US20220054064A1 - Systems and Methods for Phlebotomy Through a Peripheral IV Catheter - Google Patents
Systems and Methods for Phlebotomy Through a Peripheral IV Catheter Download PDFInfo
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- US20220054064A1 US20220054064A1 US17/519,968 US202117519968A US2022054064A1 US 20220054064 A1 US20220054064 A1 US 20220054064A1 US 202117519968 A US202117519968 A US 202117519968A US 2022054064 A1 US2022054064 A1 US 2022054064A1
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- introducer
- intravenous line
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- peripheral intravenous
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/14—Devices for taking samples of blood ; Measuring characteristics of blood in vivo, e.g. gas concentration within the blood, pH-value of blood
- A61B5/1405—Devices for taking blood samples
- A61B5/1427—Multiple blood sampling, e.g. at periodic or pre-established intervals
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/14—Devices for taking samples of blood ; Measuring characteristics of blood in vivo, e.g. gas concentration within the blood, pH-value of blood
- A61B5/1405—Devices for taking blood samples
- A61B5/1438—Devices for taking blood samples using pre-evacuated means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150015—Source of blood
- A61B5/15003—Source of blood for venous or arterial blood
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150206—Construction or design features not otherwise provided for; manufacturing or production; packages; sterilisation of piercing element, piercing device or sampling device
- A61B5/150221—Valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150381—Design of piercing elements
- A61B5/150389—Hollow piercing elements, e.g. canulas, needles, for piercing the skin
- A61B5/150396—Specific tip design, e.g. for improved penetration characteristics
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150381—Design of piercing elements
- A61B5/150503—Single-ended needles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150534—Design of protective means for piercing elements for preventing accidental needle sticks, e.g. shields, caps, protectors, axially extensible sleeves, pivotable protective sleeves
- A61B5/150572—Pierceable protectors, e.g. shields, caps, sleeves or films, e.g. for hygienic purposes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150374—Details of piercing elements or protective means for preventing accidental injuries by such piercing elements
- A61B5/150534—Design of protective means for piercing elements for preventing accidental needle sticks, e.g. shields, caps, protectors, axially extensible sleeves, pivotable protective sleeves
- A61B5/150694—Procedure for removing protection means at the time of piercing
- A61B5/150717—Procedure for removing protection means at the time of piercing manually removed
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150007—Details
- A61B5/150732—Needle holders, for instance for holding the needle by the hub, used for example with double-ended needle and pre-evacuated tube
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/150992—Blood sampling from a fluid line external to a patient, such as a catheter line, combined with an infusion line; blood sampling from indwelling needle sets, e.g. sealable ports, luer couplings, valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/15—Devices for taking samples of blood
- A61B5/153—Devices specially adapted for taking samples of venous or arterial blood, e.g. with syringes
- A61B5/154—Devices using pre-evacuated means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M2039/0202—Access sites for taking samples
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- F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
- F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
- F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
- F04C2270/00—Control; Monitoring or safety arrangements
- F04C2270/04—Force
- F04C2270/042—Force radial
- F04C2270/0421—Controlled or regulated
Definitions
- the embodiments described herein relate generally to medical devices. More particularly, the embodiments described herein relate to systems and methods for phlebotomy through an intravenous catheter.
- the typical hospitalized patient encounters a needle every time a doctor orders a lab test.
- the standard procedure for blood extraction involves using a metal needle (“butterfly needle”) to “stick” patients' veins in their arms or hands.
- Blood drawing is a manual, labor-intensive process, with the average patient requiring hours of direct skilled labor during a typical hospital stay.
- This needle stick is not only painful and a major source of patient dissatisfaction, but the nurses or specialized blood drawing personnel (phlebotomists) often have difficulty finding the vein in approximately 10-15% of patients, resulting in multiple, painful “stick” attempts. This results in significantly higher material and labor costs (needles and tubing must be disposed of after every attempt) and increased patient pain and bruising.
- the current process for drawing blood is inefficient, taking on average 7-10 minutes, and more than 21 minutes for 10% of patients. These 10% of patients are referred to as Difficult Intra-Venous Access or more commonly as “tough stick” patients. If superficial veins are not readily apparent, blood can be forced into the vein by massaging the arm from wrist to elbow, tapping the site with the index and middle finger, applying a warm, damp washcloth to the site for 5 minutes, or by lowering the extremity over the bedside to allow the veins to fill. Each of these methods is time consuming and therefore costly.
- Peripheral IV catheters are inserted into most patients while they are hospitalized and used for infusing fluids and medications. However, they are not designed for blood extractions. The failure rates for aspiration reach 20-50% when PIVs have been left inserted for more than a day. Blood extracted from PIVs is often hemolyzed, defined as the rupture of red blood cells and the release of their contents into surrounding fluid, resulting in a discarded sample and need to repeat the blood collection.
- an apparatus includes an introducer, and a catheter.
- the catheter includes a proximal end and a distal end defining a lumen.
- the introducer includes a proximal end and a distal end defining a lumen and is configured to receive the catheter.
- An actuator operatively coupled to the catheter, is configured to move the catheter between a first configuration, in which the catheter is substantially within the introducer, and a second configuration, in which the catheter is substantially outside the introducer.
- a locking mechanism coupled to the distal end of the introducer, is configured to couple the introducer to a peripheral intravenous line. The catheter extends past an end of the peripheral intravenous line when in the second configuration.
- FIG. 1 is a schematic illustration of an apparatus according to an embodiment in a first configuration.
- FIG. 2 is a schematic illustration of an apparatus according to an embodiment in a second configuration.
- FIG. 3 is a detailed schematic illustration of an apparatus according to an embodiment in a second configuration.
- FIG. 4 is a schematic illustration of an apparatus according to an embodiment in a second configuration.
- FIG. 5 is a side view of an apparatus according to an embodiment in a first configuration.
- FIG. 6 is a cross-sectional view of a portion of an apparatus according to an embodiment.
- FIG. 7 is a side view of an apparatus according to an embodiment in a first configuration.
- FIG. 8 is a side view of an apparatus according to an embodiment in a second configuration.
- FIGS. 9A and 9B are side views of an apparatus according to embodiments.
- FIGS. 10A-10C are side views of an apparatus according to embodiments.
- FIGS. 11A-11C are side views of an apparatus according to embodiments.
- an apparatus includes an introducer, and a catheter.
- the catheter includes a proximal end and a distal end defining a lumen.
- the introducer includes a proximal end and a distal end defining a lumen and is configured to receive the catheter.
- An actuator operatively coupled to the catheter, is configured to move the catheter between a first configuration, in which the catheter is substantially within the introducer, and a second configuration, in which the catheter is substantially outside the introducer.
- a locking mechanism coupled to the distal end of the introducer, is configured to couple the introducer to a peripheral intravenous line. The catheter extends past an end of the peripheral intravenous line when in the second configuration.
- a method includes coupling an introducer sheath to a peripheral intravenous line (e.g., saline locked device, heparin locked device, or the like), the introducer sheath having a proximal end and a distal end.
- the method further includes advancing a catheter from a first position inside the introducer sheath and outside the peripheral intravenous line to a second position substantially outside the introducer sheath and inside the peripheral intravenous line.
- the catheter has a length greater than a length of the peripheral intravenous line, while in other embodiments, the catheter, in the second position, is shorter than the peripheral intravenous line.
- a container is then coupled to the proximal end of the introducer sheath, the container being fluidically coupled to the catheter. The catheter is later withdrawn from the second position to the first position.
- a catheter has a proximal end and a distal end and defines a lumen therethrough.
- An introducer has a proximal end and a distal end and defines a lumen therethrough.
- the introducer is configured to receive the catheter therein.
- An adapter is coupled to the introducer.
- the adapter has a distal end configured to be coupled to a peripheral intravenous line.
- the adapter defines a first lumen and a second lumen.
- the first lumen has a first diameter and is configured to receive the catheter therethrough.
- the second lumen is orthogonal to the first lumen.
- An actuator is operatively coupled to the catheter and is configured to move the catheter between a first configuration and a second configuration. The catheter extends past the distal end of the adapter in the second configuration.
- proximal and distal refer to the direction closer to and away from, respectively, a user who would place the device into contact with a patient.
- distal end the end of a device first touching the body of the patient
- opposite end of the device e.g., the end of the device being manipulated by the user
- the term “stiffness” relates to an object's resistance to deflection, deformation, and/or displacement by an applied force. Stiffness can be characterized in terms of the amount of force applied to the object and the resulting distance through which a first portion of the object deflects, deforms, and/or displaces with respect to a second portion of the object.
- the deflected distance may be measured as the deflection of a portion of the object different from the portion of the object to which the force is directly applied. Said another way, in some objects, the point of deflection is distinct from the point where force is applied.
- Stiffness is an extensive property of the object being described, and thus is dependent upon the material from which the object is formed as well as certain physical characteristics of the object (e.g., shape and boundary conditions).
- the stiffness of an object can be increased or decreased by selectively including in the object a material having a desired modulus of elasticity, flexural modulus, and/or hardness.
- the modulus of elasticity is an intensive property of (i.e., is intrinsic to) the constituent material and describes an object's tendency to elastically (i.e., non-permanently) deform in response to an applied force.
- a material having a high modulus of elasticity will not deflect as much as a material having a low modulus of elasticity in the presence of an equally applied stress.
- the stiffness of the object can be increased, for example, by introducing into the object and/or constructing the object of a material having a high modulus of elasticity.
- a material's hardness is an intensive property of the constituent material and describes the measure of how resistant the material is to various kinds of permanent shape change when a force is applied.
- the Shore durometer scale is generally used. There are several scales for durometers with two commonly used in describing plastics, polymers, elastomers, and/or rubbers, namely, type A and type D, where type A is generally used for softer materials and type D is generally used for harder materials.
- the Shore durometer of a material is denoted by a number between 0 and 100, with higher numbers indicating a harder material, followed by the type of scale.
- a first material can be measured as having a Shore durometer of 40 Shore A and a second material can be measured as having a Shore durometer of 60 Shore D. Therefore, according to the Shore durometer scale, the second material is harder and thus, more stiff than the first material.
- FIG. 1 is a schematic illustration of an apparatus 1000 for phlebotomy through a peripheral intravenous line or catheter in a first configuration according to an embodiment.
- the apparatus 1000 includes an introducer 1100 and a catheter 1200 .
- the catheter 1200 is movably coupled (e.g., slidably coupled, rotatably coupled, etc.) to the introducer 1100 .
- the introducer 1100 includes a sheath 1110 defining a lumen 1113 between a proximal end 1120 and a distal end 1130 and configured to house, at least partially, the catheter 1200 .
- the proximal end 1120 includes an opening or port 1121 , such that the catheter 1200 moves from the first, retracted configuration ( FIG.
- the port 1121 at the proximal end 1120 of the introducer 1100 is configured such that the catheter 1200 may move through the port 1121 from the first configuration to the second configuration.
- the port 1121 can be any suitable port such as an opening in the proximal end of the introducer 1100 and can include an o-ring, a gasket, or can be a self-sealing port and can be lubricated using any suitable lubrication to aid in the movement and/or sealing of the catheter 1200 therein.
- the distal end 1130 of the introducer 1100 includes a locking mechanism 1131 configured to fluidically couple a peripheral intravenous line 1300 to the introducer 1100 and place the catheter 2200 into fluid communication with the peripheral intravenous line 1300 .
- the locking mechanism 1131 can be any suitable locking mechanism that creates a fluid-tight seal. In some embodiments, the locking mechanism can be a Luer lock or similar configuration.
- the peripheral intravenous line 1300 is in a sealed configuration until the locking mechanism 1131 is coupled to the intravenous line 1300 . Once the locking mechanism 1131 is coupled to the intravenous line 1300 , the seal can be opened to allow access for the catheter 1200 .
- FIG. 2 is a schematic illustration of an apparatus 1000 according to an embodiment in a second configuration.
- the apparatus 1000 includes an introducer 1100 and a catheter 1200 .
- the catheter 1200 defines a lumen 1201 between a proximal end 1220 and a distal end 1230 and may be any suitable diameter and stiffness.
- the catheter 1200 is between a 16-gauge and 26-gauge and having a Shore durometer of 20 Shore A to 50 Shore D.
- the catheter 1200 can be any suitable diameter to be inserted through the peripheral intravenous line 1300 and can be sufficiently stiff to be advanced through the peripheral intravenous line 1300 .
- An actuator 1112 is operatively coupled to the catheter 1200 through a groove or slot 1111 in the introducer 1100 .
- the actuator 1112 is configured to move the distal end 1230 of the catheter 1200 from the first configuration, shown in FIG. 1 , to the second configuration substantially outside the introducer 1100 , as shown in FIG. 2 .
- the length of the distal end 1230 of the catheter 1200 is greater than the length of the peripheral intravenous line 1300 and the catheter 1200 extends past the distal end of the intravenous line 1300 .
- the catheter 1200 can be moved to a third configuration in which it is retracted back into the introducer 1100 .
- the third configuration is substantially similar to the first configuration ( FIG. 1 ) in that the catheter 1200 is positioned in the introducer such that the user does not come into contact with bodily fluids.
- the apparatus 1000 can be disconnected from or connected to a peripheral intravenous line 1300 .
- the apparatus 1000 can be in the first configuration before it is coupled to the peripheral intravenous line 1300 , then remain in the first configuration for a period of time after being coupled to the peripheral intravenous line 1300 .
- the apparatus 1000 can be moved to the third configuration, can be disconnected from the peripheral intravenous line 1300 , and then remain in the third configuration.
- FIG. 3 is a detailed schematic illustration of an apparatus 2000 according to an embodiment in a second configuration.
- the apparatus 2000 includes an introducer 2100 and a catheter 2200 .
- the catheter 2200 includes a distal end 2230 and a proximal end 2220 .
- the distal end 2230 of the catheter 2200 includes a set of openings 2231 such that when in the second configuration (i.e., when the distal end 2230 of the catheter 2200 is in the vein and outside the intravenous line) the openings 2231 act to transport a bodily fluid (i.e., blood) to a volume outside the catheter 2200 .
- the set of openings can be of any arrangement on the circumference of the catheter 2200 and can include the end of the catheter 2200 .
- the catheter 2200 having the distal end 2230 can be substantially open at the tip surface.
- Each opening 2231 can be of any suitable shape or size and are not necessarily similar to any other opening included in the set of openings.
- the catheter 2200 defines a single opening.
- the proximal end 2220 of the catheter 2200 is fluidically coupled to a locking mechanism 2221 , as shown in FIG. 3 .
- the locking mechanism 2221 can be any suitable locking mechanism such as a Luer lock or the like.
- a needle 2222 is fluidically coupled to the locking mechanism and at least partially disposed within a sheath 2223 .
- the sheath 2223 can be any material with a suitable flexibility and/or compressibility such that the needle 2222 can extend through the sheath 2223 when engaged with a conventional phlebotomy fluid container (e.g., a Vacutainer®).
- the locking mechanism 2221 is configured to couple to a suitable fluid containment system such as a Vacutainer® holder (not shown in FIG.
- the sheath 2223 is configured to compress when the locking mechanism 2221 is coupled to the fluid containment system. This arrangement facilitates the passage of bodily fluids through the set of openings 2231 of the catheter 2200 , as shown in FIG. 3 by arrow AA, through the catheter 2200 , and exiting the catheter 2200 through the needle 2222 , as shown in FIG. 3 by arrow BB.
- FIG. 4 is a schematic illustration of an apparatus 3000 for phlebotomy through a peripheral intravenous catheter in a second configuration according to an embodiment.
- the apparatus 3000 includes an introducer 3100 and a catheter 3200 .
- the introducer 3100 includes a sheath 3110 defining a lumen 3113 between a proximal end 3120 and a distal end 3130 and configured to house, at least partially, the catheter 3200 .
- the distal end 3130 of the introducer 3100 includes a locking mechanism 3131 configured to fluidically couple the introducer 3100 to a peripheral intravenous line 3300 and place the catheter 3200 into fluid communication with the peripheral intravenous line 3300 .
- the locking mechanism 3131 can be any suitable locking mechanism that creates a fluid-tight seal.
- the locking mechanism can be a Luer lock or similar configuration.
- the sheath 3110 having a given stiffness, is such that when applying a force to the proximal end 3120 , the sheath 3110 compresses along an axis AAA, advancing the catheter 3200 to the second configuration. Said another way, as the sheath 3110 of the introducer 3100 is compressed, the catheter 3200 moves from the first configuration ( FIG. 1 ) to a second configuration substantially outside the introducer 3100 , as shown in FIG. 4 .
- the stiffness of the sheath 3110 is an extensive property and as such can have a set of properties (i.e.
- the set of properties allow the sheath 3110 to elastically deform (i.e. non-permanently) such that when the force is no longer applied to the proximal end 3120 of the introducer 3100 , the apparatus 3000 returns to the first configuration.
- the distal end 3230 of the catheter 3200 extends past the distal end of the peripheral intravenous line 3300 . This arrangement allows for the transport of a bodily fluid to a volume outside the catheter 3200 and when complete, the apparatus 3000 returns to a third configuration, which is substantially the same as the first configuration.
- FIG. 5 is a side view of an apparatus 4000 according to an embodiment in a first configuration.
- the apparatus 4000 includes an introducer 4100 and a catheter 4200 .
- the introducer 4100 includes a sheath 4110 defining a lumen 4113 between a proximal end 4120 and a distal end 4130 and configured to house, at least partially, the catheter 4200 .
- the introducer 4100 can be any suitable shape.
- the lumen 4113 defined by the interior walls of the sheath 4110 is not necessarily the same shape as the exterior walls of the sheath 4110 . Said a different way, the interior and exterior walls of the sheath 4110 can have a different cross sectional shape.
- the proximal end 4120 of the introducer 4100 is coupled to a locking mechanism 4122 .
- the locking mechanism 4122 can be any suitable locking mechanism such as a Luer lock or the like.
- the locking mechanism 4122 is configured to couple to a suitable fluid containment system such as a Vacutainer® holder (not shown in FIG. 5 ) and place the catheter 4200 in fluid communication with the fluid containment system.
- the distal end 4130 of the introducer 4100 includes a locking mechanism 4131 configured to fluidically couple a peripheral intravenous line (not shown in FIG. 5 ) to the introducer 4100 and place the catheter 4200 into fluid communication with the peripheral intravenous line.
- the locking mechanism 4131 can be any suitable locking mechanism that creates a fluid-tight seal.
- the locking mechanism 4131 is in a sealed configuration until the locking mechanism 4131 is coupled to the intravenous line. Once the locking mechanism 4131 is coupled to the intravenous line, the seal can be opened to allow access for the catheter 4200 .
- the locking mechanism 4131 of the distal end 4130 and the locking mechanism 4122 of the proximal end 4120 create an isolated housing for the catheter 4200 therein.
- the catheter 4200 is sterile.
- the catheter 4200 when in the second configuration and having contacted the desired bodily fluid, can be moved to the third configuration (i.e., returned to the first configuration) thereby isolating the used distal end 4230 .
- the sheath 4110 has a given stiffness such that when a force is applied to the proximal end 4120 the sheath 4110 compresses along an axis BBB advancing the catheter 4200 to a second configuration ( FIG. 6 ). Said another way, as the sheath 4110 of the introducer 4100 is compressed, the catheter 4200 moves from the first configuration to the second configuration substantially outside the introducer 4100 (i.e., the sheath 4110 retracts).
- the properties of the sheath 4110 can be any set of properties discussed herein such that applying a desired amount of force to proximal end 4120 allows the sheath to compress along axis BBB.
- the distal end 4230 of the catheter 4200 extends past the distal end of the peripheral intravenous line and allows for the transport of a bodily fluid to a volume outside of the catheter 4200 .
- the catheter 4200 includes a distal end 4230 and tapered portion 4203 .
- the tapered portion is such that the diameter of the catheter 4200 is reduced at a given location, as shown in FIG. 5 .
- the taper angle ⁇ can be any suitable angle such that the catheter 4200 is allowed to advance fully to the second configuration ( FIG. 6 ).
- the taper angle ⁇ is such that a laminar flow (i.e., smooth layered flow) is achieved.
- the catheter 4200 can include a stiffening wire 4202 , as shown in the magnified portion of FIG. 6 , and can be configured to coil around the walls of the catheter 4200 providing the catheter 4200 with a desired stiffness.
- the stiffening wire 4202 being coiled around the catheter 4200 , can provide the flexibility to advance through a set of walls defining a lumen (i.e., veins, arteries, peripheral intravenous line, and/or the like) without kinking or binding.
- the stiffening wire 4202 can provide the catheter 4200 with enough stiffness to facilitate its advancement through the lumen.
- the distal end 4230 of the catheter 4200 includes a set of openings 4231 such that when in the second configuration (i.e., when the distal end 4230 of the catheter 4200 is in the vein and outside the intravenous line) the openings 4231 act to transport a bodily fluid (i.e., blood) to a volume outside the catheter 4200 .
- the set of openings 4231 can be of any arrangement on the circumference of the catheter 4200 and can include the end of the catheter 4200 .
- the catheter 4200 having the distal end 4230 can be substantially open at the tip surface.
- FIG. 6 shows the distal end 4230 of the catheter 4200 as substantially flat, the distal end 4230 may be any suitable shape, (e.g.
- Each opening 4231 can be of any suitable shape or size and are not necessarily similar to any other opening 4231 included in the set of openings 4231 .
- the arrangement of the set of openings 4231 is configured to introduce a laminar flow through catheter 4200 to a volume substantially outside the catheter 4200 and thus avoid hemolysis.
- a blood collection system consists of two elements: (1) the introducer/catheter blood collection assembly described above; and (2) a y-adapter that is configured to attach to a standard 16 g or 22 g peripheral IV catheter.
- the y-adapter includes a dedicated port for the blood collection device and another standard port for conventional medicine and fluid infusion.
- FIG. 7 is a cross-sectional view of y-adapter 5400 and an apparatus 5000 in a first configuration according to an embodiment.
- the apparatus includes an introducer 5100 and a catheter 5200 .
- the introducer 5100 includes a sheath 5110 defining a lumen 5113 between a proximal end 5120 and a distal end 5130 and configured to house, at least partially, the catheter 5200 .
- the y-adapter 5400 is configured to be coupled between the introducer 5100 and intravenous line (not shown in FIG. 7 .).
- the y-adapter includes a distal end 5410 and defines two distinct ports.
- a first port 5420 of the y-adapter 5400 defines a first lumen 5422 with a first diameter D 1 .
- the first port 5420 is configured such that the first port 5420 is substantially similar in size, shape, configuration, and functionality of a conventional y-adapter.
- the first port 5420 is configured such that the backflow of a bodily fluid cannot exit the first port 5420 .
- the first lumen 5422 defined by the walls of the first port 5420 can be such that the lumen 5422 restricts the backflow of a bodily fluid (i.e. blood).
- the backflow can be prevented using a valve, screw cap, flip cap, port, and/or the like.
- a second port 5430 of the y-adapter 5400 defines a second lumen 5432 with a second diameter D 2 .
- the second diameter D 2 can be larger than the first diameter D 1 , as shown in FIG. 7 , in some embodiments, the second diameter D 2 can be similar or smaller than the first diameter D 1 . More particularly, the diameter D 2 of the second port 5430 is large enough to accept up to, for example, an 18-gauge catheter.
- the y-adapter can be of any suitable material and/or be of similar material to that of a conventional y-adapter.
- the first lumen 5422 defined by the first port 5420 and the second lumen 5432 defined by the second port 5430 converge to a common lumen 5401 before the distal end 5410 of the y-adapter 5400 , as shown in FIG. 7 .
- the second port 5420 is configured such that the second lumen 5432 is substantially coaxial with the common lumen 5401 and has a diameter substantially the same as the diameter D 2 .
- the walls that define the common lumen 5401 and the walls that define the second lumen 5432 are similar.
- the second port 5430 is fluidically coupled to a locking mechanism 5431 configured to couple the y-adapter to the introducer 5100 .
- the locking mechanism 5431 can be a Luer lock or the like.
- the y-adapter 5400 is in a sealed configuration until coupled to the locking mechanism 5131 at the distal end 5130 of the introducer 5100 .
- the seal can be opened to allow access for the catheter 5200 to advance to a second configuration, shown in FIG. 8 (note the introducer is not shown coupled to the y-adapter in FIG. 8 ).
- the distal end 5410 of the y-adapter 5400 is coupled to a peripheral intravenous line 5440 such as, for example, a conventional peripheral intravenous line.
- the y-adapter 5400 is monolithically formed with the peripheral intravenous line 5440 .
- the distal end 5410 of the y-adapter 5400 can be coupled to a peripheral intravenous line using any suitable locking mechanism.
- the second port 5420 of the locking mechanism 5431 configured to couple the y-adapter 5400 to the introducer 5100 can monolithically formed with the introducer 5100 . Said another way, in some embodiments, a separate introducer is not required, but rather a portion of the y-adapter can serve as the introducer.
- the distal end 5230 of the catheter 5200 in the second configuration is advanced substantially past the peripheral intravenous line 5440 .
- the distal end 5230 of the catheter 5200 includes a set of openings 5231 such that when in the second configuration (i.e., when the distal end 5230 of the catheter 5200 is in the vein and outside the intravenous line) the openings 5231 act to transport a bodily fluid (i.e., blood) to a volume outside the catheter 5200 .
- the set of openings can be of any arrangement on the circumference of the catheter 5200 and can include the end of the catheter 5200 .
- the catheter 5200 having the distal end 5230 can be substantially open at the tip surface.
- Each opening 5231 can be of any suitable shape or size and are not necessarily similar to any other opening included in the set of openings.
- the catheter 5200 in the second configuration and having transported the desired bodily fluid, can be returned to the third configuration (i.e., the first configuration) ( FIG. 7 ) thereby isolating the used distal end 5230 .
- FIG. 9A illustrates a catheter 6200 that includes a distal end 6230 with a bullet-shaped tip 6232 .
- the bullet-shaped tip 6232 includes an end portion 6233 configured to be a substantially closed rounded tip and, as such, can be used to move through clots existing within a peripheral intravenous line.
- the bullet-shaped tip 6232 includes a set of side-wall openings 6231 that are operative to transport a bodily fluid (i.e., blood) to a volume outside the catheter 6200 .
- a bullet-shaped tip 6232 ′ includes an end portion 6233 ′ that defines an end opening 6234 ′.
- the bullet-shaped tip 6232 ′ includes a set of side-wall openings 6231 ′.
- the end opening 6234 ′ and the side openings 6231 ′ can be configured to produce a laminar flow and act to transport a bodily fluid (i.e., blood) to a volume outside the catheter 6200 ′. While the openings 6231 , 6231 ′ are illustrated as having a particular configuration, the shape and orientation/relative position of the openings can be varied to facilitate the fluid flow through the catheter.
- a catheter 7200 includes a distal end 7230 with a wireframe tip 7241 having a stent-like configuration.
- the wireframe tip 7241 can be a flexible mesh configured to extend away from the distal end 7230 of the catheter 7200 .
- the wireframe tip 7241 can act to transport a bodily flow (i.e., blood) to a volume outside the catheter 7200 .
- the wireframe tip 7241 can include a capped end 7242 .
- the capped end 7242 can be any suitable size, shape, or configuration and, in some embodiments, can include any suitable number of openings.
- the wireframe tip 7241 can be connected to a guide wire 7243 and used without an additional catheter, as shown in FIGS. 11A-11C .
- the wireframe tip 7241 can be inserted into an existing peripheral intravenous line via a guide wire and without the catheter of FIG. 10 .
- the wireframe tip 7241 can act as a stent and support the walls of the vein such that blood can be drawn through the existing peripheral intravenous line.
- the wireframe tip 7241 can be positioned within the existing peripheral intravenous line at any suitable location.
- the wireframe tip can be positioned adjacent the distal end of the intravenous line.
- the components of the blood draw apparatus and the y-adapter can be packaged together or separately.
- the y-adapter can also be sold in a package with other IV dressing materials.
- the y-adapter can remain on the IV as long as the IV is in the patient.
- the blood draw apparatus can be used with a variety of peripheral IVs.
- the apparatus allows efficient blood draw while still maintaining the integrity of the sample.
- the apparatus will facilitate 20 ml of blood to be drawn in approximately 1-2 minutes. While extracting blood, the blood flow can be laminar to avoid turbulence in the catheter to minimize hemolysis.
- the blood draw apparatus can be used m a variety of settings (ER, inpatient, etc.), two examples of scenarios are described herein.
- the patient has a single peripheral IV.
- the patient has a dedicated second peripheral IV just for phlebotomy purposes. Only one y-adapter is required per patient, and can be attached for the life of the IV, for example, which is typically 3-4 days. A new catheter can be used for each blood draw.
- the assembly of the blood draw apparatus can be the same in either scenario.
- First, the apparatus is coupled to the y-adapter.
- Second, the catheter is advanced through the y-adapter and pushed through the peripheral IV catheter into the patient's vein.
- a syringe or a negative pressure collection container/tube e.g., a Vacutainer® tube
- a syringe or a negative pressure collection container/tube is connected to the rear port and fluidically coupled to the catheter to draw and store blood.
- the nurse or phlebotomist inserts a peripheral IV into a patient's arm.
- the peripheral IV is inserted following standard guidelines and the y-adapter is attached.
- the provider can turn off the IV, if it is on, for approximately 1-5 minutes to allow medicine or IV fluids to disperse from the blood-drawing site.
- the provider attaches the blood draw apparatus to the blood draw port on the y-adapter, advances the internal catheter through the peripheral IV and into the vein.
- the provider can attach the negative pressure collection container(s)/tube(s) to the apparatus (i.e., place the tube in fluid communication with the blood draw apparatus) to extract the blood sample.
- a user can discard, for example, the first 3-6 ml of the fluid or blood sample as “waste” then using the next tube(s) as the intended sample.
- This “wasting” procedure ensures all of the dead space fluid, like saline or medications, are cleared from the vein, peripheral IV and y-adapter as to not contaminate the testing sample being drawn.
- the provider inserts a peripheral IV into one arm to administer medicine and another peripheral IV into the opposite arm specifically for blood drawing purposes.
- the provider simply follows the steps mentioned above and there is no need to wait the 2-3 minutes to allow fluid or medicine dispersal as in the first scenario.
- each of the components discussed herein can be monolithically constructed or can be a combination of parts.
- the y-adapter 5400 and the introducer 5100 are coupled using locking mechanisms 5431 and 5131 , respectively.
- the y-adapter 5400 and the introducer 5100 can be the same component, wherein the y-adapter is an integral part of the introducer 5100 and vice-versa.
- Other aspects of the apparatus shown and described can be modified to affect the performance of the apparatus.
- the openings in the set of openings described herein at the distal end of the catheter can be in any arrangement, size shape, and/or number, to create preferable flow conditions through the catheter.
Abstract
An apparatus for performing phlebotomy through a peripheral intravenous line. The apparatus includes an introducer and a catheter configured to advance the catheter through a peripheral intravenous line. A y-adapter with a port of larger diameter is configured to receive the catheter and place in fluid communication with the peripheral intravenous line. When advanced the catheter is configured to transport a bodily fluid (i.e. blood) to a volume outside of the body.
Description
- This application is a continuation of U.S. patent application Ser. No. 16/120,582, entitled “Systems and Methods for Phlebotomy Through a Peripheral IV Catheter”, filed Sep. 4, 2018, which is a continuation of U.S. patent application Ser. No. 14/933,403, entitled “Systems and Methods for Phlebotomy Through a Peripheral IV Catheter”, filed Nov. 5, 2015 (now U.S. Pat. No. 10,064,576), which is a continuation of U.S. patent application Ser. No. 13/234,857, entitled “Systems and Methods for Phlebotomy Through a Peripheral IV Catheter”, filed Sep. 16, 2011 (now U.S. Pat. No. 9,186,100), which claims priority to U.S. Provisional Patent Application Ser. No. 61/479,223 entitled “Systems and Methods for Phlebotomy Through a Peripheral IV Catheter”, filed on Apr. 26, 2011, the disclosures of each of which are incorporated herein by reference in their entireties.
- The embodiments described herein relate generally to medical devices. More particularly, the embodiments described herein relate to systems and methods for phlebotomy through an intravenous catheter.
- The typical hospitalized patient encounters a needle every time a doctor orders a lab test. The standard procedure for blood extraction involves using a metal needle (“butterfly needle”) to “stick” patients' veins in their arms or hands. Blood drawing is a manual, labor-intensive process, with the average patient requiring hours of direct skilled labor during a typical hospital stay. This needle stick is not only painful and a major source of patient dissatisfaction, but the nurses or specialized blood drawing personnel (phlebotomists) often have difficulty finding the vein in approximately 10-15% of patients, resulting in multiple, painful “stick” attempts. This results in significantly higher material and labor costs (needles and tubing must be disposed of after every attempt) and increased patient pain and bruising.
- The current process for drawing blood is inefficient, taking on average 7-10 minutes, and more than 21 minutes for 10% of patients. These 10% of patients are referred to as Difficult Intra-Venous Access or more commonly as “tough stick” patients. If superficial veins are not readily apparent, blood can be forced into the vein by massaging the arm from wrist to elbow, tapping the site with the index and middle finger, applying a warm, damp washcloth to the site for 5 minutes, or by lowering the extremity over the bedside to allow the veins to fill. Each of these methods is time consuming and therefore costly.
- Peripheral IV catheters (PIVs) are inserted into most patients while they are hospitalized and used for infusing fluids and medications. However, they are not designed for blood extractions. The failure rates for aspiration reach 20-50% when PIVs have been left inserted for more than a day. Blood extracted from PIVs is often hemolyzed, defined as the rupture of red blood cells and the release of their contents into surrounding fluid, resulting in a discarded sample and need to repeat the blood collection.
- There are several mechanical barriers that can contribute to the shortcomings of extracting blood from a PIV. First, most catheters are formed from a soft bio-reactive polymer, the use of this material has led to a potential narrowing or collapse of the catheter as the negative pressure is applied for aspiration. Additionally, with longer indwelling times comes an increase in debris (e.g., fibrin/platelet clots) that build up on the tip of the catheter and within the lumen. This explains the relationship between failure rate and indwelling time. A third significant barrier is attributed to a “suction cup” effect, wherein the negative pressure created by aspiration through the catheter and the possible curved path of a vein result in the tip of the catheter adhering to the wall of the vein. As the negative pressure increases the vein can rupture resulting in “blowing the vein”, a major concern for phlebotomists during aspiration through a PIV.
- Thus, a need exists for an improved system and method for phlebotomy.
- Systems and methods for phlebotomy are described herein. In some embodiments, an apparatus includes an introducer, and a catheter. The catheter includes a proximal end and a distal end defining a lumen. The introducer includes a proximal end and a distal end defining a lumen and is configured to receive the catheter. An actuator, operatively coupled to the catheter, is configured to move the catheter between a first configuration, in which the catheter is substantially within the introducer, and a second configuration, in which the catheter is substantially outside the introducer. A locking mechanism, coupled to the distal end of the introducer, is configured to couple the introducer to a peripheral intravenous line. The catheter extends past an end of the peripheral intravenous line when in the second configuration.
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FIG. 1 is a schematic illustration of an apparatus according to an embodiment in a first configuration. -
FIG. 2 is a schematic illustration of an apparatus according to an embodiment in a second configuration. -
FIG. 3 is a detailed schematic illustration of an apparatus according to an embodiment in a second configuration. -
FIG. 4 is a schematic illustration of an apparatus according to an embodiment in a second configuration. -
FIG. 5 is a side view of an apparatus according to an embodiment in a first configuration. -
FIG. 6 is a cross-sectional view of a portion of an apparatus according to an embodiment. -
FIG. 7 is a side view of an apparatus according to an embodiment in a first configuration. -
FIG. 8 is a side view of an apparatus according to an embodiment in a second configuration. -
FIGS. 9A and 9B are side views of an apparatus according to embodiments. -
FIGS. 10A-10C are side views of an apparatus according to embodiments. -
FIGS. 11A-11C are side views of an apparatus according to embodiments. - Systems and methods for phlebotomy are described herein. In some embodiments, an apparatus includes an introducer, and a catheter. The catheter includes a proximal end and a distal end defining a lumen. The introducer includes a proximal end and a distal end defining a lumen and is configured to receive the catheter. An actuator, operatively coupled to the catheter, is configured to move the catheter between a first configuration, in which the catheter is substantially within the introducer, and a second configuration, in which the catheter is substantially outside the introducer. A locking mechanism, coupled to the distal end of the introducer, is configured to couple the introducer to a peripheral intravenous line. The catheter extends past an end of the peripheral intravenous line when in the second configuration.
- In some embodiments, a method includes coupling an introducer sheath to a peripheral intravenous line (e.g., saline locked device, heparin locked device, or the like), the introducer sheath having a proximal end and a distal end. The method further includes advancing a catheter from a first position inside the introducer sheath and outside the peripheral intravenous line to a second position substantially outside the introducer sheath and inside the peripheral intravenous line. In some embodiments, the catheter has a length greater than a length of the peripheral intravenous line, while in other embodiments, the catheter, in the second position, is shorter than the peripheral intravenous line. A container is then coupled to the proximal end of the introducer sheath, the container being fluidically coupled to the catheter. The catheter is later withdrawn from the second position to the first position.
- In some embodiments, a catheter has a proximal end and a distal end and defines a lumen therethrough. An introducer has a proximal end and a distal end and defines a lumen therethrough. The introducer is configured to receive the catheter therein. An adapter is coupled to the introducer. The adapter has a distal end configured to be coupled to a peripheral intravenous line. The adapter defines a first lumen and a second lumen. The first lumen has a first diameter and is configured to receive the catheter therethrough. The second lumen is orthogonal to the first lumen. An actuator is operatively coupled to the catheter and is configured to move the catheter between a first configuration and a second configuration. The catheter extends past the distal end of the adapter in the second configuration.
- As used in this specification, the words “proximal” and “distal” refer to the direction closer to and away from, respectively, a user who would place the device into contact with a patient. Thus, for example, the end of a device first touching the body of the patient would be the distal end, while the opposite end of the device (e.g., the end of the device being manipulated by the user) would be the proximal end of the device.
- As used herein, the term “stiffness” relates to an object's resistance to deflection, deformation, and/or displacement by an applied force. Stiffness can be characterized in terms of the amount of force applied to the object and the resulting distance through which a first portion of the object deflects, deforms, and/or displaces with respect to a second portion of the object. When characterizing the stiffness of an object, the deflected distance may be measured as the deflection of a portion of the object different from the portion of the object to which the force is directly applied. Said another way, in some objects, the point of deflection is distinct from the point where force is applied.
- Stiffness is an extensive property of the object being described, and thus is dependent upon the material from which the object is formed as well as certain physical characteristics of the object (e.g., shape and boundary conditions). For example, the stiffness of an object can be increased or decreased by selectively including in the object a material having a desired modulus of elasticity, flexural modulus, and/or hardness. The modulus of elasticity is an intensive property of (i.e., is intrinsic to) the constituent material and describes an object's tendency to elastically (i.e., non-permanently) deform in response to an applied force. A material having a high modulus of elasticity will not deflect as much as a material having a low modulus of elasticity in the presence of an equally applied stress. Thus, the stiffness of the object can be increased, for example, by introducing into the object and/or constructing the object of a material having a high modulus of elasticity.
- Similarly, a material's hardness is an intensive property of the constituent material and describes the measure of how resistant the material is to various kinds of permanent shape change when a force is applied. In discussing the hardness and the subsequent effect on the stiffness of a catheter, the Shore durometer scale is generally used. There are several scales for durometers with two commonly used in describing plastics, polymers, elastomers, and/or rubbers, namely, type A and type D, where type A is generally used for softer materials and type D is generally used for harder materials. The Shore durometer of a material is denoted by a number between 0 and 100, with higher numbers indicating a harder material, followed by the type of scale. For instance, a first material can be measured as having a Shore durometer of 40 Shore A and a second material can be measured as having a Shore durometer of 60 Shore D. Therefore, according to the Shore durometer scale, the second material is harder and thus, more stiff than the first material.
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FIG. 1 is a schematic illustration of anapparatus 1000 for phlebotomy through a peripheral intravenous line or catheter in a first configuration according to an embodiment. Theapparatus 1000 includes anintroducer 1100 and acatheter 1200. Thecatheter 1200 is movably coupled (e.g., slidably coupled, rotatably coupled, etc.) to theintroducer 1100. Theintroducer 1100 includes asheath 1110 defining alumen 1113 between aproximal end 1120 and adistal end 1130 and configured to house, at least partially, thecatheter 1200. Theproximal end 1120 includes an opening orport 1121, such that thecatheter 1200 moves from the first, retracted configuration (FIG. 1 ) to a second, extended configuration, (FIG. 2 ). Similarly stated, theport 1121 at theproximal end 1120 of theintroducer 1100 is configured such that thecatheter 1200 may move through theport 1121 from the first configuration to the second configuration. Moreover, theport 1121 can be any suitable port such as an opening in the proximal end of theintroducer 1100 and can include an o-ring, a gasket, or can be a self-sealing port and can be lubricated using any suitable lubrication to aid in the movement and/or sealing of thecatheter 1200 therein. Thedistal end 1130 of theintroducer 1100 includes alocking mechanism 1131 configured to fluidically couple a peripheralintravenous line 1300 to theintroducer 1100 and place thecatheter 2200 into fluid communication with the peripheralintravenous line 1300. Thelocking mechanism 1131 can be any suitable locking mechanism that creates a fluid-tight seal. In some embodiments, the locking mechanism can be a Luer lock or similar configuration. In some embodiments, the peripheralintravenous line 1300 is in a sealed configuration until thelocking mechanism 1131 is coupled to theintravenous line 1300. Once thelocking mechanism 1131 is coupled to theintravenous line 1300, the seal can be opened to allow access for thecatheter 1200. -
FIG. 2 is a schematic illustration of anapparatus 1000 according to an embodiment in a second configuration. Theapparatus 1000 includes anintroducer 1100 and acatheter 1200. Thecatheter 1200 defines a lumen 1201 between aproximal end 1220 and adistal end 1230 and may be any suitable diameter and stiffness. In particular, thecatheter 1200 is between a 16-gauge and 26-gauge and having a Shore durometer of 20 Shore A to 50 Shore D. Said another way, thecatheter 1200 can be any suitable diameter to be inserted through the peripheralintravenous line 1300 and can be sufficiently stiff to be advanced through the peripheralintravenous line 1300. Anactuator 1112 is operatively coupled to thecatheter 1200 through a groove orslot 1111 in theintroducer 1100. Theactuator 1112 is configured to move thedistal end 1230 of thecatheter 1200 from the first configuration, shown inFIG. 1 , to the second configuration substantially outside theintroducer 1100, as shown inFIG. 2 . In the second configuration, the length of thedistal end 1230 of thecatheter 1200 is greater than the length of the peripheralintravenous line 1300 and thecatheter 1200 extends past the distal end of theintravenous line 1300. - In some embodiments, the
catheter 1200 can be moved to a third configuration in which it is retracted back into theintroducer 1100. The third configuration is substantially similar to the first configuration (FIG. 1 ) in that thecatheter 1200 is positioned in the introducer such that the user does not come into contact with bodily fluids. While in the first configuration and the third configuration, theapparatus 1000 can be disconnected from or connected to a peripheralintravenous line 1300. Said another way, theapparatus 1000 can be in the first configuration before it is coupled to the peripheralintravenous line 1300, then remain in the first configuration for a period of time after being coupled to the peripheralintravenous line 1300. Similarly, theapparatus 1000 can be moved to the third configuration, can be disconnected from the peripheralintravenous line 1300, and then remain in the third configuration. -
FIG. 3 is a detailed schematic illustration of anapparatus 2000 according to an embodiment in a second configuration. Theapparatus 2000 includes anintroducer 2100 and acatheter 2200. Thecatheter 2200 includes adistal end 2230 and aproximal end 2220. Thedistal end 2230 of thecatheter 2200 includes a set ofopenings 2231 such that when in the second configuration (i.e., when thedistal end 2230 of thecatheter 2200 is in the vein and outside the intravenous line) theopenings 2231 act to transport a bodily fluid (i.e., blood) to a volume outside thecatheter 2200. The set of openings can be of any arrangement on the circumference of thecatheter 2200 and can include the end of thecatheter 2200. Similarly stated, thecatheter 2200 having thedistal end 2230 can be substantially open at the tip surface. Eachopening 2231 can be of any suitable shape or size and are not necessarily similar to any other opening included in the set of openings. In some embodiments, thecatheter 2200 defines a single opening. - The
proximal end 2220 of thecatheter 2200 is fluidically coupled to alocking mechanism 2221, as shown inFIG. 3 . Thelocking mechanism 2221 can be any suitable locking mechanism such as a Luer lock or the like. Aneedle 2222 is fluidically coupled to the locking mechanism and at least partially disposed within asheath 2223. Thesheath 2223 can be any material with a suitable flexibility and/or compressibility such that theneedle 2222 can extend through thesheath 2223 when engaged with a conventional phlebotomy fluid container (e.g., a Vacutainer®). Thelocking mechanism 2221 is configured to couple to a suitable fluid containment system such as a Vacutainer® holder (not shown inFIG. 3 ) and place theneedle 2222 in fluid communication with the fluid containment system. Thesheath 2223 is configured to compress when thelocking mechanism 2221 is coupled to the fluid containment system. This arrangement facilitates the passage of bodily fluids through the set ofopenings 2231 of thecatheter 2200, as shown inFIG. 3 by arrow AA, through thecatheter 2200, and exiting thecatheter 2200 through theneedle 2222, as shown inFIG. 3 by arrow BB. -
FIG. 4 is a schematic illustration of anapparatus 3000 for phlebotomy through a peripheral intravenous catheter in a second configuration according to an embodiment. Theapparatus 3000 includes anintroducer 3100 and acatheter 3200. Theintroducer 3100 includes asheath 3110 defining alumen 3113 between aproximal end 3120 and adistal end 3130 and configured to house, at least partially, thecatheter 3200. Thedistal end 3130 of theintroducer 3100 includes a locking mechanism 3131 configured to fluidically couple theintroducer 3100 to a peripheralintravenous line 3300 and place thecatheter 3200 into fluid communication with the peripheralintravenous line 3300. The locking mechanism 3131 can be any suitable locking mechanism that creates a fluid-tight seal. In some embodiments, the locking mechanism can be a Luer lock or similar configuration. Thesheath 3110, having a given stiffness, is such that when applying a force to theproximal end 3120, thesheath 3110 compresses along an axis AAA, advancing thecatheter 3200 to the second configuration. Said another way, as thesheath 3110 of theintroducer 3100 is compressed, thecatheter 3200 moves from the first configuration (FIG. 1 ) to a second configuration substantially outside theintroducer 3100, as shown inFIG. 4 . Furthermore, the stiffness of thesheath 3110 is an extensive property and as such can have a set of properties (i.e. material, thickness, shape and/or the like) to allow thesheath 3110 to compress along the axis AAA with the desired amount of force applied at theproximal end 3120 of theintroducer 3100. The set of properties allow thesheath 3110 to elastically deform (i.e. non-permanently) such that when the force is no longer applied to theproximal end 3120 of theintroducer 3100, theapparatus 3000 returns to the first configuration. In the second configuration, thedistal end 3230 of thecatheter 3200 extends past the distal end of the peripheralintravenous line 3300. This arrangement allows for the transport of a bodily fluid to a volume outside thecatheter 3200 and when complete, theapparatus 3000 returns to a third configuration, which is substantially the same as the first configuration. -
FIG. 5 is a side view of anapparatus 4000 according to an embodiment in a first configuration. Theapparatus 4000 includes anintroducer 4100 and acatheter 4200. Theintroducer 4100 includes asheath 4110 defining alumen 4113 between aproximal end 4120 and adistal end 4130 and configured to house, at least partially, thecatheter 4200. Although shown inFIG. 5 as being cylindrical, theintroducer 4100 can be any suitable shape. Moreover, thelumen 4113, defined by the interior walls of thesheath 4110 is not necessarily the same shape as the exterior walls of thesheath 4110. Said a different way, the interior and exterior walls of thesheath 4110 can have a different cross sectional shape. Theproximal end 4120 of theintroducer 4100 is coupled to alocking mechanism 4122. Thelocking mechanism 4122 can be any suitable locking mechanism such as a Luer lock or the like. Thelocking mechanism 4122 is configured to couple to a suitable fluid containment system such as a Vacutainer® holder (not shown inFIG. 5 ) and place thecatheter 4200 in fluid communication with the fluid containment system. - The
distal end 4130 of theintroducer 4100 includes alocking mechanism 4131 configured to fluidically couple a peripheral intravenous line (not shown inFIG. 5 ) to theintroducer 4100 and place thecatheter 4200 into fluid communication with the peripheral intravenous line. Thelocking mechanism 4131 can be any suitable locking mechanism that creates a fluid-tight seal. In some embodiments, thelocking mechanism 4131 is in a sealed configuration until thelocking mechanism 4131 is coupled to the intravenous line. Once thelocking mechanism 4131 is coupled to the intravenous line, the seal can be opened to allow access for thecatheter 4200. In addition, while in the unlocked configuration, thelocking mechanism 4131 of thedistal end 4130 and thelocking mechanism 4122 of theproximal end 4120 create an isolated housing for thecatheter 4200 therein. Stated similarly, prior to the proximalend locking mechanism 4122 and distalend locking mechanism 4131 being unlocked and before thecatheter 4200 is in the second configuration, thecatheter 4200 is sterile. Furthermore, thecatheter 4200, when in the second configuration and having contacted the desired bodily fluid, can be moved to the third configuration (i.e., returned to the first configuration) thereby isolating the useddistal end 4230. - The
sheath 4110 has a given stiffness such that when a force is applied to theproximal end 4120 thesheath 4110 compresses along an axis BBB advancing thecatheter 4200 to a second configuration (FIG. 6 ). Said another way, as thesheath 4110 of theintroducer 4100 is compressed, thecatheter 4200 moves from the first configuration to the second configuration substantially outside the introducer 4100 (i.e., thesheath 4110 retracts). The properties of thesheath 4110 can be any set of properties discussed herein such that applying a desired amount of force toproximal end 4120 allows the sheath to compress along axis BBB. In the second configuration, thedistal end 4230 of thecatheter 4200 extends past the distal end of the peripheral intravenous line and allows for the transport of a bodily fluid to a volume outside of thecatheter 4200. - The
catheter 4200 includes adistal end 4230 and taperedportion 4203. The tapered portion is such that the diameter of thecatheter 4200 is reduced at a given location, as shown inFIG. 5 . The taper angle θ can be any suitable angle such that thecatheter 4200 is allowed to advance fully to the second configuration (FIG. 6 ). Moreover, the taper angle θ is such that a laminar flow (i.e., smooth layered flow) is achieved. In some embodiments, thecatheter 4200 can include astiffening wire 4202, as shown in the magnified portion ofFIG. 6 , and can be configured to coil around the walls of thecatheter 4200 providing thecatheter 4200 with a desired stiffness. Moreover, thestiffening wire 4202, being coiled around thecatheter 4200, can provide the flexibility to advance through a set of walls defining a lumen (i.e., veins, arteries, peripheral intravenous line, and/or the like) without kinking or binding. In addition, thestiffening wire 4202 can provide thecatheter 4200 with enough stiffness to facilitate its advancement through the lumen. - The
distal end 4230 of thecatheter 4200 includes a set ofopenings 4231 such that when in the second configuration (i.e., when thedistal end 4230 of thecatheter 4200 is in the vein and outside the intravenous line) theopenings 4231 act to transport a bodily fluid (i.e., blood) to a volume outside thecatheter 4200. The set ofopenings 4231 can be of any arrangement on the circumference of thecatheter 4200 and can include the end of thecatheter 4200. Similarly stated, thecatheter 4200 having thedistal end 4230 can be substantially open at the tip surface. AlthoughFIG. 6 shows thedistal end 4230 of thecatheter 4200 as substantially flat, thedistal end 4230 may be any suitable shape, (e.g. conical or spherical) and can have any suitable degree of rounded edges. Eachopening 4231 can be of any suitable shape or size and are not necessarily similar to anyother opening 4231 included in the set ofopenings 4231. The arrangement of the set ofopenings 4231 is configured to introduce a laminar flow throughcatheter 4200 to a volume substantially outside thecatheter 4200 and thus avoid hemolysis. - In some embodiments, a blood collection system consists of two elements: (1) the introducer/catheter blood collection assembly described above; and (2) a y-adapter that is configured to attach to a standard 16 g or 22 g peripheral IV catheter. The y-adapter includes a dedicated port for the blood collection device and another standard port for conventional medicine and fluid infusion.
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FIG. 7 is a cross-sectional view of y-adapter 5400 and anapparatus 5000 in a first configuration according to an embodiment. The apparatus includes anintroducer 5100 and acatheter 5200. Theintroducer 5100 includes asheath 5110 defining alumen 5113 between aproximal end 5120 and adistal end 5130 and configured to house, at least partially, thecatheter 5200. In some embodiments, the y-adapter 5400 is configured to be coupled between theintroducer 5100 and intravenous line (not shown inFIG. 7 .). The y-adapter includes adistal end 5410 and defines two distinct ports. Afirst port 5420 of the y-adapter 5400 defines afirst lumen 5422 with a first diameter D1. Thefirst port 5420 is configured such that thefirst port 5420 is substantially similar in size, shape, configuration, and functionality of a conventional y-adapter. Moreover, thefirst port 5420 is configured such that the backflow of a bodily fluid cannot exit thefirst port 5420. More specifically, thefirst lumen 5422 defined by the walls of thefirst port 5420 can be such that thelumen 5422 restricts the backflow of a bodily fluid (i.e. blood). In some embodiments, the backflow can be prevented using a valve, screw cap, flip cap, port, and/or the like. Asecond port 5430 of the y-adapter 5400 defines asecond lumen 5432 with a second diameter D2. The second diameter D2 can be larger than the first diameter D1, as shown inFIG. 7 , in some embodiments, the second diameter D2 can be similar or smaller than the first diameter D1. More particularly, the diameter D2 of thesecond port 5430 is large enough to accept up to, for example, an 18-gauge catheter. The y-adapter can be of any suitable material and/or be of similar material to that of a conventional y-adapter. - The
first lumen 5422 defined by thefirst port 5420 and thesecond lumen 5432 defined by thesecond port 5430 converge to acommon lumen 5401 before thedistal end 5410 of the y-adapter 5400, as shown inFIG. 7 . Thesecond port 5420 is configured such that thesecond lumen 5432 is substantially coaxial with thecommon lumen 5401 and has a diameter substantially the same as the diameter D2. In some embodiments, the walls that define thecommon lumen 5401 and the walls that define thesecond lumen 5432 are similar. Thesecond port 5430 is fluidically coupled to alocking mechanism 5431 configured to couple the y-adapter to theintroducer 5100. Thelocking mechanism 5431 can be a Luer lock or the like. In some embodiments, the y-adapter 5400 is in a sealed configuration until coupled to thelocking mechanism 5131 at thedistal end 5130 of theintroducer 5100. Once thelocking mechanism 5431 is coupled to theintroducer 5100, the seal can be opened to allow access for thecatheter 5200 to advance to a second configuration, shown inFIG. 8 (note the introducer is not shown coupled to the y-adapter inFIG. 8 ). - In some embodiments, the
distal end 5410 of the y-adapter 5400 is coupled to a peripheralintravenous line 5440 such as, for example, a conventional peripheral intravenous line. In some embodiments, the y-adapter 5400 is monolithically formed with the peripheralintravenous line 5440. In some embodiments, thedistal end 5410 of the y-adapter 5400 can be coupled to a peripheral intravenous line using any suitable locking mechanism. Similarly, thesecond port 5420 of thelocking mechanism 5431 configured to couple the y-adapter 5400 to theintroducer 5100 can monolithically formed with theintroducer 5100. Said another way, in some embodiments, a separate introducer is not required, but rather a portion of the y-adapter can serve as the introducer. - As shown in
FIG. 8 , thedistal end 5230 of thecatheter 5200 in the second configuration is advanced substantially past the peripheralintravenous line 5440. Thedistal end 5230 of thecatheter 5200 includes a set ofopenings 5231 such that when in the second configuration (i.e., when thedistal end 5230 of thecatheter 5200 is in the vein and outside the intravenous line) theopenings 5231 act to transport a bodily fluid (i.e., blood) to a volume outside thecatheter 5200. The set of openings can be of any arrangement on the circumference of thecatheter 5200 and can include the end of thecatheter 5200. Similarly stated, thecatheter 5200 having thedistal end 5230 can be substantially open at the tip surface. Eachopening 5231 can be of any suitable shape or size and are not necessarily similar to any other opening included in the set of openings. Thecatheter 5200, in the second configuration and having transported the desired bodily fluid, can be returned to the third configuration (i.e., the first configuration) (FIG. 7 ) thereby isolating the useddistal end 5230. - While catheters are described herein as including a distal end of a particular configuration (i.e., with circumferential openings, etc.), in some embodiments the distal end of the catheter can include a different structure configured to facilitate the drawing of blood through the catheter. For example,
FIG. 9A illustrates acatheter 6200 that includes adistal end 6230 with a bullet-shapedtip 6232. The bullet-shapedtip 6232 includes anend portion 6233 configured to be a substantially closed rounded tip and, as such, can be used to move through clots existing within a peripheral intravenous line. The bullet-shapedtip 6232 includes a set of side-wall openings 6231 that are operative to transport a bodily fluid (i.e., blood) to a volume outside thecatheter 6200. In some embodiments, such as, for example, acatheter 6200′ shown inFIG. 9B , a bullet-shapedtip 6232′ includes anend portion 6233′ that defines anend opening 6234′. In such embodiments, the bullet-shapedtip 6232′ includes a set of side-wall openings 6231′. Theend opening 6234′ and theside openings 6231′ can be configured to produce a laminar flow and act to transport a bodily fluid (i.e., blood) to a volume outside thecatheter 6200′. While theopenings - In some embodiments, for example those shown in
FIGS. 10A-10C , acatheter 7200 includes adistal end 7230 with awireframe tip 7241 having a stent-like configuration. Thewireframe tip 7241 can be a flexible mesh configured to extend away from thedistal end 7230 of thecatheter 7200. Thewireframe tip 7241 can act to transport a bodily flow (i.e., blood) to a volume outside thecatheter 7200. In some embodiments, thewireframe tip 7241 can include a cappedend 7242. The cappedend 7242 can be any suitable size, shape, or configuration and, in some embodiments, can include any suitable number of openings. - In some embodiments, the
wireframe tip 7241 can be connected to aguide wire 7243 and used without an additional catheter, as shown inFIGS. 11A-11C . Similarly stated, thewireframe tip 7241 can be inserted into an existing peripheral intravenous line via a guide wire and without the catheter ofFIG. 10 . In this manner, thewireframe tip 7241 can act as a stent and support the walls of the vein such that blood can be drawn through the existing peripheral intravenous line. In such a configuration, thewireframe tip 7241 can be positioned within the existing peripheral intravenous line at any suitable location. For example, the wireframe tip can be positioned adjacent the distal end of the intravenous line. - The components of the blood draw apparatus and the y-adapter can be packaged together or separately. The y-adapter can also be sold in a package with other IV dressing materials. In some embodiments, the y-adapter can remain on the IV as long as the IV is in the patient.
- The blood draw apparatus can be used with a variety of peripheral IVs. The apparatus allows efficient blood draw while still maintaining the integrity of the sample. In some embodiments, for example, the apparatus will facilitate 20 ml of blood to be drawn in approximately 1-2 minutes. While extracting blood, the blood flow can be laminar to avoid turbulence in the catheter to minimize hemolysis.
- While the blood draw apparatus can be used m a variety of settings (ER, inpatient, etc.), two examples of scenarios are described herein. In the first scenario, the patient has a single peripheral IV. In the second scenario, which is typically less common, the patient has a dedicated second peripheral IV just for phlebotomy purposes. Only one y-adapter is required per patient, and can be attached for the life of the IV, for example, which is typically 3-4 days. A new catheter can be used for each blood draw.
- The assembly of the blood draw apparatus can be the same in either scenario. First, the apparatus is coupled to the y-adapter. Second, the catheter is advanced through the y-adapter and pushed through the peripheral IV catheter into the patient's vein. Once in the vein, a syringe or a negative pressure collection container/tube (e.g., a Vacutainer® tube) is connected to the rear port and fluidically coupled to the catheter to draw and store blood.
- The following scenario is provided by way of example. The nurse or phlebotomist inserts a peripheral IV into a patient's arm. The peripheral IV is inserted following standard guidelines and the y-adapter is attached. When it is time to draw blood, the provider can turn off the IV, if it is on, for approximately 1-5 minutes to allow medicine or IV fluids to disperse from the blood-drawing site. To draw the blood sample, the provider attaches the blood draw apparatus to the blood draw port on the y-adapter, advances the internal catheter through the peripheral IV and into the vein. Next, the provider can attach the negative pressure collection container(s)/tube(s) to the apparatus (i.e., place the tube in fluid communication with the blood draw apparatus) to extract the blood sample. In use, a user can discard, for example, the first 3-6 ml of the fluid or blood sample as “waste” then using the next tube(s) as the intended sample. This “wasting” procedure ensures all of the dead space fluid, like saline or medications, are cleared from the vein, peripheral IV and y-adapter as to not contaminate the testing sample being drawn.
- In the scenario in which there is a dedicated peripheral IV line for blood draw purposes, the provider inserts a peripheral IV into one arm to administer medicine and another peripheral IV into the opposite arm specifically for blood drawing purposes. When it is time to draw blood, the provider simply follows the steps mentioned above and there is no need to wait the 2-3 minutes to allow fluid or medicine dispersal as in the first scenario.
- Each of the components discussed herein can be monolithically constructed or can be a combination of parts. For example, in reference to
FIG. 7 , the y-adapter 5400 and theintroducer 5100 are coupled usinglocking mechanisms adapter 5400 and theintroducer 5100 can be the same component, wherein the y-adapter is an integral part of theintroducer 5100 and vice-versa. Other aspects of the apparatus shown and described can be modified to affect the performance of the apparatus. For example, the openings in the set of openings described herein at the distal end of the catheter can be in any arrangement, size shape, and/or number, to create preferable flow conditions through the catheter. - While various embodiments have been described above, it should be understood that they have been presented by way of example only, and not limitation. Where methods and/or schematics described above indicate certain events and/or flow patterns occurring in certain order, the ordering of certain events and/or flow patterns may be modified. Additionally certain events may be performed concurrently in parallel processes when possible, as well as performed sequentially. While various embodiments have been described as having particular features and/or combinations of components, other embodiments are possible having a combination of any features and/or components from any of embodiments as discussed above.
Claims (20)
1. An apparatus, comprising:
an introducer coupleable to a peripheral intravenous line, the peripheral intravenous line being at least partially insertable into a vein of a patient; and
a catheter movable from a first position inside the introducer and outside the peripheral intravenous line to a second position at least partially outside the introducer and extending through the peripheral intravenous line, a proximal end of the catheter disposed in the introducer when the catheter is in the first position and the second position.
2. The apparatus of claim 1 , further comprising:
an actuator coupled to the proximal end portion of the catheter and movable along a fixed length of the introducer to move the catheter between the first position and the second position.
3. The apparatus of claim 2 , wherein the introducer defines a slot, the actuator being movable within the slot along the fixed length of the introducer.
4. The apparatus of claim 1 , wherein the introducer is configured to transition between a first configuration and a second configuration to move the catheter between the first position and the second position.
5. The apparatus of claim 4 , wherein the introducer has a first length when in the first configuration and a second length less than the first length when in the second configuration.
6. The apparatus of claim 4 , wherein at least a portion of the introducer is collapsible from the first configuration to the second configuration.
7. The apparatus of claim 1 , further comprising:
an adapter coupleable between a lock at a distal end portion of the introducer and at least one of a first port or a second port of the peripheral intravenous line.
8. The apparatus of claim 7 , wherein the lock of the introducer is coupleable to one of a first port and a second port of the adapter, the catheter in the second position extendable through the adapter and the peripheral intravenous line such that a distal end of the catheter is distal to the peripheral intravenous line when the adapter is coupled between the lock of the introducer and the peripheral intravenous line.
9. An apparatus, comprising:
an introducer coupleable to a peripheral intravenous line, the peripheral intravenous line being at least partially insertable into a vein of a patient; and
a catheter movable between a first position inside the introducer and proximal to the peripheral intravenous line and a second position at least partially outside the introducer such that a distal end of the catheter is distal to the peripheral intravenous line, a proximal end of the catheter disposed in the introducer and proximal to the peripheral intravenous line when the catheter is in the second position.
10. The apparatus of claim 9 , further comprising:
an actuator coupled to the proximal end portion of the catheter and movable along a fixed length of the introducer to move the catheter between the first position and the second position.
11. The apparatus of claim 10 , wherein the introducer defines a slot, the actuator being movable within the slot along the fixed length of the introducer.
12. The apparatus of claim 9 , wherein a distal end portion of the introducer includes a lock that is coupleable to one of a first port and a second port of the peripheral intravenous line.
13. The apparatus of claim 9 , further comprising:
an adapter coupleable between a lock at a distal end portion of the introducer and at least one of a first port or a second port of the peripheral intravenous line.
14. The apparatus of claim 13 , wherein the catheter in the second position is extendable through the adapter and the peripheral intravenous line when the adapter is coupled between the lock of the introducer and the peripheral intravenous line such that (i) a distal end of the catheter is distal to the peripheral intravenous line and (ii) a proximal end of catheter is disposed in the introducer and proximal to the adapter.
15. An apparatus, comprising:
an introducer coupleable to an adapter connected to a port of a peripheral intravenous line that is at least partially insertable into a vein of a patient; and
a catheter movable between a first position inside the introducer and proximal to the adapter and a second position partially outside the introducer, a portion of the catheter in the second position extendable through the adapter and the peripheral intravenous line to place a distal end of the catheter distal to the peripheral intravenous line, a proximal end of the catheter in the second position disposed in the introducer and proximal to the adapter.
16. The apparatus of claim 15 , further comprising:
an actuator coupled to the proximal end portion of the catheter and movable along a fixed length of the introducer to move the catheter between the first position and the second position.
17. The apparatus of claim 16 , wherein the introducer defines a slot, the actuator being movable within the slot along the fixed length of the introducer.
18. The apparatus of claim 15 , wherein the introducer is configured to transition between a first configuration and a second configuration to move the catheter between the first position and the second position.
19. The apparatus of claim 18 , wherein the introducer has a first length when in the first configuration and a second length less than the first length when in the second configuration.
20. The apparatus of claim 15 , wherein the port of the peripheral intravenous line is a first port, the peripheral intravenous line including a second port, the adapter being connectable to one of the first port and the second port.
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