WO2005110007A2 - Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes - Google Patents

Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes Download PDF

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Publication number
WO2005110007A2
WO2005110007A2 PCT/US2004/011190 US2004011190W WO2005110007A2 WO 2005110007 A2 WO2005110007 A2 WO 2005110007A2 US 2004011190 W US2004011190 W US 2004011190W WO 2005110007 A2 WO2005110007 A2 WO 2005110007A2
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WO
WIPO (PCT)
Prior art keywords
fluid
pressure
injection
state
valve
Prior art date
Application number
PCT/US2004/011190
Other languages
English (en)
Other versions
WO2005110007A3 (fr
Inventor
Frederick W. Trombley, Iii
Robert M. Schmidt
David M. Reilly
Alan D. Hirschman
David M. Griffiths
Gerald W. Callan
Luis A. Pedraza
Jennie Kwo
Christopher T. Zirps
Roderick H. Beaulieu
Original Assignee
Medrad, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medrad, Inc. filed Critical Medrad, Inc.
Priority to PCT/US2004/011190 priority Critical patent/WO2005110007A2/fr
Priority to EP04821981A priority patent/EP1753481A4/fr
Priority to JP2007508308A priority patent/JP2007532234A/ja
Publication of WO2005110007A2 publication Critical patent/WO2005110007A2/fr
Publication of WO2005110007A3 publication Critical patent/WO2005110007A3/fr

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Classifications

    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/007—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests for contrast media
    • 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
    • A61M39/22—Valves or arrangement of valves
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/142—Pressure infusion, e.g. using pumps
    • A61M5/145—Pressure infusion, e.g. using pumps using pressurised reservoirs, e.g. pressurised by means of pistons
    • A61M5/1452—Pressure infusion, e.g. using pumps using pressurised reservoirs, e.g. pressurised by means of pistons pressurised by means of pistons
    • A61M5/14546—Front-loading type injectors
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/16877—Adjusting flow; Devices for setting a flow rate
    • A61M5/16881—Regulating valves
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/36—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests with means for eliminating or preventing injection or infusion of air into body
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M2005/1401—Functional features
    • A61M2005/1403—Flushing or purging
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/58—Means for facilitating use, e.g. by people with impaired vision
    • A61M2205/582—Means for facilitating use, e.g. by people with impaired vision by tactile feedback
    • 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
    • A61M39/22—Valves or arrangement of valves
    • A61M39/223—Multiway valves
    • 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
    • A61M39/22—Valves or arrangement of valves
    • A61M39/24—Check- or non-return valves
    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/16804—Flow controllers
    • A61M5/16827—Flow controllers controlling delivery of multiple fluids, e.g. sequencing, mixing or via separate flow-paths

Definitions

  • the present invention relates to fluid delivery systems, pressure isolation mechanisms, injector control mechanisms and methods for use thereof in medical injection or fluid delivery procedures.
  • a physician or other person injects a patient with a fluid.
  • a number of injector-actuated syringes and powered injectors for pressurized injection of fluids such as contrast media have been developed for use in procedures such as angiography, computed tomography, ultrasound and NMR MRI.
  • these powered injectors are designed to deliver a preset amount of contrast media at a preset flow rate.
  • Angiography is used generally in the detection and treatment of abnormalities or restrictions in blood vessels.
  • a radiographic image of vascular structure In an angiographic procedure, one obtains a radiographic image of vascular structure with the assistance of a radiographic contrast medium (sometimes referred to simply as contrast) injected through a catheter.
  • a radiographic contrast medium sometimes referred to simply as contrast
  • the vascular structures in fluid connection with the vein or artery in which the contrast is injected are filled with contrast.
  • X-rays passing through the region of interest are absorbed by the contrast, causing a radiographic outline or image of blood vessels containing the contrast.
  • the resulting images can be displayed on, for example, a monitor and recorded.
  • a physician places a cardiac catheter into a vein or artery.
  • the catheter is connected to either a manual or to an automatic contrast injection mechanism.
  • a typical manual contrast injection mechanism includes a syringe in fluid connection with a catheter connection.
  • the fluid path also includes, for example, a source of contrast fluid, a source of saline, and a pressure transducer P to measure patient blood pressure.
  • the source of contrast is connected to the fluid path via a valve V 1 (for example, a three-way stopcock).
  • the source of saline and pressure transducer P can also be connected to the fluid path via valves V 2 and V 3 , respectively.
  • valve V 3 The operator of the manual system of Figure 1, manually controls the syringe and each of valves V 1 and V 2 to draw saline or contrast into the syringe and to inject the saline or contrast into the patient through the catheter connection.
  • the pressure transducers used in such procedures are extremely sensitive to even moderately high pressures generated during activation of the syringe, so the operator must close valve V 3 to isolate pressure transducer P from the fluid path when the syringe is activated to prevent damage to pressure transducer P. While the syringe is not activated, valve V 3 is usually open to monitor patient blood pressure.
  • the operator of the syringe of Figure 1 can adjust the flow rate and volume of injection by altering the force applied to the plunger of the syringe.
  • Manual sources of fluid pressure and flow used in medical applications such as syringes and manifolds thus typically require operator effort that provides feedback of the fluid pressure/flow generated to the operator. The feedback can be desirable, but the operator effort often leads to fatigue. Thus, fluid pressure and flow may vary depending on the operator's strength and technique.
  • Automatic contrast injection mechanisms typically include a syringe connected to a powered injector having, for example, a powered linear actuator. Typically, an operator enters settings into an electronic control system of the powered injector for a fixed volume of contrast material and a fixed rate of injection.
  • U.S. Patent Nos. 5,460,609, 5,573,515 and 5,800,397 discloses an angiographic injector system having both high pressure and low pressure systems.
  • the high pressure system includes a motor-driven injector pump to deliver radiographic contrast material under high pressure to a catheter.
  • the low pressure system includes, among other things, a pressure transducer to measure blood pressure and a pump to deliver a saline solution to the patient as well as to aspirate waste fluid.
  • a manifold is connected to the syringe pump, the low pressure system, and the patient catheter.
  • a flow valve associated with the manifold is normally maintained in a first state connecting the low pressure system to the catheter through the manifold (and disconnecting the high pressure system from the catheter and the low pressure system).
  • pressure from the syringe pump reaches a predetermined and set level, the valve switches to a second state connecting the high pressure system/syringe pump to the catheter, while disconnecting the low pressure system from the catheter (and from the high pressure system).
  • the injector system of U.S. Patent No. 5,800,397 also includes a handheld remote control connected to a console.
  • the control includes saline push button switches and a flow rate control lever or trigger.
  • U.S. Patent No. 5,916,165 discloses a handheld pneumatic controller for producing a variable control signal to control a rate of fluid dispersement to the patient in an angiographic system.
  • U.S. Patent No. 5,515,851 discloses an angiographic system with a finger activated control pad to regulate the injection of fluids. Unlike manual injection systems, however, there is little if any feedback to the operator of system pressure in the above systems. There are potential advantages to such feedback.
  • U.S. Patent No. 5,840,026 discloses, among other things, an injection system in which an electronic control system is connected to the contrast delivery system and a tactile feedback control unit.
  • the tactile feedback control unit includes a disposable syringe that is located within a durable/reusable cradle and is in fluid connection with the fluid being delivered to the patient.
  • the cradle is electrically connected to the electronic control system and is physically connected to a sliding potentiometer that is driven by the plunger of a disposable syringe.
  • the operator holds the cradle and syringe and, as the operator depresses the sliding potentiometer/syringe piston assembly, the plunger is moved forward, displacing fluid toward the patient and creating a pressure in the syringe.
  • a sliding potentiometer tracks the position of the syringe plunger.
  • the electronic control system controls the contrast delivery system to inject an amount of fluid into the patient based on the change in position of the plunger. As the fluid is injected, the pressure the doctor feels in his hand is proportional to the actual pressure produced by the contrast delivery system.
  • the force required to move the piston provides the operator with tactile feedback on the pressure in the system. The doctor is able to use this feedback to ensure the safety of the injection procedure.
  • the injection system of U.S. Patent No. 5,840,026 does not require the doctor to develop the system pressure and flow rate.
  • the doctor develops a smaller, manually applied pressure, which corresponds to or is proportional to the system pressure.
  • the required manual power output (that is, pressure x flow rate) is decreased as compared to manual systems, whereas the tactile feedback associated therewith is retained.
  • the present invention provides an injector system including a powered injector, a pressurizing chamber in operative connection with the powered injector, a fluid path in fluid connection with the pressurizing chamber; and a manual control in fluid connection with the fluid path.
  • the manual control includes at least one actuator for controlling the injector through application of force by an operator.
  • the actuator provides tactile feedback of pressure in the fluid path to the operator via direct or indirect operative or fluid connection with the fluid path (that is, pressure in the fluid path transfers a corresponding or a proportional force to the operator).
  • the actuator is adapted to stop an injection procedure if no force is applied to the actuator.
  • the manual control can, for example, include a chamber in fluid connection with the fluid path.
  • the actuator can be a button or a plunger in operative connection with a piston disposed within the chamber.
  • the actuator can be biased in an off position.
  • the manual control includes a first actuator for controlling the injector in a low-pressure mode through application of force by an operator.
  • the first actuator provides tactile feedback of pressure in the fluid path to the operator via fluid connection with the fluid path as described above.
  • the first actuator also provides control of flow rate by changing the force thereon.
  • the manual control also can include a second actuator having an on state and an off state. The second actuator causes the injector to enter into a preprogrammed high-pressure injection mode when placed in the on state.
  • the manual control can also include a third actuator for controlling flow of saline in the fluid path.
  • the actuator provides tactile feedback of fluid pressure and is also in operative connection with an audible feedback unit that provides audible feedback of fluid pressure and/or fluid flow to the operator.
  • the manual controls of the present invention can be purged of air before injection via, for example, a purge valve.
  • the present invention also provides a system for injection of fluid into a patient including a multi-patient reusable section and a per-patient disposable section.
  • the multi-patient reusable section and the per-patient disposable section are removably connectable via a connector or connectors (for example, via a high- pressure connector).
  • the multi-patient reusable section includes a powered injector in fluid connection with a source of a first injection fluid and a first fluid path connecting the injector and a high-pressure connector.
  • the per-patient disposable section includes a second fluid path adapted to connect the high-pressure connector and the patient in fluid connection.
  • the per-patient disposable section further includes a manual control as described above including a connector to place the manual control in fluid connection with the second fluid path.
  • the multi-patient reusable section can further include a valve mechanism connecting the injector, first fluid source and the first fluid path.
  • the multi-patient reusable section further includes a source of a second injection fluid and a pumping mechanism in fluid connection with the second fluid source for pressurizing the second fluid.
  • the pumping mechanism is preferably in fluid connection with the valve mechanism.
  • the manual control includes a first actuator providing control of flow rate of the first fluid by changing the force on the first actuator and a second actuator, the second actuator causing the injector to enter into a preprogrammed high pressure injection mode when placed in an on state.
  • the system can further include a pressure sensor in fluid communication with the second fluid path via a pressure- activated isolator that isolates the pressure sensor from pressures in the second fluid path above a set pressure.
  • the per-patient disposable section can include a check valve in the second fluid path separating components of the per- patient disposable section from the multi-patient reusable section to reduce or eliminate flow of contaminated fluid into the multi-patient reusable section.
  • the present invention further provides a method of injecting a fluid into a patient including the steps of: removably connecting a multi-patient reusable section to a per-patient disposable section via a high-pressure connector, the multi-patient reusable section including a powered injector in fluid connection with a source of a first injection fluid and a first fluid path connecting the injector and the high-pressure connector, the per-patient disposable section including a second fluid path adapted to connect the high-pressure connector and the patient in fluid connection; connecting a manual control including a connector to the second fluid path to place the manual control in fluid connection with the second fluid path, the manual control including at least one actuator for controlling the powered injector through application of force by an operator, the actuator being adapted to provide tactile feedback of pressure in the second fluid path to the operator via fluid connection with the second fluid path; and injecting a fluid into a patient.
  • the method can further include the step of connecting a pressure sensor in fluid communication with the second fluid path via a pressure activated isolator that isolates the pressure sensor from pressures in the second fluid path above a set pressure.
  • a per-patient disposable set for use in an injection procedure including a fluid path adapted to form a fluid connection between a high-pressure connector and the patient, and a manual control in fluid connection with the fluid path.
  • the manual control includes at least one actuator for controlling the powered injector through application of force by an operator.
  • the actuator is adapted to provide tactile feedback of pressure in the fluid path to the operator via fluid connection with the fluid path.
  • the per-patient disposable set further includes a pressure sensor in fluid connection with the fluid path via a pressure activated isolator adapted to isolate the pressure sensor from pressures in the fluid path above a set pressure.
  • the manual (for example, handheld) controllers of the present invention provide a number of advantages including, but not limited to the following: tactile feedback of actual fluid path pressure via fluid communication with the fluid path, compact size and small priming volume; dead man switch capability; ergonomic design for control of both contrast and saline; injection pressure feedback linked to variable flow and audible feedback; rigid material construction; actuator control providing a progressively increasing flow rate as the actuator is pushed or depressed through its range of motion; and high-pressure injections that are greater in pressure than could be generated or tolerated by an operator's hand.
  • the present invention provides an injection system for use in angiography including a powered injector in fluid connection with a source of injection fluid and a pressure sensor in fluid connection with the powered injector via a pressure activated isolator adapted to isolate the pressure sensor from pressures in the fluid path above a set pressure.
  • the pressure sensor elevation is independent of or independently variable of the position of the remainder of the injection system, including the position or elevation of the powered injector.
  • the present invention provides an angiographic injection system for injecting an injection fluid into a patient including a pressurizing device for supplying injection fluid under pressure; a low pressure fluid delivery system; and a pressure isolation mechanism having a first port for connection to the pressurizing device, a second port for connection to the patient, and a third port for connection to the low pressure fluid delivery system.
  • the pressure isolation mechanism includes a valve having a first state and a second state different from the first state.
  • the first state and the second state are mutually exclusive of each other. The first state occurs when the second and third ports are connected and the first and third ports are connected. The second state occurs when the first and second ports are connected and the first and third ports are disconnected.
  • the valve is normally biased to the first state (via, for example, a spring) and is switchable to the second state when fluid pressure from the syringe pump reaches a predetermined pressure level.
  • the first and second ports remain connected in the first state and in the second state.
  • the system preferably further includes a valve in line between the pressurizing device and the first port of the pressure isolation mechanism to control flow of the injection fluid.
  • the valve is an automated valve.
  • the valve is preferably operable to minimize or eliminate the effects of compliance of the pressurizing device and related tubing.
  • the low pressure delivery system can include a source of saline or other suitable flushing medium, a drip chamber in fluid connection with the source of saline and a detector to sense the amount of saline in the source of saline.
  • the system can further include a saline control valve and an air detector in line between the saline drip chamber and the pressure isolation mechanism.
  • the pressurizing device can be in fluid connection with a source of injection fluid via an injection fluid drip chamber.
  • the system can further include a detector to sense the amount of injection fluid in the source of injection fluid.
  • the system can also include an injection fluid control valve and an air detector in line between the injection fluid drip chamber and the pressure isolation mechanism.
  • the system further includes a handheld controller to control injection of injection fluid and injection of saline.
  • the handheld controller can include a first control having a first mode to control injection of injection fluid in a low pressure mode, the flow rate of the injection corresponding to (for example, being proportional to) the distance the first control is depressed.
  • the low pressure injection is ceased if the first control is released while in the first mode.
  • the first control can, for example, have a second mode to control injection of injection fluid in a high pressure mode.
  • the high pressure mode injection is preferably ceased if the first control is released while in the second mode.
  • the hand controller can further include at least a second control to control injection of saline.
  • the injection of saline is ceased if the second control is released during injection of saline.
  • the system preferably further includes a pressure transducer in fluid connection with the third port of the pressure isolation mechanism.
  • the present invention provides an injection system for use in angiography including a source of saline, a pump in fluid connection with the source of saline to pressurize the saline, a saline valve in fluid connection via a first port thereof with an outlet of the pump, a first connector in fluid connection with a second port of the saline valve, a source of contrast, a contrast valve in fluid connection with the source of contrast via a first port of the contrast valve, a powered injector in fluid connection with a second port of the contrast valve, a second connector in fluid connection with a third port of the contrast valve, and a pressure isolation mechanism.
  • the pressure isolation mechanism has a lumen having a first port in fluid connection with the second connector and a second port in fluid connection with a patient catheter.
  • the isolation mechanism further has a third port in fluid connection with the first connector and with the lumen.
  • the pressure isolation mechanism further includes a valve having a first state and a preferably mutually exclusive second state - the first state occurring when the lumen and the third port are connected; and the second state occurring when the lumen and the third port are disconnected.
  • the valve is preferably normally biased to the first state and is switchable to the second state when fluid pressure from the powered injector reaches a predetermined pressure level.
  • the first and second ports of the lumen preferably remain connected whether in the first state or in the second state.
  • the system further includes a pressure transducer in fluid connection with the third port of the pressure isolation mechanism.
  • the system can also include a first air or air column detector in fluid connection between the saline valve and the first connector and a second air detector in fluid connection between the contrast valve and the second connector.
  • the system can also include a first drip chamber in fluid connection between the source of saline and the pump and a detector in operative connection with the first drip chamber to sense the amount of saline in the source of saline.
  • the system can include a second drip chamber in fluid connection between the source of contrast and the contrast valve and a detector in operative connection with the second drip chamber to sense the amount of injection fluid in the source of injection fluid.
  • the present invention provides a pressure isolation mechanism for use in a medical procedure.
  • the pressure isolation mechanism or pressure isolator includes a lumen, an isolation port in fluid connection with lumen, and a valve having a first state and a second state.
  • the first state occurs when the lumen and the isolation port are connected.
  • the second state occurs when the lumen and the isolation port are disconnected.
  • the lumen remains open for flow of fluid therethrough in the first state and in the second state.
  • the valve is normally in the first state and is switchable to the second state when fluid pressure in the lumen reaches a predetermined pressure level.
  • the valve can, for example, be biased to the first state (for example, via a spring or other mechanism suitable to apply a biasing force as known in the art).
  • a pressure sensor or transducer can be in fluid connection with the isolation port of the pressure isolation mechanism as described above.
  • the valve can be switched between the first state and the second state by the force of the fluid pressure.
  • an electromechanical actuator in operative connection with a pressure sensor can control the state of the valve as a function of the fluid pressure.
  • the pressure sensor can, for example, be a pressure transducer in fluid connection with the isolation port as described above.
  • the pressure isolation mechanism is useful in any medical procedure in which is it desirable to isolate a fluid pathway or fluid path component from fluid flow above a certain fluid pressure.
  • the fluid pathway or fluid path component is placed in fluid connection with the isolation port of the pressure isolation mechanism.
  • a pressure transducer can be placed in connection with the isolation port to protect the pressure transducer form damage as a result of exposure to excess fluid pressure.
  • the present invention provides a fluid delivery system including a manually operated syringe and a pressure isolation mechanism as described above.
  • the present invention provides in another aspect a method of adding a patient pressure transducer to a fluid path used in a medical procedure to deliver fluid to a patient. The method includes the step of placing a lumen of a pressure isolation mechanism as described above in the fluid path via, for example, a first port and a second port of the lumen.
  • the method also comprises the steps of connecting a pressure transducer to the third or isolation port of the pressure isolation mechanism.
  • the method is useful, for example, in adding a patient pressure transducer to an angiographic fluid delivery system including a manual syringe.
  • Figure 1 illustrates an embodiment of a manual injector system currently used in angiographic procedures.
  • Figure 2 illustrates one embodiment of an injection system of the present invention.
  • Figure 3 illustrates an embodiment of a pressure activated isolator assembly ofo the present invention.
  • Figure 4 illustrates an embodiment of a handheld controller or hand piece of the present invention.
  • Figure 5 illustrates another embodiment of a handheld controller of the present invention in which the handheld controller is connected to the fluid path via a "T"s connection.
  • Figure 6A illustrates another embodiment of a handheld controller of the present invention including a control switch for pressure feedback in low pressure injection, a switch for high pressure injection and a switch for saline injection.
  • Figure 6B illustrates another embodiment of a handheld controller of the o present invention, which is wearable on a finger of the user.
  • Figure 7A illustrates a schematic representation of another embodiment of an injection system of the present invention.
  • Figure 7B illustrates a side view of an embodiment of a portion of the injection system of Figure 7A in which a pressure transducer is in the fluid path.
  • Figure 7C illustrates a side view of an embodiment of a portion of the injection system of Figure 7A in which a pressure transducer is separated from the fluid path by a T-connector and a length of tubing.
  • Figure 7D illustrates a side cross-sectional view of an embodiment of a pressure isolation valve of the present invention in which the valve is in a first, "open" o state.
  • Figure 7E illustrates a side cross-sectional view of the pressure isolation valve of Figure 7D in which the valve is in a second, "closed” state.
  • Figure 7F illustrates a perspective view of the pressure isolation valve of Figures 7D and 7E.
  • Figure 7G illustrates a front view of the injection system of Figure 7A.
  • Figure 7H illustrates a front view of the handheld controller of the injection 5 system of Figure 7A.
  • Figure 8 A illustrates an angiographic injection system of the present invention including a manual syringe and a pressure isolation mechanism or valve of the present invention in which the pressure isolation mechanism is closed to isolate a pressure transducer from the fluid path.
  • Figure 8B illustrates the angiographic injection system of Figure 8 A in which • the pressure isolation mechanism is open to place the pressure transducer in operative communication with the fluid path.
  • the present invention provides an energy/signal source tos generate fluid pressure/flow while also providing to the user tactile and/or audible feedback of the fluid pressure generated, allowing the user to modulate the fluid pressure/flow.
  • the powered injection system of the present invention is capable of providing, for example, both precise low-flow/ low-pressure fluid delivery for powered coronary injections and high-flow/ high-pressure fluid delivery for ventricle o injections
  • Figure 2 illustrates one embodiment of the present invention in which injector system 10 is preferably divided into two sections: A) a multi-patient section or set and B) a per-patient disposable section or set.
  • Section or set A and section or set B are preferably separated and removably coupled into fluid connection by a high-5 pressure connector or by a high-pressure, "aseptic" connector 20 such as the septum connector disclosed in U.S. Patent No. 6,096,011, assigned to the assignee of the present invention, the disclosure of which is incorporated herein by reference.
  • the aseptic coupler or connector of U.S. Patent No. 6,096,011 is suitable for repeated use (coupling and uncoupling) at relatively high pressures.
  • Aseptic connector 20 o preferably maintains a leak proof seal at high pressures after many such uses and can, for example, include a surface that can be disinfected (for example, between patients) by wiping with a suitable disinfectant.
  • Multi-patient set A preferably includes a powered injector 30 which is 5 typically an electromechanical drive system for generating fluid pressure/flow via, for example, a pressurizing chamber such as a syringe 40 as known in the art.
  • a powered injector 30 typically an electromechanical drive system for generating fluid pressure/flow via, for example, a pressurizing chamber such as a syringe 40 as known in the art.
  • Suitable powered injectors and syringes for use in the present invention are disclosed, for example, in PCT Publication No. WO 97/07841 and U.S. Patent No. 4,677,980, assigned to the assignee of the present invention, the disclosures of which are o incorporated herein by reference.
  • the injector drive is an electromechanical device that creates linear motion acting on a syringe plunger (not shown in Figure 2) to provide the generation of fluid pressure/ flow.
  • a source of injection media 60 (for example, a contrast bottle) is in fluid connection with the syringe via, for example, an electromechanical valve5 actuator assembly 50 for controlling and directing fluid flow by acting upon preferably disposable valves 52 and 54.
  • Valves 52 and 54 are preferably multi-position valves that are fluid wetted. Valves 52 and 54 can alternatively or additionally be manually operated.
  • Contrast bottle or container 60 can be prepackaged contrast media, often distributed in a glass or plastic container with a rubber septum for allowing 0 connections via IV spikes.
  • An interim container or reservoir 70 is preferably placed between contrast bottle 60 and electromechanical valve assembly 50 to provide an air gap in the fluid path to enable purging of air from the system and to allow level detection of contrast source 60 which helps to prevent reintroduction of air once purged.
  • Interim reservoir 70 can operate in conjunction with a contrast level detection5 system as described in further detail below.
  • a contrast level detector 80 can, for example, include one or more electrical, optical, ultrasound, or mechanical sensors that detect the presence of fluid at a certain level in interim reservoir 70. Further protection against injection of air into a patient can be provided by variety of mechanisms for detection of air in the fluid path or stream. For example, o ultrasonic bubble detection can be used to detect the presence of air in the fluid path. Likewise, backlighting can facilitate air bubble detection by the operator.
  • the injector side of the fluid path is illuminated to increase visualization of the fluid path, fluid presence and air presence.
  • At least one source 90 of another fluid can also be provided. Additional fluid sources, such as therapeutic fluids, can also be provided. Additional fluid sources such as saline supply 90 are preferably in operative or fluid connection with a pressurizing mechanism such as a powered injector or a peristaltic pump 100.
  • peristaltic pump 100 in operative connection with the saline source 90 is in fluid connection with the fluid path of injector 30 via electromechanical valve actuator assembly 50.
  • a controller unit 200 provides power to injector 30 and to peristaltic pump 100 in a controlled manner.
  • Controller unit 200 provides communication between the various system components.
  • a graphical user interface display 210 is preferably provided in connection with controller unit 200 to display information to the user and to enable the user to set and adjust device parameters.
  • An audible feedback source 220 can be provided, for example, to provide feedback to the user of the rate of flow provided by injector 30. For example, a sound can increase in pitch, volume and/or frequency as flow rate is increased.
  • Per-patient disposable set B includes fluid wetted components of the fluid delivery path.
  • Per-patient disposable set B preferably includes a waste port 310 (for example, through which patient blood can be drawn), a pressure measurement port 320, and an interface 330 to a catheter 340 (for example, a connector such as a standard Luer connector).
  • Waste port 310 can, for example, include a manually activated or automated valve to allow discharge of unwanted fluid and connection of, for example, manually operated syringes.
  • a powered aspiration mechanism for example, a peristaltic pump 314 connected via tubing to a waste bag 316
  • Waste port 310 can, for example, a standard connector 312, to aspirate fluid from the system as well as to draw blood from the patient. Drawing fluid from the system and blood from the patient into a waste bag 316 assists in eliminating air from the fluid delivery system.
  • Pressure port 320 preferably includes a pressure-activated isolator 350 for pressure transducer isolation as, for example, illustrated in Figure 3.
  • Pressure- activated isolator 350 is a fluid activated assembly that is located in line with the injection flow, h the embodiment of Figure 3, a valve 352 within the assembly isolates pressure transducer 360 by shutting off during high-pressure injections.
  • a biasing member or mechanism such as a spring 354 returns valve 352 to its original open position when the injector system is not injecting at high pressure, thus opening the fluid path to pressure transducer 360.
  • pressure-activated isolator 350 transitions to a closed position to isolate only pressure transducer 360, which is not in fluid connection with contrast source 60 or saline 5 source 90 other than through pressure-activated isolator 350.
  • Pressure transducer 360 can, for example, be located near the patient to substantially reduce or remove pressure signal dampening resulting from intervening tubing, fluid and system components and thereby improve accuracy as compared to other pressure measurement systems currently used in angiographic procedures.
  • pressureo transducer 360 is separated by a minimum (for example, by no more than approximately three feet) of tubing from the patient/catheter connector.
  • the pressure transducer assembly and the remainder of per-patient disposable set B are preferably located downstream of a double check valve 370 to provide continuous measurements. As such, a pressure isolations mechanism such as described above is required to isolate pressure transducer 360 from high pressure during power injection.
  • the system also includes a manually operated, for example, a handheld or hand operated, control 400 that can, for example, generate or process a control signal that is electrical, mechanical, pneumatic, optical, radio frequency, audible or any o combination thereof to effect control of injector 30 and preferably to also effect control of peristaltic pump 100.
  • Handheld control 400 also preferably provides feedback (for example, tactile, visual, audible etc.) of the injected fluid pressure and flow to the operator.
  • Handheld control 400 preferably provides at least one type of feedback (for example, tactile feedback).
  • the handheld control or hand piece is in operative communication with the fluid flow and allows the user to feel the pressure in the fluid path line.
  • an electrical switch allows the user to turn on/off and modulate the fluid/flow pressure of the system for low-pressure/low-flow coronary injections only.
  • High-pressure injection is activated, for example, using either display 210 or a separate (second) control on the o handheld control.
  • the handheld control thus provides pressure feedback to the user while controlling the low-pressure/low-flow coronary injections.
  • the handheld controls of the present invention can, for example, include a fluid path containment chamber in which a movable element is able to travel a pre- determined distance.
  • the moveable element is preferably in direct contact with the fluid path and is affected by fluid flow and pressure.
  • the movable element incorporates a mechanism to process a signal, which can be used to control the fluid pressure/flow source remotely.
  • a handheld control device 500 incorporates a moveable piston 510 slideably disposed within a chamber 520 in a direction generally perpendicular to the direction of fluid flow as illustrated in Figure 4. Chamber 520 and piston 510 can be directly in the fluid path or can be spaced from the fluid path by a length of tubing (see, for example, Figure 5). Handheld device 500 allows moveable piston 510 to be positioned under one finger while device 500 is held in the hand. Piston 510 preferably incorporates a switch 530, that when compressed, controls the fluid flow generated by an external fluid pressure/flow source (for example, injector 30).
  • an external fluid pressure/flow source for example, injector 30.
  • piston 510 Upon generation of the pressure, piston 510 is displaced by increased pressure, which is detectable by the operator. Further compression of piston 510 by the operator preferably increases the signal to the fluid flow/pressure generator, resulting in an increase in the pressure/flow and an increased pressure on piston 510, which is felt by the operator. Backpressure or tubing occlusion causes increased pressure in the system, upward movement of piston 510 and tactile feedback to the operator, thereby alerting the operator to potential problems in the injection procedure.
  • the system can also provide audible andVor visual feedback of the flow rate via, for example, user display 210 that is preferably controlled by the position of piston 510. As illustrated in Figure 5, a handheld control 500' can be connected in a "T" 550 off of the main line for more flexibility.
  • a purge valve 540 can be located at the end of handheld control 500' for air elimination during system purge. Air can also be purged from the handheld control 500' before it is connected to the fluid path.
  • Figure 5 also illustrates a second switch 560' for initiation of a high pressure injection. An additional switch or switches can also be provided to, for example, control delivery of saline.
  • Figures 6A and 6B illustrate other, ergonomic handheld controls.
  • Handheld control 600 of Figure 6 A includes a chamber 620 that can be in fluid connection with the injection system fluid path as described above.
  • a low pressure control switch 610 similar in operation to piston 510 is slideably disposed within chamber 620 to control low-pressure injections of contrast. Chamber 620 can, for example, be formed to conform to the hand of the user.
  • a switch 630 to begin a high pressure injection via injector 30 is provided on handheld control 600.
  • a switch 640 to control 5 delivery of saline is provided on handheld control 600.
  • Figure 6B illustrates an embodiment of a finger-wearable handheld control 700.
  • a finger of the user's hand passes through passage 710 in control 700 while control 700 is held in the user's hand.
  • a rotating switch 720 controls low-pressure injection.
  • a high pressure injection switch 730 and a saline l o switch 740 are also provided.
  • System 10 ( Figure 2) can also include a manually operated foot controller 420 including one or more actuators 430 in communication with controller 200. Foot controller 420 can, for example, be used to control flow through system 10 in conjunction with or independently of handheld controller 400.
  • FIG. 7 A through 7H is Another embodiment of an injector system 800 is illustrated in Figures 7 A through 7H.
  • a fluid control module 810 is in operative connection with a powered injector 830 to which a syringe 840 is connected as described above.
  • Syringe 840 is in fluid connection with an automated valve 852 of fluid control module 810, which is also in fluid connection
  • Drip chamber 870 preferably includes a fluid level sensing mechanism 880.
  • a preferably automated valve/stopcock 852 such as known in the art is also in fluid connection with a first, inlet port of a lumen 954 of a pressure isolation valve 950 (see, for example, Figures 7D through 7F). Valve 852 prevents saline and/or
  • An air column detector 856 can be placed in line
  • Fluid control module 810 further includes a source of saline 890 in fluid connection with a peristaltic pump 900 via an intervening drip chamber 910.
  • Drip chamber 910 preferably includes a fluid level sensing mechanism 920.
  • Peristaltic pump 900 is in fluid connection with a preferably automated valve/stopcock 854, which is in fluid connection with pressure isolation valve 950.
  • valve 854 prevents contaminated fluids from reaching peristaltic pump 900 and saline source 890.
  • An air column detector 858 can be placed in line between stopcock 854 and pressure isolation valve 950.
  • a controller 970 and a display 974 are also in operative connection with injector 830 as described above.
  • handheld controller 1000 is in operative connection with injector 830 and thereby with fluid control module 810.
  • handheld controller 1000 does not provide tactile feedback of system pressure to the operator.
  • a handheld controller providing such tactile feedback can readily be used in connection with system 800.
  • a foot controller as described above can also be provided.
  • the preferably per-patient disposable portion or set of system 800 is illustrated within dashed lines in Figures 7A, 7B, and 7C.
  • Two connectors 990a and 990b (which are preferably aseptic connectors as described above) are used to connect the multi-patient fluid path set with the per-patient fluid path set.
  • Use of two separate/parallel fluid lines and two separate connectors to connect the multi-patient set with the per-patient disposable set affords a number of benefits over current angiographic injection systems including decreased contrast waste and avoidance of injecting potentially hazardous amounts of contrast into the patient during saline purges.
  • system 800 facilitates close placement of pressure transducer 980 to the patient, improving measurement accuracy as compared to currently available systems.
  • handheld controller 1000 in the embodiments of Figures 7 A through 7H is not in direct connection with the fluid path, it is preferably disposable because of contamination with bodily fluids that typically occurs from operator handling thereof.
  • Lumen 954 (via a second, outlet port thereof) of pressure isolation valve 950 is preferably in fluid connection with an automated or manual valve/stopcock 994, which preferably includes a waste port 996 as described above.
  • Catheter 1100 is preferably connected via a rotating Luer connection 998.
  • Figure 7B illustrates a portion of a fluid path set for use in system 800 of Figure 7A in which a pressure transducer 980 is directly in the saline fluid path.
  • Figure 7C illustrates a fluid path set for use in system 800 of Figure 7A in which pressure transducer 980 is separated from the saline fluid path by a "T" connector 982 and a length of tubing 984.
  • spikes 976a and 976b are used to connect to contrast source 860 and saline source 890, respectively.
  • standard Luer connections are used to connect most of the components of system 800.
  • Figures 7B and 7C several of these Luer connections are illustrated in a disconnected state.
  • one or more of the illustrated connections can, for example, be non-Luer or bonded connections.
  • a pressure isolation valve 950 is illustrated in Figures 7D through 7F.
  • Pressure isolation valve 950 includes a housing 952 with a high pressure lumen 954, through which fluid passes under pressure.
  • Pressure isolation valve 950 also includes a port 956 to which pressure transducer 980 and saline source 890 are connected.
  • a piston 958 acts to isolate pressure transducer 980 once a given pressure is reached in lumen 954 of pressure isolation valve 950.
  • the clearances and apertures within pressure isolation valve 950 are sufficiently generous to transmit changes in pressure that normally occur during normal heart function quickly, as to not damp or attenuate the signal.
  • piston 958 The pressure effect on piston 958 of the flow of injection fluid from syringe 840 through lumen 954 is illustrated with dashed arrows in Figure 7D while the flow of saline through pressure isolation mechanism 950 is illustrated with solid arrows.
  • piston 958 responds by moving to the right in the orientation of Figure 7D and 7E, compressing a spring 960 until a seal portion 962 at the left end of piston 958 contacts a sealing seat 964 as illustrated in Figure 7E.
  • lumen or port 956 is isolated from lumen 954 and any additional increase in pressure acts to increase or improve the effectiveness of the seal 962.
  • pressure isolation valve 950 When the pressure within lumen 954 subsides, spring 960, reopens pressure isolation valve 950 by pushing piston 958 to the left. In one embodiment, fluid does not flow through port 956. In this embodiment, pressure isolation valve 950 only isolates the tubing and devices distal to port 956 from high pressure and does not control flow. Pressure isolation valve 950 of the present invention is suited for use in any medical fluid path in which it is desirable to automatically isolate a pressure sensitive fluid path component (for example, a pressure transducer) or other fluid path component or fluid pathway from pressures above a certain predetermined pressure.
  • a pressure sensitive fluid path component for example, a pressure transducer
  • pressure isolation valve 950 isolates port 956 from lumen 954 can be readily and easily adjusted through variation of a number of variables as known to those skilled in the art, including, for example, various valve dimensions and the properties of spring 960 (for example, the force constant thereof). Connection of pressure isolation valve 950 into any fluid path is quite simple. In that regard, lumen 954 is simply placed in the fluid path via connection of ports 954a and 954b to disconnected or open ends of the fluid path without any other change to the fluid path or to pressure isolation valvp 950. Standard connections such as Luer connections as known in the medical arts can be used to connect lumen 954 to the fluid path.
  • Valve 950 can also be incorporated into or embedded within other devices such as a manifold, a pressure transducer or a connector. In an alternative to mechanical operation of valve piston 958 as described above, valve piston 958 can also be controlled via an electromechanical mechanism.
  • a pressure sensor such as pressure sensor or transducer 980 (see, for example, Figure 7B) can send a signal to an actuator (for example, in the operative position of and functioning in a similar manner to spring 960) as known in the control arts to control the position of valve piston 958 and thereby control fluid flow through port 956.
  • Figures 8A and 8B illustrate use of pressure isolation valve 950 to automatically isolate a pressure transducer P from increased pressures in a manual injection system such as set forth in Figure 1.
  • Valve V 3 (use for manual isolation of a pressure transducer as described above) can be removed from the fluid path or retained therein.
  • application of a force F to the syringe plunger extension causes pressurized fluid to flow from the syringe into the fluid path.
  • the elevated pressure causes pressure within lumen 954 to increase.
  • piston 958 responds by moving to the right in the orientation of Figures 8 A and 8B, compressing spring 960 until seal portion 962 contacts sealing seat 964 as illustrated in Figure 8A.
  • port 956 and pressure transducer P are isolated from lumen 954 and the remainder of the fluid path.
  • Injection procedures are greatly facilitated in the system of Figures 8A and 8B by automation of the isolation of pressure transducer P at elevated pressures.
  • saline is used occasionally during routine catheterization procedures.
  • controls 1020a or 1020b on handheld control 1000 can send a signal to control the flow of saline.
  • the parallel line configuration of the contrast delivery and saline deliver fluid paths of present invention assist in preventing such undesirable injections.
  • the pressures required to force saline through catheter 1100 are much less than that of contrast.
  • Protection of the saline line from high pressure is accomplished by connecting the saline line to port 956 of pressure isolation valve 950 to introduce the saline flow as illustrated with solid arrows in Figure 7D.
  • port 956 is normally open, permitting the flow of saline therethrough, when required, as well as the monitoring of the patient blood pressure.
  • pressure isolation valve 950 functions as described above and protects pressure transducer 980 and the low-pressure saline line from the high contrast injection pressures.
  • the elevation of catheter 1100 often changes during the course of an injection procedure, for example, as the patient is raised or lowered. Such changes in elevation of catheter 1100 can result in erroneous blood pressure readings by pressure transducer 980. Therefore, pressure transducer 980 is preferably positioned such that it changes elevation with catheter 1100 and is not dependent upon the position of the injection system, including the position of injector 830.
  • handheld controller 1000 included a plunger or stem control 1010 that, when in a first/low pressure mode, is depressed by the operator to control the flow of contrast from syringe 840.
  • the operator can use graphical user interface display 974 to change the mode of plunger 1010 to a second mode in which it causes injector 830 to initiate a high pressure injection as preprogrammed by the operator. In this second/high pressure mode, the operator maintains plunger 1010 in a depressed state to continue the injection.
  • Handheld controller 1000 also includes at least one switch to control saline flow in system 800.
  • handheld controller 1000 includes two saline switches 1030a and 1030b on either side of plunger 1010 for ease of access by the operator.
  • switches 1030a and 1030b include resilient cantilevered members 1032a and 1032b, respectively, which are depressed by the operator to deliver saline through system 800.
  • one of switches 1030a or 1030b must be maintained in a depressed state by the operator to continue delivery of saline.
  • saline flow is preferably stopped substantially immediately, for example, via control of valve 854.
  • Injector 830 is preferably rotatable about stand 805 as indicated by the arrow of Figure 7G.
  • stopcocks were obtained from Medical Associates Network, Inc., a distributor for Elcam Plastic, under product number 565302; spikes were obtained from Qosina under product numbers 23202 and 23207, tubing was obtained from Merit Medical under product numbers DCT-100 and DCT-148; connectors were obtained from Merit Medical under product number 102101003, a rotating hub was obtained from Medical Associates Network, Inc., a distributor for Elcam Plastic, under product number 565310; a peristaltic pump from Watson-Marlow was obtained having a product number of 133.4451.THF; and fluid level sensor from Omron were obtained under product number EESPX613
  • the first step in an injection procedure is replacing air in the fluid path with fluid.
  • the powered injector causes the syringe plunger to move rearward (toward the powered injector), thereby creating a negative pressure at the connection point to a control valve in proximity to the contrast interim container.
  • the control valve is positioned to allow fluid flow from the contrast bottle, into the interim container and into the syringe.
  • the injector drive preferably reverses direction creating a positive pressure and fluid movement in the direction of the contrast container or the catheter (which is not connected to a patient) to drive any entrapped air out of the fluid path into an "air gap" established in the interim container or through the catheter.
  • Air is further preferably initially purged from the system during start-up by, for example, distributing a fluid such as saline through the fluid path (sometimes referred to as "priming").
  • the system is preferably maintained air- free during an injection procedure and with multi-patient use. Priming is preferably done once per patient or once per multi-patient, depending on disposable fluid path configuration.
  • the system can include, for example, "contrast low" level (need for refill) and
  • a second fluid pump connected to a bulk source of saline, typically a prefilled bag, provides fluid flow in the direction of patient catheter. Enough saline is preferably pumped throughout disposable set to achieve elimination of all visible air during priming.
  • a handheld controller that is in fluid connection with the fluid path (to provide tactile feedback as described above) can, for example, be purged of air by opening an integral bleed valve. After priming is complete the bleed valve is closed.
  • the system preferably has a range of parameters for flow, pressure, variable flow, alarms and performance limits as known in the art.
  • depressing a first button, piston or other controller on the handheld controller initiates flow of contrast and in some embodiments provides feedback (for example, tactile and/or audible feedback).
  • Further depressing the button on the hand controller preferably increases the flow rate of contrast. If at any time the button is released, the fluid flow preferably stops and any feedback ends.
  • This "dead-man" operability can be provided, for example, by biasing (for example, spring loading) the first control or actuator toward the off position.
  • the minimum and maximum flow are preferably established by the parameters set using a graphical user interface on the display.
  • a separate switch or second actuator/controller on the hand control is preferably depressed.
  • a second mode of the first actuator/controller can be entered to control high pressure flow.
  • the handheld control provides tactile feedback during low-pressure injection
  • no such tactile feedback is provided during high pressure flow.
  • other feedback such as an audible tone feedback different than any audible tone provided during the low- pressure mode can be provided.
  • the high-pressure/high-flow function is preferably first input/selected from the parameters input/set using the graphical user interface on the display.
  • the high-flow and high-pressure injection is preferably preprogrammed and the flow cannot be varied. As discussed above, any direct, tactile feedback is preferably eliminated, as the pressure is often over 1000 psi. If at any time the second button is released, the injection preferably stops.
  • a second or third switch, controller or actuator on the hand controller is preferably selected, causing saline flow at a pre-selected flow rate.
  • a single controller or actuator having three different control modes can be used.
  • the saline flow preferably stops.
  • a pressure sensor is preferably connected to a pressure isolation valve as described above. Patient pressure monitoring can be determined at any time except when an injection of fluid exceeds the pressure set by the pressure isolation valve.
  • a multi-patient set can be designed so that at least some portions thereof can safely be reused for multiple patients.
  • the syringe and interface to contrast/saline components, disposable valves and related tubing, and a multi-use high-pressure, aseptic connecter can preferably be reused for multiple patients.
  • Handheld controllers (whether or not in fluid connection with the fluid path) and related tubing and check valves are preferably replaced for each patient.
  • any waste port, pressure port, and the interface to catheter are preferably replaced for each patient.
  • Aseptic connectors of a multi-patient set can, for example, be wiped clean before connecting a disposable set for each new patient.
  • Reusable or multi-patient sets preferably have a limited numbers of reuses and preferably are not used for longer than a set period of time (for example, an 8-hour period).

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Abstract

L'invention porte sur un système d'injection comprenant une source de fluide d'injection, un dispositif de pompe, un ensemble de trajet de fluide disposé entre la source d'injection de fluide et le dispositif de pompe opérationnellement associé à l'ensemble de trajet de fluide. Le dispositif de contrôle de fluide est conçu pour permettre de purger l'air issu de l'ensemble de trajet de fluide et pour arrêter le flux du fluide d'injection vers un patient à presque n'importe quelle pression ou débit généré par le dispositif de pompe en vue de la distribution d'un bolus acerbe du fluide d'injection au patient. Le dispositif de contrôle de fluide fait de préférence partie de l'ensemble de trajet de fluide entre la source du fluide d'injection et le dispositif de pompe. Dans un autre aspect, un système d'injection comprend un injecteur alimenté, une chambre de pressurisation reliée opérationnellement à l'injecteur alimenté, un trajet de fluide en connexion fluidique avec la chambre de pressurisation, et un contrôle manuel en connexion fluidique avec le trajet de fluide. Le contrôle manuel comprend au moins un actionneur afin de contrôler l'injecteur par application d'une force par un opérateur. L'actionneur fournit une rétroaction tactile de pression dans le trajet de fluide vers l'opérateur à travers une connexion fluidique avec le trajet de fluide. Un mécanisme d'isolation de pression qui s'utilise dans une procédure médicale comprend une lumière, une porte d'isolation en communication fluidique avec la lumière, et une vanne présentant un premier état et un second état. Le premier état se produit lorsque la lumière et le port d'isolation sont connectés. Le second état se produit lorsque la lumière et le port d'isolation sont déconnectés. Le lumière reste ouverte pour permettre l'écoulement du fluide à travers celle-ci dans le premier état et dans le second état. La vanne est normalement dans le premier état et peut commuter dans le second état lorsque la pression fluidique de la lumière atteint un niveau de pression prédéterminé. Un transducteur de pression peut être en connexion fluidique avec le port d'isolation du mécanisme d'isolation de pression. Un système de distribution de fluides comprend une seringue à fonctionnement manuel et un mécanisme d'isolation de pression tel que susmentionné.
PCT/US2004/011190 2004-04-12 2004-04-12 Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes WO2005110007A2 (fr)

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PCT/US2004/011190 WO2005110007A2 (fr) 2004-04-12 2004-04-12 Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes
EP04821981A EP1753481A4 (fr) 2004-04-12 2004-04-12 Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes
JP2007508308A JP2007532234A (ja) 2004-04-12 2004-04-12 流体搬送システム、圧力隔離機構、インジェクタ制御機構、及びそれらを用いる方法

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PCT/US2004/011190 WO2005110007A2 (fr) 2004-04-12 2004-04-12 Systemes de distribution de fluides, mecanismes d'isolation de pression, mecanismes de controle d'injecteur et procedes d'utilisation associes

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Cited By (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008079540A2 (fr) 2006-12-22 2008-07-03 Medrad, Inc. Système d'administration de liquide et d'isolement sous pression basé sur l'écoulement comprenant un mécanisme de déclenchement d'écoulement et d'isolement sous pression basé sur l'écoulement
JP2009539562A (ja) * 2006-06-14 2009-11-19 アシスト・メディカル・システムズ，インコーポレイテッド 医療用注入システムにおける流体不純物除去
WO2011100851A1 (fr) * 2010-02-16 2011-08-25 Medela Holding Ag Pièce de raccordement d'une unité de tuyau de drainage
WO2012071314A1 (fr) * 2010-11-24 2012-05-31 Acist Medical Systems, Inc. Système de clapet d'entrée pour une seringue d'injection de produit de contraste
WO2013184642A2 (fr) 2012-06-07 2013-12-12 Medrad Inc., Dispositif d'administration de produit radiopharmaceutique
US8747356B2 (en) 2007-11-19 2014-06-10 Mallinckrodt Llc Fluid delivery system with multi-dose fluid source
US8801684B2 (en) 2010-02-16 2014-08-12 Medela Holding Ag Coupling part of a drainage tube unit
CN104736187A (zh) * 2012-10-17 2015-06-24 拜耳医疗保健股份有限公司 带有高压和低压手动歧管的流体递送系统
WO2017095747A1 (fr) * 2015-12-01 2017-06-08 Invivo Therapeutics Corporation Procédés et systèmes pour l'administration de trace de substance thérapeutique dans un espace anatomique
EP3092017A4 (fr) * 2014-01-10 2017-08-09 Bayer Healthcare LLC Connecteur pour dispositif jetable à usage unique
US9808571B2 (en) 2012-04-03 2017-11-07 Bayer Healthcare Llc High pressure sensor for use with a fluid delivery system
CN107638610A (zh) * 2017-09-22 2018-01-30 深圳市信冠机电有限公司 一种自动高压注射系统
WO2018112300A1 (fr) * 2016-12-16 2018-06-21 Endobar Solutions Llc Commande de l'administration de billes emboliques dans une artère
CN109350114A (zh) * 2018-11-28 2019-02-19 广东省人民医院(广东省医学科学院) 一种多功能心脏彩超声学造影检查装置
US10314764B2 (en) 2011-12-22 2019-06-11 Icu Medical, Inc. Fluid transfer devices and methods of use
US10314765B2 (en) 2009-07-29 2019-06-11 Icu Medical, Inc. Fluid transfer devices and methods of use
US10376687B2 (en) 2012-10-16 2019-08-13 Acist Medical Systems, Inc. Controlling flow in a medical injection system
US10420927B2 (en) 2015-12-04 2019-09-24 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
US10507319B2 (en) 2015-01-09 2019-12-17 Bayer Healthcare Llc Multiple fluid delivery system with multi-use disposable set and features thereof
USD874644S1 (en) 2016-07-19 2020-02-04 Icu Medical, Inc. Medical fluid transfer system
US11020541B2 (en) 2016-07-25 2021-06-01 Icu Medical, Inc. Systems, methods, and components for trapping air bubbles in medical fluid transfer modules and systems
US11109766B2 (en) 2012-05-25 2021-09-07 Acist Medical Systems, Inc. Fluid flow measurement systems and methods
CN114761052A (zh) * 2019-09-16 2022-07-15 康尔福盛303公司 注射器控制组件
CN115227964A (zh) * 2022-09-21 2022-10-25 深圳核心医疗科技有限公司 流速控制方法及装置
US11478162B2 (en) 2018-05-23 2022-10-25 Acist Medical Systems, Inc. Flow measurement using image data
US11541171B2 (en) 2013-11-25 2023-01-03 Icu Medical, Inc. Methods and systems for filling IV bags with therapeutic fluid
US11560964B2 (en) 2020-08-21 2023-01-24 Acist Medical Systems, Inc. Valve actuation device coupling
US11590057B2 (en) 2020-04-03 2023-02-28 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
US11607489B2 (en) 2017-05-26 2023-03-21 Bayer Healthcare Llc Injector state logic with hemodynamic monitoring
US11633534B2 (en) 2020-08-18 2023-04-25 Acist Medical Systems, Inc. Angiogram injections using electrocardiographic synchronization
US11738152B2 (en) 2016-06-15 2023-08-29 Bayer Healthcare, Llc Multi-use disposable system and syringe therefor
US11998716B2 (en) 2020-01-30 2024-06-04 Acist Medical Systems, Inc. Valve assembly

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8080001B2 (en) 2008-11-26 2011-12-20 Acist Medical Systems, Inc. Fluid connection assembly with locking mechanism
JP5401562B2 (ja) * 2009-12-29 2014-01-29 スーガン株式会社 高低圧流路切換装置
JPWO2014104338A1 (ja) * 2012-12-28 2017-01-19 株式会社根本杏林堂 薬液回路およびそれを使用する薬液回路システム
JP6270535B2 (ja) * 2014-02-25 2018-01-31 株式会社メテク 急速輸液装置
JP6713456B2 (ja) * 2014-09-11 2020-06-24 オスプレイ メディカル インコーポレイテッド 分流された媒体を収集し再使用するためのリザーバ

Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4243031A (en) * 1978-12-18 1981-01-06 Abbott Laboratories Intravenous pump filter protector
US4396385A (en) * 1980-12-05 1983-08-02 Baxter Travenol Laboratories, Inc. Flow metering apparatus for a fluid infusion system
US5002528A (en) * 1989-12-15 1991-03-26 Aubrey Palestrant Percutaneous irrigation and drainage system
US6221045B1 (en) * 1995-04-20 2001-04-24 Acist Medical Systems, Inc. Angiographic injector system with automatic high/low pressure switching
US5573515A (en) * 1995-04-20 1996-11-12 Invasatec, Inc. Self purging angiographic injector
GB0001309D0 (en) * 2000-01-20 2000-03-08 Nestle Sa Valve arrangement
IT250665Y1 (it) * 2000-07-14 2003-09-24 Sidam Di Azzolini Graziano E C Valvola a tre vie con corpo autoportante per impiego medicale
US6896002B2 (en) * 2001-08-21 2005-05-24 Scimed Life Systems, Inc Pressure transducer protection valve

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of EP1753481A4 *

Cited By (57)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009539562A (ja) * 2006-06-14 2009-11-19 アシスト・メディカル・システムズ，インコーポレイテッド 医療用注入システムにおける流体不純物除去
US8591477B2 (en) 2006-06-14 2013-11-26 Acist Medical Systems, Inc. Fluid purge in a medical injection system
EP2099517A4 (fr) * 2006-12-22 2016-11-16 Bayer Healthcare Llc Système d'administration de liquide et d'isolement sous pression basé sur l'écoulement comprenant un mécanisme de déclenchement d'écoulement et d'isolement sous pression basé sur l'écoulement
WO2008079540A2 (fr) 2006-12-22 2008-07-03 Medrad, Inc. Système d'administration de liquide et d'isolement sous pression basé sur l'écoulement comprenant un mécanisme de déclenchement d'écoulement et d'isolement sous pression basé sur l'écoulement
US8747356B2 (en) 2007-11-19 2014-06-10 Mallinckrodt Llc Fluid delivery system with multi-dose fluid source
US11806308B2 (en) 2009-07-29 2023-11-07 Icu Medical, Inc. Fluid transfer devices and methods of use
US11007119B2 (en) 2009-07-29 2021-05-18 Icu Medical, Inc. Fluid transfer devices and methods of use
US10314765B2 (en) 2009-07-29 2019-06-11 Icu Medical, Inc. Fluid transfer devices and methods of use
WO2011100851A1 (fr) * 2010-02-16 2011-08-25 Medela Holding Ag Pièce de raccordement d'une unité de tuyau de drainage
CN102753220A (zh) * 2010-02-16 2012-10-24 美德乐控股公司 排流软管单元的耦联部件
US8801684B2 (en) 2010-02-16 2014-08-12 Medela Holding Ag Coupling part of a drainage tube unit
WO2012071314A1 (fr) * 2010-11-24 2012-05-31 Acist Medical Systems, Inc. Système de clapet d'entrée pour une seringue d'injection de produit de contraste
US10322277B2 (en) 2010-11-24 2019-06-18 Acist Medical Systems, Inc. Contrast media injector syringe inlet valve system
US12023304B2 (en) 2011-12-22 2024-07-02 Icu Medical, Inc. Fluid transfer devices and methods of use
US10314764B2 (en) 2011-12-22 2019-06-11 Icu Medical, Inc. Fluid transfer devices and methods of use
US11439570B2 (en) 2011-12-22 2022-09-13 Icu Medical, Inc. Fluid transfer devices and methods of use
US11439571B2 (en) 2011-12-22 2022-09-13 Icu Medical, Inc. Fluid transfer devices and methods of use
US9808571B2 (en) 2012-04-03 2017-11-07 Bayer Healthcare Llc High pressure sensor for use with a fluid delivery system
US11109766B2 (en) 2012-05-25 2021-09-07 Acist Medical Systems, Inc. Fluid flow measurement systems and methods
CN104812435A (zh) * 2012-06-07 2015-07-29 拜耳医疗保健公司 放射性药物递送器件
WO2013184642A2 (fr) 2012-06-07 2013-12-12 Medrad Inc., Dispositif d'administration de produit radiopharmaceutique
EP2858712A4 (fr) * 2012-06-07 2016-05-18 Bayer Medical Care Inc Dispositif d'administration de produit radiopharmaceutique
US10376687B2 (en) 2012-10-16 2019-08-13 Acist Medical Systems, Inc. Controlling flow in a medical injection system
EP2908884A4 (fr) * 2012-10-17 2016-06-29 Bayer Medical Care Inc Système de distribution de fluide ayant un collecteur portable à haute et basse pressions
US10105530B2 (en) 2012-10-17 2018-10-23 Bayer Healthcare Llc Fluid delivery system with high and low pressure hand manifold
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US11541171B2 (en) 2013-11-25 2023-01-03 Icu Medical, Inc. Methods and systems for filling IV bags with therapeutic fluid
EP3092017A4 (fr) * 2014-01-10 2017-08-09 Bayer Healthcare LLC Connecteur pour dispositif jetable à usage unique
US10549084B2 (en) 2014-01-10 2020-02-04 Bayer Healthcare Llc Single-use disposable set connector
US11491318B2 (en) 2015-01-09 2022-11-08 Bayer Healthcare Llc Multiple fluid delivery system with multi-use disposable set and features thereof
US10507319B2 (en) 2015-01-09 2019-12-17 Bayer Healthcare Llc Multiple fluid delivery system with multi-use disposable set and features thereof
WO2017095747A1 (fr) * 2015-12-01 2017-06-08 Invivo Therapeutics Corporation Procédés et systèmes pour l'administration de trace de substance thérapeutique dans un espace anatomique
US11135416B2 (en) 2015-12-04 2021-10-05 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
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US10420927B2 (en) 2015-12-04 2019-09-24 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
US11865295B2 (en) 2015-12-04 2024-01-09 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
US11738152B2 (en) 2016-06-15 2023-08-29 Bayer Healthcare, Llc Multi-use disposable system and syringe therefor
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USD905228S1 (en) 2016-07-19 2020-12-15 Icu Medical, Inc. Medical fluid transfer system
US11020541B2 (en) 2016-07-25 2021-06-01 Icu Medical, Inc. Systems, methods, and components for trapping air bubbles in medical fluid transfer modules and systems
US11951293B2 (en) 2016-07-25 2024-04-09 Icu Medical, Inc. Systems, methods, and components for trapping air bubbles in medical fluid transfer modules and systems
US11583637B2 (en) 2016-07-25 2023-02-21 Icu Medical, Inc. Systems, methods, and components for trapping air bubbles in medical fluid transfer modules and systems
US11109870B2 (en) 2016-12-16 2021-09-07 Endobar Solutions Llc Controlling the delivery of embolic beads into an artery
WO2018112300A1 (fr) * 2016-12-16 2018-06-21 Endobar Solutions Llc Commande de l'administration de billes emboliques dans une artère
US11607489B2 (en) 2017-05-26 2023-03-21 Bayer Healthcare Llc Injector state logic with hemodynamic monitoring
CN107638610A (zh) * 2017-09-22 2018-01-30 深圳市信冠机电有限公司 一种自动高压注射系统
US11478162B2 (en) 2018-05-23 2022-10-25 Acist Medical Systems, Inc. Flow measurement using image data
CN109350114A (zh) * 2018-11-28 2019-02-19 广东省人民医院(广东省医学科学院) 一种多功能心脏彩超声学造影检查装置
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CN114761052A (zh) * 2019-09-16 2022-07-15 康尔福盛303公司 注射器控制组件
US11998716B2 (en) 2020-01-30 2024-06-04 Acist Medical Systems, Inc. Valve assembly
US11590057B2 (en) 2020-04-03 2023-02-28 Icu Medical, Inc. Systems, methods, and components for transferring medical fluids
US11633534B2 (en) 2020-08-18 2023-04-25 Acist Medical Systems, Inc. Angiogram injections using electrocardiographic synchronization
US11560964B2 (en) 2020-08-21 2023-01-24 Acist Medical Systems, Inc. Valve actuation device coupling
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EP1753481A2 (fr) 2007-02-21
EP1753481A4 (fr) 2009-06-03
WO2005110007A3 (fr) 2006-12-07

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