WO2007145796A2 - Cathetér à lumiéres multiples avec bout protégé - Google Patents

Cathetér à lumiéres multiples avec bout protégé Download PDF

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Publication number
WO2007145796A2
WO2007145796A2 PCT/US2007/012487 US2007012487W WO2007145796A2 WO 2007145796 A2 WO2007145796 A2 WO 2007145796A2 US 2007012487 W US2007012487 W US 2007012487W WO 2007145796 A2 WO2007145796 A2 WO 2007145796A2
Authority
WO
WIPO (PCT)
Prior art keywords
lumen
catheter
distal
assembly
protector
Prior art date
Application number
PCT/US2007/012487
Other languages
English (en)
Other versions
WO2007145796A3 (fr
Inventor
Donald A. Schon
Original Assignee
Twincath, Llc
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 Twincath, Llc filed Critical Twincath, Llc
Publication of WO2007145796A2 publication Critical patent/WO2007145796A2/fr
Publication of WO2007145796A3 publication Critical patent/WO2007145796A3/fr

Links

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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/0069—Tip not integral with tube
    • 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
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3621—Extra-corporeal blood circuits
    • A61M1/3653—Interfaces between patient blood circulation and extra-corporal blood circuit
    • A61M1/3659—Cannulae pertaining to extracorporeal circulation
    • A61M1/3661—Cannulae pertaining to extracorporeal circulation for haemodialysis
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/003—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the distal part of the catheter, e.g. filters, plugs or valves
    • A61M2025/0031—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the distal part of the catheter, e.g. filters, plugs or valves characterized by lumina for withdrawing or delivering, i.e. used for extracorporeal circuit treatment
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M2025/0037—Multi-lumen catheters with stationary elements characterized by lumina being arranged side-by-side
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/008—Strength or flexibility characteristics of the catheter tip
    • A61M2025/0081—Soft tip
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/0029—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the middle part of the catheter, e.g. slots, flaps, valves, cuffs, apertures, notches, grooves or rapid exchange ports
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked

Definitions

  • the present invention relates to a multi-lumen catheter assembly used to simultaneously withdraw and infuse a fluid to a body, such as during hemodialysis.
  • Catheters for the introduction or removal of fluids may be placed in various venous locations and cavities throughout the body for introduction or removal of these fluids. Such catheterization may be performed by using a single catheter assembly having multiple lumens.
  • a typical example of a multiple lumen catheter assembly is a dual lumen catheter in which one lumen introduces fluid and the other lumen removes fluid.
  • Such a multiple lumen catheter assembly is known as the SPLIT STREAM® catheter, manufactured and sold by Medical Components, Inc. of Harleysville, Pennsylvania.
  • the vessel is identified by aspiration through a long hollow needle in accordance with the well known Seldinger technique.
  • a thin guide wire is then introduced, typically through the puncturing needle or other introducer device into the lumen of the vessel.
  • the introducer device is then removed, leaving the guide wire within the vessel.
  • the guide wire projects beyond the surface of the skin.
  • several options are available to a physician for catheter placement. The simplest is to pass a catheter into the vessel directly over the guide wire. The guide wire is then removed, leaving the catheter in position within MED-OI lOPC the vessel.
  • the two lumens, the arterial lumen and the venous lumen are connected to a hemodialysis machine and are used to remove toxic blood from the patient for dialysis and to return dialyzed blood to the patient, respectively.
  • suction of the toxic blood into the arterial lumen may draw the distal opening of the arterial lumen against the wall of the blood vessel into which the lumen is inserted, reducing or cutting off blood flow through the arterial lumen, and significantly reducing the amount of blood being dialyzed. This reduction in blood flow can lead to longer dialysis period, or result in less dialysis of the patient's blood. It would be beneficial to provide a catheter that reduces the suction of the arterial lumen against the blood vessel wall.
  • the present invention is a dual lumen catheter having an arterial lumen and a venous lumen with discrete, axially staggered distal tip openings, wherein the venous lumen distal tip extends a selected distance beyond the distal tip of the arterial lumen.
  • the arterial lumen is provided with an opening such as a side opening as well as with several side port openings for withdrawing blood from the body.
  • the venous lumen provides return flow of the blood into the vessel.
  • the venous lumen distal tip portion includes a protective structure proximal of the distal tip opening that includes an enlarged proximal end that expands upon insertion of the catheter into the vessel to engage the vessel wall, and includes a plurality of openings therethrough to permit blood flow therethrough-
  • the protective structure centers the distal tip portion of the venous lumen and also centers the distal tip portion of the arterial lumen within the vessel wall whereby the arterial distal tip opening is not sucked into occlusive engagement with the vessel wall and diminish its efficiency in withdrawing blood from the vessel.
  • the protective structure is thin and of soft durometer and shaped like an umbrella, with a plurality of pleats that extend proximally from the connection of the protective structure with the venous lumen distal tip portion. Rounded proximal edge portions of the protective structure facilitate later removal of the catheter from the vessel.
  • FIG. 1 is a side view of a dual lumen catheter containing the present invention
  • FIG. 2 is an enlarged side view of the distal portion of the catheter of Fig. 1 after insertion of the catheter into a vessel, with the protective structure expanded to engage the vessel walls, and the flow of the blood in the vessel and into and from the arterial and venous distal tip openings, respectively;
  • Fig. 3 is a cross-sectional view of the distal portion of the catheter of Fig. 2.
  • a dual lumen catheter assembly 100 is illustrated that includes a catheter 102 having a proximal end 104, a distal end 106, and an elongated body 108 extending therebetween.
  • Catheter 102 comprises first and second catheter lumens, one being known as a venous lumen for returning blood to the patient, and the other being known as an arterial lumen for withdrawing blood from the patient. While the catheter body 108 preferably has a generally circular cross section, the first and second lumens each may have a generally "D-shaped" cross section, juxtaposed from each other across a common sidewall.
  • the lumens of the catheter could have a round or oval cross-sectional shape, and the two lumens could be attached side-by-side or be split apart at the distal end. It is preferred that the cross section of the body 108 be a generally smooth curve to facilitate sealing of the patient's skin around the body 108 at the incision site, as well as at the entrance to the vessel, to minimize bleeding.
  • a hub 110 is affixed onto the proximal end 104 of catheter 102, and preferably includes a suture wing that extends generally transverse of the body 108 and is shown to have two suture openings that allow an inserting physician to suture the hub 110 to the external skin of the patient into whom the physician has inserted the catheter assembly 100 to prevent the catheter assembly 100 from being dislodged from its inserted position within the patient.
  • first and second extension tubes 112 Joined to the proximal ends of the first and second lumens of the catheter 102 are first and second extension tubes 112 that fluidly communicate respectively with the first and second lumens within conduits of hub 110.
  • Proximal ends of the first and second extension tubes 112 preferably terminate at a first and second connectors 114, such as standard luer locks, as is well known in the art.
  • First and second clamps 116 such as a Roberts clamps, are preferably disposed over the first and second extension tubes 112 and serve to releasably close off each of the first and second extension tubes respectively, preventing fluid flow through each of the first and second extension tubes 112 when the respective clamps are in the closed position.
  • a catheter tissue ingrowth cuff 118 is disposed along an exterior of the body 108 between the distal tip 106 and the hub 110.
  • the catheter tissue ingrowth cuff 118 is used for chronic catheter insertions, wherein the catheter assembly 100 is intended to be inserted into the patient for extended periods of time, such as for several months.
  • the catheter tissue ingrowth cuff 118 is disposed within a subcutaneous tunnel according to methods known by those skilled in the art.
  • the present invention includes a distal tip protector 120 integrally defined on the distal tip 106 of catheter 102.
  • the distal portion of the catheter is shown in position inserted within a venous vessel V .
  • Catheter 102 is shown to include first lumen 122 for withdrawal of fluids from venous vessel V , and second lumen 124 for returning blood that was withdrawn from the vessel to be returned to the vessel.
  • the distal tip of second lumen 124 is located a distance distally of the distal tip of the first lumen, which minimizes any tendency of returned blood to be aspirated by the first lumen and which thus enhances the efficiency of the hemodialysis.
  • Flow of blood generally within the vessel V is shown by directional arrow A .
  • Flow of blood within first or arterial lumen 122 is shown by directional arrow B , with its intake occurring at first distal lumen opening 126 and preferably through one or more side ports 128; also, the distal tip of lumen 122 may be open.
  • Flow of blood within second or venous lumen 124 is shown by directional arrow C , with flow exiting from the lumen into the vessel from second distal lumen opening 130 and being parallel to vessel blood flow A .
  • Distal tip protector 120 is generally shaped like an umbrella or mushroom, and has numerous pleats 132 that allow the protector 120 to be compressed for insertion into the vessel.
  • Protector 120 also includes a generally rounded bottom edge 134 that allows the catheter to be eventually slid out of the vessel for removal.
  • a plurality of through-openings 136 are defined on the protector to allow blood flowing through the vessel past first distal opening 126, to continue flowing through and past the protector.
  • First distal lumen opening 126 is shown to be directed laterally, not axially, to further lessen the tendency of aspiration of returned blood exiting from second distal lumen opening 130.
  • lateral orientation without the protector 120 of the present invention, would make the opening susceptible to occlusion by the vessel wall.
  • Protector 120 while being quite flexible to facilitate insertion and removal of the catheter into and from the patient, is sufficiently rigid for rounded bottom edge 134 to press against the vessel wall and to center the distal catheter portion within the vessel V thus preventing occlusion of first distal lumen opening 126.
  • the body 108 is constructed from a polymer or elastomer, such as polyurethane or silicone, with a radiopaque filler material therein to aid in locating the body 108 within the patient's vessel after insertion, such as by ultrasound and fluoroscopy.
  • a polymer or elastomer such as polyurethane or silicone
  • a radiopaque filler material therein to aid in locating the body 108 within the patient's vessel after insertion, such as by ultrasound and fluoroscopy.
  • the body 108 has a hardness of approximately 70- A to 80- A on the Shore durometer scale, although those skilled in the art will recognize that the body 108 may be harder or softer.
  • the thickness of tip protector 120 could be in the range of from about 0.0010 in (0.254 mm) to about 0.0035 in (0.889 mm), and more preferably, from about 0.0015 in (0.381 mm) to about 0.0025 in (0.635 mm). If the material used is silicone elastomer, the thickness may be slightly thicker.
  • Protector 120 could be molded integrally with catheter body 108, but it could be solvent bonded or fused thereto. Regarding holes 136, they may each have a size of about 0.01 in (2.54 mm) to about 0.10 in (25.4 mm), and more preferably from about 0.03 in (7.62 mm) to about 0.07 in (17.8 mm).
  • All holes 136 should be relatively spaced away a slight distance from distal tip 130 and bottom edge 134 to preserve structural integrity, and be spaced apart from each other about 0.02 in ( 5.08 mm), for example. Openings 136 could have different diameters from each other, if desired; for example,
  • the openings near to distal tip 130 could be smaller than those near rounded proximal or bottom edge 134.
  • the openings could have rounded, oblong or oval or other shapes, as desired.
  • the holes could also be aligned in four or five columns extending longitudinally along the axis of the lumen.
  • an incision is initially made near an insertion site on the patient's skin, which is to be aspirated with a syringe or other introducer apparatus near or proximate the area to be catheterized. If the catheter assembly 100 is used for hemodialysis and the area to be catheterized is the internal jugular vein, the incision is made in the supra-clavicular triangle region. The exact location of the incision can be varied by the physician. Initially, the proximal portion of the catheter would have been located within a subcutaneous tunnel in the subcutaneous area of the patient's torso, using one of various tunneling techniques.
  • the distal end region of the catheter would have been pulled through the tunnel from a remote end of the tunnel, with the tunnel formed using a trocar or other tunneling tool, leaving the proximal end region at least partially within the tunnel, with the proximal end extending beyond the tunnel and exterior of the patient.
  • a hollow needle is inserted through the incision and into the vein, and the vein is then aspirated.
  • a guide wire is then passed through the needle and the needle is removed.
  • the catheter assembly 100 is inserted over the guide wire. This insertion technique eliminates the need for a sheath to be inserted over the guide wire, greatly reducing the risk of air embolism.
  • the dialysis machine draws blood from the vessel through the first lumen 122.
  • the protector 120 prevents the vessel wall from totally occluding the first distal opening 126 and shutting off blood flow through the first lumen 122.
  • the blood drawn into the first lumen 122 flows to the hemodialysis machine where the blood is cleaned and processed.
  • the blood is then pumped through the second lumen 124 for discharge back into the vessel through second distal opening 130 and side holes 136.

Abstract

L'invention concerne un ensemble cathéter à lumières multiples (100) comprenant un cathéter (102) possédant un corps allongé (108) avec une extrémité proximale (104) et une extrémité distale (106) ainsi qu'une première lumière (122) avec une première ouverture distale (126) disposée à son extrémité distale, et une deuxième lumière (124) reliée à la première lumière mais s'étendant à distance au-delà de celle-ci vers une deuxième ouverture distale (130). Selon l'invention, un protecteur (120) est ajouté à la deuxième lumière (124) distalement par rapport à la première ouverture distale (126) et s'étend radialement et d'une manière proximale par rapport à un bord proximal libre (134) pour se mettre en prise radialement avec les parois de vaisseau autour de la première ouverture distale afin de centrer le cathéter (102) à l'intérieur du vaisseau pour empêcher l'occlusion de la première ouverture distale (126). De plus, une pluralité d'ouvertures (136) traverse le protecteur (120) pour permettre au sang de circuler à travers celui-ci.
PCT/US2007/012487 2006-06-05 2007-05-25 Cathetér à lumiéres multiples avec bout protégé WO2007145796A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US81099806P 2006-06-05 2006-06-05
US60/810,998 2006-06-05

Publications (2)

Publication Number Publication Date
WO2007145796A2 true WO2007145796A2 (fr) 2007-12-21
WO2007145796A3 WO2007145796A3 (fr) 2008-07-31

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021084460A1 (fr) * 2019-10-29 2021-05-06 Orbusneich Medical Pte. Ltd. Dispositif de cathéter
US11338111B2 (en) 2014-09-15 2022-05-24 Orbusneich Medical Pte. Ltd. Vascular re-entry catheter

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5405320A (en) * 1990-01-08 1995-04-11 The Curators Of The University Of Missouri Multiple lumen catheter for hemodialysis
US20040167463A1 (en) * 2003-02-21 2004-08-26 Zawacki John A. Multi-lumen catheter with separate distal tips
US7335023B2 (en) * 2003-10-27 2008-02-26 Mahlmann Lee A Aspirator having a cushioned and aspiration controlling tip

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5405320A (en) * 1990-01-08 1995-04-11 The Curators Of The University Of Missouri Multiple lumen catheter for hemodialysis
US20040167463A1 (en) * 2003-02-21 2004-08-26 Zawacki John A. Multi-lumen catheter with separate distal tips
US7335023B2 (en) * 2003-10-27 2008-02-26 Mahlmann Lee A Aspirator having a cushioned and aspiration controlling tip

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11338111B2 (en) 2014-09-15 2022-05-24 Orbusneich Medical Pte. Ltd. Vascular re-entry catheter
WO2021084460A1 (fr) * 2019-10-29 2021-05-06 Orbusneich Medical Pte. Ltd. Dispositif de cathéter
EP4051162A4 (fr) * 2019-10-29 2023-12-27 Orbusneich Medical Pte. Ltd Cathéter à ré-entrée vasculaire

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