US20080119823A1 - Injection Tube for Jet Injection Device - Google Patents

Injection Tube for Jet Injection Device Download PDF

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Publication number
US20080119823A1
US20080119823A1 US11944081 US94408107A US2008119823A1 US 20080119823 A1 US20080119823 A1 US 20080119823A1 US 11944081 US11944081 US 11944081 US 94408107 A US94408107 A US 94408107A US 2008119823 A1 US2008119823 A1 US 2008119823A1
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Prior art keywords
polymeric
device
tubular
metal
non
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Abandoned
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US11944081
Inventor
Justin M. Crank
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AMS Research LLC
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AMS Research LLC
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/178Syringes
    • A61M5/30Syringes for injection by jet action, without needle, e.g. for use with replaceable ampoules or carpules
    • A61M5/3007Syringes for injection by jet action, without needle, e.g. for use with replaceable ampoules or carpules with specially designed jet passages at the injector's distal end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/307Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the urinary organs, e.g. urethroscopes, cystoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0043Catheters; Hollow probes characterised by structural features
    • A61M25/005Catheters; Hollow probes characterised by structural features with embedded materials for reinforcement, e.g. wires, coils, braids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0074Dynamic characteristics of the catheter tip, e.g. openable, closable, expandable or deformable
    • A61M25/0075Valve means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/08Tubes; Storage means specially adapted therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/178Syringes
    • A61M5/30Syringes for injection by jet action, without needle, e.g. for use with replaceable ampoules or carpules

Abstract

A non-metal, polymeric tubular device for delivering a therapeutic fluid to a treatment site within a patient. The non-metal, polymeric tubular device can be fabricated using suitable high strength polymers and in some versions can be reinforced through the inclusion of reinforcement materials or braiding. The non-metal, polymeric tubular device can be fabricated so as to have a burst strength exceeding at least about 2,000 psi. The non-metal, polymeric tubular device can be fabricated so as to have distention properties, wherein an orifice or jet port located at a distal end of the polymeric tubular device retains its shape and/or size without suffering swelling that can have a detrimental impact on a fluid jet used to deliver the therapeutic fluid at the treatment site.

Description

    PRIORITY CLAIM
  • [0001]
    The present application claims priority to U.S. Provisional Patent Application No. 60/866,741, filed Nov. 21, 2006 and entitled, “INJECTION TUBE FOR JET INJECTION DEVICE, which is herein incorporated by reference in its entirety.
  • FIELD OF THE INVENTION
  • [0002]
    The present invention relates generally to jet injection devices for the delivery of therapeutic fluids to a treatment site. More specifically, the present invention relates to a non-metal reinforced polymeric injection tube having performance characteristics compatible with minimally invasive jet injection devices.
  • BACKGROUND OF THE INVENTION
  • [0003]
    A wide variety of medical treatments are at least partially performed through the delivery and introduction of therapeutic compositions to a treatment location. In home or outpatient settings, typical delivery methods can comprise oral delivery, via liquid or solid forms, as well as a variety of inhalant style devices. In clinical or hospital settings, therapeutic fluids can be injected using needle based or in some minimally invasive procedures, the therapeutic fluid can be delivered through a tubular device such as a catheter or endoscope based systems.
  • [0004]
    One way in which therapeutic fluids can be delivered internally is through the use of a tubular device configured to provide a jet-injection of the therapeutic fluid at a desired treatment site. Generally, a remote injector is utilized to deliver the therapeutic fluid from an external reservoir located at a proximal end of the tubular device such administration can occur at a distal end of the tubular device. Due to the relatively long travel length of the therapeutic fluid through the tubular device, the remote injector must generally be capable of pressurizing the therapeutic fluid to pressures exceeding about 2,000 psi. In order to accommodate these pressures, the tubular devices have been fabricated of alloys such as NiTi or stainless steel or with metal-reinforced polymers such as the braided tubes typically found in catheters. While the use of alloys and metal reinforced polymers satisfy the operational requirements related to burst pressure and distention strength, they are generally of limited flexibility making them difficult to navigate within the tortuous paths often found in the human body such as, for example, the urogenital tract.
  • SUMMARY OF THE INVENTION
  • [0005]
    The present invention comprises a non-metal, polymeric tubular device for delivering a therapeutic fluid to a treatment site within a patient. The non-metal, polymeric tubular device can be fabricated using suitable high strength polymers including, for example, polyimide, polyetherimide available from General Electric under the trade name Ultem® and linear aromatic polymers such as PEEKTM available from Victrex plc. In some embodiments, the non-metal, polymeric tubular device can be reinforced through the inclusion of materials including nano-particles, clays and/or glass. In some presently contemplated embodiments, the non-metal, polymeric tubular device can be reinforced with one or more polymers such as, for example, tubes braided with carbon fiber, synthetic para-aramid fiber such as Kevlar available from E.I. du Pont de Nemours and Company or other high-strength polymers. The non-metal, polymeric tubular device can be fabricated so as to have a burst strength exceeding at least about 2,000 psi and in some embodiments, having a burst strength within a range of about 2,000 psi to about 5,000 psi. The non-metal, polymeric tubular device can be fabricated so as to have distention properties, wherein an orifice or jet port located at a distal end of the polymeric tubular device retains its shape and/or size without suffering swelling that can have a detrimental impact on a fluid jet used to deliver the therapeutic fluid at the treatment site.
  • [0006]
    In one aspect, the present disclosure is directed to a non-metal, polymeric tubular device for delivering a therapeutic fluid to a treatment site within the body wherein the non-metal, polymeric tubular device has a burst strength within a range of about 2,000 psi to about 5,000 psi. The non-metal, polymeric tubular device can be fabricated using suitable high strength polymers including, for example, polyimide, polyetherimide available from General Electric under the trade name Ultem® and linear aromatic polymers such as PEEKTM available from Victrex plc. In some embodiments, the non-metal, polymeric tubular device can be reinforced through the inclusion of materials including nano-particles, clays and/or glass. In some presently contemplated embodiments, the non-metal, polymeric tubular device can be reinforced with one or more polymers such as, for example, tubes braided with carbon fiber, synthetic para-aramid fiber such as Kevlar available from E.I. du Pont de Nemours and Company or other high-strength polymers. In some embodiments, the non-metal, polymeric tubular device can have a tube length ranging from about 18 to about 72 inches. In some embodiments, the non-metal, polymeric tubular device can include an orifice functioning as a jet nozzle, wherein the non-metal, polymeric tubular device has sufficient strength to avoid distention at the orifice.
  • [0007]
    In another aspect, the present disclosure is directed to a method of delivering a therapeutic fluid comprising providing a non-metal, polymeric tubular device having a burst strength range of about 2,000 psi to about 5,000 psi, delivering the therapeutic fluid through the non-metal, polymeric tubular device and administering the therapeutic fluid to the treatment site with a jet orifice located at a distal end of the non-metal, polymeric tubular device. The method can further comprise positioning the non-metal, polymeric tubular device through an internal lumen within a patient such as a patient's urogenital tract.
  • [0008]
    In yet another aspect of the present disclosure, a therapeutic fluid delivery system can comprise an injector device and a non-metal, polymeric tubular device for delivery a therapeutic fluid to a treatment location within a patient's body. The non-metal, polymeric tubular device can have a burst strength ranging from about 2,000 psi to about 5,000 psi so as to prevent tube failure and to similarly, avoid distention at a jet orifice located at a distal end of the non-metal, polymeric tubular device.
  • [0009]
    The above summary of the various representative embodiments of the invention is not intended to describe each illustrated embodiment or every implementation of the invention. Rather, the embodiments are chosen and described so that others skilled in the art may appreciate and understand the principles and practices of the invention. The figures in the detailed description that follows more particularly exemplify these embodiments.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0010]
    The invention may be more completely understood in consideration of the following detailed description of various embodiments of the invention in connection with the accompanying drawings, in which:
  • [0011]
    FIG. 1 is a perspective view of an embodiment of a therapeutic fluid delivery system for delivering a therapeutic fluid to a treatment location according to the present disclosure.
  • [0012]
    FIG. 2 is a side view of an embodiment of a non-metal, polymeric tubular device according to the present disclosure.
  • [0013]
    FIG. 3 a is a section view of the non-metal, polymeric tubular device of FIG. 2 taken at line 3-3 of FIG. 2.
  • [0014]
    FIG. 3 b is a side view of a portion of an embodiment of a non-metal, polymeric tubular device according to the present disclosure.
  • [0015]
    FIG. 4 is an illustration of the non-metal, polymeric tubular device positioned for delivery of a therapeutic fluid within a patient's urogenital tract.
  • [0016]
    FIG. 5 is a side view of a prior art polymeric tube suffering distention at a jet orifice located at a distal end of the prior art polymeric tube.
  • [0017]
    FIG. 6 is a side view of a non-metal, polymeric tubular device of the present invention delivering a therapeutic fluid through jet injection from a jet orifice at a distal end of the non-metal, polymeric tubular device.
  • [0018]
    While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives.
  • DETAILED DESCRIPTION OF THE DRAWINGS
  • [0019]
    In the following detailed description of the present invention, numerous specific details are set forth in order to provide a thorough understanding of the present invention. However, it will be obvious to one skilled in the art that the present invention may be practiced without these specific details. In other instances, well-known methods, procedures, and components have not been described in detail so as to not unnecessarily obscure aspects of the present invention.
  • [0020]
    A needleless fluid delivery system 100 is illustrated generally in FIG. 1. Needleless fluid delivery system 100 can comprise an injector 102 and an applicator lumen 104. Injector 102 can be as simple as manually activated syringe or injector 102 can comprise an automated injector 103 including a user interface 106 and a connector member 108. Connector member can include a surface opening 109 and a therapeutic fluid supply 110. User interface 106 can comprise an input means for selectively delivering a pressurized fluid through the connector member 108. Representative input means can include foot pedal 107, switches, buttons or a touch-screen capable of receiving touch commands as well as displaying system information including a mode of operation as well as operating parameters.
  • [0021]
    As seen in FIGS. 2 and 3 a, the applicator lumen 104 can comprise a non-metal, polymeric tubular device 200 having a proximal attachment end 202 and a distal treatment end 204. Non-metal, polymeric tubular device 200 can have a tube length 206 that corresponds to a type of treatment to be performed within a patient's body. For example, when non-metal, polymeric tubular device 200 is configured to perform a cytoscopic or endoscopic procedure, the tube length 206 can range from about 18 to about 72 inches in length.
  • [0022]
    Non-metal, polymeric tubular device 200 is generally formed so as to have a burst strength of at least about 2,000 psi. In a preferred embodiment, the non-metal, polymeric tubular device is formed to have a burst strength ranging from about 2,000 psi to about 5,000 psi. In one representative embodiment, non-metal, polymeric tubular device 200 is formed of a single high strength polymer such as, for example, a polyimide, polyetherimide available from General Electric under the trade name Ultem® and linear aromatic polymers such as PEEKTM available from Victrex plc. Alternatively, the non-metal, polymeric tubular device 200 can be formed from a reinforced polymer that is reinforced with reinforcing materials 207 such as, for example, nano-particles, clays or glass. In another embodiment as shown in FIG. 3 b, the non-metal, polymeric tubular device 200 is reinforced with a reinforcing fiber 209 such as, for example, tubes braided with carbon fiber, synthetic para-aramid fiber such as Kevlar available from E.I. du Pont de Nemours and Company or other high-strength polymers braided within non-metal, polymeric tubular device 200. Generally, the non-metal, polymeric tubular device 200 is extruded though other appropriate fabrication methods including molding can be utilized as well.
  • [0023]
    As illustrated in FIG. 4, non-metal, polymeric tubular device 200 can be configured as a cytoscope 300 to deliver therapeutic fluid to a treatment location 302 such as, for example, the urinary bladder 304. Distal treatment end 204 generally accesses the urogenital tract through the urethra 306 wherein the distal treatment end 204 enters the urinary bladder 304. Cytoscope 300 can include a fiber optic scope such that a medical professional can verify the distal treatment end 204 is positioned proximate the treatment location 302.
  • [0024]
    In positioning the non-metal polymeric tubular device 200 at treatment location 302, it will be understood that a medical professional frequently employs a medical imaging system such as, for example, computer axial tomography (CAT), magnetic resonance imaging (MRI), or in the case of treatment of a prostate gland, the preferred imaging means is transrectal ultrasound (TRUS) so as to achieve the desired position of administration orifice 208. Through the use of a medical imaging system, a medical professional can verify that the therapeutic fluid is in fact administered at the treatment location 302.
  • [0025]
    Once the distal treatment end 204, and more specifically, the administration orifice 208 is positioned with respect to the treatment location 302, the injector 102 can be actuated so as to begin delivery of a therapeutic fluid 308 as illustrated in FIG. 6. Generally, injector 102 directs therapeutic fluid 308 through the non-metal, polymeric tubular device 200 at low velocities and high pressures generally between about 2,000 psi to about 5,000 psi. The high pressures supplied by the injector 102 are necessary due to the pressure losses experienced in the relatively, small diameter non-metal, polymeric tubular device 200. As the therapeutic fluid 308 reaches distal treatment end 204, the therapeutic fluid 308 is rapidly accelerated through the administration orifice 208 to form a fluid jet 310. Using fluid jet 310, therapeutic fluid 308 can be controllably dispensed directly at the treatment location 302 so as to reduce the potential for exposure to other non-desired areas. As the fluid jet 310 moves away from the administration orifice 208, the pressure of fluid jet 310 is rapidly lost.
  • [0026]
    By using non-metal, polymeric tubular device 200, problems associated with using conventional polymeric tubing can be avoided. With reference to FIG. 5, conventional polymeric tubing 400 can suffer a variety of failure modes including, for example, distention or swelling of the conventional polymeric tubing 400 at an administration orifice 402. When distention occurs, the changing dimensional characteristics of the administration orifice cause uncontrolled variations in the characteristics of a fluid jet 404 as well as potential failure and rupture of the conventional polymeric tubing 400.
  • [0027]
    While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives.

Claims (20)

  1. 1. A non-metal, polymeric tubular device for delivering therapeutic fluids to treatment locations within a patient's body comprising:
    an applicator body defining a lumen, the applicator body including a distal end and a proximal connection end, wherein an administration orifice is positioned proximate the distal end, and wherein the applicator body has a burst pressure of at least about 2,000 psi such that dimensional characteristics of the administration orifice remain constant under the influence of a fluid jet.
  2. 2. The non-metal, polymeric tubular device of claim 1, wherein the applicator body is fabricated of a polymer selected from the group consisting of: a polyimide polymer, a polyetherimide polymer and a liner aromatic polymer.
  3. 3. The non-metal, polymeric tubular device of claim 1, wherein the applicator body is fabricated of a polymer having a reinforcing material selected from the group consisting of: nano-particles, clay particles and glass particles.
  4. 4. The non-metal, polymeric tubular device of claim 1, wherein the applicator body is fabricated of a polymer having a reinforcing fiber selected from the group consisting of: carbon fiber and a synthetic para-aramid fiber.
  5. 5. The non-metal, polymeric tubular device of claim 1, wherein the applicator body has a tube length of about 18 inches to about 72 inches.
  6. 6. The non-metal, polymeric tubular device of claim 1, wherein the applicator body comprises an extruded applicator body.
  7. 7. The non-metal, polymeric tubular device of claim 1, wherein the burst pressure of the applicator body is about 2,000 to about 5,000 psi.
  8. 8. A needleless fluid delivery system comprising:
    an injector; and
    an applicator body defining a lumen, the applicator body including a distal end and a proximal connection end, wherein an administration orifice is positioned proximate the distal end, and wherein the applicator body has a burst pressure of about 2,000-5,000 psi such that dimensional characteristics of the administration orifice remain constant under the influence of a fluid jet.
  9. 9. The needleless fluid delivery system of claim 8, further comprising:
    a medical imaging system for visualizing the position of the administration orifice at a treatment location.
  10. 10. The needleless fluid delivery system of claim 8, wherein the injector comprises a syringe.
  11. 11. The needleless fluid delivery system of claim 8, wherein the injector comprises an automated injector having a user interface and a connector member attaching to the proximal connection end.
  12. 12. The needleless fluid delivery system of claim 8, wherein the applicator body is fabricated of a polymer selected from the group consisting of: a polyimide polymer, a polyetherimide polymer and a liner aromatic polymer.
  13. 13. The needleless fluid delivery system of claim 8, wherein the applicator body is fabricated of a polymer having a reinforcing material selected from the group consisting of: nano-particles, clay particles and glass particles.
  14. 14. The needleless fluid delivery system of claim 8, wherein the applicator body is fabricated of a polymer having a reinforcing fiber selected from the group consisting of: carbon fiber and a synthetic para-aramid fiber.
  15. 15. The needleless fluid delivery system of claim 8, wherein the applicator body has a tube length of about 18 inches to about 72 inches.
  16. 16. The needleless fluid delivery system of claim 8, wherein the applicator body comprises an extruded applicator body.
  17. 17. A method for delivering a therapeutic fluid to a treatment location with a non-metal, polymeric tubular device comprising:
    providing a non-metal, polymeric applicator body having a distal end and a proximal connection end, wherein an administration orifice is positioned proximate the distal end, and wherein the applicator body has a burst pressure of at least about 2,000 psi;
    positioning the administration orifice proximate a treatment location; and
    generating a fluid jet through the administration orifice for dispensing a therapeutic fluid at the treatment location such that dimensional characteristics of the administration orifice remain constant under the influence of the fluid jet.
  18. 18. The method of claim 17, further comprising:
    reinforcing the non-metal, polymeric applicator body through the inclusion of reinforcing materials.
  19. 19. The method of claim 17, further comprising:
    reinforcing the non-metal, polymeric applicator body through the inclusion of a reinforcing fiber.
  20. 20. The method of claim 17, wherein generating the fluid jet comprises pressurizing the therapeutic fluid with an injector attached to the proximal connection end.
US11944081 2006-11-21 2007-11-21 Injection Tube for Jet Injection Device Abandoned US20080119823A1 (en)

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US11944081 US20080119823A1 (en) 2006-11-21 2007-11-21 Injection Tube for Jet Injection Device
US12491531 US20090259213A1 (en) 2006-11-21 2009-06-25 Injection tube for jet injection device
US14515757 US9814837B2 (en) 2006-11-21 2014-10-16 Injection tube for jet injection device

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US14515757 Active US9814837B2 (en) 2006-11-21 2014-10-16 Injection tube for jet injection device

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Cited By (18)

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US20090259213A1 (en) * 2006-11-21 2009-10-15 Crank Justin M Injection tube for jet injection device
US20090312696A1 (en) * 2005-12-28 2009-12-17 Copa Vincent G Devices, Systems, and Related Methods for Delivery of Fluid to Tissue
WO2010074705A2 (en) 2008-12-16 2010-07-01 Ams Research Corporation Needleless injection device components, systems, and methods
WO2010065133A3 (en) * 2008-12-05 2010-08-19 Ams Research Corporation Devices, systems, and related methods for delivery of fluid to tissue
US20100234875A1 (en) * 2008-10-30 2010-09-16 R4 Vascular, Inc. Rupture-resistant compliant radiopaque catheter balloon and methods for use of same in an intravascular surgical procedure
US20110015614A1 (en) * 2008-12-16 2011-01-20 Rykhus Jr Robert L Needleless injection device components, systems, and methods
WO2011011382A1 (en) 2009-07-20 2011-01-27 Ams Research Corporation Devices, systems, and related methods for delivery of fluid to tissue
US20110046600A1 (en) * 2008-12-05 2011-02-24 Crank Justin M Devices, systems, and related methods for delivery of fluid to tissue
US20110172631A1 (en) * 2008-12-05 2011-07-14 Crank Justin M Needleless injection device components, systems, and methods
US20120157917A1 (en) * 2010-12-16 2012-06-21 Schroeder Tania M High pressure delivery system and method for treating pelvic disorder using large molecule therapeutics
US8628494B2 (en) 2009-07-20 2014-01-14 Ams Research Corporation Devices, systems, and methods for delivering fluid to tissue
US8852084B2 (en) 2006-11-09 2014-10-07 Ams Research Corporation Orientation adapter for injection tube in flexible endoscope
US8876759B2 (en) 2008-12-05 2014-11-04 Ams Research Corporation Devices, systems and methods for delivering fluid to tissue
US8945045B2 (en) 2009-07-20 2015-02-03 Ams Research Corporation Needleless injection device components, systems, and methods
US9138535B2 (en) 2009-07-20 2015-09-22 Ams Research Corporation High pressure injection catheter systems
US9370646B2 (en) 2008-12-05 2016-06-21 Justin M. Crank Devices, systems and methods for delivering fluid to tissue
US9421326B2 (en) 2008-12-29 2016-08-23 Robert L. Rykhus Method and apparatus for compensating for injection media viscosity in a pressurized drug injection system
US9706900B2 (en) 2007-11-19 2017-07-18 Ams Research Corporation Systems, apparatus and associated methods for needleless delivery of therapeutic fluids

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US20130138082A1 (en) * 2010-03-24 2013-05-30 Amr Salahieh Intravascular Tissue Disruption
US8840601B2 (en) * 2010-03-24 2014-09-23 Shifamed Holdings, Llc Intravascular tissue disruption

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