.

Luer-lock 24 is adapted to receive a complementary fitting 26, which in turn couples through a second length of tubing 28 to a three-way stopcock 30. Three-way stopcock 30 may be used to selectively connect tubing 28 to various sources of irrigation or .aspiration.

Adjacent the closed end 32, tubing 22 is perforated as at 34. A balloon-like tonometric catheter nmebrane 36 is fitted over the closed end so that the perforations 34 are enclosed, as illustrated. The tonometric catheter membrane 36 has an internal sleeve diameter at 38 which forms a tight fit with tubing 22.

The preferred form of tonometric catheter membrane is 25 polydimethylsiloxane elastomer, The membrar. may be sealed to S the tubing 22 with appropriate adhesive so that the tonometric catheter membrane iq sealed in a closed relationship to the outer wall of tubing 22, thereby forming a sampling chamber 40 adjacent S closed end 32. The tonometric catheter mnerrarie has a certain 30 elasticity to allow the membrane to expanil vhen filled with an Saspirating liquid in order to contact the wall of the organ under examination, as will be explained below.

The membrane 36 is preferably constructed such that at least a portion of it is selectively pezmeabl. to the gas or fluid property of interest. In a preferred embodiment, it is selectively permeable to. hydrogen, oxygen, or so that pH, -12pCO 2 and/or p0 2 can be measured. It is also preferably impermeable to other materials that would interfere with the desired measurements,, such as other gases, proteins, and the like. In a highly preferred embodiment, an ion-selective membrane is employed.

Bonded to either the inner wall or the outer wall of tubing 22 are one or more sensors 42 for detecting a property indicative of pH and/or temperature. Two such sensors are illustrated in Figure 1, bonded to the outside wall of tubing 22 with suitable adhesive. Figures 2A and 2B illustrate two alternate means of sensor attachment, Figure 2A illustrating the sensor attached to the inner wall of tubing 22 and Figure 2B illustrating the sensor attached to the outer vall of tubing 22.

In a preferred embodiment, at least a portion of the tubing, but not all of it, is made of a CO 2 impermeable material, such as polyester elastomers derived from the reaction of dinethylterephtalate -1,4-butanediol and a-hydro- R -hydroxypoly (oxytetramethylene). In a highly preferred embodiment, this is a material such as Hytril, sold by DuPont.

For purposes of sensing temperature, thermistor devices are presently preferred. For sensing properties indicative of pH chemically responsive field effect transistors or "Chemfets" may S be employed. In this regard, Chemfet sensors 44 have been illustrated in Figures 2A and 2B. Chemfet sensor 44 comprises a field effect semiconductor device 46, vhich is encapsulated in a solution impervious material 48, such as a polymerized epoxy resin. The encapsulation material 48 in turn ray be encapsulated in a housing 50 (Figure 2A). Semiconductor device 46 is Selectrically coupled by bonding wires 52 to a terminal 54.

".0J Suitable electrical conductors such as conductor 56 are attached to terminal 54 for electrically communicating between the Chemfet device 44 and the electronic circuitry described below in connection with Figure 9. Conductor 56 is preferably routed through tubing 22 and exits through a sealed aperture at or near the luer-lock end of tubing 22, as at 58. A more detailed description of a suitable electronic sensor ray be found in U.S.

Patent No. 4,020,830 to Johnson, entitled "Selective Chemical -13- Sensitive FET Transducers," incorporated herein by reference. In order to allow a solution to contact the chemically sensitive surface of semiconductor device 46, tubing 22 may be provided with an aperture 60 when implementing the embodiment of Figure 2A. Such an aperture is not needed in the embodiment of Figure 2B, since the semiconductor device 46 is exposed to sampling chamber 40 by virtue of the external mounting configuration.

The sampling chamber 40 can be filled with an aspiration or sampling medium that is used to absorb or otherwise provide a means for incorporating and delivering or measuring the the fluids or gases of interest. Such a medium is selected depending upon many factors, including the properties of the fluids or gases of interest, the type of sensor 42 employed, and the type of calibration that is necessary. Such mediums include bicarbonate solutions and saline solution. It might be noted that gases often behave as fluids and are therefore frequently considered to be fluids.

As noted above, when the sensor employed does not 0.:require frequent recalibration, the need for the sampling *:.:'chamber 40 to be in communication with the proximate end of the :"itonometric catheter (that remains outside the patient) may be eliminated since no aspiration is needed. However, in many instances such communication may still be desirable as aspiration 25. may be required to calibrate the sensor or sensors, to replace the aspirating or sampling medium with a fresh medium, and to incorporate the gas or gases of interest.

Another embodiment of the tonometric catheter is illustrated in Figures 4, 4A and 4B. As illustrated, the tonometric catheter is appropriately configured to also serve as a nasogastric sump, either with or without gastric suction. With reference to Figure 4, the tonometric catheter 20a comprises a multipassage tubing 62 which defines three individual noncommunicating (between each other) passageways or lumens, an air lumen 64, an optional suction lumen 66 and a tonometric catheter lumen 68. A tonometric catheter membrane, similar to that previously described, is attached at an intermediate lczation on tubing 62, allowing a portion of the tubing to extend beyond the end of membrane 36 to define the nasogastric sump T'-bing 62 is provided with a plurality of perforations 72 which communicate between tonometric catheter lumen E£ and the sampling chamber 40 defined by membrane 36. If desired, one or more sensors 42 can be included in accordance with the above teachings, in which case a suitable conductor 56 may be routed through tonometric catheter lumen 68 to exit at sealed aperture 58.

The nasogastric sump portion 70 is suitably provided with a pluv 'ity of openings 74 through which the stomach may be aspirated.

At the opposite end of tubing 62 the tubing splits to form three separate connections. Air lumen 64 communicates with air lumen passageway 76, suction lumen connects with suction lumen passageway 78 and tonometric catheter lumen 68 communicates with tonometric catheter lumen passageway 80. The tonometric catheter lumen passageway is fitted with three-way stopcock similar in function and purpose to the three-way stopcock 2 described in connection with Figure 1. If desired, a quick connect fitting 82 may be used to couple the suction lumen passageway 78 with an aspiration source. As illustrated, the uick connect fitting preferably has angularly cut ends and a slightly enlarged midsection, making it easy to insert into the end of passageway 78 and also into the aspiration hose coupling (not shown). The enlarged midsection helps form a seal with the adjoining passageways. Preferably the quick connect fitting is fabricated of disposable plastic.

Yet another embodiment of the tonometric catheter is 0 illustrated in Figures 5 and 5A. This embodiment is a multiple tonometric catheter embodiment employing a tubing 84 having a plurality of passageways or lumen as shown in the cross-sectional view of Figure 5A. Specifically, tubing 84 includes an air lunen 86a which communicates with the endmost tonometric catheter 36a and three additional tonometric catheter lumens 86b, 86c and 86d, which communicate respectively with tonometric catheters 36b, 36c and 36d. As with the other embodiments, each tonometric catheter may be provided with one cr more sensors such as sensors 42. A radiopaque tungsten pluc 88 is positioned within each of the three tonometric catheter lumen 86b, 86c and 86d adjacent the distal end of each tonometric catheter, serving to block the remainder of the tonometric catheter lumen passageway and thereby ensuring that fluid pressure introduced into each tonometric catheter lumen will cause the associated tonometric catheter to balloon outwardly as required during use.

Similarly, a radiopaque tungsten rod 90 is fitted as a plug in the end of air lumen 86a, serving to terminate the end of the air lumen passageway. Being radiopaque, the tungsten plugs and tungsten rod aid in properly positioning the tonometric catheters by being visible under fluoroscope or x-ray. In addition, if desired, tubing 84 can be provided with a radiopaque stripe along all or part of its length.

At the proximal end of tubing 84 the lumen 86a-86d diverge to define four separate tubes 92a-92d. Each tube is fitted with a three-way stopcock similar to those described above. Each sampling connector may optionally be coded numerically by color, etc. While four approximately equally Sspaced tonometric catheters have been illustrated in Figure 5, it will be understood that the invention can be modified to include a greater or fewer number of tonometric catheters at different spacing as required for a particular application. It will also 25 be understood that some or all of the tonometric catheters can include one or more sensors coupled to conductors 56, each S: preferably routed through the corresponding lumen passageway.

Referring now to Figure 9, a suitable electronic monitoring circuit will now be described. In Figure 9 CHEMFET 0 semiconductor device 46 has been shown schematically by the equivalent circuit model enclosed in dotted lines. The device 46 thus comprises drain electrode 150, source electrode 152 and reference electrode 154. The chemically selective system, such as a membrane system is depicted diagrammatically at 156. The substrate is grounded as at 158.

Source electrode 154 is coupled to an input lead of operational amplifier 160 which includes feedback network -16diagrammatically depicted at 162. Operational amplifier 160 senses the drain source current flowing thr:--gh device 46 and ccnverts this signal into a voltage signal vtich is output on le-ad 164. The drain source current changes in accordance with changes in the chemical system under test. Mcre specifically, as the pCO 2 level changes in the fluid exposed to device 46, the drain source current changes accordingly. Hence the output vcltage signal on lead 164 is likewise an indication of the pCO 2 level of the organ under test. This voltage signal on lead 164 is coupled to an input of comparator 166 which also receives a reference voltage Vref, which may be supplied using a voltage divider network (not shown) or which may alternatively be provided by a digitally controlled voltage source 168. The output of comparator 166 is fed to reference electrode 154 to provide a stable reference bias voltage. If a digitally controlled voltage source is used, this reference voltage can be adjusted and calibrated by a computer circuit yet to be discussed. The voltage signal on lead 164 is also fed to an analog to digital convertor 170, which is in turn coupled to a microprocessor-based microcomputer 172.

In order to automatically determine the pH of the wall of the hollow viscous organ under test, a separate gas analyzer sensor 174 is used to determine the bicarbonate concentration in the arterial blood of the patient. The outFut of sensor 174 is 5 coupled through analog to digital convertor 176 to rricrocomputer 172. Microcomputer 172 is preprogrammed to -alculate the pH of the organ wall using the values provided by :analog to digital convertors 170 and 176. Conversion of pCO 2 measurements can be converted into pH measurements automatically ty microcomputer 172 using various equations and references well-known in the art.

Although many different types of output devices may be employed, strip chart recorder 178 and CRT mnitor 180 have been illustrated. Strip chart recorder 178 and monitor 180 are coupled as output devices to microcomputer 172. Strip chart recorder 178 offers the advantage of developing an easily readable, permanent record of the fluctuations in organ wall pH.

-17- ?onitor 180 offers the advantage of providing digital readout of the pH value as well as displaying the upper and lower excursions of pH fluctuation. If desired, microcorputer 172 can be preprogrammed using keyboard 182 to compare the instantaneous pH value with doctor-selected upper and lower alarm limits. If the measured instantaneous pH fluctuates outside those limits, ricrocomputer 172 can sound an alarm to alert hospital staff.

While a single semiconductor device 46 has been illustrated in conjunction with the electronic circuit of Figure 9, the circuit may be readily adapted for use with a plurality of semiconductor devices in order to measure the pH at different locations substantially simultaneously. In such an embodiment, the data coming' from each sensor can be fed to a separate I/O port of microcomputer 172. In the alternative, a single I/O port can be used with the individual input signals being time multiplexed.

As an alternative to electronic pH sensors, the invention may also be practiced using optical sensor technology.

Referring to Figure 10, the presently preferred optical sensor embodiment uses a first fiber optic cable 94 which is optically coupled through a series of lenses 96, selectable color filters 98 and heat absorber 100 to an illumination source 102, such as a 100 watt tungsten-halogen lamp. Fiber optic cable 94 Sis routed through the tonometric catheter lumen in a fashion similar to the conductor 56 of the above-described embodiments, with the end thereof protruding through the tubing and into the sampling chamber 40. A second fiber optic cable 104 is routed parallel to the first fiber optic cable 94, with one end ."..protruding through the tubing and held in place adjacent the end of first cable 94 with a collar 106. Collar 106 may be adhesively bonded to the outside wall of the tubing. The Sopposite end of second fiber optic cable 104 is positioned for optically coupling with a phototransistor 108 which is electrically connected to an operational amplifier circuit 110.

The operational amplifier circuit can be coupled to an analog to digital converter, such as A/D converter 170 of Figure 7.

In use, fiber optic cable 94 illjmninates a region within the sampling chamber 40 which is filled with a sampling fluid containing a colorimetric pH indicator. The illumination from fiber optic cable 94 reflects from the rolecules suspended in the pH indicator solution, with some of the reflected illumination passing back through second fiber optic cable 104 to the phototransistor. By selecting the appropriate filter 98, a monochromatic illumination or illumination of otherwise known spectral content is employed to illuminate the colorimetric pH indicator solution. When the color of the filtered illumination r-atches that of the indicator, the illumination is absorbed and a low illumination signal is received at the phototransistor. When a pH change causes a color change in the indicator away from the color of the filtered illumination, more illumination is reflected back to the phototransistor, with an attendant increase in detected signal output. In this fashion, the proper selection cf indicator dye and illumination filtration can be used to detect pH ranges. For a further description of fiber optic pH sensor technology, refer to G. G. Vurek "A Fiber Optic pCO 2 *20 Sensor," Annals of Biomedical Engineering, Vol. 11, pp. 499-510, 1983, which is available from Pergamon Press, Ltd., and is .expressly incorporated herein by reference.

While the preferred embodiments have been disclosed in o o connection with monitoring of the gastrointestinal tract and the urinary and ureteric tracts it will be appreciated that its principles are applicable to other hollow internal organs to onitor pH and hence perfusion of those organs. Also while several presently preferred detailed constructions for tonometric catheters have been disclosed, it will be appreciated that other ."SD constructions may be developed which are equally suitable. The disclosed constructions are presently preferred for the reason t-.hat they are readily fabricated using existing available aterials. Other embodiments may include other, but equivalent _-aterials for the tonometric catheter membrane and/or connective tubing. They may also differ in the specific fabrication details. As an example, the sampling chamber may be eccentric rather than symmetric about the connective tubing.

-19- In still another embodiment, conventional gas analyzers may be employed externally. A device such as; that shown in Figure 1 may be used in combination with a pump or aspiration means (not shown) for continuous or regular intermittent aspiration of a sample of the aspirating liquid or medium that is used to fill the sampling chamber 40. The sample removed by pump or aspiration means via attachment to the luer-lock 24 can be optionally designed so that the sample aspirated at each sampling interval can be brought in contact with an exterior, separate gas analyzing means or sensor (not shown) to determine the pH, pO 2 pCO 2 and/or the like, of the sample. Such automatic sampling can be conducted employing a system as shown in Figure 12. In the assembly a sampling system employs a personal computer to conduct evaluations and analysis of the samples withdrawn from the tonometric catheter 299.

Pump 203 is loaded with the sampling or aspirating medium such as saline. Next, valve 201 is activated to withdraw a desired amount of the sampling fluid. The valve 201 is deactivated and pump 203 is used to enforce the sampling chamber of the tonometric catheter 299 using a calibrated amount or optionally a pressure transducer 215. The sampling fluid or e.dium is allowed to come to equilibrium with the wall of the organ or area of interest. Next the "dead space," the area of the lumen filled with the sampling fluid that is not in equilibrium, is removed by activating valve 205, activating pump 207, activating valve 209 and infusing pump 207; the waste 219 is discarded. A sample for analysis is then withdrawn by deactivating valve 209, activating pump 207 to then deliver the sampling to a gas analyzer (not showny that provides data from the sample to the PC 217, and the evaluation is conducted as described herein.

The sample gas analyzer or a separate gas analyzer may be employed to determine the bicarbonate concentration in the arterial blood of the patient, as described above.

Another embodiment of the tonoretric catheter is illustrated in Figures 11 and 11A. As illustrated, the tonometric catheter is appropriately configured to also serve as a urinary or ureteric catheter, either with cr without suction, which optionally employs sensors. With reference to Figures 11 and 11A, the tonometric catheter 220 comprises a multipassage tubing 262 which defines three individual noncommunicating (between each other) passageways or lumens, an optional air or irrigation lumen 264, a drainage or suction lumen 266 and a tonometric catheter lumen 268. A tonometric catheter membrane, similar to that previously described, is attached at a distal location on tubing 262, allowing an intermediate portion of the tubing not extending beyond the end of membrane 236 to define the uretary or uretary catheter 270. Tubing 262 is provided with a plurality of perforations 272 which cummunicate between tonometric catheter lumen 268 and the sampling chamber 240 defined by membrane 236. If desired, one or ore sensors 242 can be included in accordance with the above teachings, in which case a suitable conductor 256 may be routed through tonometric catheter lumen 268 to exit at sealed aperture 258.

The urinary catheter or ureteric catheter portion 270 is suitably provided with a plurality of openings 274 through 20 which the bladder or ureters may be aspirated or irrigated.

At the opposite end of tubing 262 the tubing splits to form three separate connections. Air or irrigation lumen 264 optionally communicates with air lumen passageway 276,. urinary lumen connects with suction or drainage lumen passageway 278 and tonometric catheter lumen 268 communicates with tonometric catheter lumen passageway 280. The tonometric catheter lumen passageway is fitted with three-way stopcock 230, similar in function and purpose to the three-way stopcock 30 described in connection with Figure 1. If desired, a quick connect fitting 82 as seen in Figure 4 may be used to couple the suction urinary passageway 278 with an aspiration source. As illustrated, the quick connect fitting preferably has angularly cut ends and a slightly enlarged midsection, making it easy to insert into the end of passageway 278 and also into the aspiration hose coupling (not shown). The enlarged midsection helps form a seal with the adjoining passageways. Preferably the quick connect fitting is fabricated of disposable plastic.

-21- Yet another embodiment of the urinary cat-'eter/tonometric catheter combination illustrated in F.g--res 11 and 11A may employ a multiple tonometric catheter embodiment employing a tubing having a plurality of passageways cr lumen as shown in the cross-sectional view of Figure In another embodiment of the present invention, a tonometric catheter may be adopted to deliver a pharmaceutically-active agent, either for systemic, local or topical activity, or a combination thereof. For example, an additional lumen may be added such as that and for irrigation or aspiration, to deliver the active. For example, the irrigation/aspiration lumen 264 shown in Figure 11 and 11A, may She used to deliver an active agent. In another embodiment, a portion of the device may be modified so as to provide sustained release of the active agent of interest.

Thus, for example, the problems of nosacomial infection associated with catheter insertion can be overcome by incorporating an antimicrobial into at least a portion of the polymeric material used to manufacture the tonometric catheter, cr by coating at least a portion of the device with a sustained Srelease composition, or by delivering the antimicrobial via the tonometric catheter. Such modifications are well known to those Sskilled in the art. See U.S. Patent No. 4,677,143, incorporated herein by reference.

25 Classes of useful agents include antinicrobial agents, onsteroidal anti-inflammatory agents, topical anesthetics, topical vasodialators, metabolic suppressants, and other agents that could be delivered for absorption at the sites of the tonometric catheter.

Accordingly, while several preferred embodiments of the invention have been disclosed, it will be appreciated that principles of the invention, as set forth in the following claims, are applicable to other embodiments.

Claims (7)

1. A tonometric catheter apparatus for measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising: a) an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough; b) at least one walled sampling chamber on said catheter tube in fluid communication 'with the interior of said lumen, said walled sampling chamber generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, at least a portion of the wall of said sampling chamber being composed of a wall material that is freely and selectively permeable to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids, and said sampling chamber forming an interior space with said catheter tube in order to allow said one or more liquid fluids or gaseous fluids of interest from the tissue of the wall portion of the internal organ to permeate into said sampling chamber, with said catheter tube extending to a position outside of the body of the human or other mammal, and with said lumen providing fluid communication between said sampling chamber and the outside of the body of the human or other mammal for a sampling medium to flow therebetween; and c) analyzing sensor means positioned outside of the body of the human or other mammal and in communication with said lumen, for sensing the level of at least one of said liquid fluids or gaseous fluids of interest permeated from the tissue of the wall portion of the internal organ with said sampling medium in sampling chamber.

2. An apparatus according to claim 1, wherein said walled sampling chamber is defined by a balloon member generally surrounding a portion of said catheter tube and sealingly interconnected therewith, the wall of said balloon member being composed of said wall material that is freely permeable to said one or more liquid fluids or gaseous fluids of interest and substantially impermeable to other liquid 930610,p:\oper~kaytonomietdiv,22 -23- fluids or gaseous fluids, said balloon member being deformable for forming said interior space with said catheter tube.

3. A tonometric catheter apparatus for measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising: a) an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough; b) at least one walled sampling chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber being defined by a balloon member generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, at least a portion of the wall of said balloon member being composed of a wall material being substantially impermeable to other liquid fluids or gaseous fluids, and said balloon member being inflated for 15 forming an interior space between said balloon member and said catheter tube in order to allow said one or more liquid fluids or gaseous fluI B s of interest from the i tissue of the wall portion of the internal organ to permeate into said sampling chamber, with said catheter tube extending to a position outside of the body of the human or other mammal, and with said lumen providing fluid communication between said sampling chamber and the outside of the body of the human or other mammal for a sampling medium to flow therebetween; and c) analyzing sensor means positioned outside of the body of the human Sor other mammal in communication with said lumen, for sensing the level of at least :one of said liquid fluids or gaseous fluids of interest permeated from the tissue of the wall portion of the internal organ into said sampling medium in said sampling chamber.

4. A method of measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising the steps of: a) providing an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough with at least one walled sampling S941223,p:\oper\kay,tonometdiv,23 -24- chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, the wall of said sampling chamber being composed of a wall material that is freely and selectively permeable to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids said sampling chamber defining an interior space between said sampling chamber and said catheter tube; b) providing a gas analyzing apparatus for sensing the level of at least one of said liquid fluids or gaseous fluids of interest; c) introducing the catheter tube into the organ of interest so that said walled sampling chamber is disposed at a desired sampling site, said catheter tube extending to a position outside the body of the human or other mammal so that said lumen provides fluid communication between said sampling chamber and the outside of the body of the human or other mammal; d) introducing a sampling medium into said catheter tube and into said interior space between said sampling chamber and said catheter tube; e) leaving said sampling chamber disposed at said sampling site for a length of time sufficient to allow said liquid fluid or gaseous fluids of interest that are present at said sampling site to diffuse across the wall of the sampling chamber S. into said sampling medium contained within said sampling chamber; f) withdrawing at least a portion of said sampling medium through said catheter tutl and Sg) analyzing the sample thus withdrawn using said gas analyzer means to 25 determine the level present of said liquid fluid or gaseous fluid in said withdrawn sampling medium.

A method of measuring a liquid fluid or gaseous fluid property indicative of the condition of an internal organ of a human or other mammal in vivo, comprising the steps of: a) providing an elongated tonometric catheter tube having at least one lumen extending longitudinally therethrough with at least one walled sampling 941223,p:\oper\ky,onometdiv,24 chamber on said catheter tube in fluid communication with the interior of said lumen, said walled sampling chamber being defined by a balloon member generally surrounding a portion of said catheter tube and being sealingly interconnected therewith, the wall of said balloon member being composed of a wall material that is freely and selectively permeable to one or more liquid fluids or gaseous fluids of interest, said wall material being substantially impermeable to other liquid fluids or gaseous fluids, said balloon member defining an interior space between said sampling chamber and said catheter tube; b) providing a gas analyzing apparatus for sensing the level of at least one of said liquid fluids or gaseous; fluids of interest; c) introducing the catheter tube into the organ of interest so that said balloon member is disposed at a desired sampling site, said catheter tube extending to a position outside the body of the human or other mammal so that said lumen provides fluid communication between said balloon member and the outside of the 15 body of the human or other mammal; d) introducing a sampling medium into said catheter tube and into said interior space between said balloon member and said catheter tube; leaving said sampling chamber disposed at said sampling site for a length of time sufficient to allow said liquid fluids or gaseous fllids of interest that are present at said sampling site to diffuse across the wall of the balloon member into said sampling medium contained within said balloon member; f) withdrawing at least a portion of said sampling medium through said S* catheter tube; and g) analyzing the sample thus withdrawn using said gas analyzer means to determine the level present of said liquid fluid or gaseous fluid in said withdrawn sampling medium.

6. A tonometric catheter apparatus substantially as hereinbefore described with reference to the accompanying drawings. 941223,p.\oper\kay,tonomediv,25 -26-

7. A method of measuring a liquid fluid or gaseous fluid property substantially as hereinbefore described with reference to the accompanying drawings. DATED this 22nd day of January 1994 Mountpelier Investments S.A. By Its Patent Attorneys DAVIES COLLISON CAVE a a a aaaa aaaa a a aaa a a aa a aaa a aaa o a a a aa aa a aa aa a a s c a aa aa a a aa a a aa a a 941223,p:\oper\kay,tonorneLdiv,26 A tonometric catheter apparatus (20) and method for sampling of a fluid or gas property of interest in an internal organ. The tonometric catheter (20) assists in early detection of the problems of stress ulceration and/or intestinal ischemia. The tonometric catheter (20) has one or more sampling chambers (20) for introduction into an internal organ or an area adjacent thereto. Preferably the wall (36) of the sampling chamber (40) is freely permeable to the gas or fluid of interest, but is poorly permeable to other gases or fluids. The method is accomplished by introducing the catheter into the organ such that the sampling chamber is disposed at a portion of the wall of the organ. The sampling chamber is left in position at the wall of the organ for a time sufficient to allow the fluid or gas of interest to diffuse into the sampling chamber. The concentration of the fluid or gas of interest is analyzed. 930610,p:\oper\kay,tonomedivA28