U.S. patent application number 13/679958 was filed with the patent office on 2013-03-28 for methods for image-guided delivery of anesthetics into the anatomy.
This patent application is currently assigned to CARTICEPT MEDICAL, INC.. The applicant listed for this patent is Carticept Medical, Inc.. Invention is credited to Michael Axelrod, Richard Knostman, Timothy Patrick, Carribeth Ramey.
Application Number | 20130079635 13/679958 |
Document ID | / |
Family ID | 48168771 |
Filed Date | 2013-03-28 |
United States Patent
Application |
20130079635 |
Kind Code |
A1 |
Patrick; Timothy ; et
al. |
March 28, 2013 |
METHODS FOR IMAGE-GUIDED DELIVERY OF ANESTHETICS INTO THE
ANATOMY
Abstract
Devices and systems for injecting fluids, such as anesthetics,
to or near nerve tissue or other targeted anatomical location are
disclosed herein. A conduit is generally configured to place the
fluid delivery module in fluid communication with a needle that is
configured to be inserted into the patient's anatomy. One or more
medicaments (e.g., anesthetics) and/or other materials contained
within containers (e.g., vials) that are secured to the injection
system can be selectively delivered into an anatomy through the
needle. Nerve stimulation and/or imaging technologies (e.g.,
ultrasound) can be used to locate a targeted anatomical location.
Aspiration can be used to confirm needle location. An overlay on
the imaging display can include, in addition to real-time imaging
data, data and other information relating to back pressure at or
near the needle tip, volumes or other amounts of fluids delivered
by and remaining within the system, stimulation level and/or the
like.
Inventors: |
Patrick; Timothy;
(Alpharetta, GA) ; Knostman; Richard; (Alpharetta,
GA) ; Axelrod; Michael; (Roswell, GA) ; Ramey;
Carribeth; (Suwanee, GA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Carticept Medical, Inc.; |
Alpharetta |
GA |
US |
|
|
Assignee: |
CARTICEPT MEDICAL, INC.
Alpharetta
GA
|
Family ID: |
48168771 |
Appl. No.: |
13/679958 |
Filed: |
November 16, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13493910 |
Jun 11, 2012 |
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13679958 |
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12823004 |
Jun 24, 2010 |
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13493910 |
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12340595 |
Dec 19, 2008 |
8002736 |
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12823004 |
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61016395 |
Dec 21, 2007 |
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61551760 |
Oct 26, 2011 |
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61618507 |
Mar 30, 2012 |
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Current U.S.
Class: |
600/439 ; 604/28;
604/512 |
Current CPC
Class: |
A61B 8/465 20130101;
A61M 1/0039 20130101; A61M 2039/242 20130101; A61M 2039/246
20130101; A61B 8/00 20130101; A61B 8/464 20130101; A61M 5/16827
20130101; A61M 5/1452 20130101; A61M 2209/084 20130101; A61B 8/461
20130101; A61M 5/19 20130101; A61M 2202/0241 20130101; A61M 5/20
20130101; A61B 2090/378 20160201; A61M 5/142 20130101; A61M 5/162
20130101; A61B 2017/3413 20130101; A61N 1/0502 20130101; A61B
5/4839 20130101; A61N 1/3605 20130101; A61M 2205/505 20130101; A61M
5/14216 20130101; A61M 5/1408 20130101; A61B 8/467 20130101 |
Class at
Publication: |
600/439 ;
604/512; 604/28 |
International
Class: |
A61M 5/20 20060101
A61M005/20; A61B 8/00 20060101 A61B008/00; A61M 1/00 20060101
A61M001/00; A61N 1/05 20060101 A61N001/05 |
Claims
1. A method of delivering an anesthetic to a target anatomical
location of a patient, comprising: positioning a container
containing an anesthetic to an injection system; wherein the
container is configured to be secured to a loading area of a fluid
delivery module of the injection system, said loading area being
configured to securely receive various sizes and shapes of the
container; wherein the fluid delivery module comprises at least one
fluid reservoir within its interior; wherein at least one fluid
conduit is configured to be placed in fluid communication with the
at least one fluid reservoir, said at least one fluid conduit
comprising a distal end; selectively transferring at least a
portion of the anesthetic from the container through the at least
one fluid conduit via the at least one fluid reservoir; removably
securing a stimulation needle along the distal end of the at least
one fluid conduit, said stimulation needle being configured to
provide electrical stimulation to an anatomy of the patient;
wherein the fluid delivery module comprises at least one motor,
said at least one motor being configured to facilitate the transfer
of the fluid through the at least one fluid conduit and to the
stimulation needle; and manipulating at least one controller to
regulate at least one aspect of the delivery of the anesthetic from
the fluid delivery module to the target anatomical location of the
patient according to a delivery scheme; and wherein the injection
system comprises a display configured to provide status information
related to the delivery of the anesthetic to the target anatomical
location; and wherein the system is configured to be placed in data
communication with an imaging device to assist in accurately
advancing the stimulation needle into the anatomy of the
patient.
2. The method of claim 1, wherein the stimulation needle is
configured to be in electrical communication with a nerve
stimulator device via at least one lead.
3. The method of claim 1, further comprising selectively delivering
an electrical impulse to the stimulation needle.
4. The method of claim 2, wherein the nerve stimulator device is
operatively coupled to the fluid delivery module.
5. The method of claim 1, wherein the display is additionally
configured to provide at least one real-time image obtained by the
imaging device.
6. The method of claim 1, wherein the imaging device comprises an
ultrasound device.
7. The method of claim 1, wherein the at least one controller
comprises a foot pedal assembly.
8. The method of claim 1, further comprising aspirating a volume of
native bodily fluid from the anatomy of the patient through the
stimulation needle.
9. The method of claim 8, wherein aspirating a volume of native
bodily fluid is performed, at least in part, to ensure that the
needle is appropriately positioned within the anatomy of the
patient.
10. The method of claim 8, wherein aspirating a volume of native
bodily fluid comprises applying a negative pressure to the at least
one fluid conduit.
11. The method of claim 1, further comprising a second container
containing a second medicament to the fluid delivery module of the
injection system, wherein the injection system is configured to
sequentially or simultaneously deliver the second medicament
through the at least one fluid conduit.
12. The method of claim 1, wherein the anesthetic comprises one or
more of mepivacaine, ropivacaine, ropivacaine with epinephrine,
mepivacaine with epinephrine and dextrose (D5W).
13. The method of claim 1, wherein the display is additionally
configured to provide data relating to an electrical impulse
provided to the stimulation needle.
14. The method of claim 1, wherein, during delivery of the
anesthetic to the at least one fluid conduit, the display is
additionally configured to provide data relating to a back pressure
against which the anesthetic is being delivered.
15. A method of delivering an anesthetic to a target anatomical
location of a patient, comprising: positioning a container
containing an anesthetic to an injection system; wherein the
container is configured to be secured to a loading area of a fluid
delivery module of the injection system, said loading area being
configured to securely receive various sizes and shapes of the
container; wherein the fluid delivery module comprises at least one
fluid reservoir within its interior; wherein at least one fluid
conduit is configured to be placed in fluid communication with the
at least one fluid reservoir, said at least one fluid conduit
comprising a distal end; selectively transferring at least a
portion of the anesthetic from the container through the at least
one fluid conduit via the at least one fluid reservoir; removably
securing a needle along the distal end of the at least one fluid
conduit; wherein the fluid delivery module comprises at least one
motor, said at least one motor being configured to facilitate the
transfer of the fluid through the at least one fluid conduit and to
the needle; and manipulating at least one controller to regulate at
least one aspect of the delivery of the anesthetic from the fluid
delivery module to the target anatomical location of the patient
according to a delivery scheme; and wherein the injection system
comprises a display configured to provide status information
related to the delivery of the anesthetic to the target anatomical
location; wherein the display is additionally configured to provide
at least one real-time image obtained by the imaging device; and
wherein the system is configured to detect a back-pressure
associated with a delivery of the anesthetic through the at least
one fluid conduit.
16. The method of claim 15, wherein the distal end of the at least
one conduit is configured to receive a stimulation needle, said
stimulation needle being configured to provide an electrical
impulse to an anatomy of the patient.
17. The method of claim 15, wherein the imaging device comprises an
ultrasound device.
18. The method of claim 15, wherein the at least one controller
comprises a foot pedal assembly.
19. The method of claim 15, further comprising aspirating a volume
of native bodily fluid from the anatomy of the patient through the
needle.
20. The method of claim 15, wherein the display is additionally
configured to provide data relating to at least one or more of the
following: the back-pressure associated with a delivery of the
anesthetic through the at least one fluid conduit, a volume of the
anesthetic delivered to the patient, a volume of the anesthetic
remaining to be delivered to the patient and an electrical output
provided to the needle.
Description
RELATED APPLICATIONS AND INCORPORATION BY REFERENCE
[0001] This is a continuation of U.S. patent application Ser. No.
13/493,910, filed Jun. 11, 2012, which is a continuation-in-part of
U.S. patent application Ser. No. 12/823,004, filed Jun. 24, 2010
and published on Jan. 27, 2011 as U.S. Publication No.
2011/0021905, which is a continuation-in part of U.S. patent
application Ser. No. 12/340,595, filed Dec. 19, 2008 and issued
Aug. 23, 2011 as U.S. Pat. No. 8,002,736, which claims priority
benefit under 35 U.S.C. .sctn.119(e) of U.S. Provisional Patent
Application No. 61/016,395, filed Dec. 21, 2007, the entireties of
all of which are hereby incorporated by reference and made a part
of the present specification. U.S. patent application Ser. No.
13/493,910, filed Jun. 11, 2012 also claims priority benefit under
35 U.S.C. .sctn.119(e) of U.S. Provisional Patent Applicant No.
61/551,760, filed Oct. 26, 2011, the entirety of which is hereby
incorporated by reference herein and made a part of the present
specification. The present application also claims priority benefit
under 35 U.S.C. .sctn.119(e) of U.S. Provisional Patent Applicant
No. 61/618,507, filed Mar. 30, 2012, the entirety of which is also
hereby incorporated by reference herein and made a part of the
present specification.
BACKGROUND
[0002] 1. Field
[0003] This application relates generally to injection and/or
aspiration devices, systems and methods, and more specifically, to
devices, systems and methods of delivering anesthetics, other
pharmaceuticals or fluids and/or other substances to a patient.
[0004] 2. Description of the Related Art
[0005] Physicians, clinicians and/or other medical personnel often
need to deliver a volume of anesthetic or other medication (e.g.,
steroid), other fluid and/or other material to or near (or aspirate
fluid from) an anatomical location, such as, for example nerve
tissue, a joint, an organ and/or the like. Accordingly, a needle
can be inserted through a patient's skin and into the targeted
location. A syringe or other fluid source that is in fluid
communication with the needle can then be used to deliver the
desired volume or other dosage of a medicament (e.g., anesthetic),
fluid and/or other material to the targeted anatomical
location.
[0006] For example, physicians, clinicians, and/or other medical
personnel often administer anesthetic agents to patients before
and/or during surgical and/or other medical procedures. Anesthetics
(e.g., nerve blocks) can be delivered to or near particular nerves
to cause the temporary loss or reduction of sensation in particular
areas of the patient's body. Anesthetics can provide one or more
benefits and/or other advantages to patients, such as, for example,
decreased post-operative pain, decreased nausea, lower incidence of
blood clots, less blood loss, shorter hospital stays after
ambulatory surgery, such as orthopedic surgery, a lessened stress
response by the body and/or the like. Anesthetics can be
particularly appealing to patients undergoing orthopedic
procedures, which often involve limbs and are associated with a
significant amount of post-operative pain. For example, nerve
blocks are often used for procedures used in the repair of certain
joints and/or other portions of the anatomy (e.g., shoulders, ACL,
knee, elbow, hand procedures wrist, ankle, fingers, toes,
etc.).
[0007] Anesthetics can also be used for pain management purposes,
for example, chronic neck, back, joint pain and/or the like. In
some embodiments, an anesthetic injection procedure is
accomplished, at least in part, using one or more drugs, other
medicaments or fluids (e.g., alcohol or phenol) and/or the like
that at least partially destroy nerve tissue. Although anesthetics
can provide significant pain relief and offer many advantages and
other benefits relating to surgical and/or other medical
procedures, it still carries a risk of injury and other
complications, such as, for example, inadvertent or unintended
nerve damage and adverse effects resulting from a failure to
properly locate targeted nerve tissue. Accordingly, various
embodiments of improved anesthetic delivery systems are disclosed
herein.
SUMMARY
[0008] According to some embodiments, an imaging-guided injection
system for delivering an anesthetic to a target anatomical location
of a patient comprises a fluid delivery module comprising at least
one loading area configured to receive a container comprising an
anesthetic, the at least one loading area (e.g., nest or other
receiving area) being configured to securely receive various sizes
and shapes of the container, at least one fluid reservoir (e.g.,
syringe, other reservoir, etc.) within an interior of the fluid
delivery module and at least one fluid conduit (e.g., single or
multiple lumen tubing or other conduit) configured to be placed in
fluid communication with the at least one fluid reservoir, wherein
the at least one fluid conduit comprising a distal end. In some
embodiments, the fluid delivery module is configured to selectively
transfer at least a portion of the anesthetic from the container
through the at least one fluid conduit via the at least one fluid
reservoir, wherein the distal end of the at least one fluid conduit
is configured to removably receive a needle (e.g., a stimulation
needle, a non-stimulation needle, etc.), and wherein the
stimulation needle being configured to provide electrical
stimulation to an anatomy of the patient. In some embodiments, the
fluid delivery module comprises at least one motor (e.g., stepper
motor, other type of motor or actuator, etc.), wherein the at least
one motor being configured to facilitate the transfer of the fluid
through the at least one fluid conduit and to the stimulation
needle. In some embodiments, the injection system further comprises
at least one controller configured to regulate at least one aspect
of the delivery of the anesthetic from the fluid delivery module to
the target anatomical location of the patient according to a
delivery scheme. In one embodiment, the system further includes a
display configured to provide status information related to the
delivery of the anesthetic to the target anatomical location. The
display can be associated with the fluid delivery module, another
component or portion of the injection system, an imaging device
and/or the like. In some embodiments, the system is configured to
be placed in data communication with an imaging device (e.g.,
ultrasound device) to assist in accurately advancing the
stimulation needle into the anatomy of the patient.
[0009] According to some embodiments, the stimulation needle is
configured to be in electrical communication with a nerve
stimulator device via at least one lead (e.g., wire). In some
embodiments, the nerve stimulator device is operatively coupled to
the fluid delivery module. In other embodiments, the nerve
stimulatory device is not operatively coupled to the fluid delivery
module or any other portion of the injection system. In some
embodiments, the display is additionally configured to provide at
least one real-time image obtained by the imaging device. In some
embodiments, the imaging device comprises an ultrasound device. In
one embodiment, the at least one controller comprises a foot pedal
assembly. In some embodiments, the foot pedal assembly comprises
two, three, four or more independently controllable foot pedals,
wherein each of the foot pedals are configured to regulate a
different aspect of the system.
[0010] According to some embodiments, the system is configured to
aspirate a volume of native bodily fluid from the anatomy of the
patient through the stimulation needle. In some embodiments, a
volume of native bodily fluid from the anatomy of the patient is
configured to be aspirated through the stimulation needle by
applying a negative pressure to the at least one fluid conduit.
[0011] According to some embodiments, the at least one loading area
comprises a first loading area and at least a second loading area,
wherein the first loading area is configured to receive a container
containing the anesthetic, and wherein the second loading area is
configured to receive a second container comprising a second fluid.
In some embodiments, the second fluid comprises an anesthetic (the
same or a different anesthetic that is loaded in the first loading
area) and a non-anesthetic (e.g., steroid, saline, other active or
non-active ingredients, formations thereof, etc.). In some
embodiments, the system comprises three or more than three loading
areas. In some embodiments, the anesthetic comprises one or more of
mepivacaine, ropivacaine, ropivacaine with epinephrine, mepivacaine
with epinephrine, dextrose (D5W) and/or the like.
[0012] According to some embodiments, the display is additionally
configured to provide data relating to an electrical output
provided to the stimulation needle. In some embodiments, during
delivery of the anesthetic to the at least one fluid conduit, the
display is additionally configured to provide data relating to a
back pressure against which the anesthetic is being delivered. In
some embodiments, the display is additionally configured to provide
data relating to at least one or more of the following: the
back-pressure associated with a delivery of the anesthetic through
the at least one fluid conduit, a volume of the anesthetic
delivered to the patient, a volume of the anesthetic remaining to
be delivered to the patient, an electrical output provided to the
needle, patient information, physician and/or facility information,
date and time and/or the like.
[0013] According to some embodiments, a method of delivering an
anesthetic to a target anatomical location of a patient comprises
positioning a container containing an anesthetic to an injection
system, wherein the container is configured to be secured to a
loading area (e.g., nest or received area) of a fluid delivery
module of the injection system, wherein the loading area is
configured to securely receive various sizes and shapes of the
container (e.g., vial, syringe, ampoule, etc.). In some
embodiments, the fluid delivery module comprises at least one fluid
reservoir within its interior, wherein at least one fluid conduit
is configured to be placed in fluid communication with the at least
one fluid reservoir, said at least one fluid conduit comprising a
distal end. The method further comprises selectively transferring
at least a portion of the anesthetic from the container through the
at least one fluid conduit via the at least one fluid reservoir and
securing (e.g., removably) a needle (e.g., stimulation needle,
non-stimulation needle, etc.) along the distal end of the at least
one fluid conduit, wherein the stimulation needle is configured to
provide electrical stimulation to an anatomy of the patient. In
some embodiments, the fluid delivery module comprises at least one
motor (e.g., stepper motor, other type of motor, etc.), wherein the
motor is configured to facilitate the transfer of the fluid through
the at least one fluid conduit and to the stimulation needle. In
some embodiments, the method further comprises manipulating at
least one controller to regulate at least one aspect of the
delivery of the anesthetic from the fluid delivery module to the
target anatomical location of the patient according to a delivery
scheme. In some embodiments, the injection system comprises a
display configured to provide status information related to the
delivery of the anesthetic to the target anatomical location. In
one embodiment, the system is configured to be placed in data
communication with an imaging device to assist in accurately
advancing the stimulation needle into the anatomy of the
patient.
[0014] According to some embodiments, the stimulation needle is
configured to be in electrical communication with a nerve
stimulator device via at least one lead. In some embodiments, the
method further comprises selectively delivering an electrical
impulse to the stimulation needle. In one embodiment, the nerve
stimulator device is operatively coupled to the fluid delivery
module. In some embodiments, the display is additionally configured
to provide at least one real-time image obtained by the imaging
device (e.g., ultrasound device). In some embodiments, the
controller comprises a foot pedal assembly (e.g., with one, two,
three or more individual pedals), a button, a dial and/or the
like.
[0015] According to some embodiments, the method further comprises
aspirating a volume of native bodily fluid from the anatomy of the
patient through the stimulation needle. In some embodiments,
aspirating a volume of native bodily fluid is performed, at least
in part, to ensure that the needle is appropriately positioned
within the anatomy of the patient. In some embodiments, aspirating
a volume of native bodily comprises applying a negative pressure to
the at least one fluid conduit. In one embodiment, aspirating fluid
comprises attaching a syringe or other device to a stopcock in
fluid communication with the conduit and creating a suction or
vacuum in the conduit by manipulating the syringe or other device.
In some embodiments, aspirating fluids comprises using a mechanical
or other non-manual device (e.g., fluid delivery module), other
handheld device, etc. According to some embodiments, the display is
additionally configured to provide data relating to an electrical
impulse provided to the stimulation needle. In some embodiments,
during delivery of the anesthetic to the at least one fluid
conduit, the display is additionally configured to provide data
relating to a back pressure against which the anesthetic is being
delivered. In some embodiments, the display is additionally
configured to provide data relating to at least one or more of the
following: the back-pressure associated with a delivery of the
anesthetic through the at least one fluid conduit, a volume of the
anesthetic delivered to the patient, a volume of the anesthetic
remaining to be delivered to the patient, an electrical output
provided to the needle, patient information, physician and/or
facility information, date and time and/or the like.
[0016] Several embodiments of the present application
advantageously help provide for more precise and accurate delivery
of anesthetics to or near target nerves or other anatomical
locations to help reduce the risks of nerve damage, anesthesia
toxicity, and/or other adverse effects. As used herein, the term
anesthetic is a broad term and includes, without limitation, any
pharmaceutical, medicament, formulation and/or any other fluid,
substance or material that causes anesthesia or a loss (e.g.,
reversible or permanent loss) of sensation. Anesthetics include,
but are not limited to, local or regional anesthetics, analgesics
and/or other painkillers or pain relieving materials, medicaments,
materials and/or substances (e.g., alcohol, phenol, etc.) that at
least partially destroy nerve tissue and/or the like. The terms
anesthetic, anesthetic agent, nerve block and the like are used
interchangeably herein. Anesthetics can include pharmaceuticals
and/or formulations or combinations thereof. Further, anesthetics
can include one or more substances that are also configured to
provide at least some benefit or effect on nerves and related
tissues, including cooling or cryogenic materials, other numbing or
related substances and/or the like.
[0017] According to some embodiments, a system for delivering one
or more fluids, for example, anesthetic agents, to a target
anatomical location of a patient, for example, to or near a nerve,
includes a fluid delivery module. The fluid deliver module can
include at least one loading area configured to receive a container
holding a fluid, the loading area configured to securely receive
various sizes and shapes of the container. The container can be,
for example, a vial, ampoule, syringe, or any other container. In
some embodiments, the one or more fluids is/are one or more
anesthetic agents selected from the group: mepivacaine,
ropivacaine, ropivacaine with epinephrine, mepivacaine with
epinephrine, dextrose (D5W), and/or saline. The fluid delivery
module further includes at least one reservoir, for example, a
syringe body, within its interior and at least one moveable member,
for example, a syringe plunger, slidably positioned within the
reservoir. The fluid delivery module is configured to transfer at
least a portion of the fluid from the container to the reservoir.
In some embodiments, the fluid delivery module includes at least
one motor configured to move the moveable member into or out of the
reservoir. Fluid is transferred from the container to the reservoir
when the movable member is moved in a first direction, for example,
by the at least one motor. In some embodiments, fluid is
transferred from the container to the reservoir when the movable
member or plunger is moved out of the reservoir or syringe body,
thereby creating a vacuum within the reservoir and drawing fluid
into the reservoir from the container. The system further includes
a needle configured to be positioned within an anatomy of a
patient. The needle is also configured to be in fluid communication
with the reservoir of the fluid delivery module via tubing situated
between the needle and fluid delivery module. Fluid is transferred
from the reservoir to the tubing and needle when the movable member
is moved in a second direction, for example, by the at least one
motor. In some embodiments, fluid is transferred from the reservoir
to the tubing and needle when the movable member or plunger is
moved into the reservoir or syringe body, thereby forcing the fluid
into the tubing from the reservoir. The fluid delivery module is
configured to receive instructions for delivering fluid to the
needle, for example, via user input into a user interface. The
system also includes a nerve stimulator. The needle is configured
to provide electrical stimulation to the anatomy of the patient to
help determine a position of the needle within the anatomy of the
patient. The system further includes a display configured to
provide status information of an injection procedure.
[0018] According to some embodiments, the needle is configured to
be in electrical communication with the nerve stimulator via a lead
situated between the needle and nerve stimulator. The nerve
stimulator can be a stand-alone device or integrated with the fluid
delivery module. In some embodiments, the needle is a nerve
stimulation needle. For example, the needle can be insulated over a
majority of its length and can have a conductive tip to localize
electrical stimulation of the anatomy of the patient to the area
proximate the needle tip.
[0019] In some embodiments, the system includes an imagining device
configured to assist the user with accurately advancing the needle
to the target anatomical location. For example, the imaging device
can be an ultrasound device. The display can be configured to
provide at least one real-time image obtained by the imagining
device. In some embodiments, the display can provide dynamic
real-time images throughout a duration of an injection procedure.
In some embodiments, the display is an ultrasound display. In some
embodiments, the display is a display of the fluid delivery module.
According to some embodiments, the display is configured to provide
data obtained from an output of the nerve stimulator.
[0020] According to some embodiments, the system includes a
controller configured to regulate the delivery of the fluid to the
needle. For example, the controller can be a foot pedal or foot
pedal assembly, button, knob, or any other suitable controller. The
system can further be configured to aspirate a volume of native
body fluids from the anatomy of the patient through the needle.
Aspiration can be performed manually or with mechanical, hydraulic,
pneumatic, or other assistance. For example, aspiration can be
performed manually by coupling a syringe to a stopcock, valve, or
the like positioned in the tubing between the needle and fluid
delivery module, adjusting the stopcock, valve, or the like to a
position whereby a portion of the tubing between the stopcock,
valve, or the like and the fluid delivery module is blocked, and
withdrawing a plunger of the syringe to create a negative pressure
within the syringe, portion of tubing between the stopcock, valve,
or the like and the needle, and needle to draw native bodily fluids
into and through the needle. Alternatively, the fluid delivery
module can be configured to provide aspiration of native body
fluids through the needle.
[0021] According to some embodiments, a method for delivering one
or more fluids, for example, one or more anesthetic agents, to a
target anatomical location of a patient, for example, to or near a
nerve, comprises loading a fluid delivery module with a fluid
container. In some embodiments, the fluid delivery module includes
at least one loading area configured to receive a container holding
a fluid, and the loading area is configured to securely receive
various sizes and shapes of the container. In some embodiments, the
one or more fluids are one or more anesthetic agents, for example,
selected from the group of: mepivacaine, ropivacaine, ropivacaine
with epinephrine, mepivacaine with epinephrine, dextrose (D5W),
and/or saline: The fluid delivery module further includes at least
one reservoir, for example, a syringe body, within its interior, at
least one moveable member, for example, a syringe plunger, slidably
positioned within the reservoir or syringe body, and at least one
motor configured to move the moveable member into or out of the
reservoir. The fluid delivery module can be configured to transfer
at least a portion of the fluid from the container to the
reservoir.
[0022] The method further includes transferring fluid from the
container to the reservoir by moving the movable member in a first
direction. For example, fluid can be transferred from the container
to the reservoir by withdrawing the plunger from the syringe body.
The method includes manipulating at least a portion of a needle
into an anatomy of a patient. The needle is configured to be in
fluid communication with the reservoir of the fluid delivery module
via tubing situated between the needle and fluid delivery module.
In some embodiments, the needle is further configured to provide
electrical stimulation to the anatomy of the patient, and the
method includes electrically stimulating portions of the patient's
anatomy to determine a position of the needle. Once the target
location has been located, the method includes transferring fluid
from the reservoir of the fluid delivery module to the tubing and
needle by moving the movable member in a second direction, for
example, by advancing the syringe plunger within the syringe body.
In some embodiments, the method further includes viewing status
information regarding an injection procedure on a display.
[0023] In some embodiments, the method includes visualizing the
needle as it is manipulated into the anatomy of the patient with an
imaging device, for example, an ultrasound device. The method can
include viewing at least one real-time image obtained by the
imaging device on the display. In some embodiments, dynamic
real-time images can be viewed on the display throughout a duration
of an injection procedure. In some embodiments, the method also
includes viewing data from a nerve stimulator that is in electrical
communication with the needle on the display. In some embodiments,
the method further comprises aspirating a volume of native bodily
fluids from the anatomy of the patient through the needle to
confirm the needle is not positioned improperly, for example, to
confirm the needle is not within a blood vessel.
[0024] According to some embodiments, a system for delivering one
or more fluids, for example, one or more anesthetic agents, to a
target anatomical location, for example, to or near a nerve,
comprises a fluid delivery module that includes at least one
loading area configured to receive a container comprising a fluid,
the loading area configured to securely receive various sizes and
shapes of the container. In some embodiments, the one or more
fluids are one or more anesthetic agents selected from the group
of: mepivacaine, ropivacaine, ropivacaine with epinephrine,
mepivacaine with epinephrine, dextrose (D5W), and/or saline. The
fluid delivery module also includes at least one reservoir, for
example, a syringe body, within its interior, at least one moveable
member, for example, a syringe plunger, slidably positioned within
the reservoir, and at least one motor configured to move the
moveable member into or out of the reservoir. The fluids delivery
module can be configured to transfer at least a portion of the
fluid from the container to the reservoir. Fluid can be transferred
from the container to the reservoir when the moveable member is
moved in a first direction, for example, when the syringe plunger
is withdrawn from the syringe body, thereby creating a vacuum
within the syringe body to draw fluid into the syringe body.
[0025] In some embodiments, a needle is configured to be positioned
within an anatomy of a patient and is further configured to be in
fluid communication with the reservoir of the fluid delivery module
via tubing situated between the needle and fluid delivery module.
Fluid is transferred from the reservoir to the tubing and needle
when the movable member is moved in a second direction, for
example, when the plunger is pushed into the syringe body, thereby
forcing fluid out of the syringe body into the tubing and to the
needle. The fluid delivery module can be configured to receive
instructions for delivering the fluid to the needle. In some
embodiments, the system is configured to aspirate a volume of
native body fluids from the anatomy of the patient through the
needle. Aspiration can be performed manually or with mechanical,
hydraulic, pneumatic, or other assistance. For example, aspiration
can be performed manually by coupling a syringe to a stopcock,
valve, or the like positioned in the tubing between the needle and
fluid delivery module, adjusting the stopcock, valve, or the like
to a position whereby a portion of the tubing between the stopcock,
valve, or the like and the fluid delivery module is blocked, and
withdrawing a plunger of the syringe to create a negative pressure
within the syringe, portion of tubing between the stopcock, valve,
or the like and the needle, and needle to draw native bodily fluids
into and through the needle. Alternatively, the fluid delivery
module can be configured to provide aspiration of native body
fluids through the needle.
[0026] In some embodiments, the system further includes an imaging
device, for example, and ultrasound device, configured to assist a
user with accurately advancing the needle to the target anatomical
location. The system can also include a display configured to
provide status information of an injection procedure. In some
embodiments, the display is an ultrasound display. In some
embodiments, the display is a display of the fluid delivery module.
According to some embodiments, the system includes a nerve
stimulator, and the needle is configured to be in electrical
communication with the nerve stimulator via a lead. Data from the
nerve stimulator can also be provided on the display.
[0027] According to some embodiments, a method for delivering one
or more fluids, for example, one or more anesthetic agents, to a
target anatomical location of a patient, for example, to or near a
nerve, includes loading a fluid delivery module with a fluid
container. In some embodiments, the fluid delivery module includes
at least one loading area configured to receive a container holding
a fluid, and the loading area is configured to securely receive
various sizes and shapes of the container. In some embodiments, the
one or more fluids are one or more anesthetic agents, for example,
selected from the group of: mepivacaine, ropivacaine, ropivacaine
with epinephrine, mepivacaine with epinephrine, dextrose (D5W),
and/or saline: The fluid delivery module further includes at least
one reservoir, for example, a syringe body, within its interior, at
least one moveable member, for example, a syringe plunger, slidably
positioned within the reservoir or syringe body, and at least one
motor configured to move the moveable member into or out of the
reservoir. The fluid delivery module can be configured to transfer
at least a portion of the fluid from the container to the
reservoir.
[0028] The method further includes visualizing the needle as it is
manipulated into the anatomy of the patient with an imaging device,
for example, an ultrasound device. The method can also include
aspirating a volume of native bodily fluids from the anatomy of the
patient through the needle to confirm the needle is not positioned
improperly, for example, to confirm the needle is not within a
blood vessel. The needle is configured to be in fluid communication
with the reservoir of the fluid delivery module via tubing situated
between the needle and fluid delivery module, and the method
includes transferring fluid from the reservoir to the tubing and
needle by moving the movable member in a second direction, for
example, by pushing the syringe plunger into the syringe body. The
method includes viewing status information regarding an injection
procedure on a display. In some embodiments, the display is an
ultrasound display. In some embodiments, the display is a display
of the fluid delivery module.
[0029] According to some embodiments, the method includes
electrically stimulating portions of the patient's anatomy with a
nerve stimulator in electrical communication with the needle to
determine a position of the needle. In some embodiments, the method
also includes viewing data obtained from an output of the nerve
stimulator on the display.
[0030] According to some embodiments, a system for delivering one
or more fluids, for example, one or more anesthetic agents, to a
target anatomical location, for example, an epidural space,
comprises a fluid delivery module that includes at least one
loading area configured to receive a container comprising a fluid,
the loading area configured to securely receive various sizes and
shapes of the container. In some embodiments, the one or more
fluids are one or more anesthetic agents. The fluid delivery module
also includes at least one reservoir, for example, a syringe body,
within its interior, at least one moveable member, for example, a
syringe plunger, slidably positioned within the reservoir, and at
least one motor configured to move the moveable member into or out
of the reservoir. The fluids delivery module can be configured to
transfer at least a portion of the fluid from the container to the
reservoir. Fluid can be transferred from the container to the
reservoir when the moveable member is moved in a first direction,
for example, when the syringe plunger is withdrawn from the syringe
body, thereby creating a vacuum within the syringe body to draw
fluid into the syringe body.
[0031] In some embodiments, a catheter is configured to be
positioned within an anatomy of a patient, for example, the
epidural space, and is further configured to be in fluid
communication with the reservoir of the fluid delivery module.
Fluid is transferred from the reservoir to the catheter when the
movable member is moved in a second direction, for example, when
the plunger is pushed into the syringe body, thereby forcing fluid
out of the syringe body to the catheter. The fluid delivery module
can be configured to receive instructions for delivering the fluid
to the catheter.
[0032] According to some embodiments, an injection system for
delivering at least two different medicaments (e.g., an anesthetic)
into a patient using a single needle penetration includes a fluid
delivery module comprising a first loading area configured to
receive a first container and a second loading area configured to
receive a second container. The injection system further includes a
handpiece assembly in fluid communication with the fluid delivery
module. In one embodiment, the handpiece assembly is disposable. In
some embodiments, the handpiece assembly is configured to removably
receive a needle assembly at a distal end of the handpiece
assembly. In one embodiment, the needle assembly comprises a
needle. In several embodiments, the handpiece assembly comprises
tubing that places the handpiece assembly and the needle assembly
in fluid communication with the fluid delivery module. In some
embodiments, the injection system further includes a control module
comprising at least one controller configured to receive
instructions for delivery of the first medicament and the second
medicament to the patient. In some embodiments, the control module
is configured to be removably secured to the handpiece assembly. In
one embodiment, the first container comprises a first medicament,
and the second container comprises a second medicament or other
fluid, wherein the second medicament or fluid is different than
said first medicament. In some embodiments, the first loading area
is configured to securely receive varying sizes and shapes of the
first container, and the second loading area is configured to
securely receive varying sizes and shapes of the second container.
In one embodiment, the injection system is configured to receive
instructions for delivering the first and second medicaments to the
handpiece assembly. According to some embodiments, the fluid
delivery module is configured to transfer at least a portion of the
first medicament from the first container to a first reservoir of
the fluid delivery module, and the fluid delivery module is
configured to transfer at least a portion of the second medicament
from the second container to a second reservoir of the fluid
delivery module. In several embodiments, the handpiece assembly is
maneuverable to position the needle within the patient to
facilitate delivery of the first medicament and the second
medicament into said patient with a single penetration of said
needle. In some embodiments, the injection system further includes
at least one motor housed within the fluid delivery module to
mechanically transfer the first medicament and the second
medicament to the patient.
[0033] According to some embodiments, an injection system for
delivering at least one medicament (e.g., an anesthetic) into a
patient using a single needle penetration comprises a fluid
delivery module having a disposable cassette, which comprises a
first loading area configured to receive a first container and a
second loading area configured to receive a second container. In
some embodiments, the first container comprises a first medicament,
and the second container comprises a second medicament. In one
embodiment, the first loading area is configured to securely
receive varying sizes and shapes of the first container, and the
second loading area is configured to securely receive varying sizes
and shapes of the second container. In some embodiments, the
injection system additionally comprises a handpiece assembly in
fluid communication with the cassette. In one embodiment, the
handpiece assembly is configured to removably receive a needle
assembly at a distal end of the handpiece assembly, wherein the
needle assembly includes a needle. In some embodiments, the
handpiece assembly comprises tubing that places the handpiece
assembly and the needle assembly in fluid communication with the
cassette. In several embodiments, the injection system is
configured to receive instructions for delivering the first and
second medicaments to the handpiece assembly. In one embodiment,
the fluid delivery module is configured to transfer at least a
portion of the first medicament from the first container to a first
reservoir of the fluid delivery module, and the fluid delivery
module is configured to transfer at least a portion of the second
medicament from the second container to a second reservoir of the
fluid delivery module. In some embodiments, the first medicament
exiting the first reservoir and the second medicament exiting the
second reservoir are configured to be combined within the
disposable cassette, upstream of the handpiece assembly. In some
embodiments, the handpiece assembly is maneuverable to position the
needle within the patient. In some embodiments, the fluid delivery
module comprises at least one motor to mechanically deliver at
least one of the first medicament and the second medicament to the
patient.
[0034] According to some embodiments, a method for delivering at
least one or more (e.g., two, three, etc.) different anesthetic
agents and/or other medicaments into a patient using a single
needle penetration includes providing a fluid delivery module
comprising a first loading area configured to receive a first
container and a second loading area configured to receive a second
container. The method further includes providing a disposable
handpiece assembly configured to be placed in fluid communication
with the fluid delivery module. In some embodiments, the handpiece
assembly is configured to removably receive a needle assembly at a
distal end of the handpiece assembly, said needle assembly
comprising a needle. In one embodiment, the handpiece assembly
comprises tubing that places the handpiece assembly and the needle
assembly in fluid communication with the fluid delivery module. In
some embodiments, the method additionally comprises providing a
control module having at least one controller configured to receive
instructions for delivery of the first medicament and the second
medicament to the patient. In some embodiments, the control module
is configured to be removably secured to the handpiece assembly. In
one embodiment, the first container comprises a first medicament,
and the second container comprises a second medicament. In some
embodiments, the second medicament is different (e.g., in type,
concentration, etc.) than said first medicament. In some
embodiments, the first loading area is configured to securely
receive varying sizes and shapes of the first container, and the
second loading area is configured to securely receive varying sizes
and shapes of the second container.
[0035] According to some embodiments, the first medicament exiting
the first reservoir and the second medicament exiting the second
reservoir are configured to be combined within the disposable
cassette, upstream of the handpiece assembly. In some embodiments,
the first and/or the second medicaments comprise an anesthetic. In
some embodiments, the method additionally comprises maneuvering the
handpiece assembly to position the needle into or near a targeted
anatomical location of the patient (e.g., at or near a nerve or
nerve bundle, an organ, a joint, etc.). In one embodiment, the
method includes delivering a volume of at least one of the first
medicament and the second medicament into the patient with a single
needle penetration. In some embodiments, the fluid delivery module
comprises at least one motor to mechanically facilitate the
delivery of at least one of the first medicament and the second
medicament to the patient.
[0036] According to some embodiments, the first loading area and
the second loading area are configured to receive nonspecific fluid
containers. In one embodiment, the first container and/or the
second container is an original manufacturer's vial, ampoule or
other container. In one embodiment, the first and second
medicaments are delivered simultaneously to a target anatomical
location of the patient. In other embodiments, the first and second
medicaments are delivered sequentially to a target anatomical
location of the patient. In some embodiments, the first and second
loading areas and the first and second reservoirs are included in a
disposable cassette, wherein the disposable cassette is removably
positioned within a corresponding recess of the fluid delivery
module. In one embodiment, the first and second medicaments exiting
the first and second reservoirs, respectively, are configured to be
combined within the disposable cassette, upstream of the handpiece
assembly.
[0037] According to some embodiments, the fluid delivery module
further comprises a third loading area configured to receive a
third container containing a third medicament, wherein the
injection system is configured to receive instructions for
simultaneously or sequentially delivering the first, second and
third medicaments through the handpiece assembly to a patient. In
another embodiment, the controller comprises at least one button,
dial, knob, switch, rollerball, rollerwheel and/or the like. In one
embodiment, the fluid delivery module comprises a display (e.g.,
touchscreen) configured to provide status information of an
injection procedure. In some embodiments, the status information
comprises a volume of the first or second medicaments delivered
through the handpiece assembly, a volume remaining in the first and
second reservoirs of the fluid delivery module, the pressure
against which the fluids are being delivered, an ultrasound or
other imaging display showing the needle in relation to the
patient's anatomy and/or any other data, images or information. In
some embodiments, the fluid delivery module is in data
communication with an imaging device (e.g., ultrasound device or
system) configured to help locate a targeted anatomical location
within the patient.
[0038] According to some embodiments, the first medicament
comprises an anesthetic and the second medicament comprises a
steroid. In some embodiments, the first medicament and the second
medicament are different in type (e.g., formulation), strength
(e.g., concentration) and/or other properties or characteristics.
In one embodiment, the first medicament and the second medicament
are similar in type but different in concentration or strength. In
some embodiments, the motor comprises a stepper motor, a mechanical
actuator and/or any other mechanically-driven device. In other
embodiments, the motor is pneumatically operated.
[0039] According to some embodiments, the injection system further
includes a control module having at least one controller, wherein
the controller is configured to receive instructions for delivery
of at least one of the first medicament and the second medicament
to the patient. In some embodiments, the control module is
configured to be removably secured to the handpiece assembly. In
one embodiment, the control module is configured to be in data
communication with the fluid delivery module using a wireless
(e.g., radio frequency, Bluetooth, Wi-Fi, etc.) and/or a hardwired
connection. In some embodiments, the control module is configured
to be powered by one or more batteries (e.g., disposable,
rechargeable, etc.). In one embodiment, the control module is
configured to recharge in a docking station of the fluid delivery
module and/or any other portion of the injection system. In some
embodiments, the first loading area and the second loading area are
configured to receive nonspecific fluid containers. In one
embodiment, the first container and/or the second container
includes an original manufacturer's vial, ampoule or other
container. In one embodiment, such an original manufacturer's vial
is as supplied by the original manufacturer or a supplier to the
clinician using the injection system.
[0040] According to some embodiments, an injection system for
delivering a fluid contained within a pre-filled syringe to a
patient includes comprises a fluid delivery module comprising a
receiving area configured to receive a pre-filled syringe and a
handpiece assembly in fluid communication with the fluid delivery
module. In some embodiments, the handpiece assembly is configured
to removably receive a needle assembly at a distal end of the
handpiece assembly, said needle assembly comprising a needle. In
one embodiment, the handpiece assembly comprises tubing that places
the handpiece assembly and the needle assembly in fluid
communication with the fluid delivery module. In some embodiments,
the injection system additionally comprises a control module having
one or more controllers configured to receive instructions for
delivery of the fluid contained within the pre-filled syringe to
the patient. In some embodiments, the receiving area is configured
to securely receive varying sizes and shapes of the pre-filled
syringe. In one embodiment, the injection system is configured to
receive instructions for delivering the fluid contained within the
pre-filled syringe to the handpiece assembly. According to some
embodiments, the fluid delivery module is configured to transfer at
least a portion of the fluid from the pre-filled syringe to the
handpiece assembly. In one embodiment, the handpiece assembly is
maneuverable to position the needle within the patient to
facilitate delivery of the fluid from the pre-filled syringe into
the patient with a single penetration of the needle. In some
embodiments, the injection system additionally includes at least
one motor housed within the fluid delivery module to mechanically
transfer the fluid to the patient. In some embodiments, the
receiving area is included on a disposable cassette, said
disposable cassette being removably positioned within a
corresponding recess of the fluid delivery module.
[0041] According to some embodiments, the pre-filled syringe
comprises hyaluronic acid. In one embodiment, the pre-filled
syringe is configured to be placed within a centrifuge. In some
embodiments, the pre-filled syringe comprises a centrifuged blood
component (e.g., plasma, red blood cells, platelets, etc.). In some
embodiments, the controller comprises at least one button, dial,
knob, switch, rollerball, rollerwheel and/or the like. In some
embodiments, the fluid delivery module comprises a display
configured to provide status information of an injection procedure.
In one embodiment, the status information comprises a volume of the
fluid contained within the pre-filled syringe that has been
delivered through the handpiece assembly, a volume of fluid
remaining in the pre-filled syringe, a back-pressure reading, an
ultrasound or other imaging device image and/or the like. In some
embodiments, the fluid delivery module is in data communication
with an ultrasound device or other imaging device configured to
help locate a targeted anatomical location within the patient. In
some embodiments, the motor comprises a stepper motor or another
mechanically or pneumatically actuated device or system. In some
embodiments, the pre-filled syringe comprises a first fitting along
its distal end, wherein the proximal end of the tubing comprises a
second fitting, said first fitting being configured to removably
couple to said second fitting to place the handpiece assembly in
fluid communication with the pre-filled syringe.
[0042] According to some embodiments, an injection system for
delivering medicaments into a patient using a single needle
penetration comprises a fluid delivery module configured to receive
a first disposable cassette and a second disposable cassette. In
one embodiment, the first disposable cassette comprises a first
loading area configured to receive a first container, and a second
loading area configured to receive a second container. In some
embodiments, the first container comprises a first medicament, and
the second container comprises a second medicament. In one
embodiment, the first loading area is configured to securely
receive varying sizes and shapes of the first container, and the
second loading area is configured to securely receive varying sizes
and shapes of the second container. In some embodiments, the second
disposable cassette comprises a single receiving area for receiving
a pre-syringe, which includes a pre-filled fluid (e.g., hyaluronic
acid, blood plasma, blood cells, other blood component, stem cells
or other biologics, anesthetic, steroid, other medicament, other
centrifugable material, other fluids or materials, etc.). In some
embodiments, the single receiving area is configured to securely
receive varying sizes and shapes of the pre-filled syringe. In some
embodiments, the injection system further includes a handpiece
assembly in fluid communication with the fluid delivery module,
regardless of whether the first disposable cassette or the second
disposable cassette is secured to the fluid delivery module. In
some embodiments, the handpiece assembly is configured to removably
receive a needle assembly at a distal end of the handpiece
assembly, said needle assembly comprising a needle. In one
embodiment, the handpiece assembly comprises tubing that places the
handpiece assembly and the needle assembly in fluid communication
with the cassette. In several embodiments, the injection system is
configured to receive instructions for delivering one of (i) the
first and second medicaments and (ii) the pre-filled fluid to the
handpiece assembly, depending on whether the first disposable
cassette or the second disposable cassette is secured to the fluid
delivery module. In one embodiment, the fluid delivery module is
configured to transfer either (a) the first medicament and/or the
second medicament or (b) the pre-filled fluid to the handpiece
assembly. In some arrangements, the handpiece assembly is
maneuverable to position the needle within the patient. In one
embodiment, the fluid delivery module comprises at least one motor
(e.g., stepper motor) to mechanically facilitate the delivery of at
least one of the first medicament, the second medicament and the
pre-filled fluid to the patient.
[0043] According to some embodiments, the first loading area and
the second loading area are configured to receive nonspecific fluid
containers. In some arrangements, the first container and/or the
second container is an original manufacturer's vial, ampoule or
other container. In some embodiments, the first and second
medicaments are delivered simultaneously or sequentially to a
target anatomical location of the patient. In one embodiment, the
pre-filled syringe comprises hyaluronic acid. In some embodiments,
the pre-filled syringe is configured to be placed within a
centrifuge. In several embodiments, the fluid delivery module is in
data communication with an imaging device (e.g., ultrasound device)
configured to help locate a targeted anatomical location within the
patient.
[0044] According to certain embodiments, systems for injecting
fluids and/or other materials into a targeted anatomical location,
in particular, an area surrounding a nerve, include a handpiece
assembly having a needle extending from its distal end, a fluid
delivery module comprising a cassette and a fluid transfer device.
A conduit is generally configured to place the fluid delivery
module in fluid communication with the handpiece assembly.
Medications, formulations and/or other fluids or materials
contained within vials that are secured to the fluid delivery
module can be selectively delivered into an anatomy through a
needle located at the distal end of the handpiece assembly. In some
embodiments, ultrasound or other imaging technologies can be used
to locate a targeted anatomical location.
[0045] According to some embodiments, the handpiece assembly is
disposable. In one embodiment, the handpiece assembly does not
include a core or other controllers for regulating the flow of
fluids and/or other materials therethrough. In some embodiments,
the delivery of fluids and/or other materials from a fluid delivery
module to the handpiece assembly is controlled using one or more
foot pedals or other controllers. In one embodiment, such other
controller is not positioned on the handpiece assembly. According
to certain embodiments, vials or other containers containing
medicaments, fluids and/or other substances are configured to be
secured to a cassette of a fluid delivery module. In one
embodiment, such vials or other containers are configured to be
positioned within nests or loading areas having vented spikes. In
some embodiments, such vented spikes do not include a needle or
other sharps.
[0046] Several embodiments of the present application are
particularly advantageous because they offer precise and accurate
delivery of medications. For example, studies have shown that
conventional needles miss the target location quite frequently.
Many medications utilized for the treatment of arthritis, such as
steroids and other medicaments can provide benefit to the patient
only if they are injected directly into the patient's synovial
fluid. Further, certain medications, such as steroids, break down
connective tissue and cause other tissue damage. Therefore, when
such medications or other formulations are not precisely delivered
to the target intra-articular location, adverse tissue damage can
occur to one or more anatomical locations of patients.
[0047] Moreover, in order to deliver a second medication, other
fluid and/or other material to the same anatomical location,
physicians or other medical personnel require multiple needle
penetrations or leave the needle within the targeted nerve area,
intra-articular space or other anatomical area, while unhooking the
tubing or other conduit which is in fluid communication with the
needle. Forceps or other tools are often used to disconnect and/or
connect the tubing or other conduits to the needle in order to
deliver a different medication or fluid to the patient. This can
complicate the process for the physician or other person performing
the procedure and breaks the sterile fluid path, thereby increasing
the chance for infection. In addition, the process can prove to be
uncomfortable and painful to the patient. Thus, several embodiments
of the present inventions are directed to the delivery of two or
more fluids or other medications to a patient with single needle
penetration and/or without the use of tools to disconnect and/or
connect the tubing or other conduits to the needle.
[0048] According to certain embodiments, a handpiece assembly for
simultaneous or sequential delivery of one or more anesthetic
agents and/or other fluids into a targeted anatomical location of a
patient comprises a core, a clip, a disposable tip, a needle, a
first lumen and a second lumen. In any of the arrangements
disclosed herein, a handpiece assembly can be configured to deliver
medications, pharmaceutical compositions, drugs, cells (e.g., stem
cells and other biologics), liquid and non-liquid fluids and
flowable materials, nanoparticles, cement, microbeads and/or the
like. In one embodiment, the handpiece assembly is configured to
simultaneously or sequentially deliver one or more anesthetics,
other medicaments and/or any fluid (e.g., saline) into a patient
(e.g., at or near nerves, a joint, etc.). In one embodiment, the
core comprises at least one button, dial, knob, switch, rollerball,
rollerwheel and/or other controller configured to control a rate of
flow of at least one of a first fluid and a second fluid. In some
configurations, the first fluid is adapted to flow through the
first lumen and the second fluid is configured to flow through the
second lumen. In other arrangements, the handpiece assembly can
include three or more lumens for delivering three or more different
fluids and/or other materials to a targeted anatomical location.
The controller can be configured to control whether the first and
second fluids are delivered simultaneously or sequentially through
the handpiece assembly and/or other components or portions (e.g., a
tip, needle, etc.). In any of the embodiments described herein,
two, three, four or more controllers are used.
[0049] In some arrangements, simultaneous delivery of said fluids
is performed by combining the first and second fluids in the
handpiece assembly. In one embodiment, the core of the handpiece
assembly is in data communication with a fluid delivery module. In
other configurations, the first and second lumens are adapted to
direct said fluids from a fluid delivery module, through the clip,
through the disposable tip and to the needle. In another
embodiment, each of the lumens comprises a valve to prevent
backflow of said fluids toward the fluid delivery module. The
needle can be configured to be removably attached to the disposable
tip and the disposable tip can be configured to be removably
attached to the clip. In some embodiments, the needle is configured
to be positioned within a patient to selectively deliver at least
one said first fluid or said second fluid to a targeted anatomical
location of the patient. In some embodiments, such fluids comprise
anesthetic agents.
[0050] According to other arrangements, the first and second fluids
are configured to be combined within the clip under a simultaneous
delivery scheme. In one embodiment, the first and second fluids are
configured to be combined at or near an interface between the clip
and the disposable tip under a simultaneous delivery scheme. In
another embodiment, the first and second fluids are configured to
be combined at a distal end of the clip, near an interface between
the clip and the disposable tip under a simultaneous delivery
scheme. According to other arrangements, the first and second
fluids are maintained separate until immediately upstream of the
disposable tip. In some configurations, the handpiece assembly
comprises one or more buttons and/or other controllers. In any of
the embodiments disclosed herein, a handpiece assembly can include
any type of controller, such as, multi-mode buttons, multi-depth
buttons, rheostats, dials, knobs, switches, rollerballs,
rollerwheels and/or combinations thereof.
[0051] According to certain arrangements, the one or more buttons
and/or other controllers of the handpiece assembly are configured
to control the rate of flow of at least one of the first fluid and
the second fluid between a no flow condition, a first flowrate
condition and at least a second flowrate condition. In any of the
embodiments disclosed herein, the buttons and/or other controllers
are configured to have additional modes and or functions. In
addition, in some arrangements, the buttons and/or other
controllers are configured to control or otherwise regulate the
flow of one, two, three or more different fluid and/or other
material streams through a handpiece assembly.
[0052] In certain embodiments, the handpiece assembly further
comprises a third lumen, such that a third fluid is configured to
be selectively conveyed therethrough. In one arrangement, the one
or more buttons and/or other controllers are configured to control
a rate of flow of the first fluid, the second fluid and/or the
third fluid. The fluids being conveyed through the handpiece
assembly can be configured to flow from the fluid delivery module
to the needle either sequentially or simultaneously. For example,
in one embodiment, two or more of the various fluid and/or other
material streams can be delivered simultaneously through the
handpiece assembly and the downstream needle.
[0053] According to certain arrangements, the core of the handpiece
assembly includes a first controller configured to control the rate
of flow of the first fluid, a second controller configured to
control the rate of flow of the second fluid and a third controller
configured to control the rate of flow of the third fluid. In any
of the embodiments described herein, the buttons or other
controllers on the core or other portions of the handpiece assembly
can be used to control one or more other properties or aspects of
the injection procedure. For example, in one embodiment, the
buttons and/or other controllers control an ultrasound or other
imaging device, regulate the sequence of delivery and/or the like.
In another embodiment, at least one function of the imaging device
or system is configured to be selectively controlled by an imaging
controller and/or another portion or component of the handpiece. In
some arrangements, the imaging controller of the handpiece
comprises a button, dial, switch, knob, rollerball, rollerwheel
and/or the like.
[0054] In some embodiments, a handpiece device for use in an
anatomical injection system comprises an outer housing enclosing a
handpiece interior. The outer housing of the handpiece device or
assembly can be configured to be grasped and manipulated by a user.
In some arrangements, the handpiece device additionally includes a
first and second conduit routed through the handpiece interior. In
other arrangements, more or fewer conduits may be routed through
the handpiece. According to one embodiment, the handpiece device
further comprises a disposable tip having a first end and a second
end, with the first end being adapted to removably receive a needle
and the second end configured to secure to the outer housing.
[0055] In one embodiment, the first conduit is configured to place
the needle in fluid communication with a first reservoir of a fluid
delivery module and the second conduit is configured to place the
needle in fluid communication with a second reservoir of the fluid
delivery module. In alternative embodiments, additional conduits
can place the needle in fluid communication with additional
reservoirs of the fluid delivery module. In certain embodiments,
the handpiece device includes at least one button or other
controller positioned along the outer housing. Such a button or
other controller can be adapted to selectively regulate a flow of
fluids through at least one of the first conduit, the second
conduit and/or any additional conduits that may be present. In some
configurations, the handpiece device is adapted to deliver fluids
and/or other materials through the first and second conduits to the
needle simultaneously or sequentially. In one embodiment, each of
the conduits comprises a check valve, a duckbill valve and/or any
other type of valve to prevent fluid backflow toward the fluid
delivery module. The needle positioned at the distal end of the
handpiece device can be positioned within a targeted anatomical
location of a patient (e.g., at or near nerves, a joint, etc.) to
selectively deliver one or more fluids thereto.
[0056] According to other arrangements, the one or more buttons
and/or other controllers are in data communication with a fluid
delivery module and/or any other portion of the injection system.
The handpiece can additionally include a common chamber located
upstream of the needle, wherein such a common chamber is configured
to receive fluids and/or other materials from the first and second
conduits. In any of the embodiments disclosed herein, the handpiece
can include additional conduits configured to deliver fluids and/or
other materials to a common chamber or other portion or area of the
handpiece. In some configurations, the common chamber is located at
or near a distal end of the outer housing of the handpiece device.
However, in other embodiments, the common chamber is located at or
near an interface between the outer housing and the disposable tip.
In certain arrangements, the controller includes one or more
buttons, dials, knobs, switches, rollerballs, rollerwheels, other
controller and/or any other device configured to allow a user to
regulate one or more aspects of an injection procedure.
[0057] According to some embodiments, an injection system
configured for simultaneous or sequential delivery of different
fluids into a patient includes a fluid delivery module adapted to
receive a first container and at least a second container. In some
arrangements, the fluid delivery module is configured to receive
three or more vials or other containers. In one embodiment, the
fluid delivery module comprises a first reservoir, a second
reservoir and/or additional reservoirs that are configured to be
placed in fluid communication with fluids and/or other materials
contained within the containers secured to the fluid delivery
module. In certain embodiments, the injection additionally includes
a handpiece comprising a core, a clip, a disposable tip, a needle
positioned at a distal end of said disposable tip, a first conduit
and at least a second conduit. In some arrangements, the core
comprises one or more buttons and/or other controllers configured
to control a rate of flow of fluids through the first conduit
and/or the second conduit. Such buttons and/or other controllers
can be configured to control the flow of fluids through additional
conduits that may be included in a handpiece assembly. In other
embodiments, the buttons and/or other controllers can regulate one
or more other aspects of the injection system and/or devices or
systems operatively connected to the injection system, such as, an
ultrasound or other imaging device. In certain arrangements, at
least one function of the imaging device or system is configured to
be selectively controlled by an imaging controller and/or another
portion or component of the handpiece. In some arrangements, the
imaging controller of the handpiece comprises a button, dial,
switch, knob, rollerball, rollerwheel and/or the like.
[0058] In some arrangements, the first fluid is configured to flow
through the first conduit and the second fluid is configured to
flow through the second conduit. In embodiments that include more
than two conduits, additional fluids and/or other materials can be
configured to be conveyed through such conduits. According to some
arrangements, the first and second conduits are configured to
direct fluids and/or other materials from the fluid delivery
module, through the clip and the disposable tip and to the needle.
The one or more buttons and/or other controllers of the handpiece
assembly can be configured to control whether the first, second
and/or additional fluids are delivered from the fluid delivery
module to the needle simultaneously or sequentially. In one
embodiment, the simultaneous delivery of fluids and/or other
materials is performed by combining the fluids in the handpiece.
According to certain arrangements, the core is in data
communication with the fluid delivery module. Further, each of the
conduits can include a valve or other feature or device to help
prevent backflow of the fluids from the handpiece toward the fluid
delivery module. In some embodiments, the disposable tip is
configured to be removably attached to the clip. In any of the
embodiments described herein, the needle is configured to be
positioned within a target anatomical location to selectively
deliver one or more medicaments, other fluids and/or other
materials to or near a nerve, joint or other anatomical location of
a patient. Other target anatomical locations include, but are not
limited to, soft tissue, dermal/subdermal tissue, organs and/or the
like. Several embodiments of the inventions disclosed herein are
particularly advantageous for the anesthesiology and dermatological
(aesthetics) fields.
[0059] In some embodiments, the controller comprises at least one
button, dial, knob, switch, lever, rollerball, rollerwheel, other
modulating device and/or the like. According to other arrangements,
the handpiece assembly comprises a multi-function button configured
to permit a user to select between a no flow condition and at least
two flow conditions of varying speed. In one embodiment, such a
button permits a user to selectively adjust the flowrate or any
other flow property of one or more fluids and/or other materials
being conveyed through the handpiece assembly. For example, the
button and/or other controller can permit a user to choose between
two, three or more distinct flowrates. Alternatively, the rheostat,
button and/or other controller can permit a user to select between
various non-distinct flowrates or other settings. In certain
arrangements, the handpiece assembly includes one or more
multi-depth buttons that are configured to be moved to one of two,
three or more different depths. In one embodiment, each distinct or
non-distinct depth corresponds to a different rate of flow for the
first fluid, the second fluid and/or additional fluids and/or other
materials being conveyed from the fluid delivery module to the
needle. According to other embodiments, the core comprises a
battery that is configured to be recharged using induction, simple
charging (e.g., using a DC or AC connection), pulse charging and/or
other charging methods or devices. In some arrangements, the
battery of the core is configured to be inductively or otherwise
recharged when the handpiece is positioned within a docking station
of the fluid delivery module.
[0060] According to certain embodiments disclosed in the present
application, a method of injecting two, three or more fluids into
or near a nerve, joint or other anatomical location (e.g., organ,
bone, etc.) of a patient using a handpiece assembly includes
providing a handpiece assembly. In some arrangements, the handpiece
assembly includes a core, a clip, a disposable tip, a needle, a
first conduit and a second conduit. In other configurations, the
handpiece assembly comprises three or more conduits. A first fluid
or other material is configured to flow through the first conduit
and a second fluid or other material is configured to flow through
the second conduit. Other fluids or materials can be configured to
flow through additional conduits of the handpiece assembly. In one
embodiment, the core comprises at least one button or other
controller adapted to control a rate of flow and/or other flow
characteristics of the first fluid, second fluid and/or other
fluids or materials being conveyed through the conduits of the
handpiece assembly.
[0061] In certain embodiments, the core is configured to be in data
and fluid communication with a fluid delivery module. The first,
second and/or additional conduits are configured to convey fluids
and/or other materials through the clip and the disposable tip, and
to the needle. The conduits are routed through an interior of the
handpiece assembly. In addition, the each conduit comprises a valve
or other device to prevent backflow of fluids and/or materials
flowing therethrough. In some embodiments, the needle is configured
to be removably attached to the disposable tip, and the disposable
tip is configured to be removably attached to the clip of the
handpiece assembly. The needle is configured to be positioned
within or near a nerve, joint or other anatomical location to
selectively deliver a first fluid, a second fluid and/or additional
fluids or materials to a target nerve, joint or other anatomical
location. Other target anatomical locations include, but are not
limited to, soft tissue, dermal/subdermal tissue, organs and/or the
like. Several embodiments of the inventions disclosed herein are
particularly advantageous for the anesthesiology and dermatological
(aesthetics) fields.
[0062] The method additionally comprises positioning the needle
into or near a nerve, joint or other target anatomical location of
a patient, and delivering a volume of the first fluid, the second
fluid and/or additional fluids or materials to the needle. In some
arrangements, the one or more buttons and/or other controllers of
the handpiece assembly are configured to control a rate of flow of
the first fluid, second fluid and/or additional fluids or materials
through the conduits. In one embodiment, the one or more
controllers control whether the first and second fluids are
delivered simultaneously or sequentially. In other arrangements,
simultaneous delivery of fluids and/or other materials is performed
by combining the first, second and/or additional fluids and/or
other materials in the handpiece assembly. In some embodiments, the
fluids are configured to be combined within the clip, at or near an
interface between the clip and the disposable tip at a distal end
of the clip, near an interface between the clip and the disposable
tip and/or at any other location of the handpiece assembly. In one
embodiment, the various fluids and/or other materials conveyed
through the handpiece assembly are maintained separate until
immediately upstream of the disposable tip.
[0063] According to certain arrangements, the controller comprises
one or more buttons, dials, knobs, switches, rollerballs,
rollerwheels and/or any other devices adapted to be modulated or
adjusted. The buttons or other controllers are configured to
regulate the rate of flow of the first fluid, the second fluid
and/or any other fluids adapted to pass through the handpiece
assembly. In some embodiments, such buttons or other controllers
can permit a user to select between a no flow condition, a first
flowrate condition and at least a second flowrate condition. In
some arrangements, the handpiece assembly additionally includes a
third conduit configured to convey a third fluid and/or other
material therethrough. The buttons and/or other controllers can be
configured to control a rate of flow of the first fluid, second
fluid, third fluid and/or additional fluids or other materials. In
one embodiment, the fluids are configured to sequentially or
simultaneously flow through the clip and the disposable tip of the
handpiece assembly to the needle. In other embodiments, the core
comprises a first button or controller configured to control a rate
of flow of the first fluid, a second button or controller
configured to control a rate of flow of the second fluid and a
third button or controller configured to control a rate of flow of
the third fluid. Additional buttons or other controllers can be
provided to regulate the flow of additional fluid or other material
streams through the handpiece assembly. According to some
configurations, the method additionally comprises monitoring a
position of a distal end of the needle using an ultrasound, radio
frequency, spectroscopy and/or other imaging device or system to
accurately locate a target nerve, joint or other anatomical
location of the patient. Other target anatomical locations include,
but are not limited to, soft tissue, dermal/subdermal tissue,
organs and/or the like. Several embodiments of the inventions
disclosed herein are particularly advantageous for the
anesthesiology and dermatological (aesthetics) fields. In some
arrangements, at least one function of the imaging device or system
is configured to be selectively controlled by an imaging controller
and/or another portion or component of the handpiece. In some
arrangements, the imaging controller of the handpiece comprises a
button, dial, switch, knob, rollerball, rollerwheel and/or the
like.
[0064] In certain embodiments, a method of injecting two, three or
more medicaments, fluids and/or other materials into an anatomy
using a handpiece assembly includes providing a handpiece assembly
that comprises a main body and needle removably positioned at a
distal end of the main body. The handpiece assembly includes a
first conduit and at least a second conduit that are positioned
within an interior of the main body. In any of the embodiments
described herein, the method can include the injection of three or
more medicaments, fluids and/or other materials. A first fluid or
other material is configured to flow through a first conduit, and a
second fluid or other material is configured to flow through the
second conduit. In one embodiment, the main body comprises at least
one button and/or other controller configured to regulate a rate of
flow of the first fluid, the second fluid and/or additional fluids
or materials through the various conduits of the handpiece
assembly. The handpiece assembly is configured to be in data and
fluid communication with a fluid delivery module. In certain
arrangements, the first and second conduits are configured to
convey fluids and/or other materials to the needle. Each of the
conduits can include a valve and/or other retrograde flow devices
to prevent backflow of the fluids and/or other materials toward a
proximal end of the main body. According to some embodiments, the
needle is configured to be positioned within a target anatomical
location to selectively deliver a volume of the first fluid, the
second fluid and/or additional fluids or materials to a target
anatomical location. The method further comprises positioning the
needle into an anatomy and delivering a volume of the first fluid,
the second fluid and/or additional fluids or materials through the
conduits to the needle. In some embodiments, positioning the needle
into an anatomy comprises using an ultrasound, radio frequency,
spectroscopy and/or other imaging device or system to accurately
locate the target anatomical location. The one or more buttons
and/or other controllers are configured to control a rate of flow
of the first fluid, the second fluid and/or additional fluid or
other material streams conveyed through the conduits of the
handpiece assembly. Simultaneous delivery of the various fluids
and/or other materials can be performed by combining such fluids in
the handpiece assembly.
[0065] According to certain embodiments, under a simultaneous
delivery scheme, the first, second and/or other fluids are
configured to be combined within the main body, at a distal end of
the main body, immediately upstream of a proximal end of the needle
and/or at any other location. In other arrangements, different
fluid and/or other material streams are maintained separate until
immediately upstream of the needle. In other arrangements, the
controller includes one or more push buttons, dials, knobs,
switches, rollerballs, rollerwheels, rheostats and/or the like. In
one embodiment, a button or other controller is configured to
control the rate of flow of one or more various fluid streams
passing through the conduits of the handpiece between a no flow
condition, a first flowrate condition and at least a second
flowrate condition. The buttons or other controllers can be
configured to provide additional flowrate settings.
[0066] In certain embodiments, a method of injecting two or more
different medicaments or other materials contained in nonspecific
fluid containers into a patient using a single needle penetration
comprises providing an injection system. The injection system
includes a fluid delivery module and a handpiece assembly.
According to one embodiment, the fluid delivery module comprises a
first loading area configured to receive a first container and a
second loading area configured to receive a second container. A
fluid delivery module can include additional loading areas to
receive additional containers. In some configurations, the first
container comprises a first medicament and the second container
comprises a second medicament. In certain embodiments, the loading
areas are configured to securely receive vials or other containers
of varying type, size, shape and/or one or more other
characteristics. In one embodiment, such containers comprise
standard or non-standard vials. In another embodiment, the vials
are supplied to a clinician or other user of an injection system by
a manufacturer or supplier of such medicaments, fluids and/or other
materials.
[0067] According to certain arrangements, the injection system is
configured to receive instructions for delivering the first, second
and/or additional medicaments. The medicaments can include
medications, pharmaceutical compositions, drugs, cells (e.g., stem
cells and other biologics), liquid and non-liquid fluids and
flowable materials, nanoparticles, cement, microbeads and/or the
like. In one embodiment, the injection system is configured to
simultaneously or sequentially deliver an anesthetic and a steroid
for treating a nerve, joint, or other target anatomical area. In
one embodiment, the fluid delivery module is configured to transfer
at least a portion of the first medicament from the first container
to a first reservoir of the fluid delivery module and at least a
portion of the second medicament from the second container to a
second reservoir of the fluid delivery module.
[0068] In certain arrangements, the handpiece assembly is
configured to receive a needle. The handpiece assembly is adapted
to selectively be in fluid communication with the first, second
and/or additional reservoirs of the fluid delivery module. In one
embodiment, the handpiece assembly is maneuverable to position the
needle within the patient. In another arrangement, based at least
in part on instructions entered by a user, the injection system is
configured to combine the first, second and/or additional
medicaments or other materials prior to their delivery to the
patient. In an alternative embodiment, the injection system is
configured to administer the first, second and/or additional
medicaments and/or other materials sequentially. The method further
comprises delivering a volume of the first medicament from the
fluid delivery module to the patient through the needle of the
handpiece assembly based at least in part on instructions provided
to the injection system, and delivering a volume of the second
medicament from the fluid delivery module to the patient through
the needle of the handpiece assembly based at least in part on
instructions provided to the injection system. In other
embodiments, additional medicaments and/or other materials are
selectively delivered from the fluid delivery module to the patient
through the needle of the handpiece assembly.
[0069] In certain arrangements, the handpiece assembly comprises at
least one button and/or other controller configured to receive
instructions for delivery of the first, second and/or additional
medicaments and/or other materials. In one embodiment, the fluid
delivery module is configured to transfer a predetermined volume of
the first medicament and the second medicament to the patient. In
another arrangement, the fluid delivery module comprises a motor to
facilitate the delivery of the various medicaments and/or other
materials to the patient. According to some embodiments, the first
medicament comprises an anesthetic and the second medicament
comprises a steroid.
[0070] In another configuration, the fluid delivery module further
comprises a third loading area adapted to receive a third container
comprising a third medicament or other material. The injection
system is configured to receive instructions for simultaneously or
sequentially delivering the first, second and third medicaments
through the handpiece assembly to a patient. In certain
embodiments, the first, second, third and/or additional medicaments
are delivered either simultaneously or sequentially to a nerve,
joint or other target anatomical location of a patient. In one
embodiment, the fluid delivery module comprises a display
configured to provide status information about an injection
procedure, such as, the volume of the first or second medicaments
delivered through the handpiece assembly or remaining in the first
and second reservoirs of the fluid delivery module. In some
arrangements, one or more of the containers secured to the loading
areas of the fluid delivery module are original manufacturer's
vials. In another embodiment, the needle is secured to a removable
tip of the handpiece assembly. The method can additionally include
monitoring a position of a distal end of the needle using an
ultrasound, radio frequency, spectroscopy and/or other imaging
device or system to accurately locate a target anatomical location
(e.g., nerve, joint, organ, etc.). In any of the embodiments
disclosed herein, the imaging device or system can be configured to
cooperate with the injection system. In some embodiments, the
imaging device or system is in data communication with the
handpiece assembly, the fluid delivery module and/or another
portion of the injection system. In some embodiments, one or more
buttons or other controllers of the handpiece assembly are
configured to control one or more aspects of the imaging device or
system (e.g., capturing an image, zoom, etc.).
[0071] According to certain embodiments, a method of treating a
nerve, joint, or other anatomical location of a patient by
selectively delivering at least two different fluids through a
single needle penetration includes providing an injection system.
The injection system comprises a fluid delivery module and a
handpiece assembly. In one embodiment, the handpiece assembly
comprises a disposable tip with a needle positioned at a distal end
of the tip. In certain arrangements, the handpiece assembly
comprises one or more buttons or other controllers configured to be
operated while a user grasps the handpiece assembly. In some
embodiments, a user can handle, manipulate and/or otherwise operate
one or more of these buttons or other controllers without having to
let go of the handpiece assembly. In certain configurations, the
fluid delivery module comprises a first loading area adapted to
receive a first container and a second loading area adapted to
receive a second container. The first container comprises a first
fluid, and the second container comprises a second fluid. A fluid
delivery module can include additional loading areas for securing
additional containers thereto. In some arrangements, the first
fluid or other material is configured to be selectively placed in
fluid communication with a first reservoir of the fluid delivery
module and a first conduit of the handpiece assembly after the
first container is secured to the first loading area. In addition,
the second fluid or other material is configured to be selectively
placed in fluid communication with a second reservoir of the fluid
delivery module and a second conduit of the handpiece assembly
after the second container is secured to the second loading area.
In one embodiment, the first and second conduits are routed through
an interior of the handpiece assembly.
[0072] In any of the arrangements disclosed herein, the first
loading area and second loading area are configured to securely
receive vials or other containers of various types, designs, sizes
and shapes. In some embodiments, such containers comprise
medications, pharmaceutical compositions, drugs, cells (e.g., stem
cells and other biologics), liquid and non-liquid fluids and
flowable materials, nanoparticles, cement, microbeads and/or the
like. In one embodiment, the first fluid comprises an anesthetic
and the second fluid comprises a steroid. In some embodiments, such
containers comprise standard or non-standard vials. In one
embodiment, the vials are supplied, either directly or indirectly,
to a clinician or other user of an injection system by a
manufacturer or supplier of such medicaments, fluids and/or other
materials. The injection system is configured to receive
instructions for delivering the first, second and/or additional
fluids or other materials to the needle of the handpiece assembly.
In one arrangement, the fluid delivery module is configured to
simultaneously or sequentially transfer a volume of the first
fluid, the second fluid and/or additional fluids or materials to
the needle through the first, second and/or additional conduits. In
one embodiment, the handpiece assembly is configured to be in data
communication with the fluid delivery module of the injection
system. The handpiece assembly is maneuverable to position the
needle within the patient.
[0073] According to some arrangements, under a simultaneous
injection mode, the first, second and/or additional fluids or
materials are combined within the handpiece assembly at a location
upstream of the needle. The method additionally comprises
delivering a volume of the first fluid from the fluid delivery
module to the patient through the needle and through the first
conduit based at least in part on instructions provided to one or
more of the buttons and/or other controllers of the handpiece
assembly. In some embodiments, the method comprises delivering a
volume of the second fluid from the fluid delivery module to the
patient through the needle and through the second conduit based at
least in part on instructions provided to one or more of the
buttons and/or other controllers of the handpiece assembly. In one
embodiment, the controller comprises at least one button, knob,
dial, switch, lever, rheostat, rollerball, rollerwheel and/or the
like. In some embodiments, each of the conduits comprises a valve
or other device to prevent backflow of fluids and/or other
materials toward the fluid delivery module. In some arrangements,
the method additionally includes monitoring a position of the
distal end of the needle using an ultrasound, radio frequency,
spectroscopy and/or other imaging device or system to accurately
locate a nerve, joint or other target anatomical area of the
patient.
[0074] In accordance with other embodiments disclosed in the
present application, a system for injecting two, three or more
different medicaments into a patient through a single needle
penetration using nonspecific fluid containers includes a fluid
delivery module and a handpiece. The fluid delivery module
comprises a first loading area configured to secure a first fluid
container and a second loading area configured to secure a second
fluid container. In some embodiments, the first fluid container
comprises a first medicament and/or other fluid or material, and
the second fluid container comprises a second medicament and/or
other fluid or material. The first loading area and the second
loading area are configured to securely receive containers of
various types, sizes and shapes. In some embodiments, such
containers comprise standard or non-standard vials, ampoules and/or
the like. In one embodiment, the vials are supplied to a clinician
or other user of an injection system by a manufacturer or supplier
of such medicaments, fluids and/or other materials.
[0075] In one embodiment, a disposable needle is configured to
removably attach to a distal end of said handpiece. The needle is
configured to be positioned within or near a nerve, joint or
another portion of a patient's anatomy. In certain configurations,
the fluid delivery module is adapted to receive instructions for
delivering the first and second medicaments and/or other materials
to the needle through an interior portion of the handpiece. In any
of the embodiments disclosed herein, the fluid delivery module may
be adapted to receive and subsequently deliver through the
handpiece additional medicaments and/or other fluids. In some
arrangements, first and second reservoirs are positioned within an
interior of the fluid delivery module. The fluid delivery module
can be configured to transfer at least a portion of the first
medicament from the first fluid container to the first reservoir,
and at least a portion of the second medicament from the second
fluid container to the second reservoir. According to some
arrangements, a first conduit is configured to selectively place
the handpiece in fluid communication with the first reservoir of
the fluid delivery module and a second conduit is configured to
selectively place the handpiece in fluid communication with the
second reservoir of the fluid delivery module. The injection system
can include additional conduits for placing the handpiece in fluid
communication with additional reservoirs of the fluid delivery
module. In one embodiment, the first and second conduits are
positioned within an interior portion of said handpiece. In certain
embodiments, the fluid delivery module is configured to combine the
first and second fluids prior to delivery to the patient.
Alternatively, the fluid delivery module can be configured to
administer the first and second fluids sequentially, depending on
the instructions received by the fluid delivery module, the
handpiece and/or any other component or portion of the injection
system. In one arrangement, each of the conduits comprises a valve
to prevent backflow of fluids toward the fluid delivery module.
[0076] According to other embodiments, the handpiece comprises at
least one button or other controller configured to receive at least
one instruction related to an injection procedure. In some
configurations, the controller comprises at least one button, dial,
knob, rheostat, rollerball, rollerwheel, switch and/or the like. In
another arrangement, the fluid delivery module comprises a motor to
facilitate delivery of the first, second and/or additional fluids
and/or other materials from the reservoirs to the conduits and
needle. In one embodiment, the fluid delivery module additionally
comprises a display configured to receive at least one instruction
related to an injection procedure and/or configured to provide
status information regarding a particular injection procedure. In
some embodiments, the first, second and/or additional fluids are
delivered either simultaneously or sequentially to a nerve, joint
or other anatomical location of a patient. In certain
configurations, the status information provided by the display of
the fluid delivery module comprises the volume of the first or
second fluids already delivered through the handpiece assembly or
remaining in the first and second reservoirs of the fluid delivery
module. In other arrangements, at least one of the first fluid
container and the second fluid container is a nonspecific fluid
container. In one embodiment, the first and/or second fluid
container comprises an original manufacturer's vial (e.g., having a
capacity of 5 ml, 10 ml, 50 ml, 100 ml, less than 5 ml, greater
than 100 ml, ranges between these values and/or the like). In one
embodiment, the fluid delivery module is in data communication with
an ultrasound, radio frequency, spectroscopy and/or other imaging
device or system configured to locate a targeted nerve, joint or
other anatomical location within the patient.
[0077] According to certain embodiments, a system for injecting two
or more different fluids into a patient using a single needle
penetration includes a fluid delivery module having a base and a
disposable portion. The disposable portion comprises a first
loading area and at least a second loading area, such that each of
the loading areas is configured to securely receive a container
thereon. The system further comprises a first reservoir configured
to be placed in fluid communication with an interior of a first
container securely positioned within the first loading area, and a
second reservoir configured to be placed in fluid communication
with an interior of a second container securely positioned with the
second loading area. In other embodiments, the system comprises
additional loading areas and corresponding reservoirs to
accommodate additional fluids and/or other materials. In some
embodiments, the first reservoir comprises a first outlet, and the
second reservoir comprises a second outlet. The base of the fluid
delivery module comprises a fluid transfer device adapted to
selectively transfer fluids from the first reservoir to the first
outlet and from the second reservoir to the second outlet. In one
embodiment, the disposable portion is configured to be removably
positioned within a recess of the base.
[0078] The injection system additionally includes a handpiece
assembly comprising a handle portion configured to be grasped and
manipulated by a user and a tip having at least one internal
passage. The handle portion includes an interior and a chamber. The
tip additionally includes a proximal end and a distal end. In one
embodiment, the proximal end of the tip is secured to the handle
portion. In another arrangement, the internal passage is in fluid
communication with the chamber when the tip is secured to the
handle portion. The injection system further comprises a needle
extending from the distal end of the tip. According to certain
configurations, the needle is adapted to be positioned within an
anatomy of a patient. In one embodiment, the system further
includes a first conduit placing the first outlet in fluid
communication with the chamber of the handpiece assembly, and a
second conduit placing the second outlet in fluid communication
with the chamber. In certain arrangements, the handpiece assembly
comprises at least one controller configured to at least partially
control the delivery of fluids from at least one of the first and
second reservoirs through the chamber and to the needle. In some
arrangements, fluids and/or other materials conveyed within the
first and second conduits are maintained separate upstream of the
chamber. In some embodiments, each of the conduits comprises a
valve to prevent backflow of said fluids toward the fluid delivery
module.
[0079] In certain arrangements, the chamber is located at or near
an interface between the handle portion and the tip of the
handpiece assembly, upstream of an interface between the handle
portion and the tip of the handpiece assembly or at any other
location. In another embodiment, one or more of the loading areas
are configured to receive a nonspecific container. The nonspecific
container can include a vial as originally supplied by a drug
manufacturer. In one embodiment, the controller comprises at least
one button, dial, knob, switch, rheostat, lever, rollerball,
rollerwheel and/or the like positioned along an exterior surface of
the handle portion of the handpiece assembly. In one embodiment,
the button comprises a multi-mode and/or multi-depth button that
permits a user to vary a flowrate and/or other flow characteristic
of the fluids through the handpiece assembly based on the depth or
other position of the button. In another arrangement, the injection
system is operatively connected to an ultrasound, radio frequency,
spectroscopy and/or other imaging device or system configured to
assist a user in advancing the needle to a desired anatomical
position within the patient. In any of the embodiments described or
otherwise disclosed herein, one or more of the loading areas is
adapted to continuously or intermittently rotate a fluid container
positioned thereon in order to mix the contents of a vial or other
container positioned within the loading area.
[0080] According to certain embodiments disclosed in the present
application, a method of injecting a plurality of fluids into
multiple patients using nonspecific fluid containers includes
providing an injection system. The injection system includes a
fluid delivery module and a handpiece. The handpiece comprises a
clip, a disposable tip, a reusable core and at least one button or
other controller. In addition, the fluid delivery module comprises
a first loading area configured to secure a first container, and a
second loading area configured to secure a second container. In
some embodiments, a fluid delivery module can comprise three or
more loading areas to receive additional containers. In some
embodiments, the loading areas are configured to securely receive
vials or other containers of various types, designs, shapes and/or
sizes. In some arrangements, the fluid delivery module is
configured to receive instructions for delivering the first, second
and/or additional fluids or materials for a first patient. Further,
the fluid delivery module is configured to receive instructions for
delivering the first, second and/or additional fluids or materials
for a second patient. In some arrangements, the instructions are
modifiable between patients. According to some embodiments, the
fluid delivery module is configured to transfer at least a portion
of the first fluid from the first container to a first reservoir
and at least a portion of the second fluid from the second
container to a second reservoir. In one embodiment, the first and
second reservoirs are positioned within an interior of the fluid
delivery module. In certain configurations, a distal end of the
disposable tip of the handpiece is adapted to receive a first
disposable needle for use with a first patient and a second
disposable needle for use with a second patient. In one embodiment,
the tip is configured to be disposed between patients. The
disposable tip can comprise a valve to prevent reverse flow of the
first, second and/or additional fluids from the needle into the
clip of the handpiece. In certain embodiments, the handpiece is
configured to be in fluid communication with the first and second
reservoirs of the fluid delivery module. In certain arrangements,
the handpiece is maneuverable to position the needle within the
patient. In one embodiment, the fluid delivery module and handpiece
are configured to combine the first and second fluids and/or other
materials prior to delivery to the patient. In an alternative
embodiment, the fluid delivery module and handpiece are configured
to administer the first and second fluids and/or other materials
sequentially, depending on the instructions received by the fluid
delivery module and/or the handpiece.
[0081] In some arrangements, the controller of the handpiece
comprises at least one button, knob, dial, switch, rheostat,
rollerball, rollerwheel and/or other device configured to receive
instructions for controlling at least one aspect of an injection
procedure. According to another embodiment, the fluid delivery
module is configured to simultaneously or sequentially transfer a
predetermined volume of the first fluid and the second fluid to a
patient. In one arrangement, the fluid delivery module comprises a
motor to facilitate the delivery of the fluids to a patient. In
other arrangements, the first fluid comprises an anesthetic and the
second fluid comprises a steroid. In certain configurations, the
first and second fluids are delivered either simultaneously or
sequentially to a nerve, joint or other anatomical location in a
patient. In another embodiment, the injection system further
comprises a display adapted to provide information regarding the
delivery of the first and second fluids into a patient. In some
arrangements, the first and/or the second containers comprise vials
as supplied by a drug manufacturer or another nonspecific
container. According to other embodiments, the method further
includes monitoring a position of the distal tip of the needle
using an ultrasound, radio frequency, spectroscopy and/or other
imaging device or system operatively connected to the injection
system to accurately locate a target anatomical location of a
patient.
[0082] In some embodiments, a method of locating a target
anatomical location of a patient and injecting at least two
different medicaments into the target anatomical location using a
single needle penetration includes providing an injection system.
The injection system comprises a fluid delivery module and a
handpiece having at least one controller. The fluid delivery module
comprises a first loading area configured to secure a first
container and a second loading area configured to secure a second
container. In other embodiments, a fluid delivery module includes
additional loading areas configured to secure additional
containers. The first container comprises a first medicament or
other material and the second container comprises a second
medicament or other material. In one embodiment, the handpiece is
configured to be in fluid and data communication with the fluid
delivery module. In other arrangements, the fluid delivery module
is configured to selectively transfer a portion of the first
medicament, the second medicament and/or additional medicaments or
other materials to the handpiece. In one embodiment, a distal end
of said handpiece is configured to receive a needle. The handpiece
is maneuverable to position the needle within the patient. The
method further comprises locating the needle at or near the target
anatomical location using an imaging device that is in data
communication with the injection system. In certain embodiments,
the injection system is configured to combine the first and second
medicaments prior to delivery to the patient. Alternatively, the
injection system is configured to administer the first and second
medicaments sequentially, depending on the instructions received by
the injection system. In addition, the method comprises delivering
a volume of the first medicament, the second medicament and/or
additional medicaments or other materials to the patient through
the needle based on instructions received by the injection
system.
[0083] According to some embodiments, the fluid delivery module is
configured to receive instructions for delivering the first and
second medicaments using one or more buttons or other controllers
positioned on the handpiece. In one embodiment, the imaging device
is operatively connected to the injection system using a hardwired
or a wireless connection. In another configuration, at least one
function of the imaging device or system is configured to be
selectively controlled by an imaging controller and/or another
portion or component of the handpiece. In some arrangements, the
imaging controller of the handpiece comprises a button, dial,
switch, knob, rollerball, rollerwheel and/or the like. In another
embodiment, the fluid delivery module comprises a motor to
facilitate the delivery of the medicaments and/or other materials
to the handpiece. In one embodiment, the first and second
medicaments are delivered either simultaneously or sequentially
through the handpiece to the patient. In another arrangement, the
fluid delivery module comprises a display configured to display or
otherwise provide the volume of the first and/or second medicaments
already delivered to the patient or remaining within the fluid
delivery module or other status information regarding the injection
procedure. In one embodiment, the display comprises a touchscreen
that is configured to receive instructions that help control an
injection procedure. In certain embodiments, the first and/or
second containers are standard or non-standard vials supplied by a
manufacturer or some other nonspecific container.
[0084] According to other embodiments, a system for injecting at
least two fluids into an anatomy of a patient includes a handpiece
assembly having a proximal end and a distal end. The handpiece
assembly comprises at least one controller and a needle extending
from the distal end of the handpiece assembly. The system further
includes a fluid delivery module configured to securely receive at
least a first container comprising a first fluid and a second
container comprising a second fluid. The fluid delivery module is
configured to selectively transfer a volume of the first fluid
and/or the second fluid into the patient. According to some
embodiments, the system further includes a first conduit configured
to convey the first fluid from the fluid delivery module to the
needle and a second conduit configured to convey the second fluid
from the fluid delivery module to the needle. In one embodiment,
the first and second conduits are routed through an interior of the
handpiece assembly. In another embodiment, the system further
includes an imaging device operatively connected to the fluid
delivery module, the handpiece assembly and/or any other portion of
the injection system. The imaging device is configured to help a
user advance the needle to a nerve, joint or another target
location of the patient's anatomy. In one embodiment, the transfer
of the first, second and/or additional fluids or other materials
from the fluid delivery module to the needle is at least partially
controlled using the at least one button or other controller of the
handpiece assembly. In one embodiment, the imaging device comprises
an ultrasound device.
[0085] In several embodiments, the injection systems, devices and
methods described herein are configured to use nonspecific
containers. As used herein, nonspecific containers shall be given
its ordinary meaning and shall include, without limitation,
containers that vary in size or shape, such as original vial from a
drug manufacturer, formulator and/or supplier. Thus, a nonspecific
container may include, without limitation, a standard or
non-standard vial or other container that includes one or more
medications, formulations and/or other active or non-active
ingredients. The size (e.g., diameter, height, etc.), capacity,
shape, material of construction, closure type and/or other details
can vary between different nonspecific containers. For example, the
nonspecific container used by a first drug manufacturer or supplier
may comprise a relatively small or wide vial, while the nonspecific
container used by a second drug manufacturer or supplier may
comprise a relatively large or narrow vial.
[0086] According to one preferred embodiment, an injection system
is configured to selectively deliver two or more medications,
formulations and/or other fluids or substances into or near a nerve
or joint of a patient (or another target anatomical location) using
a single needle penetration. The injection system includes a fluid
delivery module that is adapted to receive vials or other
containers comprising the medicaments and/or other materials to be
transferred to the patient through a needle positioned along the
distal end of a downstream handpiece assembly. In some embodiments,
vials or other containers comprising the desired medicaments and/or
other substances to be used in a particular injection procedure are
nonspecific containers that are secured to corresponding loading
areas of the fluid delivery module or other portion of the system
with the assistance of adapter.
[0087] According to a second preferred embodiment, the injection
system comprises a handpiece assembly that includes a removable
tip, needle and one or more other components or portions.
Nonspecific containers (e.g., vials) containing one, two or more
different medicaments and/or other substances can be secured onto a
fluid delivery module and be subsequently placed in fluid
communication with the handpiece assembly. The various types of
medicaments and/or other substances can be administered, in
sequential injection procedures, to a plurality of patients in a
manner that permits the clinician or other user to selectively
modify and customize the manner in which the various substances
loaded onto the fluid delivery module are administered to each
patient (e.g., modifying the sequence of delivery, the volume or
other amount of each medication and/or other substance delivered,
etc.).
[0088] Such systems, devices and methods can be adapted to allow a
clinician to quickly and efficiently treat one or more nerves,
joints or other anatomical locations of multiple patients.
Moreover, the system permits a clinician to customize the injection
protocol according to the patient being treated or as otherwise
desired or required. In addition, pain and discomfort to the
patient being treated is generally reduced by the various
embodiments of the injection system disclosed herein. The various
medicaments and/or other materials can be delivered simultaneously
or according to a desired sequence. A clinician or other user can
advantageously regulate the delivery of the medicaments and/or
other materials into the patient using buttons or other controllers
conveniently positioned on the handpiece assembly or another
component of the injection system.
[0089] In some arrangements, an injection system is configured to
be in data communication with and operate concurrently with an
ultrasound wand and/or other imaging or intra-anatomical location
systems or technologies.
[0090] According to some embodiments of the present inventions, a
system for injecting two or more fluids into a targeted anatomical
location includes a handpiece assembly having a proximal end and a
distal end, a needle extending from the distal end of the handpiece
assembly, a fluid delivery module comprising a fluid transfer
device and at least two openings for inserting fluid containers and
a conduit being at least partially routed through an interior of
the handpiece assembly, the conduit being configured to place the
fluid delivery module in fluid communication with the needle.
According to some embodiments, the fluid transfer device is
configured to transfer fluid from fluid containers placed within
the openings of the fluid delivery module to the targeted
anatomical location. In some embodiments, the targeted anatomical
location comprises a bone, organ, muscle tissue, other tissue, a
bodily cavity or any other portion of the anatomy. In other
embodiments, the anatomical location comprises a nerve, an
intra-articular space (e.g., ankle, wrist, hand joint, knee, foot
joint, spine joint, shoulder joint, any other joint or space,
etc.), bone, muscle tissue, other tissue, an organ and/or the
like.
[0091] According to other embodiments, a method for injecting at
least two fluids into a targeted anatomical location comprises
inserting a needle into the targeted anatomical location, the
needle being in fluid communication with a handpiece assembly and a
fluid delivery module, loading at least a first and second fluid
into the fluid delivery module, instructing the fluid delivery
module to deliver the first fluid through the handpiece assembly
and the needle, instructing the fluid delivery module to deliver
the second fluid through the handpiece assembly and the needle and
removing the needle from the anatomical location.
[0092] In one embodiment, a method for aspirating and injecting
fluids into a targeted anatomical location is provided. In one
embodiment, the method comprises inserting a needle into the
targeted anatomical location, the needle being in fluid
communication with a handpiece assembly and a fluid delivery
module, aspirating a first fluid through the handpiece assembly and
the needle, loading at least a second fluid into the fluid delivery
module, delivering the second fluid through the handpiece assembly
and the needle, and removing the needle from the anatomical
location. The first fluid can comprise one or more endogenous
and/or exogenous fluids (e.g., naturally occurring fluids, such as
synovial fluid, lavage fluids, serum, etc.). The second fluid can
comprise one or more endogenous and/or exogenous fluids. In some
embodiments, endogenous fluids include fluids that were
pre-existing in the target area prior to delivery of the needle
and/or a second fluid. For example, an endogenous fluid may include
a diagnostic fluid, a visualization fluid, an anesthetic, or a
lavage fluid such as saline, for which aspiration prior to delivery
of the exogenous fluid may be desirable or any other fluid.
Exogenous fluids include, but are not limited to, medications,
pharmaceutical compositions, drugs, cells (e.g., stem cells and
other biologics), liquid and non-liquid fluids and flowable
materials, nanoparticles, cement, microbeads, therapeutics or
diagnostic fluids, imaging fluids, lavage fluids and/or the like,
and any combinations thereof. In one embodiment, the system for
dual aspiration and fluid delivery comprises a single conduit for
both aspiration and delivery. In another embodiment, the system
comprises separate aspiration and delivery conduits.
[0093] In several embodiments, an imaging device is used to guide
the insertion of the needle, the aspiration of fluid, and/or the
delivery of fluid to the target. In one embodiment, the imaging
device comprises an ultrasound device.
[0094] In some embodiments, a method of transferring a volume of
fluid to an anatomical location comprises providing a module having
an imaging component and an injection component, with the injection
component being configured to receive and selectively deliver a
volume of fluid to a needle. The method further includes inserting
the needle into an anatomy, positioning the needle in a targeted
anatomical location using the imaging component and injecting a
volume of fluid into the targeted anatomical location using the
injection component.
BRIEF DESCRIPTION OF THE DRAWINGS
[0095] These and other features, aspects and advantages of the
present application are described with reference to drawings of
certain embodiments, which are intended to illustrate, but not to
limit, the various inventions disclosed herein. It is to be
understood that the attached drawings are for the purpose of
illustrating concepts and embodiments of the present application
and may not be to scale.
[0096] FIG. 1 illustrates a perspective view of an injection system
according to one embodiment;
[0097] FIG. 2 illustrates a perspective view of an injection system
according to another embodiment;
[0098] FIG. 3 illustrates a rear perspective view of an injection
system according to one embodiment;
[0099] FIG. 4 illustrates a perspective view of a cassette
configured for placement within a fluid delivery module of an
injection system, according to one embodiment;
[0100] FIGS. 5A and 5B illustrate side perspective views of a
cassette being inserted within and removed from a fluid delivery
module, according to one embodiment;
[0101] FIG. 6A illustrates a front perspective view of one
embodiment of a nest or loading area configured to be secured to a
cassette of a fluid delivery module;
[0102] FIG. 6B illustrates a perspective view of another embodiment
of a nest or loading area configured to be secured to a cassette of
a fluid delivery module;
[0103] FIG. 7 illustrates an exploded perspective view of a
cassette and corresponding nests or loading areas and vials or
other containers configured to be positioned thereon, in accordance
with one embodiment;
[0104] FIG. 8 illustrates one embodiment of a cassette (with a
portion of its housing removed to show the internal components)
configured for placement within a fluid delivery module;
[0105] FIGS. 9A-9E illustrate various views of a manifold of a
cassette according to another embodiment;
[0106] FIG. 10 schematically illustrates a cross-sectional view of
the interior of a manifold according to embodiment;
[0107] FIG. 11A illustrates a schematic cross-sectional view of the
interior of a manifold according to another embodiment;
[0108] FIG. 11B illustrates a schematic cross-sectional view of the
manifold of FIG. 11A when fluids and/or other materials are being
transferred from a vial to the syringe or other reservoir according
to one embodiment;
[0109] FIG. 11C illustrates a schematic cross-sectional view of the
manifold of FIG. 11A when fluids and/or other materials are being
transferred from the syringe or other reservoir to the outlet of
the manifold according to one embodiment;
[0110] FIG. 12A illustrates a top view of the syringes or other
reservoirs of a cassette in a first position;
[0111] FIG. 12B illustrates a top view of the syringes or other
reservoirs of a cassette in a second position;
[0112] FIG. 13A illustrates a perspective view of a motor and
accompanying components of a fluid delivery module according to one
embodiment;
[0113] FIG. 13B illustrates a side view of the fluid delivery
module of FIG. 13A;
[0114] FIG. 14A illustrates another embodiment of a cassette (with
a portion of its housing removed to show the internal components)
configured for placement within a fluid delivery module;
[0115] FIG. 14B illustrates a perspective view of the internal
components of the cassette of FIG. 14A;
[0116] FIG. 14C illustrates an exploded perspective view of the
internal components of the cassette of FIG. 14A;
[0117] FIG. 15A illustrates a perspective view of the collection
member of the cassette of FIG. 14A;
[0118] FIG. 15B illustrates an exploded perspective view of the
collection member of the cassette of FIG. 14A;
[0119] FIG. 15C illustrates a side view of the internal components
of the cassette of FIG. 14A;
[0120] FIG. 15D illustrates a cross-sectional side view of the
internal components of the cassette of FIG. 14A;
[0121] FIGS. 16A-16D schematically illustrate, in time-sequential
steps, the transfer of fluids and/or other materials from a vial to
and through a corresponding reservoir, according to one
embodiment;
[0122] FIG. 16E schematically illustrates a top view of a cassette
configured for placement within a fluid delivery module according
to one embodiment;
[0123] FIG. 17A illustrates an exploded perspective view of the
internal components of a cassette according to one embodiment;
[0124] FIG. 17B illustrates a partial detailed perspective view of
the internal components of the cassette of FIG. 17A;
[0125] FIG. 17C illustrates a partial cross-sectional view of the
internal components of the cassette of FIG. 17A;
[0126] FIG. 17D illustrates a partial top view of the internal
components of the cassette of FIG. 17A;
[0127] FIG. 17E illustrates another partial cross-sectional view of
the internal components of the cassette of FIG. 17A;
[0128] FIG. 17F illustrates another partial perspective view of the
internal components of the cassette of FIG. 17A;
[0129] FIGS. 18A and 18B illustrate different views of the internal
components of a cassette according to another embodiment;
[0130] FIG. 18C illustrates a top view of the internal components
of a cassette according to yet another embodiment;
[0131] FIG. 19A illustrates a perspective view of a cassette
configured for placement within a fluid delivery module, according
to another embodiment;
[0132] FIG. 19B illustrates a perspective view of the cassette of
FIG. 19A with an upper portion of the cassette housing or cover
separated from the remaining portion of the housing, thereby
revealing at least some of the internal components of the
cassette;
[0133] FIG. 19C illustrates a perspective view of a unitary
structure configured for placement within an interior of the
cassette of FIG. 19A;
[0134] FIG. 19D illustrates a partial, exploded perspective view of
the upper portion of the cassette of FIG. 19A;
[0135] FIGS. 19E and 19F illustrate perspective views of different
embodiments of a clamp or nest configured to be secured to the
cassette of FIG. 19A;
[0136] FIG. 19G illustrates a cross-sectional view taken though an
interior portion of the cassette of FIG. 19A;
[0137] FIGS. 19H and 19I illustrate perspective views of a cassette
according to one embodiment;
[0138] FIG. 20A illustrates a perspective view of one embodiment of
a cassette configured for placement within a fluid delivery module
and adapted to receive a prefilled syringe or other container;
[0139] FIGS. 20B and 20C illustrate different views of the cassette
of FIG. 20A;
[0140] FIGS. 21A-21E illustrate various views of a fluid conduit
and a handpiece assembly configured for use with an injection
system according to one embodiment;
[0141] FIG. 21F illustrates one embodiment of a nerve stimulation
needle configured for use with an anesthetic injection system;
[0142] FIG. 21G illustrates an embodiment of an anesthetic
injection system comprising a nerve stimulator operatively coupled
to a fluid delivery module;
[0143] FIG. 21H illustrates an embodiment of an anesthetic
injection system comprising a nerve stimulator integrated with a
fluid delivery module;
[0144] FIGS. 22A and 22B illustrate views of a handpiece assembly
configured for use with an injection system according to another
embodiment;
[0145] FIG. 23A illustrates a perspective view of a handpiece
assembly configured to receive a removable control module;
[0146] FIG. 23B illustrates an exploded view of the handpiece
assembly and control module of FIG. 23A;
[0147] FIG. 24 illustrates a perspective side view of another
embodiment of a handpiece assembly;
[0148] FIG. 25A illustrates a detailed side perspective view of the
handpiece assembly of FIG. 24;
[0149] FIG. 25B illustrates a cross-sectional view of the handpiece
assembly of FIG. 24;
[0150] FIGS. 26A and 26B illustrate different views of the
handpiece assembly of FIG. 24 and a control module configured to
attach thereto;
[0151] FIGS. 27A and 27B illustrate different perspective view of
another embodiment of a control module configured to removably
attach to a handpiece assembly;
[0152] FIG. 27C illustrates a perspective view of yet another
embodiment of a control module configured to removably attach to a
handpiece assembly;
[0153] FIG. 28 illustrates a perspective view of a handpiece
assembly according to one embodiment;
[0154] FIG. 29A illustrates a perspective view of a handpiece
assembly according to another embodiment;
[0155] FIG. 29B illustrates a perspective view of a handpiece
assembly according to yet another embodiment;
[0156] FIG. 29C illustrates a side view of the handpiece assembly
of FIG. 29B;
[0157] FIG. 29D illustrates a bottom view of the handpiece assembly
of FIG. 29B;
[0158] FIG. 29E illustrates a perspective view of a handpiece
assembly comprising a removable controller according to one
embodiment;
[0159] FIG. 29F illustrates a side view of the handpiece assembly
of FIG. 29E;
[0160] FIG. 29G illustrates a bottom view of the handpiece assembly
of FIG. 29E;
[0161] FIG. 30A illustrates a perspective view of a handpiece
assembly configured for use with an injection system according to
one embodiment;
[0162] FIG. 30B illustrates an exploded perspective view of the
handpiece assembly of FIG. 30A;
[0163] FIG. 30C illustrates a perspective view of a core of a
handpiece assembly according to one embodiment;
[0164] FIG. 30D illustrates a side view of the core of FIG.
30C;
[0165] FIG. 31A illustrates a perspective view of a clip of a
handpiece assembly according to one embodiment;
[0166] FIG. 31B illustrates a side view of the clip of FIG.
31A;
[0167] FIG. 31C illustrates a top view of the clip of FIG. 31A;
[0168] FIG. 31D illustrates a front view of the clip of FIG.
31A;
[0169] FIGS. 32A-32C illustrate perspective views of a clip of a
handpiece assembly according to another embodiment;
[0170] FIG. 33A illustrates an exploded perspective view of a clip
of a handpiece assembly according to another embodiment;
[0171] FIG. 33B illustrates a perspective view of the clip of FIG.
33A;
[0172] FIGS. 34A-34C illustrate various perspective views of the
delivery line and portions of the clip of FIG. 33A;
[0173] FIG. 35 illustrates a perspective view of one embodiment of
a foot pedal configured to regulate one or more aspects of an
injection system;
[0174] FIGS. 36A-36E illustrate various embodiments of a fluid
delivery module operatively coupled to an ultrasound device or
other imaging system;
[0175] FIG. 36F illustrates a detailed perspective view of one
embodiment of an imaging wand configured to be operatively coupled
to an injection system;
[0176] FIG. 36G illustrates a perspective view of a user
simultaneously manipulating both an imaging wand and a handpiece
assembly of an injection system to treat a patient's foot according
to one embodiment;
[0177] FIG. 37A illustrates an embodiment of an integrated system
configured to be used in the delivery of anesthetic within a
patient and comprising a fluid delivery module operatively
connected to a nerve stimulator and an imaging display;
[0178] FIG. 37B illustrates an embodiment of a nerve stimulation
needle and aspiration assembly coupled to a cassette and configured
to be used in an anesthetic delivery system;
[0179] FIGS. 38A and 38B illustrate embodiments of summaries or
reports configured to be generated in relation to injection
procedures;
[0180] FIG. 38C illustrates one embodiments of a screenshot of an
ultrasound display configured for use with an anesthetic delivery
system;
[0181] FIGS. 39A-39J illustrate various screenshots from the visual
display of a fluid delivery module related to an injection
procedure according to some embodiments;
[0182] FIGS. 40A-40T illustrate various screenshots from the visual
display of a fluid delivery module related to an injection
procedure according to other embodiments; and
[0183] FIG. 41 schematically illustrates a flowchart of one
embodiment of a sequence for delivering medication to a nerve or
another anatomical location.
DETAILED DESCRIPTION
[0184] In some embodiments, regional, peripheral or local
anesthesia (e.g., a nerve block) involves the application of one or
more local anesthetic agents or anesthetics to or near nerves
(e.g., individual nerves, nerve bundles, other nerve tissue, etc.).
As used herein, the term anesthetic is a broad term and includes,
without limitation, any pharmaceutical, medicament, formulation
and/or any other fluid, substance or material that causes
anesthesia or a loss (e.g., reversible or permanent loss) of
sensation. Anesthetics include, but are not limited to, local or
regional anesthetics, analgesics and/or other painkillers or pain
relieving materials, medicaments, materials and/or substances
(e.g., alcohol, phenol, etc.) that at least partially destroy nerve
tissue and/or the like. The terms anesthetic, anesthetic agent,
nerve block and the like are used interchangeably herein.
Anesthetics can include pharmaceuticals and/or formulations or
combinations thereof. Further, anesthetics can include one or more
substances that are also configured to provide at least some
benefit or effect on nerves and related tissues, including cooling
or cryogenic materials, other numbing or related substances and/or
the like.
[0185] In some embodiments, anesthetics (e.g., nerve blocks) are
used for surgical procedures, pain management purposes and/or any
other clinical purpose or reason. For example, pain caused by
inflammation of joints (e.g., facet joints, other portions of the
spine, other joints, etc.) and/or other portions of the anatomy can
be at least partially alleviated through the injection of one or
more anesthetics to or near nerves associated with such pain. In
some embodiments, injections of local anesthetics into a
corresponding joint capsule or surrounding tissue can help relieve
such inflammation and pain. By way of example, certain types of
anesthetics that are used for various indications include, but are
not limited to, interscalene plexus block, supraclavicular plexus
block, infraclavicular plexus block, axillary plexus block, median
nerve block, radial nerve block, ulnar nerve block, femoral nerve
block, popliteal nerve block, tibial block, deep peroneal block,
saphenous nerve block, sural nerve and/or the like. Accordingly,
anesthetics can be selectively delivered to any portion of the
anatomy including, but not limited to: the shoulder, upper arm,
elbow, forearm, wrist, hand, thigh, femur, knee, jaw, foot, toes,
fingers, spine, neck, internal organs, and/or the like.
[0186] Anesthetics can be generally classified into two groups--the
ester group and the amide group. The difference in chemical
structure of the two groups affects the pathway by which the drugs
are metabolized, as well as the potential for allergic reaction.
Ester anesthetics are metabolized by hydrolysis, while amides are
metabolized by microsomal enzymes located in the liver. By way of
example, ester anesthetics that can be delivered using one or more
of the injection system embodiments disclosed herein include, but
are not limited to, cocaine, procaine, chloroprocaine, tetracaine,
and/or the like. Further, amide anesthetics that can be delivered
using one or more of the injection system embodiments disclosed
herein include, but are not limited to, lidocaine, mepivacaine,
bupivacaine, etidocaine, prilocalne, and/or the like. However, any
other type of local or regional anesthetic and/or other type of
anesthetic can be delivered using the various injection system
embodiments, disclosed herein. One or more anesthetics can be
delivered using one or more of the injection system embodiments
disclosed herein either alone or in combination with one or more
other fluids, medicaments and/or other substances or materials. As
discussed in greater detail herein, such anesthetics and/or other
substances can be delivered by the injection system either
sequentially or concurrently, as desired or required. In addition,
in any of the embodiments of an injection system disclosed herein,
one or more fluids (e.g., anesthetics, steroids, other
anti-inflammatory, etc.) can be delivered to a targeted portion or
region of the anatomy either alone or in combination with another
treatment step or procedure, such as, for example, energy delivery.
For example, in some embodiments, a needle secured to the injection
system can be configured to provide one or more forms of energy,
such as, radiofrequency (RF), ultrasound, microwave, laser and/or
the like. Such energy forms can be used to modulate, ablate and/or
otherwise affect native tissue of the patient. For instance, such
energy delivery can be configured to ablate tissue (e.g., create
lesions), stimulate, modulate and/or ablate nerve tissue (e.g.,
denervation, neural modulation, etc.), enhance the efficiency and
therapeutic effect accompanying the delivery of medicaments and/or
other materials into the patient and/or the like.
[0187] One or more anesthetics can be delivered alone or in
combination with another fluid or substance, for example,
epinephrine. In some embodiments, anesthetic agents can be
delivered for a duration ranging, for example, from about 15
minutes to about 240 minutes. According to some embodiments, for
example, the duration of delivery can be about 15 to about 30
minutes, about 30 to about 60 minutes, about 45 minutes, about 30
to about 120 minutes, about 120 to about 240 minutes, about 200
minutes, less than about 45 minutes, more than about 240 minutes,
or any duration or range of durations between these example
durations and ranges. Such anesthetic agents in combination with,
for example, epinephrine and/or any other substance, can be
delivered for a duration ranging, for example, from about 30
minutes to about 480 minutes. For example, the duration of delivery
can be about 30 to about 90 minutes, about 30 to about 120 minutes,
about 60 to about 400 minutes, about 240 to about 280 minutes,
about 240 to about 360 minutes, about 240 to about 480 minutes,
less than 30 minutes, more than 480 minutes, or any duration or
range of durations between these example durations and ranges.
[0188] In some embodiments, anesthetic agents and/or other
medicaments or materials are delivered up to a maximum dose in the
range of, for example, about 1.5 mg/kg to about 11.5 mg/kg. For
example, a maximum dose of an anesthetic agent can be about 1.5
mg/kg, 2.5 mg/kg, 2.8 mg/kg, 4.2 mg/kg, 4.5 mg/kg, 5.7 mg/kg, 7.1
mg/kg, 11.4 mg/kg, less than 1.5 mg/kg, more than 11.5 mg/kg, or
any other dose between these example doses. In some applications,
such anesthetic agents in combination with, for example,
epinephrine, can be delivered up to a maximum dose in the range of,
for example, about 3.2 mg/kg to about 14.2 mg/kg. For example, a
maximum dose of an anesthetic agent in combination with, for
example, epinephrine, can be about 3.2 mg/kg, 5.7 mg/kg, 7.0 mg/kg,
8.5 mg/kg, 14.2 mg/kg, less than 3.2 mg/kg, more than 14.2 mg/kg,
or any other dose between these example doses.
[0189] Anesthetic injection or delivery procedures can be
time-consuming and often involve two, three, or more clinicians for
a single procedure. Inefficiencies associated with certain tasks,
such as, for example, manual syringe preparation and drug and
patient data recording, can contribute to the time and labor
required for such procedures. The devices, systems, and methods
discussed herein can provide more accurate, precise, and controlled
delivery of local anesthetic agents as well as automated record
keeping, which can enhance quality control and allow for more
efficient nerve block procedures. In some situations, these
devices, systems, and methods can advantageously allow for
anesthetic delivery procedures to be performed with fewer personnel
and resources, such as, for example, only one or two clinicians.
Thus, the demand and associated cost of additional clinicians
(e.g., anesthesiologists, other physicians, nurses, other
healthcare professionals, etc.) can be advantageously reduced.
[0190] Although the devices, systems, and methods described herein
are often discussed in the context of nerve block or anesthesia
injection procedures, and in some instances intra-articular
procedures, the devices, systems, and methods can also be adapted
for use for any other indication and/or for any other purpose. For
example, any of the injection systems disclosed herein or variants
thereof can be used to delivery cancer or other relatively potent
medications to a particular portion of the anatomy (e.g., to or
within a specific diseased organ, internal blood vessel, etc.). In
other embodiments, the injection system can be used to deliver
contrast agent to a particular organ and/or other portion of the
anatomy. In some embodiments, the injection system is used for
biopsies or diagnostic procedures where a volume or mass of a
native bodily fluid and/or tissue (e.g., from within an organ,
cyst, cavity, etc) is extracted (e.g., using aspiration features of
the injection system). In such biopsy or diagnostic procedures, the
system can be used to selectively delivery one or more medicaments
and/or other fluids (e.g., anesthetics, contrasting agents, etc.)
to the targeted anatomical location.
[0191] According to some embodiments, the injection system is used
for epidural analgesia or spinal anesthesia procedures. For
example, in such embodiments, epidural analgesia is the anesthetic
that is delivered, either alone or in combination with one or more
other medicaments or fluids, to a patient's epidural space. In any
of the embodiments disclosed herein, the injection system can be
used to deliver one, two or more medicaments (e.g., anesthetics)
and/or other materials to a targeted anatomical location through a
needle, catheter, another body-inserted tube or lumen and/or
combinations thereof, as desired or required. For example, in
epidural or other spinal injections, the injection system can be
used to deliver one or more medicaments (e.g., anesthetics) and/or
any other fluid or substance either through a percutaneous needle
secured to a distal end of the system or through a catheter
positioned within the patient. Regardless of the exact indication
or manner of delivery, an injection of one or more anesthetics can
advantageously block, at least partially, the transmission of
signals through nerves to offer one or more advantages and/or
benefits to the patient (e.g., temporary or long-term pain relief
or reduction).
[0192] The discussion and the figures illustrated and referenced
herein describe various embodiments of an injection device and
system, as well as methods related thereto. A number of these
embodiments of injection systems, devices and methods are
particularly well suited to transfer a volume of one or more fluids
and/or other materials (e.g., anesthetics) to or near (and/or from)
a location of the human anatomy such as a nerve (e.g., nerves,
nerve bundle, nerve tissue, etc.). Such devices, systems and
methods are well-suited for inducing and maintaining anesthesia
during surgical and/or other medical procedures. However, the
various devices, systems, methods and other features of the
embodiments disclosed herein may be utilized or applied to other
types of apparatuses, systems, procedures and/or methods,
regardless of whether they are medically-related or not.
[0193] As discussed in greater detail herein, this application
discloses devices, systems and methods of locating target nerve
tissue or region or other anatomical location and delivering and/or
withdrawing fluids and/or other materials (e.g., anesthetics, other
medications, pharmaceutical compositions, drugs, cells (e.g., stem
cells and other biologics), liquid and non-liquid fluids and
flowable materials, nanoparticles, cement, microbeads, etc.)
thereto and/or therefrom. According to some embodiments, the
devices, systems and methods disclosed herein facilitate the
delivery and/or aspiration of fluids and/or other materials to
and/or from a nerve or other anatomical location by advantageously
using a single needle penetration. Other target anatomical
locations include, but are not limited to, intra articular spaces
(e.g., joints), soft tissue, dermal/subdermal tissue, organs and/or
the like. Several embodiments of the inventions disclosed herein
are particularly advantageous for the anesthesiology and
dermatological (aesthetics) fields. The fluids and/or other
materials can vary in type (e.g., formulation), strength (e.g.,
concentration) and/or in any other manner. The delivery of
anesthetic agents, other fluids and/or other materials to or near
nerves and/or other anatomical locations using the embodiments
disclosed herein can help decrease the risk of complications during
surgical procedures. Such systems, devices and methods can be
especially useful for the treatment of smaller target areas. In
addition, such devices and methods can simplify the execution of
related procedures by physicians and other medical personnel.
Accurately locating a target nerve is typically a very difficult
task. According to some embodiments, the devices, systems and
methods disclosed herein help a clinician or other user to locate
targeted nerves or other anatomical spaces for the subsequent
accurate delivery of fluids and/or other materials thereto.
[0194] FIG. 1 illustrates a perspective view of one embodiment of
an injection system 10. The injection system 10 can include a
handpiece assembly 200 having a needle assembly 290 positioned
along its distal end. In the illustrated embodiment, a delivery
conduit 250 (e.g., flexible tubing) or other some other conduit can
be used to deliver one or more fluids and/or other materials to
and/or from a targeted area or region of the anatomy (e.g., a
nerve, joint, an organ, etc.) via the handpiece assembly 200. In
some embodiments, the materials delivered to the target anatomical
location include one or more medications or medicaments (e.g.,
anesthetics, steroids, hyaluronic acid, etc.), other formulations,
other fluids or substances, such as, for example, pharmaceutical
compositions, drugs, cells (e.g., stem cells and other biologics),
liquid and non-liquid fluids and flowable materials, nanoparticles,
cement, microbeads, therapeutics or diagnostic fluids, imaging
fluids, lavage fluids, other endogenous or exogenous fluids or
materials and/or the like.
[0195] As illustrated in FIG. 1, the delivery conduit 250, and
thus, the handpiece assembly 200, can be placed in fluid
communication with a fluid delivery module 100. As discussed in
greater detail herein, the fluid delivery module 100 can be
advantageously configured to accurately deliver one, two or more
different fluids, compositions, other substances or materials
and/or the like to the handpiece assembly 200 in accordance with a
desired delivery protocol. In some embodiments, the fluid delivery
module 100 is an electromechanical software-controlled device that
uses motors, pumps and/or other mechanical, pneumatic, electrical
or other types of devices to transfer fluids and/or other materials
from multi-dose vials or other containers to a downstream handpiece
assembly via a cassette 300 or other component or device. In one
embodiment, the system comprises one or more stepper motors and/or
other mechanically-operated actuators or devices to accomplish the
accurate delivery of fluids from the fluid delivery module to and
through the handpiece assembly. Further, in some embodiments, a
needle positioned at the distal end of the handpiece assembly 200
is placed in fluid communication with an aspiration source in order
to selectively remove fluids and/or other materials or substances
from a targeted anatomical location (e.g., a nerve, a nerve bundle
or region, a joint, an organ, a cyst, another body cavity, etc.),
as desired or required. The terms "handpiece," "handpiece assembly"
and "handpiece device" are used interchangeably herein.
[0196] According to some embodiments, the fluid delivery module 100
of the injection system 10 includes one or more motors, pumps,
other fluid transfer devices (e.g., syringes operated by a motor,
actuator and/or other mechanical device) to help transfer one or
more medicaments, fluids and/or other substances or materials to a
targeted anatomical location (e.g., an innervated region of the
anatomy). Such fluids, substances and/or materials can be included
in vials 400, ampoules and/or other containers that may be
conveniently secured to the fluid delivery module 100. In some
embodiments, the motor comprises a stepper motor or any other type
of motor that is configured to accurately transfer a volume of
anesthesia (e.g., regional anesthetic), other fluid and/or other
material from the injection system to or near a nerve or another
targeted anatomical location. Stepper motors or other
mechanically-driven motors or devices can be especially helpful in
anesthetic injections (e.g., due to the need to deliver very
accurate volumes of fluids and/or other materials to the target
nerve(s) and/or other factors or reasons). In addition, the
execution of such injections can be facilitated and enhanced by the
systems and devices disclosed herein, as the need for two or more
different needle penetrations to access a nerve or other targeted
anatomical area is advantageously eliminated.
[0197] According to other embodiments, the fluid transfer device
comprises one or more peristaltic pumps, syringe pumps, gear pumps,
bladder pumps, diaphragm pumps, metering pumps and/or any other
type of pump (e.g., mechanical, pneumatic, etc.). Such a fluid
transfer device can be adapted to deliver liquids, gases, other
fluids, solids, non-Newtonian fluids, other non-flowable materials,
combinations thereof and/or the like to a desired anatomical
location.
[0198] The general arrangement of the devices, systems and methods
illustrated and discussed herein permits one or more anesthetics,
fluids, substances or other materials to be delivered to and/or
removed from nerve with a single needle penetration. Therefore,
pain and/or discomfort to a patient can be advantageously reduced.
Further, the complexity and other difficulties associated with
executing such procedures can be reduced for physicians or other
clinicians. In addition, as discussed in greater detail herein,
such systems can be configured to easily and accurately deliver a
desired quantity of one or more medicaments (e.g., pharmaceuticals,
drugs, medications, etc.) and/or other fluids, substances or
materials, or a combination thereof, to a desired anatomical
location. In some embodiments, an injection system can comprise
and/or can be operatively coupled to an imaging device (e.g.,
ultrasound device) to assist a user in accurately positioning the
needle within a patient's anatomy (e.g., nerve) prior to delivering
the desired pharmaceuticals and/or other fluids or materials.
[0199] According to some embodiments, as part of a desired
treatment protocol, one or more anesthetics are initially delivered
into the patient using the injection system. For example, a desired
volume of Lidocaine and/or any other short-acting and/or
long-acting anesthetic can be delivered within the anatomy to
reduce the pain and discomfort to the patient. Such anesthetics can
be delivered before and/or while the needle located at the distal
end of a handpiece assembly is being advanced through the skin and
other anatomical tissues and portions of the patient. Alternatively
or additionally, a short or long acting anesthetic can be delivered
into the patient after the needle has been accurately positioned at
or near the target anatomical location (e.g., nerve). Further, in
some embodiments, the delivery of an anesthetic is followed by the
delivery of a second anesthetic (e.g., a slow-acting anesthetic), a
steroid (e.g., Depo-Medrol.RTM.) and/or any other pharmaceutical or
other material (e.g., hyaluronic acid, saline, pain-relieving
medications, pharmaceutical compositions, other medications or
drugs, cells (e.g., stem cells and other biologics), liquid and
non-liquid fluids and flowable materials, nanoparticles, cement,
microbeads, etc.) in accordance with a desired treatment protocol.
For example, a physician or other clinician can use particular
injection protocols for treating certain diseases, conditions
and/or patients. As discussed in greater detail herein, various
medications, formulations and/or other fluids and/or other
materials can be delivered into a patient simultaneously and/or
sequentially.
[0200] With continued reference to the injection system illustrated
in FIG. 1 the fluid delivery module 100 can be configured to
receive a cassette 300, cartridge or other member, which in some
arrangements, is configured to be removably secured to the fluid
delivery module 100. The injection system 10 can be configured so
that one or more vials 400, ampoules or other containers comprising
anesthetic agents, other medications and/or other fluids,
substances or materials can be easily loaded onto (and subsequently
removed from) the cassette 300 or other portion of the fluid
delivery module 100. In some embodiments, a cassette or other
portion of the fluid delivery module is configured to receive
off-the-shelf medication and/or fluid packages in multi-dose vials
or ampoules. Further, in certain arrangements, a cassette or other
portion of the fluid delivery module is configured to receive one
or more non-specific fluid containers. In alternative embodiments,
the fluid delivery module 100 does not include a cassette or other
removable member on which vials or other containers can be
loaded.
[0201] Anesthetics, other medications, fluids, materials and/or
substances included within vials or other containers that are
loaded onto the cassette 300 can be accurately and conveniently
administered to a targeted nerve or other anatomical location. The
injection system 10 can be configured to selectively transfer such
fluids and/or other materials from the respective vials, through
the cassette 300, to a needle assembly 290 located at the distal
end of the handpiece 200. In some embodiments, the handpiece
assembly 200 is configured to be in fluid communication with the
fluids and/or other materials contained within the vials 400 or
other containers. In some arrangements, the system 10 is
additionally configured to selectively aspirate fluids and/or other
substances from an area surrounding a nerve, an intra-articular
space or other portion of the anatomy, either in lieu of or in
addition to delivering one or more fluids and/or other substances
within the anatomy.
[0202] In some embodiments, the needle assembly 290 secured to the
distal end of the handpiece assembly 200 includes a needle 240 that
can be advanced through the skin and other tissues of a patient so
as to adequately reach a targeted nerve or other anatomical
location (e.g., joint, organ, cyst, cavity, etc.). In several
embodiments, the needle has a gauge of 18 G-30 G and a length of
about 0.5 to 5.0 inches (e.g., 1.0 to 1.5 inches). However, in
other arrangements, the gauge, length and/or other details of the
needle can be greater or smaller than the range indicated herein,
as desired or required by a particular application. Further, the
needle can comprise surgical-grade stainless steel and/or any other
suitable material (e.g., other metals, alloys, etc.).
[0203] With continued reference to FIG. 1, the injection or
delivery system 10 can include one or more displays 130 or other
user interfaces along one or more of its outer surfaces. As
discussed in greater detail herein, the display 130 can be
configured to provide various data and/or other information to the
user. In some embodiments, the fluid delivery module 100 comprises
a data input device (e.g., touchscreen, keyboard, keypad, dials,
buttons, etc.) to permit a user to enter data and/or other
information regarding a particular procedure. For example, in one
arrangement, the display 130 comprises a touchscreen configured to
both provide information to and receive information and
instructions from a user.
[0204] In some embodiments, the handpiece assembly includes one or
more electrical components, such as, for example, an
electrically-operated controller. Thus, the fluid delivery module
100 can include one or more charging receptacles or other docking
stations that are sized, shaped and otherwise configured to receive
a handpiece assembly. However, in other arrangements, as
illustrated in FIG. 1 and discussed in greater detail herein, the
handpiece assembly 200 does not comprise any electrical components.
As a result, the need for a docking or recharging station on or
near the fluid delivery module 100 can be advantageously
eliminated.
[0205] In addition, the fluid delivery module 100 can include one
or more other components or features to enhance the function,
aesthetic appearance and/or other aspect of the system 10. For
example, in FIG. 1, the fluid delivery module 100 comprises a
recess or groove 114 along its upper end that facilitates
positioning the cassette 300 into and/or out of the top of the
module 100. The quantity, location, shape, size and/or other
details of such recesses or grooves 114 can be different than
depicted in FIG. 1. Moreover, an anesthetic injection system 10 can
include one or more other components or features, as desired or
required by a particular application.
[0206] As shown in the embodiment of FIG. 1, the housing 110 or
outer chassis of the fluid delivery module 100 can include
generally rounded corners. Alternatively, however, the housing 110
can comprise any other shape, size, configuration and/or feature.
Further, the fluid delivery module 100 can include generally smooth
or glossy surfaces that are configured to withstand frequent
cleaning. In some arrangements, the fluid delivery module 100 is
waterproof or water-resistant or substantially waterproof or
water-resistant. In some embodiments, generally smooth exterior
surfaces of the module 100 can facilitate cleaning and prevent
residual contamination from remaining on the housing. Further, the
fluid delivery module 100 can be configured to maintain vials
and/or other containers secured thereon at a particular thermal
setting or temperature range. For example, the module 100 can
include a temperature control system (e.g., cooling/heating device,
temperature sensor, regulator, etc.) that permits the module 100 to
maintain a pharmaceutical or other material to be delivered into a
patient within a desired temperature range. This can be
particularly useful and beneficial for the delivery of formulations
or other substances that degrade or otherwise become
disadvantageously transformed when not adequately
temperature-controlled (e.g., cooled or otherwise refrigerated,
heated, etc.).
[0207] In some embodiments, as illustrated in FIG. 1, a touchscreen
display 130 of a fluid delivery module 100 is generally
rectangular. In certain arrangements, the display 130 comprises a
flat panel touchscreen having a 7-inch color TFT LCD. The
resolution of the display 130 can be approximately 800.times.600
with a total of about 480,000 pixels and a brightness rating of
approximately 300 cd/m.sup.3. In addition, the touchscreen display
130 can use restive technology for sending touch input. In some
embodiments, the touchscreen is compatible with and/or without the
use of gloves (e.g., latex gloves). However, the type, size,
resolution, brightness, compatibility and/or other details about
the display 130 can vary, as desired or required.
[0208] In some embodiments, the touchscreen display 130 can
comprise a 16 to 9 aspect ratio. However, as noted above, the type,
shape, size, aspect ratio, resolution and/or other characteristics
of the display 130 can vary, as desired or required. As discussed
in greater detail herein, the touchscreen display 130 can be
adapted to identify one or more characteristics regarding the vials
and/or other containers (e.g., syringe, etc.) secured to the module
100. In addition, the touchscreen display 130 can be configured to
display status information, patient information (e.g., name, vital
signs, known allergies, etc.), imaging information, injection
procedure programming and/or status information and/or any other
information. Further, the touchscreen display 130 and/or another
data entry device can permit a physician, other clinician or other
user to control the operation of the procedure (e.g., verify
patient, verify fluids or other materials to be delivered, locate
target nerve, start, stop, reduce/increase flowrate or other rate
of delivery, etc.) and/or to enter other data within the system
10.
[0209] According to some arrangements, the touchscreen display 130
is configured to illustrate text and/or images (e.g., icons). The
use of icons can facilitate the physician or other user in
performing the required injection and/or aspiration procedure. For
example, the touchscreen display 130 can be configured to display a
list of various body parts (e.g., foot, hand, arm, leg, spine,
knee, other body parts or organs, etc.) into which a desired
injection is to occur. Once a user selects the general anatomical
area targeted by the procedure, the touchscreen display 130 can
provide a more detailed selection list of available target sites
(e.g., specific nerves) within that general area. For example, if a
particular body part, organ or region is selected, the touchscreen
display 130 can provide a more detailed list of subparts or
subregions associated with that area of the patient's anatomy.
Alternatively, the display 130 can provide a list of various
treatment procedures or injection protocols from which to choose.
In other embodiments, as illustrated in FIGS. 39A-39J and 40A-40T,
the touchscreen display 130 can include "UP" and "DOWN" softkeys,
arrows, other icons, text and/or other images that facilitate the
user during the execution of the corresponding procedure.
[0210] In some embodiments, the selected icon or other portion of
the display 130 can be configured to change color, shade, shape
and/or the like when a user selects it. Further, the fluid delivery
module 100 can be configured to provide visual and/or audible
verification that a selection was made (e.g., tone, beep, etc.). In
some embodiments, a touchscreen display 130 and/or any other
component of the fluid delivery module 100 includes one or more
other features, as required or desired by a particular application.
As discussed, an injection system can also include a voice
command/notification system that permits a user to receive audile
updates from the system (e.g., volume dispensed, volume remaining,
etc.) and/or to control the operation of the system using audible
instructions (e.g., "START," "STOP," "DECREASE DELIVERY RATE,"
"INCREASE DELIVERY RATE," "PAUSE," "TERMINATE" and/or the like).
The disclosure included herein regarding the display 130 (e.g.,
touchscreen device) and other features of the injection system can
be applied to any other embodiment of a fluid delivery module
disclosed herein or equivalents thereof.
[0211] The fluid delivery module 100 and/or any other components of
the injection system 10 can be electrically energized by one or
more power sources. For example, in some embodiments, the fluid
delivery module 100 is configured to connect to an AC power supply
(e.g., via a cord or other connection). In such arrangements, an AC
transformer can be situated either within or outside of the module
housing 110. Thus, in some embodiments, a fluid delivery module
includes an external power supply. In other embodiments, however,
the fluid delivery module is powered by one or more batteries
(e.g., rechargeable lithium batteries, disposable batteries, etc.)
or another DC power source, either in addition to or in lieu of an
AC power supply. This can provide an extra measure of protection to
ensure that an injection procedure is not interrupted because of a
power outage or other disruption. In addition, the use of batteries
and/or an external AC power transformer can advantageously enhance
the portability of the injection system and/or help to reduce its
overall size and/or weight. However, in alternative embodiments,
one or more other types of devices and/or methods are used to
provide electrical power to the fluid delivery module 110 and/or
other components of the injection system 10.
[0212] According to some embodiments, a fluid delivery module 100
includes one or more other ports, slots and/or other connection
sites configured to operatively connect the module 100 to one or
more other devices, processors and/or the like (e.g., ultrasound or
other imaging device, personal computer, internet, other local or
non-local network, etc.). Such ports or slots can be standard
(e.g., USB, mini-B, parallel, etc.) or non-standard, as desired or
required.
[0213] Further, a fluid delivery module 100 can comprise one or
more memory, communication and/or other types of slots or
connections. Thus, the module 100 can be upgraded with additional
programs, functions and/or other capabilities in accordance with a
desired protocol. In some embodiments, a fluid delivery module 100
comprises a USB or other port that is configured to communicate
with a personal computer, a PDA, a Smartphone and/or any other
device (e.g., the hospital's computing network, an internet
connection, a monitoring device, an ultrasound device, another
medical device, etc.). In yet other arrangements, the fluid
delivery module 100 includes one or more wireless connections or
communication systems (e.g., modem, Wi-Fi, RFID, Bluetooth, etc.)
that advantageously permit the module to selectively communicate
with other components of the injection system (e.g., handpiece
assembly) and/or one or more other computing systems or devices.
These types of communication devices and/or systems can permit a
user to transfer data (e.g., continuously or intermittently) to
and/or from the module 100, as desired or required. For example,
new software or software patches can be periodically installed onto
the module 100, either automatically or manually. In other
embodiments, information about a particular treatment procedure
(e.g., patient information, date and time, drug types, dosages and
volumes injected, other injection protocol details, etc.) is
selectively transmitted from the fluid delivery module 100 to an
external source (e.g., network, computer, etc.).
[0214] The fluid delivery module 100 can comprise and/or can be in
communication with one or more processors, control devices and/or
the like. This can permit the module 100 to adequately process data
and control the operation of the various components of the fluid
injection/aspiration system. In some embodiments, the processor
and/or control unit are included within the housing 112 of the
fluid delivery module 110. Alternatively, such components can be
external to the module 100. In such arrangements, the fluid
delivery module 100 can be placed in data communication with an
external processor and/or control unit using one or more hardwired
and/or wireless communications.
[0215] FIG. 2 illustrates another embodiment of a fluid delivery
module 100A configured for use in an anesthetic of articular
injection system 10A. As shown in FIG. 2, the fluid delivery module
100A can include a cassette 300A configured to be selectively
positioned within and removed from the module housing 110A. The
cassette 300A can comprise an outer housing that is configured to
enclose one or more internal components (e.g., manifolds, syringes
or other reservoirs, etc.). As shown in FIG. 2, the cassette 300A
can include a generally contoured rectangular shape. In other
embodiments, the cassette 300A is permanently or semi-permanently
secured to the fluid delivery module 100A, or the cassette 300A
forms a generally unitary structure with the fluid delivery module
100A. Further, in some embodiments, the cassette 300A and/or any of
its components or portions comprise one or more materials, such as,
for example, plastic or other polymers, rubber, other elastomers,
metals, alloys and/or any other synthetic or natural materials, or
combinations thereof. However, the shape, size, materials of
construction and/or other characteristics of the cassette 300A can
vary, as desired or required for a particular application or use.
In addition, the cassette 300A can comprise one or more finger
wells, grooves and/or other recessed areas or features that
facilitate placement of the cassette 300A into and/or out of the
corresponding area of a fluid delivery module 100A.
[0216] According to some embodiments, the cassette 300A is a
disposable item that is configured to be replaced according to a
desired or required protocol or schedule (e.g., once, twice or more
often per day, less often than once a day, etc.). As discussed in
greater detail herein, the cassette 300A can be configured to be
removed and replaced together with the downstream delivery line 250
(e.g., tubing, other conduit, etc.) and/or handpiece assembly 200
(FIG. 1) once a day, whenever a treatment scheme is varied or
modified and/or according to any other protocol. In other
embodiments, the cassette 300A may be configured to be replaced
more or less often than indicated herein, as desired or required.
Alternatively, the cassette 300A can be removed and replaced when
one or more medications or other fluids or substances being
delivered through the injection system are changed (e.g., types of
fluids, dosages or concentrations, etc.). This can help prevent
cross-contamination between different types of substances,
different dosages of substances and/or the like.
[0217] In the embodiment depicted in FIG. 2, up to three vials (not
shown) or other containers may be secured to receiving sites 310A,
312A, 314A located along the top surface of the cassette 300A. In
some embodiments, each receiving site comprises a nest or loading
area that is adapted to accept a standard or non-standard vial or
other container. The cassette 300A can include more or fewer
receiving sites 310A, 312A, 314A, as desired or required. In
addition, the location, spacing and other details of the receiving
sites 310A, 312A, 314A can be different than illustrated in FIG. 2.
As discussed in greater detail herein, once the vials 400 (FIG. 1)
or other containers are secured to the cassette 300A, the injection
system can be configured to selectively transfer the contents of
such vials or other containers within the fluid delivery module
100, 100A (e.g., within one or more syringes or other reservoirs of
a removable cassette secured to the fluid delivery module), and
subsequently, accurately deliver the interior contents of one or
more of such vials to a targeted anatomical location in a precise
and accurate manner, in accordance with a desired protocol.
According to some embodiments, one or more of the vials can be
configured to be continuously or intermittently mixed, either
automatically or manually, while they are secured to the cassette
and/or during the execution of an injection procedure. Such mixing
may be desired or required for certain medicaments, substances
and/or other materials, such as, for example, steroids or other
solutions or mixtures having solids or other components that have a
tendency to settle or that require mixing. In certain arrangements,
the receiving sites of the cassette are configured to receive a
variety of different vials or other containers, including
off-the-shelf vials and/or customized vials or containers.
[0218] FIG. 3 illustrates a rear portion of one embodiment of a
fluid delivery module 100. One or more buttons, ports or other
connection points and/or the like can be included along one or more
portions of the module's housing 110. In the depicted embodiment,
the fluid delivery module 100 comprises an On/Off button 112,
switch or other controller, a power port 113, one or more
electrical fuses, one or more USB ports 118, an Ethernet or other
network port 116 and/or the like. As discussed in greater detail
herein, such ports and/or other connection points can help place
the fluid delivery module in data communication with an external
device (e.g., a computer, an imaging device, etc.), system, network
(e.g., a facility's main network, the Internet, etc.) and/or the
like.
[0219] FIG. 4 illustrates one embodiment of a cassette 300 adapted
for placement within a fluid delivery module of an injection
system. The cassette 300 can be configured to receive up to three
different vials and/or other containers (not shown in FIG. 4).
However, in other embodiments, the cassette 300 is adapted to
receive fewer (e.g., one or two) or more (e.g., four, five, more
than five, etc.) vials or other containers, as desired or
required.
[0220] With continued reference to FIG. 4, the cassette 300 can
include an outer housing 302 that encloses one or more of its
internal components, such as, for example, reservoirs, syringes,
tubing, manifolds and/or the like. As shown in FIG. 4, the cassette
300 can comprise one or more resilient tabs 304, clips, recesses
and/or other features that are configured to engage corresponding
members, recesses or features 115 on the fluid delivery module 100
(FIGS. 5A and 5B). For example, in some embodiments, as illustrated
in FIG. 5A, the cassette 300 is secured to the fluid delivery
module 100 by urging it within a corresponding recess 114 along the
top of the module 100. Tabs 304 on either side of the cassette 300
can engage corresponding recesses 115 or other features of the
fluid delivery module. As a result, in some embodiments, the
cassette 300 is releasably locked to the fluid delivery module
100.
[0221] In one embodiment, in order to release the cassette 300 from
the fluid delivery module 100, the tabs 304 are urged toward one
another. Accordingly, the interlocking features between the
cassette 300 and the module 100 can disengage, permitting the
cassette 300 to be lifted or otherwise removed, as illustrated in
FIG. 5B. When lockingly engaged to the fluid delivery module 100,
the cassette 300 can be properly connected to the motors (e.g.,
stepper motors) and/or other devices or components that help
control the internal components of the cassette (e.g., the plungers
or other movable members) to selectively deliver one or more fluids
and/or other substances from the vials (or other containers) to the
handpiece assembly.
[0222] The cassette 300 can include one or more receiving sites 310
located along the top surface of the cassette 300. For example, the
arrangement illustrated in FIG. 4 includes a total of three
receiving sites 310. Alternatively, however, a cassette can include
more or fewer receiving sites 310, as desired or required. In some
embodiments, a nest (or loading device or area) is configured to
removably or permanently attach to one or more of the receiving
sites 310. As discussed in greater detail herein, such nests or
loading devices (not shown in FIG. 4) are adapted to receive a
standard or non-standard vial, ampoule, syringe and/or other
container. The location, spacing and other details of the receiving
sites 310 can be different than illustrated in FIG. 4.
[0223] Regardless of their exact design and configuration, the
nests or loading devices are adapted to attach to the cassette 300
using a luer lock or other standard or non-standard connection
(e.g., threaded, friction fit, flanged, clipped, etc.). As
illustrated in FIG. 4, the cassette can include, at each receiving
site 310, a female or male luer lock fitting 312 that is sized,
shaped and otherwise configured to removably attach to a
corresponding fitting of a nest or other loading device. Additional
details regarding certain embodiments of nests or other devices
adapted to secure to a cassette's receiving sites 310 are provided
below.
[0224] Once the desired vials or other containers are secured to
the cassette's nests or loading areas, the injection system can be
configured to transfer the contents of such vials or other
containers within the fluid delivery module 100 and subsequently
deliver them to a targeted anatomical location in a precise and
accurate manner. In some embodiments, the cassette 300 comprises
one or more rigid and/or semi-rigid materials, such as, for
example, plastic, metal, elastomer, ceramic, composite, any other
natural or synthetic material and/or the like. The housing 302 of
the cassette 300 can be manufactured in two or more pieces (e.g.,
upper and lower portions) that are subsequently secured to each
other using screws or other fasteners, adhesives, welds and/or any
other connection device or method. Alternatively, the cassette
housing 302 can comprise a generally unitary structure.
[0225] According to some arrangements, each receiving site of a
cassette 300 comprises a nest, loading area or other component,
region or portion to which a vial, ampoule, syringe and/or other
container may be secured. One embodiment of such a nest or loading
area 370 is illustrated in FIG. 6A. The loading area 370 or nest
can be a separate member that is permanently or removably joined to
the housing or other portion of the cassette 300 using one or more
attachment devices or methods (e.g., luer lock fitting, other
standard or non-standard fittings or connections, etc.).
Alternatively, as noted herein, the loading areas 370 or nests (or
equivalents thereof) can form a unitary structure with the cassette
300 (e.g., the loading area or nest can be molded or manufactured
as a single piece or unit with the housing or other portion of the
cassette 300 or fluid delivery module). As used herein, the term
loading area is a broad term and includes, without limitation, a
nest, docketing port or station, an opening, a slot and/or any
other component, area or portion configured to receive a vial or
other container. Accordingly, the terms loading area, loading
device, nest and the like are used interchangeably herein.
[0226] A nest or loading area or device 370 can be sized, shaped
and otherwise adapted to securely receive the top portion (e.g.,
neck area) and/or any other feature or portion of various vials or
other containers. Accordingly, a clinician or other user of the
injection system can easily, quickly and conveniently position
multi-dose vials (e.g., standard or non-standard vials as supplied
to the clinician by a manufacturer or other supplier) onto the
fluid delivery module (e.g., cassette). Such vials or other
containers can vary in size, shape, closure member design and/or
any other characteristic. Thus, the need to transfer liquids, other
fluids and/or other substances from such vials to other reservoirs
or containers of an injection system (e.g., to a separate
reservoir, syringe, other container and/or the like, either within
or outside of the injection system, etc.) can be advantageously
reduced or eliminated. This can result in one or more benefits or
other advantages. For example, potentially time-consuming efforts
to transfer the medicaments, fluids and/or other substances from
vials or other containers in which they are initially supplied to
the injection system can be eliminated. Relatedly, the use of such
nests or other loading areas can make the injection procedure
safer, as the likelihood of contamination of the various fluids or
other substances (e.g., with the outside environment, by the
clinician, between the various medicament streams, etc.) can be
reduced. In some embodiments, this is the case because, among other
things, the need to manually transfer the contents of vials and
other containers is eliminated or reduced. Further, the volume or
other amount of wasted fluids and/or other materials that would
otherwise remain as unused and discarded residual within the vials
or other containers can be advantageously reduced or eliminated.
This can provide one or more environmental, cost-saving and/or
other benefits.
[0227] FIG. 6A illustrates one embodiment of a nest 370 or loading
area, which is configured to be attached to a cassette and which is
adapted to securely receive a vial or other container. As noted
above, the nest 370 (or loading area) and the cassette 300 can be
separate items that are attached to one another using one or more
connection devices or methods. For example, in the depicted
embodiment, the nest 370 comprises a bottom portion 372 (e.g.,
tube) that is configured to removably secure to the cassette 300.
In some embodiments, as illustrated in FIG. 6A, the bottom portion
or tube 372 comprises a luer lock or any other standard or
non-standard connection or fitting 374 that is adapted to fit
within a corresponding coupling or feature of the cassette 300.
However, in other arrangements, other types of standard or
non-standard fittings or connection devices, features or methods
are used to help secure (e.g., either removably or permanently) the
nest 370 or loading area to the cassette 300, such as, for example,
threaded connections, press-fit connections, snap or clip
connections and/or the like. Alternatively, as noted herein, the
cassette 300 and the nest 370 can be integrally formed with one
another.
[0228] With continued reference to FIG. 6A, the nest 370 or loading
area can include an interior region 375 into which a vial or other
container may be positioned. In the illustrated arrangement, the
nest 370 comprises wings 376 that are positioned opposite of one
another. In some embodiments, as illustrated in FIG. 6A, the nest
370 or loading area includes two wings 376 or other flexible
members that are adapted to releasably secure a vial or other
container to the nest. Each wing 376 can include a vertical portion
392 that helps to define the interior region 375 of the nest 370 or
loading area. In other embodiments, the nest 370 includes more
(e.g., three, four, five, six, more than six, etc.) or fewer than
two wings 376 or other flexible members. Further, the shape, size,
design and/or other characteristics of the wings 376 can be
different than discussed and illustrated herein.
[0229] An upper portion of each wing 376 can include an
inwardly-facing locking portion or member 377 that is configured to
engage and maintain the neck or other closure portion of a vial or
other container within the interior region of the nest 370 or
loading area or device. In some arrangements, each locking portion
377 comprises one or more sloped portions. In addition, an upper
region of each wing 376 can include a handle member 378 that can
facilitate moving the wing 376 away from the interior region of the
nest 370 or loading area (e.g., to place a vial or other container
within the interior region 375 of the nest). According to some
embodiments, the wings 376 or other flexible members are configured
to maintain the position illustrated in FIG. 6A. Thus, after the
wings 376 are pulled apart (e.g., to insert or remove a vial within
the nest 370), the wings 376 resiliently return to their inward
(e.g., static) position upon their release by the user.
[0230] According to some embodiments, as illustrated in FIG. 6A,
the nest 370 or loading area comprises a ventilated spike 380.
Thus, when a vial or other container is properly secured to the
nest or loading area or device 370, the ventilated spike 380 can
place the internal contents of the vial (e.g., anesthetic, steroid,
other drug or medicament, other fluid, material or substance, etc.)
in fluid communication with one or more subcomponents of the
cassette 300 (e.g., manifold, syringe or other reservoir, etc.)
and/or other components of the injection system. The ventilated
spike 380 can be sized, shaped and otherwise configured to
penetrate a septum or other membrane of a vial or other container
secured to the cassette. A ventilation member 390 of the loading
area 370 can selectively permit air to pass into the vial or other
container when fluids or other substances are being transferred
from the vial or other container to one or more other components of
the cassette 300. The ventilation member can be incorporated into
the ventilated spike design. In some embodiments, the ventilation
member 390 comprises or is operatively connected to a filter to
reduce the likelihood of contaminants from the surrounding
environment (e.g., ambient air) entering the vial. The filter can
include pores having a cross-sectional dimension of approximately
0.05 .mu.m, 0.1 .mu.m, 0.2 .mu.m, 0.3 .mu.m, 0.4 .mu.m, 0.5 .mu.m,
less than 0.05 .mu.m, greater than 0.5 .mu.m and/or ranges between
such values.
[0231] As noted above, the use of a nest 370 or other loading area
or device with a ventilated spike can provide one or more
advantages. For example, by eliminating needles (e.g., a main
needle, a vent needle, etc.) or other sharps from the interior of
the nest 370, the likelihood of puncture or other sharps-related
injuries to a user of the injection system can be advantageously
reduced or eliminated. Relatedly, this provides a safer environment
for a physician, nurse or other clinician or user associated with
the execution of an injection procedure. For example, such a
configuration can make it easier for a clinician to load or remove
one or more vials or other containers to or from the cassette in
order to manually shake, agitate or otherwise mix the contents
thereof (e.g., anesthetics, hyaluronic acid, steroid, stem cells,
other cells or other biologics, bone cement, beads, etc.). In some
embodiments, a clinician or other user can manually remove and
shake such vials or other containers one or more times (e.g.,
before loading the vial to the cassette, immediately prior to the
transfer of fluids from the vial or other container to the fluid
delivery module, at any other time), as desired or required. Thus,
the contents of the vial or other container can be maintained in a
mixed state and thereby reducing the likelihood of settling,
stratification and/or any other undesirable occurrences. In other
embodiments, the internal contents of a vial or other container can
be automatically mixed (e.g., continuously or intermittently).
Additional details regarding such embodiments are provided in U.S.
patent application Ser. No. 12/340,595, filed Dec. 19, 2008 and
published as U.S. Publication No. 2009/0163860, the entirely of
which is hereby incorporated by reference herein.
[0232] In some embodiments, the nest or loading area 370 can be
removed from the cassette 300, thereby allowing a syringe or
another container to be secured directly to the cassette. This can
be facilitated by the use of standard connections or fittings on
the cassette 300, such as, for example, a universal luer lock
connection 312 (FIG. 4), a threaded connection and/or the like.
Thus, a syringe or other container having a similar connection can
be directly secured to the cassette 300. Consequently, as with the
internal contents of a vial or other container secured within a
nest or loading area, the contents of a syringe or other container
that is secured to the cassette (e.g., without the nest or loading
area) can be subsequently transferred within one or more
subcomponents of the cassette (e.g., reservoir, manifold, etc.) and
other downstream components and portions of the injection system
(e.g., handpiece assembly) for selective delivery into or near a
nerve or other target anatomical location.
[0233] With continued reference to FIG. 6A, in order to secure a
vial or other container to the nest 370, a clinician or other user
can align the closure member or other portion of the vial within
the interior region 375 defined by the wings 376. In some
embodiments, during this alignment and loading process, the closure
member or other leading surface of the vial initially contacts the
sloped or slanted surfaces 377 of the wings 376. As the vial is
urged downwardly (e.g., into the interior region of the nest 370),
the closure member of the vial or other container can slide against
the sloped surfaces 377, thereby causing the wings 376 to separate
outwardly (e.g., away from each other). The presence of the wings
376 can help center or properly align the vial or other container
within the nest 370. If the vial is urged far enough into the
interior area 375, the ends of the slanted surfaces can move above
the closure member of the vial so that the wings 376 resiliently
move inwardly (e.g., toward each other) within the neck of the
vial. Thus, in some embodiments, once properly positioned within a
nest 370, the vial or other container cannot be removed, at least
temporarily, from the interior region of the nest 370, because the
wings 376 engage the adjacent surfaces of the closure member or
other portion of the vial. Consequently, the vial or other
container can "snap" or "lock" into the nest 370 or loading area to
removably secure it thereto.
[0234] In any of the embodiments disclosed herein, the nest 370 or
other loading area or device can be adapted to receive vials or
other containers of different shapes, sizes, designs,
configurations and/or the like. According to some embodiments, the
loading area 370 can accommodate containers (e.g., standard or
non-standard vials, ampoules or other vessels having a capacity of
5 ml, 10 ml, 50 ml, 100 ml, smaller than 5 ml, larger than 100 ml,
ranges between these ranges and/or the like) as provided, either
directly or indirectly, to the clinician or other user by a
pharmaceutical manufacturer or supplier. In other arrangements, the
nest 370 or loading area is configured to receive vials or
containers of various types and/or sizes. As discussed, once a vial
or other container is positioned within the loading area 370, the
ventilated spike 380 can penetrate a septum or other portion of the
vial's closure member to access the interior of such vial or other
container. Thus, the internal contents of the vial (e.g.,
medicaments, other fluids or materials, etc.) can be placed in
fluid communication with other portions of the cassette and fluid
delivery module (e.g., internal reservoirs, tubing, handpiece
assembly, etc.).
[0235] In order to remove a vial or other container from the nest
370, the clinician or other user can pull the handles 378 outwardly
so the wings 376 move far enough apart from one another to permit
the closure member of the vial to be lifted out of the interior
region 375. In some embodiments, the handles 378 are configured so
that they may be selectively grasped and separated using a single
hand. This can permit a user to conveniently separate the wings 376
of the loading area 370 with one hand while removing the vial or
other container with the other. In other arrangements, one or more
other ways of securing a vial to a nest 370 or loading area (and/or
removing it therefrom) can be used.
[0236] As discussed herein, one or more of the cassette's nests or
loading areas can be configured to continuously or intermittently
mix the contents (e.g., steroids, other pharmaceuticals or
medicaments, other fluids, solids or other mixtures, etc.) of a
vial or other container secured thereto. Such mixing can be
performed manually (e.g., by the user) or automatically (e.g., by
one or more features or components of the fluid delivery module).
In some arrangements, it is desirable to maintain the internal
contents of a vial or other container at least partially mixed
while such vial or other container is positioned on the cassette.
For example, certain types of formulations (e.g., steroids) that
include a relatively high solids concentration may need to be mixed
to ensure that a generally consistent and homogeneous dose is drawn
into the injection system and delivered to the patient during an
injection procedure. It may be desirable for other types of fluids,
materials and/or other mixtures to be continuously or
intermittently mixed to mitigate or eliminate problems other than
settling in relation to an injection or other treatment procedure.
Thus, one or more devices or methods of agitating the internal
contents of a vial or other container can be advantageously
provided. As discussed above, in any of the embodiments disclosed
herein, such vials or other containers can be easily removed from
the cassette or other portion of the fluid delivery module,
manually mixed (e.g., by shaking or otherwise moving the vial or
other container) and re-securing it to the cassette.
[0237] In any of the arrangements disclosed herein, or variations
thereof, the nests or loading areas and/or other components of the
cassette comprise one or more plastic, metal and/or other rigid,
semi-rigid and/or flexible materials. The materials can be selected
to withstand the various elements and potentially damaging
conditions to which they may become exposed, including, for
example, forces, moments, temperature and pH variations, other
physical or chemical factors and/or the like.
[0238] FIG. 6B illustrates another embodiment of a nest or loading
device 370' configured to receive a vial, ampoule and/or another
standard or non-standard container. As discussed herein with
reference to the nest of FIG. 6A, the nest 370' can be configured
to accommodate vials and/or other containers of different or
varying sizes, shapes, designs and/or configurations, as desired or
required. The nest 370' can include a plurality of resilient wings
376' that help define an interior area 375' into which a vial (not
shown) or other container can be selectively inserted and secured.
In some embodiments, the wings 376' define a generally cylindrical
shape with relatively small spaces between adjacent wings. However,
in other arrangements, the spaces between adjacent wings 376' can
be larger or smaller than illustrated in FIG. 6B. Further, the
overall shape formed by the wings 376' can be different than
cylindrical.
[0239] With continued reference to FIG. 6B, the wings 376' can be
configured to be resilient so that they move outwardly (e.g., away
from the interior area 375') when a vial or other container is
inserted therein. As with the nest described herein with reference
to FIG. 6A, one or more of the wings 376' can comprise an
inwardly-facing locking portion or member 377' that is adapted to
engage and maintain the neck or other closure portion of a vial or
other container within the interior region of the nest 370' or
loading area or device. In some embodiments, the wings 376' are
moved radially outwardly in order to disengage the vial or other
container from the corresponding locking portion(s) or member(s)
377' and remove it from the nest 370' or other loading area or
device.
[0240] In some embodiments, when a vial or other container is
properly secured to the nest or loading area or device 370', a
ventilated spike 380' contained therein can place the internal
contents of the vial (e.g., anesthetic, steroid, other drug or
medicament, other fluid, other material or substance, etc.) in
fluid communication with one or more subcomponents of the cassette
300 (e.g., manifold, syringe or other reservoir, etc.) and/or other
components of the injection system. As discussed above with
reference to the nest of FIG. 6A, the ventilated spike 380' can be
sized, shaped and otherwise configured to penetrate a septum or
other membrane of a vial or other container secured to the
cassette. Further, one or more ventilation members (not shown in
FIG. 6B) of the loading area 370' can selectively permit air to
pass into the vial or other container when fluids or other
substances are being transferred from the vial or other container
to one or more other components of the cassette 300. In some
embodiments, the ventilation member comprises or is operatively
connected to a filter to reduce the likelihood that one or more
contaminants will enter the vial or other container from the
surrounding environment (e.g., ambient air).
[0241] FIG. 7 illustrates an exploded view of one embodiment of a
cassette 300 configured to be positioned within a fluid delivery
module of an injection system. As discussed and illustrated in
greater detail herein, the cassette 300 can comprise an outer
housing 302 that is configured to enclose one or more internal
components (e.g., manifolds, syringes or other reservoirs, etc.).
The depicted cassette 300 has a generally rectangular shape with
contoured, smooth edges or corners. The cassette 300 can be
removably secured to the fluid delivery module, as illustrated, for
example, in FIGS. 5A and 5B. Alternatively, the cassette 300 can
form a generally unitary structure with the fluid delivery module.
Further, in some embodiments, the cassette 300 and/or any of its
components or portions comprise one or more plastic, other
polymeric, metal and/or other synthetic or natural materials, or
combinations thereof. However, the shape, size, materials of
construction and/or other characteristics of the cassette 300 can
vary, as desired or required for a particular application or use.
In addition, the cassette 300 can comprise one or more finger wells
303, grooves, recessed areas and/or other features that facilitate
placement of the cassette 300 into and/or out of the corresponding
area of a fluid delivery module. Such finger wells 303 can be
located on one or both sides of the cassette 300.
[0242] As discussed in greater detail herein, the cassette 300 can
be a disposable item that is replaced periodically (e.g., once,
twice or more often per day). In other embodiments, the cassette
300 is configured to be replaced more or less often than indicated
herein, as desired or required. Alternatively, the cassette 300 can
be removed and replaced when one or more medications or other
fluids or substances being delivered using the injection system are
modified or otherwise changed (e.g., formulation or type, strength,
etc.). This can help prevent cross-contamination between different
types of substances, different dosages of substances and/or the
like. According to some arrangements, the cassette 300 is replaced
along with one or more other components of the injection system,
such as, for example, the handpiece assembly and the corresponding
delivery line (e.g., tubing) that places the handpiece assembly in
fluid communication with the cassette 300 and/or the like. In other
embodiments, the cassette is replaced less or more often that the
handpiece assembly and/or any other component of the injection
system.
[0243] In the embodiment depicted in FIG. 7, up to three vials
400A-400C or other containers may be secured to receiving sites 310
located along the top surface of the cassette 300. In some
embodiments, each receiving site comprises a nest or loading device
that is adapted to accept a standard or non-standard vial or other
container 400A-400C. As illustrated in FIG. 7, the nests 370, 370'
can be identical or similar to the embodiments of FIG. 6A and/or
FIG. 6B. However, any other nest design can be used (e.g., to
accommodate a particular vial, ampoule and/or other anticipated
container). Additional embodiments and details of nest designs or
loading area are provided in U.S. patent application Ser. No.
12/340,595, filed Dec. 19, 2008 and published as U.S. Publication
No. 2009/0163860, the entirely of which is hereby incorporated by
reference herein. In addition, the cassette 300 can include more or
fewer receiving sites 310, as desired or required. In addition, the
location, spacing and other details of the receiving sites 310 (and
thus, the corresponding nests or other loading devices) can be
different than illustrated in FIG. 7. As discussed in greater
detail herein, once the vials 400A-400C or other containers are
secured to the cassette 300, the injection system can be configured
to transfer the contents of such vials or other containers within
the fluid delivery module 100 and accurately deliver the interior
contents of one or more of such vials 400A-400C to a targeted
anatomical location in a precise and accurate manner.
[0244] In the illustrated embodiment, larger vials 400A, 400B
(e.g., 50 ml capacity) are secured to two receiving sites of the
cassette, while a smaller vial 400C (e.g., 5 ml capacity) is
secured to one receiving site. The type of nest or other loading
device used at each receiving site 310 can be selected according to
the vial or other container that will be attached thereto. In some
embodiments, one or more vials or other containers can be secured
to a nest or loading area of the cassette 300 that is configured to
keep the internal contents of such vial mixed. Thus, as discussed
in greater detail herein, such mixing may be desired or required
for certain medicaments or other materials, such as, for example,
steroids or other solutions or mixtures that have a tendency to
settle or that require mixing. In certain arrangements, the
receiving sites of the cassette are configured to receive a variety
of different vials or other containers (e.g., varying in size,
shape, design, closure member and/or the like).
[0245] In the embodiment illustrated in FIG. 8, the top portion of
a cassette housing has been removed to reveal the interior of the
cassette 300. As shown, the cassette 300 can comprise one manifold
330 and one syringe 360 for each receiving station 310 (FIGS. 4 and
7). In the illustrated embodiment, the interior of the cassette 300
includes grooves and other recesses into which the various
components of the cassette 300 can be positioned. For example, one
or more interior surfaces (e.g., bottom, top, etc) of the cassette
300 can comprise recesses and/or other features that are sized,
shaped and otherwise configured to receive the manifolds 330. In
addition, the cassette 300 can include one or more other
positioning baffles 328 or other members that are configured to
support and securely maintain the position of the syringes 360,
other reservoirs and/or any other component of the cassette 300. In
the depicted arrangement, the positioning baffles 328 include slots
that are sized, sized and otherwise adapted to receive one or more
portions of the syringes 360. However, the manifolds 330, syringes
360 and/or any other component or feature can be secured to the
cassette 300 using one or more other attachment methods or devices
(e.g., adhesives, fasteners, etc.), either in addition to or in
lieu of the recesses, positioning baffles 328 and other features
illustrated in FIG. 8.
[0246] With continued reference to FIG. 8, each syringe 360 or
other reservoir positioned within the cassette 300 can include an
inner plunger 364 that is slidably movable within an outer barrel
362. In some embodiments, the syringes 360 are standard plastic,
sterile syringes. Alternatively, the syringes 360 can be
non-standard syringes that are specifically designed for use with a
cassette 300. In some embodiments, as illustrated in FIGS. 14B-16B,
the reservoirs, plungers and/or other internal components of the
cassette can include one or more unitary structures or components.
In addition, the syringes 360 can comprise one or more other
materials (e.g., glass), as desired or required. As discussed and
illustrated in greater detail herein, movement of the inner plunger
364 away from the outer barrel 362 (e.g., in a direction generally
away from the manifold 330), can cause fluids and/or other
materials from the respective vial 400A-400C (FIG. 7) to be drawn
into the interior of the syringe 360 or other reservoir. Once one
or more fluids and/or other materials have been loaded into the
syringe 360 or other reservoir, a stepper motor, a pump, another
mechanically-driven (e.g., mechanical motor), pneumatically-driven
device and/or the like can be used to selectively move the inner
plunger 364 toward the manifold 330, thereby delivering a desired
volume of such fluids and/or other materials to the handpiece
assembly of the injection system. As discussed in greater detail
herein, a stepper motor or other mechanical device can be used to
initially move the inner plunger 364 away from the manifold 330 in
order to transfer fluids and/or other materials from a vial into
the corresponding syringe 360 or other reservoir.
[0247] According to some arrangements, in part for patient safety,
the motor, pump or other fluid transfer device incorporated into
the fluid delivery module is configured to accurately measure and
regulate the flowrate and/or pressure of a medication, fluid and/or
other material being delivered to a patient. Thus, the system can
comprise pressure and/or flow measurement devices (e.g., pressure
transducers, flowmeters, etc.). Pressure sensing devices can be
used to ensure that the pressure or vacuum created by the discharge
of the medication, fluid or other material within the anatomy does
not exceed a particular threshold level. This can help prevent or
reduce the likelihood of harm or other damage occurring to the
patient being treated using the injection system. In some
embodiments, such an internal force measurement system is
configured to automatically shut off the pump or other transfer
device when the discharge pressure exceeds a maximum level (e.g., 3
psi, levels lower or higher than 3 psi, etc.). In other
arrangements, the fluid delivery module and/or any other portion of
the injection system (e.g., handpiece assembly) includes a visual
and/or audible alarm or other feature to alert the user than a
threshold pressure has been attained, either in lieu of or in
addition to any automatic shut-off mechanism. Such safety features
can be incorporated in any of the embodiments of the modules or
systems disclosed herein.
[0248] With continued reference to the embodiment illustrated in
FIG. 8, the cassette 300 includes a plurality of slots or other
openings adjacent to the syringe plunger 364 (e.g., generally along
the lower end of the cassette). Thus, an arm, lever or other
actuation device mechanically or otherwise connected to a
mechanical (or other type of) motor or other movement device can be
used to slidably move the inner plunger 364 relative to the outer
barrel 362 of the syringe 360 or other reservoir to selectively
transfer fluids and/or other materials into or out of the syringes
360. As medicaments, other fluids and/or other materials are
selectively expelled through a syringe 360, they are directed
through an interior portion of the downstream manifold 330 to an
outlet 390. In some embodiments, the outlet 390 places the syringe
360 and manifold 330 in fluid communication with a corresponding
outlet conduit 251. As shown in FIG. 8, the conduits 251 at the
downstream end of each manifold 330 can be connected to a
downstream hub or junction 253 configured to combine the flow
streams from one or more of the individual conduits 251. In some
embodiments, one or more one-way valves (e.g., duckbill or other
check valve) can be positioned immediately upstream of the hub 253
to reduce the likelihood of cross-contamination of various
medicaments, other fluids and/or other substances (e.g., through
retrograde flow) included in the various vials or other containers
loaded onto the cassette.
[0249] With continued reference to FIG. 8, the hub or junction 253
can include a luer fitting 306 or any other standard or
non-standard connection. In some embodiments, as illustrated in
FIGS. 4 and 7, such a fitting 306 or other connection can extend
through a corresponding opening of the cassette housing 302. A
corresponding connector can be secured to the luer lock fitting 306
or other coupling in order to place a handpiece assembly and/or any
other component of the injection system in fluid communication with
the cassette 300. For example, as illustrated herein, a handpiece
assembly 200, which includes corresponding tubing (e.g., single
lumen, multi-lumen, etc.) and a luer fitting (or other type of
standard or non-standard connection) at the proximal end thereof,
can be sized, shaped and otherwise configured to removably connect
to the fitting 306 of the cassette 300. In some embodiments, such a
handpiece assembly 200 is disposable so that it can be replaced
after use. Thus, one or more of the medicaments, other fluids
and/or any other materials provided in the vials or other
containers loaded onto the cassette 300 can be selectively
delivered to or near a target nerve, joint (e.g., toe, ankle, knee,
other joints, etc.) and/or other anatomical location (e.g., organ,
cavity, etc.).
[0250] FIGS. 9A-9E illustrate various views of a manifold 330
configured to be positioned within a cassette 300 of an injection
system. As shown, the manifold 330 can include one or more standard
or non-standard inlet and outlet fittings 312, 390 or other
connections, such as, for example, universal luer lock fittings,
threaded connections and/or the like. As discussed in greater
detail herein, the use of such fittings, couplings or other
connections can facilitate the connection of the manifolds to the
other hydraulic components of the cassette and injection system
(e.g., syringes, other reservoirs, nests or loading areas, etc.).
As shown, the manifold 330 can include an inlet 340 into which the
distal end of a syringe or other reservoir attaches. In some
embodiments, the receiving site 312, the inlet 340 (and/or the
outlet) and/or any other port or connection of the manifold 330 is
adapted to receive a standard or non-standard fitting or
corresponding mating portion (e.g., a luer lock, a threaded
connection, another type of coupling 390, etc.). As discussed
herein, an outlet coupling 390 can be used to place the manifold
330 in fluid communication with a downstream discharge conduit 251.
In some embodiments, a ventilated spike 380 (FIGS. 6A and 6B),
needle and/or another type of conduit is used to place one or more
of the internal fluid passages of the manifold 330 in fluid
communication with a vial or other container removably secured to a
cassette. Such ventilated spikes, needles or other connectors can
be included in a nest or other loading device that attaches to the
manifold 330 (e.g., to the receiving site 312). Alternatively, the
spike, needle or other conduit can directly attach to a loading
area or any other component or portion of the cassette 300 or fluid
delivery module.
[0251] FIG. 10 illustrates one embodiment of a schematic generally
representing the movement of fluids and/or other materials within
and between various components (e.g., separate, unitary, etc.) of
an injection system, such as, for example, a vial 400, a manifold
330, a syringe 360 or other reservoir, other components or portions
of a cassette 300 and/or the like. As shown, once a vial 400 has
been properly secured to a nest 370, other loading area or other
device of a cassette 300 (e.g., between opposing wings 376), a
ventilated spike 380 or other portion of the nest 370 can be
configured to extend into the interior of the vial 400. In some
embodiments, the closure member 410 of the vial 400 comprises a
septum or other pierceable membrane or member (not shown) through
which the spike 380 may pass. As a result, the medicament, other
fluid and/or other material contained within the vial 400 can be
advantageously placed in fluid communication with the ventilated
spike 380 of the nest 370. As discussed in greater detail herein,
the nest 370 can be attached to a receiving site of the cassette
300 using a luer lock connector or other standard or non-standard
fitting 312.
[0252] Next, in order to load the syringe 360 with the internal
contents of the vial 400 (e.g., anesthetic agent, steroid, etc.),
the inner plunger of the syringe 360 can be retracted relative to
the outer barrel of the syringe or other reservoir 360. As
discussed in greater detail herein, a mechanical motor, other type
of motor, actuator or other device within the fluid delivery module
can be used to selectively move the inner plunger relative to the
outer barrel. Thus, in some embodiments, the fluids and/or other
materials contained within a vial or other container are
transferred through the injection system mechanically (e.g., not
pneumatically). In some embodiments, this provides a more accurate
and controlled delivery of fluids and/or other materials. In
addition, mechanically-driven injections can allow a clinician to
more easily overcome any back pressure associated with injecting
fluids and/or other materials into the target location (e.g.,
joints, relatively tight spaces, etc.).
[0253] The suction created within the syringe 360 or other
reservoir of the cassette can cause the fluid and/or other
materials contained within the vial 400 to be drawn into the
syringe 360 in the direction generally represented by arrow A in
FIG. 10. Thus, fluids and/or other materials can be delivered from
the vial 400 to the syringe 360 through a valve 350 or other
flow-control device. In some embodiments, the valve 350 comprises a
combination duckbill-umbrella valve that is configured to permit
flow in the direction generally represented by arrow A when suction
is created within the syringe or other reservoir 360. This can help
ensure that fluids and/or other materials are not inadvertently
transferred toward the discharge conduit 251, the collection hub or
junction 253 or any other component of the injection system located
downstream of the manifold 330. Alternatively, one or more other
types of valves and/or flow schemes can be used.
[0254] With continued reference to the schematic of FIG. 10, once
fluids and/or other materials have been transferred from the vial
400 to the syringe 360 or other reservoir within the cassette, the
fluid delivery module can selectively transfer a desired volume of
fluids and/or other materials through the injection system to the
downstream handpiece assembly. In one embodiment, the syringe 360
or other reservoir is configured to draw out the entire contents of
a vial 400 during the initial loading stage. Alternatively, only a
portion of the internal contents of the vial 400 or other container
are transferred to the syringe 360 or other reservoir before such
contents are selectively delivered to the handpiece assembly 200
and/or other downstream components of the injection system.
[0255] Once a syringe 360 or other reservoir has been properly
loaded with fluids and/or other materials, a desired volume of such
fluids and/or other materials can be selectively transferred
through the manifold 330. The transfer of fluids and/or materials
from the syringe 360 or other reservoir to downstream components of
the injection system (e.g., discharge conduit 251, hub 253,
handpiece assembly, etc.) can be accomplished with the help of a
mechanical motor (e.g., stepper motor), hydraulic pump and/or other
device. For example, a stepper motor or other mechanically-driven
actuator can be configured to operate the syringe 360 or other
reservoir of the cassette (e.g., move the inner plunger relative to
the outer barrel) in order to selectively transfer fluids and/or
other materials from the syringe 360 or other reservoir to the
manifold 330. In the depicted embodiment, fluids and/or other
materials are transferred from the syringe or other reservoir
toward the discharge line or conduit 251 in a direction generally
represented by arrow B. Thus, fluids and/or other materials can be
routed through the same valve 350 that is used to control the
transfer of fluids and/or other materials from the vial 400 (or
other container) to the syringe 360 or other reservoir. For
example, the valve 350 or other flow control device can be
configured to allow fluid flow in a direction generally represented
by arrow B when a sufficiently high positive pressure is created
within the syringe 360 or other reservoir. This can be accomplished
by using a valve 350 (e.g., a combination duckbill-umbrella valve,
other direction valve, etc.) that regulates flow of fluids and/or
other materials in certain desired directions depending on the type
of forces and pressures exerted within the syringe 360 or other
reservoir (e.g., negative or suction, positive, etc.). Additional
details regarding flow through such a combination duckbill-umbrella
valve 350 are provided herein in reference to the discussion of
FIGS. 11A-11C.
[0256] In other embodiments, the quantity, type, orientation,
general configuration and other details of the passages, valves
and/or other components of the manifold 330 and/or other components
of a cassette 300 can vary, as desired or required. Further, the
general manner in which the syringes or other reservoirs 360 of a
cassette are filled (e.g., with the internal contents of the vials
or other containers) can be different than discussed and
illustrated herein. For example, in some embodiments, the contents
of the vials 400, ampoules or other containers can be configured to
gravity flow into desired portion (e.g., syringe 360, other
reservoir, etc.) of the cassette 300. In other arrangements, the
vials 400 or other containers can be directly secured within an
interior of the cassette 300 or other portion of the fluid delivery
module. Moreover, a cassette 300 need not include a syringe 360 or
other reservoir, a manifold 330 and/or any other component or
feature illustrated and discussed herein. Other methods or devices
can be utilized to load a fluid and/or other substance into the
cassette 300 for later delivery to a downstream handpiece assembly
200 or other component of an injection system.
[0257] With continued reference to the schematic of FIG. 10, a
fluid or other material exiting an outlet fitting 390 (e.g., luer
lock, threaded, flanged and/or any other coupling or connector,
etc.) of the manifold 330 can be routed to a discharge conduit or
line 251. Discharge conduits 251 from two or more manifolds 330 of
a cassette 300 can connect to a common hub or other junction 253. A
one-way valve 255 (e.g., a duckbill valve, a check valve, etc.) can
be located immediately upstream of the hub 253 to prevent
cross-contamination of fluids and/or other materials flowing within
the various discharge lines 251. As shown, the hub or junction 253
can include a luer connection 306 or other fitting or coupling. In
some embodiments, the luer lock 306 or other fitting is configured
to removably attach to a corresponding coupling 260 of a fluid
delivery line 250 that places the cassette 300 and other portion of
the fluid delivery module in fluid communication with a handpiece
assembly. With reference back to FIGS. 4, 7 and 8, the luer or
other coupling 306 can extend through an opening of the cassette
housing 302 (e.g., along the top, side or any other surface). Thus,
a user can easily attach and detach a handpiece assembly to a fluid
delivery module of the injection system.
[0258] The schematic cross-sectional view of FIG. 11A illustrates
the internal configuration of a manifold 330 according to one
embodiment. As discussed, a ventilated spike of a nest (not shown)
can be used to place the manifold 330 in fluid communication with a
vial or other container (not shown) loaded onto a cassette or other
portion of a fluid delivery module. In FIG. 11A, such a ventilated
spike (not shown), needle or other conduit directly or indirectly
attaches to the luer fitting 312 or other connection site of the
manifold 330. Thus, the spike, needle or other conduit can be
placed in fluid communication with one or more voids 334 located
within an interior of the manifold 330. In some arrangements, the
void 334 comprises an annular area that completely or partially
surrounds a valve 350 (e.g., combination duckbill-umbrella valve).
However, the type, shape, size and/or other details of the void
334, valve 350, general fluid scheme and other components or
features of the manifold can be different than illustrated and
discussed herein, as desired or required.
[0259] With continued reference to FIG. 11A, the manifold 330 can
be configured so that the void 334 is selectively placed in fluid
communication with an upstream cavity 346 to permit fluids and/or
other materials to be advantageously transferred through the
ventilated spike or other portion of the nest (not shown) to the
inlet 340 of the manifold 330. As discussed, such a step can be
performed in order to fill the syringe 360 or other reservoir of
the cassette that is positioned upstream of the inlet 340. Such a
syringe 360 or other reservoir can be a separate item from the
manifold or can form a generally unitary structure with it.
Regardless of the exact interior design of the cassette, some or
all of the contents of a vial or other container with which the
main needle 332 is in fluid communication (e.g., medication,
formulation, other fluids or substances, etc.) can be delivered to
the syringe, other reservoir and/or any other portion of the fluid
delivery module.
[0260] FIG. 11B schematically illustrates the manifold of FIG. 11A
while fluids and/or other materials are being transferred through
the receiving site 312 (e.g., from a ventilated spike or other
portion of the nest or loading area attached to the receiving site)
to the inlet 340 of the manifold 330. In some embodiments, a
suction force can be applied to the upstream cavity 346 of the
manifold (e.g., by moving the inner plunger away from the outer
barrel of a syringe). Thus, if the tip of the syringe or other
reservoir is attached to, inserted into or otherwise placed in
fluid communication with the inlet 340 of the manifold 330, a
corresponding suction force can be created within the upstream
cavity 346.
[0261] As shown in FIG. 11B, if the vacuum force is sufficiently
high, the umbrella portion 356 of the combination valve 350 can
move away from the void 334, thereby allowing fluids and/or other
materials to be delivered from the main needle 332 to the upstream
cavity 346 in a direction generally represented by arrows A.sub.1
and A.sub.2 in FIG. 11B. From the upstream cavity 346, the fluids
and/or other contents of a vial or other container can be routed to
a syringe or other reservoir (not shown) attached to, constructed
together with or placed in fluid communication with the inlet 340
of the manifold 330. For example, in the depicted embodiment,
fluids and/or other materials can be delivered into a syringe or
other reservoir that is positioned within the inlet nozzle 342 in a
direction generally represented by arrow A.sub.3. Once the suction
force is terminated or sufficiently reduced (e.g., by stopping the
movement of the inner plunger relative to the outer barrel of the
syringe or other reservoir), the umbrella portion 356 of the valve
350 can seat against the void 334, thereby preventing the flow of
materials from the ventilated spike, needle or other conduit of the
nest (not shown), through the luer or other fitting of the
receiving site 312 and to the upstream cavity 346.
[0262] FIG. 11C schematically illustrates the manifold 330 of FIG.
11A as fluids and/or other materials are being delivered through
the combination duckbill-umbrella valve 350 to the downstream
cavity 348. As shown, if sufficient positive backpressure is
applied to the upstream cavity 348, fluids and/or other materials
may be transferred through the duckbill portion 352 of the
combination valve 350 in a direction generally represented by arrow
B. As discussed, in some embodiments, the necessary backpressure
may be generated by moving the inner plunger within the outer
barrel of the syringe or other reservoir positioned along the inlet
340 of the manifold 330 in order to expel the fluids and/or other
materials contained within the syringe or other reservoir. As a
result, such fluids and/or other materials can pass through the
duckbill portion 352 of the valve 350 to the downstream cavity 348.
At the same time, the positive backpressure within the upstream
cavity 348 can cause the umbrella portion 356 of the valve to seat
against the void 334, thereby ensuring that no fluids and/or other
materials enter the void 334, toward the receiving site 312, the
ventilated spike or other portion of the nest (not shown) and/or
any other components. Consequently, as discussed herein with
reference to, inter alia, FIGS. 8 and 10, a desired volume of
fluids and/or other materials exiting the manifold 330 can be
delivered to a discharge conduit 251 and a collection hub or
junction 253. According to some embodiments, from the collection
hub 253, one or more fluid and/or other material streams can be
directed through a downstream fluid conduit and handpiece
assembly.
[0263] FIGS. 12A and 12B schematically illustrate the filling of
the syringes 360 or other reservoirs positioned within a cassette
300. As discussed in greater detail herein, the syringes or other
reservoirs can be separate items or can be incorporated into a
unitary structure with one another and/or other internal components
of a cassette 300 (e.g., manifolds). In FIG. 12A, each of the three
syringes 360 is empty or substantially empty, as the inner plunger
364 is positioned completely within the outer barrel 362. As the
inner plungers 364 are drawn rearwardly away from the respective
manifolds 330 (e.g., in a direction generally represented by arrow
A), fluids F and/or other substances from the vials or other
containers secured to the cassette (e.g., nests, loading areas or
devices, other receiving areas, etc.) can be drawn through the
manifolds 330 and into the syringes 360 or other reservoirs. As
discussed, such fluids F and/or other substances can be
subsequently delivered to a downstream handpiece assembly from one
or more of the syringes 360 (e.g., through individual discharge
conduits 251 downstream of each manifold, a hub or junction, a
fluid delivery line, etc.). Accordingly, one, two or more different
drugs, pharmaceuticals or medicaments, formulations, mixtures,
other fluids and/or other materials can be accurately delivered
into a patient's anatomy through a single needle positioned at the
distal end of the handpiece assembly. Once a syringe 360 has been
partially or fully emptied, the inner plunger 364 can once again be
moved to fill the interior of the syringe 360 or other reservoir
with additional fluids and/or other materials from the
corresponding vial or other container positioned on the cassette.
For example, once a spent vial positioned on the cassette is
replaced with the a filled vial, a motor, actuator and/or other
device within the fluid delivery module can mechanically move the
inner plunger 364 relative to the outer barrel 362 of the syringe
360 or other reservoir in order to refill the syringe or other
reservoir of the cassette 300.
[0264] According to some embodiments, the syringes 360 (or other
reservoirs positioned within a cassette) are filled and emptied
with the assistance of a stepper motor or other mechanical or
pneumatic device. For example, such a device can be configured to
slidably move the inner plunger 364 of each syringe 360 relative to
the outer barrel 362. As discussed in greater detail herein with
reference to FIGS. 8 and 11A-12B, fluids and/or other materials
contained within a vial or other container can be selectively
loaded into the syringe 360 or discharged from the syringe 360
toward a needle at the distal end of a handpiece assembly.
Preferably, such a motor or other mechanical device, pneumatic
device and/or the like can be configured to precisely move the
inner plunger 364 into or out of the outer barrel 362 (or otherwise
fill and/or empty the syringe 360 or other reservoir) to help
ensure that a desired volume of fluids and/or other materials is
accurately delivered to the anatomy.
[0265] One embodiment of a fluid delivery module 100 configured to
accurately adjust the position of the inner plungers 364 relative
to their respective outer barrels 362 or other portion of a syringe
or other reservoir is illustrated in FIGS. 13A and 13B. As shown,
an interior of the fluid delivery module 100 can comprise one or
more stepper motors 180 or other devices (e.g., pumps, another
mechanical or pneumatic device, etc.) configured to move fluids
and/or other materials between vials (or other containers),
syringes 360 or other reservoirs, a handpiece assembly and/or other
components of an injection system.
[0266] With continued reference to FIGS. 13A and 13B, the fluid
delivery module 100 can comprise a stepper motor 180 or other
device for each syringe or other reservoir positioned within a
cassette (not shown). Alternatively, a stepper motor or other
device can be configured to control two or more syringes or other
reservoirs. As shown, each stepper motor 180 can be adapted to
selectively move a corresponding pusher block 190 along one or more
guide rails 186. In the depicted embodiment, each pusher block 190
is configured to move linearly relative to two guide rails 186.
However, in other embodiments, a pusher block 190 is configured to
move in two or more directions, along more or fewer guide rails
and/or in a completely different manner, as desired or
required.
[0267] In the illustrated embodiment, each pusher block 190
includes a vertical portion 192 that is sized, shaped and otherwise
adapted to engage the end portion 365 of a syringe's or other
reservoir's inner plunger 364 (FIG. 12B). As discussed herein with
reference to, inter alia, FIG. 8, a cassette 300 can include one or
more openings 324 adjacent to the syringes 360 or other reservoirs
(e.g., along the bottom of the cassette housing, along any other
surface or portion of the cassette, etc.). Accordingly, the
vertical portion 192 of each pusher block 190 can be configured to
extend through such an opening 324 of the cassette 300 in order to
engage a movable portion of the syringe 360 or other reservoir
(e.g., the end portion 365 of the inner plunger 364).
[0268] In FIG. 13A, the vertical portion 192 of the pusher block
190 comprises a slot 194 that is sized, shaped, positioned and
otherwise configured to securely receive the end portion 365 of the
inner plunger 364 or other movable member of a reservoir. Thus, as
the pusher block 190 is moved along the guide rails 186, the
position of the inner plunger 364 relative to the outer barrel 362
of the syringe or other reservoir can be selectively modified. As
discussed in greater detail herein, this permits anesthetic, other
medicaments, other fluids or materials and/or the like to be loaded
into the cassette and/or to be accurately delivered to or near a
targeted anatomical location (e.g., a nerve, joint, an organ, a
cavity, etc.) using a handpiece assembly. In order to ensure that
the position of the pusher blocks 190 is being accurately
controlled, the fluid delivery module 100 can comprise one or more
sensors (e.g., optical sensors), other position detection devices
and/or the like. In some embodiments, one or more other methods
and/or devices for controlling the loading of vials or other
containers and/or the subsequent delivery of fluids and/or other
substances can are used.
[0269] Medicaments and/or other fluids or materials to be delivered
to or near a targeted anatomical location (e.g., a target nerve)
are typically provided to clinicians and other users of an
anesthesia injection system in standard or non-standard drug vials.
The size or capacity (e.g., 5 ml, 10 ml, 50 ml, less than 5 ml,
more than 50 ml, etc.), shape, material type (e.g., glass, plastic,
acrylic, etc.) and/or characteristics of such vials can vary,
depending on the physician or other clinician performing the
procedure, the specific protocol, the pharmaceutical manufacturer
or distributor and/or other factors. As discussed herein with
reference to various embodiments of a cassette, it may be desirable
to secure a vial, ampoule and/or other container to a nest, loading
area or device and/or any other portion of the cassette or fluid
delivery module. This can facilitate delivery of the internal
contents of the vials to the anatomy using an injection system.
Accordingly, as illustrated in FIG. 7, a nest 370, 370' or other
loading area or device can be configured to receive one or more
nonspecific containers (e.g., vials of varying sizes, shapes,
capacities, etc.) 400A-400C.
[0270] FIGS. 14A-16B illustrate another embodiment of a cassette
1300 configured for use with an injection system. In FIG. 14A, the
top portion of the cassette housing 1302 has been removed to reveal
the cassette interior. In the depicted embodiment, the individual
syringes or reservoirs, manifolds and other separate components
(for example, as described herein with reference to FIG. 8) are
replaced with one or more portions that can connect into a unitary
structure 1310. For example, in FIG. 14A, the syringes are replaced
by a single reservoir portion 1350 that includes three individual
reservoirs 1360. In other embodiments, the reservoir portion 1350
comprises fewer (e.g., one or two) or more (e.g., four, five, six,
more than six, etc.) reservoirs 1360, as desired or required. Each
reservoir 1360 can include a generally cylindrical shape configured
to slidably receive a plunger member 1364 therein. As discussed
herein with reference to other embodiments (e.g., FIGS. 7-13B),
movement of the plunger members 1364 within the reservoirs 1360 can
cause fluids and/or other materials from corresponding vials to be
loaded therein and/or to be subsequently discharged to one or more
downstream components (e.g., handpiece assembly, tubing, needle
assembly, etc.).
[0271] With continued reference to FIGS. 14A-16B, manifolds 1330
can be incorporated into the distal end of the reservoir portion
1350. Alternatively, the manifolds 1330 can be separate items that
are removably attached to the reservoir portion 1350. As discussed
herein with reference to FIGS. 7-13B, for example, the manifolds
1330 in the depicted embodiment can be configured to selectively
direct fluids and/or other materials from a vial or other container
attached to a nest of the cassette to the reservoirs 1360.
Subsequently, such fluids and/or other materials can be directed
from the reservoirs 1360 to a collection member 1320 positioned
downstream of the reservoir portion 1350.
[0272] As illustrated in FIGS. 14B and 14C, a luer or other
standard or non-standard fitting 1312 can be attached to the top of
each reservoir 1330. Such luers, other fittings and/or other
receiving sites 1312 can be configured to extend through
corresponding openings of the cassette housing (e.g., as
illustrated in FIG. 4). Thus, nests or other loading devices can be
secured to one or more of the receiving sites 1312, allowing vials,
ampoules and/or other containers positioned within the nests or
other loading device to be advantageously placed in fluid
communication with the reservoir portion 1350.
[0273] According to some embodiments, as illustrated in FIGS. 14C
and 16B, the manifold reservoir portion design can be
advantageously configured to simplify the manner in which fluids
are moved therein (e.g., into or out of the manifold reservoir
portion). For example, as illustrated in the cross-sectional view
of FIG. 15D, a one-way valve 1311 (e.g., a duckbill valve, other
check valve, etc.) can be positioned immediately beneath the luer
fittings or other receiving sites 1312 within an interior of the
reservoir portion 1350. In the depicted embodiment, the plunger
member 1364 is positioned completely or substantially completely
within the interior of the corresponding reservoir 1360 such that
the stopper or end portion 1365 of the plunger member contacts the
distal end of the reservoir interior. As the plunger member 1364 is
retracted (e.g., generally away from the one-way valve), a vacuum
or negative pressure is created within the reservoir 1360, causing
fluids and/or other materials to flow from a vial or other
container (not shown), through the receiving site 1312 and the
one-way valve 1311 and into the reservoir 1360. As a result, the
reservoir can be completely or partially filled or loaded in
preparation for a subsequent injection process. As discussed with
reference to other embodiments herein, the plunger member 1364 can
be slidably moved into and/or out of the interior of the reservoir
mechanically (e.g., using a stepper motor, other types of motors,
actuator or other mechanical device), pneumatically (e.g., using a
pump) and/or in any other manner.
[0274] With continued reference to FIG. 15D, the one-way valve 1311
can include a flange, other radially extending portion and/or any
other feature to help maintain a desired position of the valve 1311
within the unitary structure 1310. For example, in FIG. 15D, a
flange located along the upper portion of the one-way valve 1311 is
generally sized, shaped and configured to fit within a
corresponding recess of the manifold 1330 (e.g., below the luer
lock fitting 1312, other receiving site, etc.).
[0275] With continued reference to the embodiment illustrated in
FIGS. 14C and 15D, the distal end of the reservoir portion 1350
comprises outlet nozzles 1370 through which fluids and/or other
materials can exit the corresponding manifolds 1330. In some
embodiments, the outlet nozzles 1370 have a generally cylindrical
shape and extend outwardly from the distal end of the reservoir
portion 1350. However, in other embodiments, the shape, size and/or
configuration of the outlet nozzles 1370 can vary, as desired or
required. As best depicted in FIG. 15D, fluids and/or materials
that have been loaded into the interior of a reservoir 1360, can
exit the reservoir and enter into an interior of the nozzle 1370
through one or more outlet openings 1327. In some embodiments, the
outlet nozzle 1370 is configured to receive an inlet nozzle 1322 of
the downstream collection member 1320. As discussed in greater
detail below, fluids and/or other materials from one or more of the
reservoirs 1360 can be directed into the collected member 1320 and
combined therein.
[0276] According to some embodiments, the collection member 1320 is
secured to the unitary reservoir portion 1350 using a friction fit
or press fit connection between the corresponding nozzles 1370,
1322. However, any other connection device, feature and/or method
can be used to removably or permanently attach the collection
member 1320 to the reservoir portion 1350, as desired or
required.
[0277] With reference to FIGS. 15A and 15B, the collection member
1320 can include an inlet nozzle 1322 corresponding to each outlet
nozzle 1370 of the reservoir portion 1350. In some embodiments, the
collection member 1320 additionally comprises an outlet port 1326.
In the depicted arrangement, the outlet port 1326 extends from a
first side or surface of the collection member 1320 that is
generally opposite of the side or surface from which the inlet
nozzles 1322 extend. However, the location, spacing, orientation,
shape, size and/or other details regarding the nozzles, ports
and/or other connection points 1322, 1326 of the collection member
1320 can vary.
[0278] According to some embodiments, as illustrated in the
exploded perspective view of FIG. 15B, the collection member 1320
can comprise two or more portions 1321A, 1321B that are configured
to removably or permanently attach to one another. In such
arrangements, the separate portions 1321A, 1321B can attach to one
another using adhesives, welds, hot melt connections, press-fit or
snap-fit connections, friction fit connections, screws, bolts,
rivets or other fasteners and/or the like. As illustrated in FIG.
15B, one or more gaskets 1325 or other sealing members can be
positioned between the separate portions 1321A, 1321B of the
collection member 1320 in order to prevent or reduce the likelihood
of undesirable leaks. The gasket 1325 or other sealing member can
include an O-ring, another elastomeric or polymeric member and/or
the like.
[0279] In some embodiments, the collection member 1320 comprises an
internal chamber 1324 that is in fluid communication with one or
more of the inlet nozzles 1322, and thus, one or more of the
reservoirs 1360. For example, with continued reference to FIG. 15D,
the internal chamber 1324 can be in fluid communication with a
channel 1329 that extends, at least partially, within an inlet
nozzle 1322 of the collection member 1320. In some embodiments,
another one-way valve 1323 (e.g., duckbill valve, another check
valve, etc.) is positioned between the channel 1329 of the
collection member 1320 and the corresponding outlet opening 1327 of
the reservoir portion's outlet nozzle 1370. As with the valve 1311
located between the receiving site 1312 (e.g., luer lock fitting)
and the reservoir 1360, the position of this additional one-way
valve 1323 can be properly maintained using one or more securement
devices or methods, such as, for example, press-fit or friction-fit
connections, clasps, clamps or other fasteners and/or the like.
[0280] As illustrated in the cross-sectional view of FIG. 15D, the
one-way valve 1323 can be configured to only allow fluids to flow
from the upstream reservoir 1360 and the outlet opening 1327 to the
downstream channel 1329 and chamber 1324 of the collection member
1320. Consequently, the one-way valve 1323 can advantageously
prevent fluids and/or other materials from being transferred from
the collection member 1320 into the upstream reservoirs 1360 (e.g.,
in a retrograde direction). This can help prevent or reduce the
likelihood of cross-contamination between the various fluids and/or
other materials loaded onto a cartridge of the injection
system.
[0281] Once fluids and/or other materials from one or more of the
reservoirs 1360 have passed through the respective backflow
prevention valve(s) 1323, they can pass into the main chamber 1324
of the collection member. In the chamber 1324, the fluids and/or
other materials can be mixed and combined (e.g., if originating
from two or more different reservoirs 1360). Ultimately, as
illustrated in FIGS. 14C-16A, such fluids and/or other materials
will exit the collection member 1320 through an outlet port 1326.
In some embodiments, the outlet port 1326 comprises a standard or
non-standard fitting or connection, such as, for example, a luer
lock fitting, a threaded fitting, a flanged fitting and/or the
like. Thus, as discussed in greater detail herein, a handpiece
assembly comprising proximal tubing can easily attach or otherwise
mate to the outlet port 1326 using a corresponding standard or
non-standard fitting or connection. In some embodiments, the outlet
port 1326 is configured to extend along an exterior surface of the
cassette to further facilitate connecting to or disconnecting from
a corresponding component or system (e.g., handpiece assembly).
[0282] As noted herein, the reservoir portion 1350, collection
member 1320 and/or one or more other internal components or
features of the cassette can be manufactured using an injection
molding or any other molding method (e.g., thermoforming,
compression molding, etc.). Thus, the number of separate components
used in a particular cassette can be reduced and the overall design
of the cassette can be advantageously simplified. In other
embodiments, however, the methods of manufacture, the number of
separate components and/or other details or features of a cassette
and its design can vary, as desired or required.
[0283] One embodiment of how fluids are transferred from a vial,
ampoule or other container 400 through the internal components of a
cassette is schematically illustrated in FIGS. 16A-16D. For
example, once a vial or other container 400 has been properly
secured to a nest 377 or other loading device or area of the
cassette, a ventilated spike 380 or other conduit can be configured
to place the internal contents of the container 400 (e.g.,
anesthetic, steroid, other medicament, any other fluid or
substance, etc.) in fluid communication with a corresponding
reservoir 1360. In some embodiments, the nest 370 is adapted to
removably couple to an adjacent receiving site 1312 (e.g., luer
fitting, other standard or non-standard fitting, etc.). Thus, as
noted in greater detail herein, the nest can be easily and promptly
attached and/or removed from the cassette or other portion of the
fluid delivery module.
[0284] According to some embodiments, as illustrated in FIG. 16A,
before fluids and/or other materials are transferred from the vial
400 to the corresponding reservoir 1360 of the cassette, the
plunger member 1364 is positioned completely or substantially
completely (e.g., distally) within the reservoir interior. As the
plunger member 1364 is slidably retracted away from the receiving
site 1312 (e.g., in a direction generally represented by arrow 1365
in FIG. 16B), a vacuum or negative pressure is created within the
interior of the reservoir 1360. Consequently, fluids and/or other
materials from the vial or other container 400 can be drawn into
the reservoir 1360, through the one-way valve 1311, as generally
represented by arrow 401 in FIG. 16B. As discussed in greater
detail herein, the one-way valve 1311 can comprise a duckbill valve
or any other type of check or retrograde prevention valve. Further,
due to the negative pressure created within the reservoir, fluids
and/or other materials are generally not permitted to pass through
the other valve 1323. Thus, in some embodiments, fluids and/or
other materials will pass from the vial 400 only to the interior of
the reservoir 1360 as a result of retracting the plunger member
1364.
[0285] Once a desired volume of fluids and/or other materials have
been loaded into the interior of the reservoir 1360, the retraction
of the plunger member 1364 can be stopped. In some embodiments, all
or substantially all of the fluids and/or other materials from a
vial or other container 400 are transferred into the corresponding
reservoir 1360. Alternatively, however, only a portion of the
vial's contents may be delivered to the corresponding reservoir
during this initial loading step, as desired or required. For
example, the plunger member 1364 can slidably retract just far
enough to load the volume of fluids and/or other materials into the
reservoir that will be delivered through a handpiece assembly in a
subsequent injection stage.
[0286] FIG. 16C schematically illustrates one embodiment in which
all or substantially all of the fluids and/or other materials have
been transferred or loaded from the vial 400 to the corresponding
reservoir 1360. If the two or more other fluids and/or materials
are to be delivered into a patient's anatomy in a particular
injection protocol, the above steps can be repeated to load such
fluids and/or other materials from other vials or containers into
corresponding reservoirs of the cassette. Once the various fluids
and/or other materials have been properly loaded into their
respective reservoirs, the subsequent injection into the anatomy
can be initiated by a user. As discussed in greater detail herein,
the various fluid or other material streams can be delivered to the
downstream handpiece assembly either sequentially and/or
simultaneously, in accordance with a desired protocol or
procedure.
[0287] In some embodiments, as schematically depicted in FIG. 16D,
in order to evacuate the fluids and/or other materials from the
interior of the reservoir 1360, the plunger member 1364 is slidably
moved toward the distal end of the reservoir (e.g., in a direction
generally represented by arrow 1390). As a result, the fluids
and/or other materials will be forced out through one or more
openings along the distal end of the reservoir and a downstream
one-way valve 1323. In some embodiments, in to order to purge any
entrapped gasses (e.g., air bubbles), the injection system can be
configured to expel a certain volume of "waste" fluid prior to
initiating the injection of fluids and/or other materials into the
anatomy.
[0288] As discussed in greater detail herein, the one-way valve
(e.g., duckbill valve, umbrella valve, other check valve or
retrograde-prevention valve, etc.) can help ensure that fluids
and/or other materials only pass from the reservoirs 1360 to the
collection member, thereby eliminating or reducing the likelihood
of undesirable cross-contamination of fluids and/or other
materials. Fluids and/or other materials passing through the valve
1323 can be directed into an internal chamber 1324 of a downstream
collection member. In some embodiments, the collection member is
configured to receive and combine fluids and/or materials from two,
three or more different reservoirs 1360. The internal chamber 1324
can be placed in fluid communication with a downstream handpiece
assembly (e.g., tubing, handpiece, etc.), in order to allow the
fluids and/or other materials entering the internal chamber 1324 to
be selectively injected into a patient's anatomy.
[0289] FIG. 16E schematically illustrates one embodiment of a
cassette 300 configured for placement within a fluid delivery
module of an injection system. As shown, the cassette 300 can
include three reservoirs 1360, each of which is configured to
receive a medicament (e.g., slow acting and/or fast acting
anesthetic, steroid, other pharmaceutical, etc.), other fluid
and/or any other materials. In alternative embodiments, the
cassette 300 comprises more or fewer reservoirs 1360, as desired or
required. As discussed herein with reference to FIGS. 14A-16D,
fluids and/or other materials from each of the reservoirs 1360 can
be selectively transferred through a downstream valve 1323 and into
a common internal chamber 1323 of a collection member. Once in the
collection member, the various fluids and/or other materials can be
mixed, combined and exit through an outlet 1326. In some
embodiments, the outlet 1326 (e.g., luer lock fitting, nozzle,
port, other standard or non-standard connection, etc.) can be
selectively coupled or otherwise attached to a corresponding
connection 260 of a handpiece assembly 200. For example, the
connection 260 of the handpiece assembly 200 can include a luer
fitting that is adapted to mate with, and thus, selectively attach
to and detach from, the outlet 1326 of the collection member.
Consequently, fluids and/or other materials can be transferred from
one or more of the reservoirs 1360, through the downstream
collection member and handpiece assembly 200, ultimately into a
patient's anatomy (e.g., to or near a targeted nerve or joint).
[0290] As discussed herein, in some embodiments, fluids and/or
other materials are transferred into and out of the reservoirs 1360
by mechanically moving plunger members 1364 within the
corresponding reservoirs 1360. The plunger members 1364 can be
moved with the help of a mechanically-operated actuator or motor
(e.g., stepper motor, other type of motor, etc.) and/or any other
mechanical device capable of accurately delivering fluids and/or
other materials into relatively small spaces (e.g., small joints)
under relatively high back pressure. In other embodiments, the
plunger members are moved using pneumatic and/or other methods or
devices. In yet other embodiments, fluids and/or other materials
are selectively transferred through an injection system without the
use of plunger members. For example, one or more pumps can be used
to transfer one or more fluid and/or other material streams from a
vial or other container into a patient's anatomy (e.g., to or near
nerve tissue, a joint, an organ, a cavity, etc.) using an injection
system.
[0291] One embodiment of the internal components of a cassette
configured for use in an injection system is illustrated in FIGS.
17A-17F. The depicted cassette, as with any other embodiments
disclosed herein, can be configured to be removably positioned or
otherwise coupled to a fluid delivery module (e.g., a motor, an
actuator, a control module, etc.) of an injection system. In some
embodiments, such cassettes are disposable or reusable, as desired
or required. In FIG. 17A, the cassette housing is hidden so as to
reveal the cassette interior and at least some of the components
included therein.
[0292] In the embodiment depicted in FIG. 17A, the interior of the
cassette includes a generally unitary structure 1310' that is
configured to receive a plurality of individual syringes or other
reservoirs 1360'. The unitary structure 1310' can include a single
component or member. However, in other arrangements, the unitary
structure 1310' comprises two or more separate components, members
and/or portions that are configured to permanently or releasably
attach or otherwise couple to one another. In some embodiments, the
unitary structure is molded (e.g., injection molded, compression
molded, etc.) and/or otherwise formed into a desired shape.
[0293] One or more of the syringes or other reservoirs 1360'
included as part of the cassette interior can comprise standard or
non-standard syringes. Such syringes can comprise a luer fitting or
other quick-connect coupling along their distal ends 1362'. The
luer fittings and/or other distal couplings or fittings can
advantageously enable the syringe or other reservoir to mate with a
corresponding fitting or coupling 1326' of the unitary structure
1310'. Thus, in some embodiments, off-the-shelf syringes,
containers and/or other reservoirs can be configured to couple to
(or otherwise become incorporated with) one or more specially
molded and/or shaped internal portions (e.g., unitary structure
1310') of a cassette. This can help to reduce manufacturing costs
of a cassette and simplify the cassette design. Such a feature can
be incorporated into any of the cassette designs disclosed herein
or equivalents thereof.
[0294] With continued reference to FIG. 17A, the syringes or other
reservoirs 1360' can be inserted through corresponding cylindrical
portions (e.g., slots, openings, recesses, etc.) 1320' of the
unitary structure 1310'. As noted above, the distal ends 1362' of
the syringes 1360' can engage and mate with corresponding fittings
or couplings 1326' of the unitary structure 1310'. In some
embodiments, as shown in FIG. 17A, the unitary structure 1310' can
further comprise one or more recesses (e.g., slots, openings, other
receiving portions, etc.) 1324' that are sized, shaped and
otherwise configured to receive corresponding portions of the
syringe flanges 1366'. These and/or other securement features
between the unitary structure 1310' and the syringes 1360' help
ensure that the syringes 1360' remain firmly in place within and/or
relative to the cassette.
[0295] As shown in FIG. 17A, the cassette can further comprise an
inlet block (e.g., a vial retaining or receiving portion) 1350'
that is sized, shaped and otherwise adapted to cover a portion of
the unitary structure 1310'. Specifically, as discussed in greater
detail below, the inlet block 1350' can be positioned over (and, in
certain embodiments, mate with) fluid nozzles 1328' and channels of
the unitary structure 1310'. In addition, according to some
embodiments, the inlet block 1350' is positioned on top of or above
(e.g., directly or indirectly) certain fluid channels 1332', 1334',
1336' located along the discharge portion 1330' of the unitary
structure 1310'. These fluid channels 1332', 1334', 1336' can be
used to place one or more of the syringes or other reservoirs 1360'
of the cassette in fluid communication with a mixing cavity 1340'
of the unitary structure 1310'. As discussed in greater detail
herein, such fluid channels 1332', 1334', 1336' can be kept
hydraulically isolated from one another until the mixing cavity
1340' or some other confluence zone within or near the
cassette.
[0296] With continued reference to FIG. 17A, as with other
embodiments disclosed herein, the inlet block 1350' can comprise
one or more fittings, nests or other loading areas 1352' to which
vials or other containers can directly or indirectly secure. For
example, such a loading area 1352' (e.g., port, fitting, nest,
etc.) can include a luer or other standard or non-standard fitting
that is configured to receive a vial connector or other
intermediate device. Alternatively, however, the fittings, nests or
other loading areas 1352' can be designed to directly receive and
retain vials and/or other containers. As illustrated in FIG. 17A,
one or more valves 1358' (e.g., duckbill valves, other one-way
valves, etc.) can be positioned between the inlet block 1350' and
the corresponding nozzles or fittings 1328' of the unitary
structure 1310'. These types of valves or other devices can help
ensure that fluids and/or materials that are transferred to the
syringes 1360' from the vials or other containers secured to the
inlet block 1350' (e.g., during a filling phase) do not re-enter
the inlet block 1350' during the subsequent discharge phase of an
injection procedure.
[0297] As illustrated in FIGS. 17B-17F, fluids and/or other
materials that are discharged from one or more syringes or other
reservoirs 1360' of the cassette (e.g., when the corresponding
plungers or other movable members 1364' are moved distally toward
an interior of the syringes 1360') can pass through the distal ends
1362' of the syringes (or reservoirs) and the corresponding nozzles
or fittings 1326' of the unitary structure to which the syringes
are coupled. Next, the fluids and/or other materials are routed
through fluid channels 1332', 1334', 1336' formed within (e.g., at
least partially through an interior of) and/or near the discharge
portion 1330' of the unitary structure 1310'. In some embodiments,
these fluid channels 1332', 1334', 1336' are maintained independent
of each other (e.g., physically, hydraulically, etc.) upstream of a
mixing portion 1340'.
[0298] According to some embodiments, one or more of the fluid
channels 1332', 1334', 1336' extend to or near the top surface of
the discharge portion 1330' and/or another region of the cassette.
Thus, in such arrangements, the inlet block 1350' and/or another
member or component can be positioned above the discharge portion
1330' to enclose the fluid channels and form corresponding enclosed
passages within the unitary structure 1310'. As illustrated in FIG.
17B, the fluid channels 1332', 1334', 1336' can vary in width,
length, depth, other dimensions, shape, configuration and/or any
other characteristic or property. In some embodiments, the
dimensions and/or other characteristics of the channels 1332',
1334', 1336' are carefully designed to ensure that the total
internal volume of the channels between the distal ends of the
syringes or other reservoirs 1360' and the mixing portion 1340' are
identical or substantially identical for the various fluid paths.
This can help ensure that approximately an equal amount of fluid
and/or other material is transferred from the reservoirs 1360' to
the mixing portion 1340' during an initial priming or other
preparatory step or procedure.
[0299] With reference to FIG. 17C, in some embodiments, one or more
of the fluid channels 1332', 1334', 1336' that place the syringes
or reservoirs 1360' in fluid communication with the mixing portion
1340' are oriented vertically and/or horizontally within the
discharge portion 1330'. However, in other embodiments, the actual
fluid path of the channels 1332', 1334', 1336' can be different
than illustrated herein, as desired or required. For example, the
fluid channels can include a vertical, horizontal, diagonal and/or
other orientation within the cassette. Further, a gasket or other
sealing member 1356' can be positioned between the inlet block
1350' and the upper surface of the discharge portion 1330'. Such a
gasket 1356' can help prevent or reduce the likelihood of fluid
leaks between the inlet block 1350' and the unitary structure
1310'. Further, such gaskets or other sealing members can help form
the internal passageways of the fluid channels 1332', 1334',
1336'.
[0300] As shown in FIG. 17F, the fluid channels 1332', 1334', 1336'
can terminate and discharge through corresponding outlet openings
1333', 1335', 1337' located at or near the mixing portion 1340'. In
some embodiments, fluids and/or other materials passing through the
outlet openings 1333', 1335', 1337' travel through duckbill valves
1386' and/or other one-way valves or devices (FIG. 17A) before
entering the mixing cavity 1342'. As a result, the various fluids
and/or other materials transferred to the mixing cavity 1342' from
one or more of the reservoirs 1360' are kept separate and discreet
from one another upstream of the mixing portion 1340'. This can
help reduce or eliminate any negative impacts resulting from the
exposure of two or more of the fluids and/or other materials, as
such fluids and/or other materials will not come in contact with
one another until the relatively small cavity 1342' of the mixing
portion 1340' located at the hydraulic distal end of the
cassette.
[0301] With continued reference to FIG. 17A, the mixing portion
1340' can comprise an outlet case 1380' that helps define the
mixing cavity 1342'. In some embodiments, the outlet case is
configured to secure to the adjacent components of the mixing
portion 1340' using one or more attachment devices or methods, such
as, for example, ultrasonic welds, other types of welds, adhesives,
fasteners, friction-fit, pressure-fit and/or snap-fit connections
and/or the like. In other arrangements, the outlet case 1382' forms
a generally unitary or monolithic structure with the mixing portion
and/or other components of the cassette, as desired or required. As
illustrated in FIG. 17A, the outlet case 1382' can comprise an
outlet port 1382'. The outlet port 1382' can include a standard or
non-standard fitting or coupling (e.g., luer lock, threaded
connection, etc.) to facilitate the connection of a handpiece
assembly to the cassette. In some embodiments, the outlet port
1382' is sized, shaped and otherwise configured to extend to or
past the outer housing of a cassette to enable a user to directly
secure a corresponding fitting or portion of a handpiece assembly
to the port 1382'.
[0302] Accordingly, in some embodiments, fluid lines exiting each
of the reservoirs (e.g., syringes, other containers, etc.) within
or coupled to the cassette (and/or other portions of a fluid
delivery module or an injection system) are not mixed until a
location at or near when the handpiece assembly of the system is
configured to attach. As noted above, this can help reduce or
eliminate any intermixing between the various fluids being injected
into a patient.
[0303] Another embodiment of the internal hydraulic components
1310A and structure of a cassette is illustrated in FIGS. 18A and
18B. The depicted arrangement is similar to the one discussed above
with reference to FIGS. 16A-16E. As discussed above, the embodiment
of FIGS. 16A-16E is configured to combine the fluids and/or
materials exiting each reservoir in a collection member positioned
immediately downstream of the reservoir portion. In contrast, the
structure 1310A of FIGS. 18A and 18B includes a separate outlet
1326A for each reservoir 1360A. Therefore, the various fluids
and/or other materials can be maintained separate from each other
until a location that is further downstream. For example,
individual conduits or other lines (not shown) can place each of
the outlets 1326A in fluid communication with a handpiece assembly
that is similar or identical to the one discussed herein with
reference to FIGS. 30A-34C. In such arrangements, the various fluid
and/or other material streams can be combined within the handpiece
assembly (e.g., immediately upstream of the tip or needle
assembly).
[0304] As noted herein, the collection member 1320B located at the
downstream end of the cassette's internal hydraulic components can
be manufactured as a unitary structure (e.g., as a single piece,
thereby eliminating the need to subsequently attach two or more
portions to each other). A top view of one such embodiment is
illustrated in FIG. 18C. In addition, the outlet port 1326B of the
collection member 1320B can be orientated along the side of the
collection member 1320B (FIG. 18C), along the front (FIG. 14A),
along the top or at any other location, as desired or required.
[0305] As discussed in greater detail herein, a cassette, another
portion of a fluid delivery module and/or any other component of an
injection system can be configured to receive (and selectively
deliver within a patient's anatomy) fluids and/or other materials
contained in any one of a variety of containers. For example, in
any of the embodiments disclosed herein, or equivalents thereof, a
cassette can be adapted to receive standard or non-standard vials,
ampoules and/or any other container. In some arrangements, such
containers are in the form supplied by a pharmaceutical
manufacturer or distributor. However, in other embodiments, the
containers are re-packaged, either prior to or after being provided
to the users of the injection system.
[0306] Another embodiment of a cassette 1300B is illustrated in
FIGS. 19A-19F. As shown and discussed in greater detail herein, the
cassette 1300B can include an outer housing 1302B that encloses a
plurality of internal components (e.g., one or more of a unitary
structure, a manifold, syringes or other fluid reservoirs, valves,
etc.). In addition, in some embodiments, the cassette 1300B
comprises one or more recesses or openings 1306B that
advantageously enable a user to grasp and separate an upper portion
1303 of the housing from a lower portion 1305B. In other
arrangements, the cassette 1300B comprises more (e.g., three, four,
more than four, etc.) or fewer (e.g., a single or unitary
structure) portions, as desired or required. As with other
embodiments disclosed herein, the depicted cassette 1300B can
comprise one or more other features or components, such as, for
example, one or more receiving sites, loading areas or nests 1312B,
one or more resilient tabs or other securement features 1304B
(e.g., to help secure the cassette within a recess or opening of a
fluid delivery module) and/or the like.
[0307] With continued reference to FIG. 19A, the cassette 1300B can
comprise one or more receiving sites, loading areas or nests 1312B
that are configured to receive vials and/or other fluid or
medicament containers. As discussed with respect to other cassette
embodiments described herein, the receiving sites 1312B are
configured to securely receive standard or non-standard vials
and/or other containers. Such receiving sites, loading areas or
nests 1312B can be advantageously configured to receive vials or
other containers of various sizes and shapes. Moreover, similar to
other cassette embodiments disclosed herein, the depicted cassette
1300B can be configured to removably couple to a fluid delivery
module to enable the transfer of the internal contents of any vials
and/or other containers that are secured to one or more of the
receiving sites 1312B to be transferred to a corresponding internal
reservoir (e.g., syringe) 1360B located within the cassette 1300B.
Fluids and/or other medicaments transferred to such reservoirs
1360B can be selectively transferred out of the cassette 1300B
(e.g., toward and through a downstream handpiece assembly in fluid
communication with the cassette).
[0308] As illustrated in FIG. 19B, the cassette 1300B can be
configured to be opened so as to provide access to its internal
components. In some embodiments, for example, the cassette housing
1302B comprises a top or upper housing portion 1303B that is
movable relative to a bottom or lower housing portion 1305B. The
cassette 1300B can comprise one or more hinges 1307B or other
joints or couplings that permit one portion of the cassette 1300B
to be at least partially moved and/or separated from one or more
other portions of the cassette. In other embodiments, however, the
cassette 1300B comprises a generally unitary structure such that
the housing is not configured to be separated or otherwise opened.
Thus, the reservoirs (e.g., syringes) 1360B, manifold 1330B and/or
other internal components of the cassette 1300B may not be readily
accessible without breaking, compromising or otherwise destroying
the cassette 1300B.
[0309] The internal components and general internal configuration
of the cassette 1300B can be similar or substantially similar to
any other cassette embodiments disclosed herein. For example, as
shown in FIGS. 19A and 19B, the interior of the cassette 1300B can
include a generally unitary structure 1310B that is configured to
receive a plurality of individual syringes or other reservoirs
1360B. The unitary structure 1310B can include a single component
or member. However, in other arrangements, the unitary structure
1310B comprises two or more separate components, members and/or
portions that are configured to permanently or releasably attach or
otherwise couple to one another. In some embodiments, the unitary
structure is molded (e.g., injection molded, compression molded,
etc.) and/or otherwise formed into a desired shape.
[0310] One or more of the syringes or other reservoirs 1360B
included as part of the cassette interior can comprise standard or
non-standard syringes. Such syringes can comprise a luer fitting or
other quick-connect coupling along their distal ends 1362'. The
luer fittings and/or other distal couplings or fittings can
advantageously enable the syringe or other reservoir to mate with
one or more corresponding fittings or couplings of the unitary
structure 1310B. Thus, in some embodiments, off-the-shelf syringes,
containers and/or other reservoirs can be configured to couple to
(or otherwise become incorporated with) one or more specially
molded and/or shaped internal portions (e.g., unitary structure
1310B) of a cassette. This can help to reduce manufacturing costs
of a cassette and simplify the cassette design.
[0311] With continued reference to FIGS. 19B and 19C, the syringes
or other reservoirs 1360B can be inserted through corresponding
cylindrical portions (e.g., slots, openings, recesses, etc.) 1320B
of the unitary structure 1310B. The distal ends of the syringes
1360B can engage and mate with corresponding fittings or couplings
of the unitary structure's manifold portion 1330B. In some
embodiments, the unitary structure and/or other portions of the
cassette 1300B further comprise one or more recesses (e.g., slots,
openings, other receiving portions, etc.) that are sized, shaped
and otherwise configured to receive corresponding portions of the
syringe flanges. These and/or other securement features between the
unitary structure 1310B and the syringes 1360B help ensure that the
syringes 1360B remain firmly in place within and/or relative to the
cassette 1300B.
[0312] As with other embodiments disclosed herein, fluids and/or
other materials that are discharged from one or more syringes or
other reservoirs 1360B of the cassette (e.g., when the
corresponding plungers or other movable members are moved distally
toward an interior of the syringes 1360B) can pass through the
distal ends of the syringes (or reservoirs) and the corresponding
manifold portion or discharge portion 1330B of the unitary
structure to which the syringes are coupled. Next, the fluids
and/or other materials are routed through one or more fluid
channels formed within (e.g., at least partially through an
interior of) and/or near the manifold portion or discharge portion
1330B of the unitary structure 1310B. In some embodiments, these
fluid channels are maintained independent of each other (e.g.,
physically, hydraulically, etc.) upstream of a mixing portion
1342B. Alternatively, however, the various fluid and/or other
material streams can be mixed or otherwise combined at any other
location within or near the manifold portion 1330B (e.g., upstream
of an outlet 1326B, a mixing portion 1342B and/or other discharge
location of the structure 1310B), as desired or required.
[0313] Once fluids and/or other materials have been discharged from
the manifold or discharge portion 1330B (or any other portion of
the unitary structure 1310B), they can be transferred through a
conduit (e.g., tubing) to a handpiece assembly placed in fluid
communication with the cassette 1300B. In some embodiments, fluids
and/or other materials exiting the internal structure 1310B of the
cassette 1300B can be directed through one or more valves and/or
other devices. For example, in FIG. 19C, a luer connector 1327B (or
other quick connect coupling or feature) is secured to the outlet
1326B of the structure 1310B. According to some embodiments, the
distal end of such a luer or other fitting 1327B can extend through
the housing 1302B of the cassette to enable a user to conveniently
attach a corresponding fitting or coupling to the cassette.
[0314] With continued reference to FIGS. 19A, 19B and 19C, the
manifold portion 1330B and/or any other portion of the internal
structure 1310B or other internal component of the cassette 1300B
can comprise integrated spikes or spike assemblies 1380B that are
configured to pass through corresponding openings of the cassette
housing 1302B. According to some embodiments, such spikes 1380B can
be integrally formed with the internal structure 1310B of the
cassette. For example, as best illustrated in the partial
cross-sectional view of FIG. 19G, the spike assemblies 1380B can be
injection molded with the manifold or discharge portion 1330B of
the unitary structure 1310B. However, the spike assemblies 1380B
can be formed with the unitary structure 1310B and/or any other
portion of the cassette 1300B using any other method or technology.
In other embodiments, the spike assemblies 1380B are separate items
that are subsequently attached to the unitary structure 1310B
and/or another internal or external portion of the cassette 1300B
using one or more connection methods or devices (e.g., adhesives,
welding, fasteners, etc.), as desired or required.
[0315] With continued reference to the cross-sectional view of FIG.
19G, the spike assembly 1380B can comprise a dual-lumen design or
configuration. For example, in the depicted embodiment, the
assembly comprises a main fluid lumen 1382B that is adapted to
place the fluid and/or other medicament contained within a vial or
other container secured to the receiving site 1312B in fluid
communication with a syringe 1360B or other internal reservoir of
the cassette 1300B. In addition, the spike assembly 1380B can
include one or more vent passages 1384B that place an interior of a
vial or other container secured to the receiving site in fluid
communication with the ambient environment (e.g., through an exit
opening 1385B). The vent passage 1384B can advantageously
facilitate the transfer of fluid from the interior of a vial or
other container to a downstream syringe or other reservoir 1360B
without affecting the internal pressure of the vial or other
container and/or without inhibiting such transfer.
[0316] With reference to FIG. 19D, the cover or upper portion 1303B
of the cassette housing 1302B comprises openings 1314B through
which the spike assemblies 1380B may pass. Thus, as illustrated in
FIG. 19A, the spike assemblies 1380B can extend from the upper
surface of the cassette housing 1302B to enable a user to secure a
vial and/or other container thereto along one or more receiving
sites, loading areas or nests 1312B. As illustrated in FIGS. 19B
and 19D, one or more of the openings 1314B along the housing 1302B
of the cassette 1300B can be sized, shaped and/or otherwise
configured to receive a clamp 1370B. According to some embodiments,
the clamps 1370B help form the loading areas 1312B along the top of
the cassette 1300B and facilitate the securement of a vial or other
container in such loading areas 1312.
[0317] In some embodiments, the clamps or other vial receiving
portions 1370B can be configured to be removably secured to the
cassette housing 1304B, thereby allowing such clamps to be
separated from the cassette for disposal, cleaning, reuse and/or
the like. The clamps 1370B can be secured to the housing (and/or
any other portion of the cassette 1300B) using one or more types of
attachment methods, features or devices. For example, a clamp or
other vial receiving portion 1370B can be permanently or removably
secured to the housing and/or another portion of the cassette using
a snap-fit connection, a press-fit or friction-fit connection,
tabbed or locking ear connection, adhesives, flanged connection,
rivets and/or other mechanical fasteners and/or the like, as
desired or required for a particular application or use.
[0318] With reference to FIGS. 19E and 19F, the clamps or other
vial receiving portions or members 1370B, 1370B' can comprise a
base portion 1372B, 1372B' that defines a generally cylindrical
interior opening. According to some embodiments, the walls or
generally vertical portions of the base portion 1372B, 1372B' are
generally non-continuous so as to intermittently surround a vial or
other container secured therein. Alternatively, however, the walls
of the base portion 1372B, 1372B' can be generally or substantially
continuous around a periphery of the clamp. In some embodiments,
clamps of various sizes and/or shapes may be provided, thereby
allowing a user to customize the cassette 1300B for specific types
of vials and/or other containers. For example, clamps 1372B, 1372B'
of varying size and/or shape can be used on a single cassette. In
some embodiments, the peripheral or outermost dimensions of the
clamps 1372B, 1372B' are similar or substantially similar,
regardless of the specific size and/or shape of vial or container
that the clamps are configured to receive. Therefore, as
illustrated by the embodiments depicted in FIGS. 19E and 19F, a
clamp that is configured to receive vials and/or other containers
comprising smaller necks can include one or more inwardly oriented
tabs 1379B' to ensure that the vial or container is secured to the
clamp 1372B' in a stable manner (e.g., with little or no movement
or slack once secured to the corresponding receiving site).
[0319] With further reference to FIGS. 19E and 19F, the clamp
1372B, 1372B' can comprise one, two or more movable portions or
legs 1374B, 1374B' that allow for the vial and/or other container
to be easily inserted within and/or removed from the clamp. As
shown, such movable members or legs 1374B, 1374B' can comprise a
handle or grasping portion 1376B, 1376B' that may be selectively
grasped and manipulated by a user. In addition, the movable members
or legs 1374B, 1374B' can include a sloped portion or section
1378B, 1378B' that facilitates placement of the vial and/or other
container within the interior of the receiving area defined by the
clamp. These legs can also help ensure that the vial or other
container positioned therein will not be inadvertently removed. In
some embodiments, the legs or movable members 1378B, 1378B' are
resiliently biased, such that they can be moved radially outwardly
when a vial or container is urged downwardly into the interior
space of the clamps 1372B, 1372B'. In such a configuration, the
legs can then move back to their original position (e.g., radially
inwardly) to ensure that the neck of the vial or other container is
securely maintained below the bottom of the sloped portion or legs.
In order to remove a vial or other container from the receiving
site or nest, a user can move the legs or other movable members
1378B, 1378B' apart from one another and simultaneously lift the
vial or container from the interior of the clamp.
[0320] Accordingly, in some embodiments, a syringe or other
reservoir within an interior portion of a cassette is configured to
be placed in fluid communication with a vial or other container
secured to a corresponding receiving site, loading area or nest of
the cassette via at least one conduit (e.g., spike assembly) that
attaches directly or is incorporated into a single (e.g.,
monolithic) design as the manifold or discharge portion and/or any
other portion of the cassette's unitary structure. Thus, the
syringes and/or other reservoirs can be placed in fluid
communication with corresponding vials and/or other containers
without the need or use of separate luer fittings and/or other
swabbable or cleanable portions and/or other portions or members
configured to be sterilized or disinfected. In addition, as
discussed herein, the clamps and/or other portions of the receiving
sites, loading areas and/or nests can be removable from the
cassette and/or reusable, as desired or required.
[0321] According to some embodiments, the housing or outer portion
of a cassette that houses one or more internal components (e.g.,
syringes or other fluid reservoirs, manifolds, etc.) is referred to
as a cassette adapter. Further, for embodiments where the housing
or cassette adapter is configured to be opened so that one or more
internal components can be removed and replaced (e.g., removable
cassette adapters), the component or components that are replaced
can be generally referred to as the cassette.
[0322] In any of the embodiments disclosed herein or equivalents
thereof, the cassette can comprise one or more standard or
non-standard syringes S that include a simple distal fitting D, as
illustrated in FIG. 191. In other words, the distal end of such a
syringe S or other reservoir does not need to include a luer or
other standard or non-standard fitting (e.g., no threaded fitting,
snap-connect fitting, etc.). Thus, a plan, generally cylindrical or
generally conical distal end can be configured to be inserted
within a corresponding opening of the cassette's internal structure
1310, as illustrated in FIGS. 19H and 19I. Such an embodiment can
not only simplify the cassette design, but it can also help ensure
that the syringes S or other reservoirs are accurately positioned
relative to the cassette and the corresponding motors, actuators
and/or other movable devices that will selectively move the
plungers or other movable members within the corresponding syringes
or reservoirs. For example, since it is important that the correct
volume of each fluid is injected out of the corresponding syringe
S, the syringe or other reservoir must be precisely positioned
within the cassette.
[0323] In some embodiments, as illustrated in FIGS. 19H and 19I,
the luer-less syringes or other reservoirs S are properly
positioned relative to the adjacent unitary structure 1310 of the
cassette 1300 using one or more retention members R (e.g., flanges,
slotted openings, recesses, etc.) along the proximal end of the
unitary structure 1310. As shown, such retention members R can be
advantageously shaped, sized and/or otherwise configured to receive
a standard or non-standard flange F of a syringe S or other
reservoir. For instance, in some embodiments, the flange F of the
syringe S is aligned with the corresponding retention member R of
the cassette and is subsequently rotated (e.g., by about a quarter
turn or 90 degrees, less or more than a quarter turn, etc.) in
order to secure or lock the syringe or reservoir S within the
unitary structure 1310. In some embodiments, one or more special
grasping and/or turning tools can be used to grab and rotate the
syringe into the "locked" position, as desired or required. Such
tools can advantageously provide the required mechanical advantage
(e.g., force, moment, etc.) to overcome the necessary frictional
and other forces.
[0324] In some embodiments, as illustrated in FIGS. 19H and 19I,
the unitary structure 1310 and/or any other portion of the cassette
1300 comprises one or more dimples, tabs and/or other protruding
members T that help prevent the flange of the syringe or other
reservoir S from unlocking or other undesirably rotating once
properly secured to the retention member. In some embodiments, such
a tab T or other protruding member can provide audible confirmation
to the user that the syringe S has been properly positioned within
the retention member. The dimples, tabs and/or other protruding
members can be molded as part of the unitary structure or other
portion of the cassette. In other embodiments, such protruding
members are separate features or members that are subsequently
adhered or otherwise attached to the cassette. According to some
embodiments, the syringes or other reservoirs are secured to
adjacent portions of the cassette 1310 (e.g., unitary structure
1310) only using such mechanical engagement features (e.g., syringe
flanges mating within corresponding retention portion with or
without the use of dimples or other protruding members). Thus, in
some embodiments, no adhesives are used to secure the syringes or
other reservoirs within the cassette. However, in other
embodiments, the mechanical engagement features are used in
combination with one or more other attachment devices or features
(e.g., glue or other adhesives, fasteners, etc.), as desired or
required.
[0325] According to some embodiments, the conical or cylindrical
distal end D of the syringes and/or the mechanical locking features
described herein (e.g., dimples, tabs, etc.) enable the injection
system to accurately deliver fluids from the cassette to a
downstream handpiece at relatively high backpressures (e.g.,
approximately 50 psi). However, in other embodiments, the cassette
design can be configured so that the injection system can be
operated at backpressures that are higher or lower than 50 psi
(e.g., approximately, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60,
65, 70, 75, 80, 85, 90, more than about 90 psi, less than about 10
psi, etc.), as desired or required. The syringes having generally
conical or cylindrical distal ends (e.g., without a luer or other
matable fitting) and/or the mechanical only engagement between the
syringe flanges and the corresponding retention features of the
cassette, as illustrated and described herein with reference to
FIGS. 19H and 19I, can be used in conjunction with any other
cassette embodiments disclosed herein.
[0326] With reference to the embodiment illustrated in FIG. 20A, a
cassette 1400 adapted for placement within a fluid delivery module
or other portion of an injection system can be configured to
receive a pre-filled syringe 400 or other container. The cassette
1400 can be sized, shaped and otherwise configured to replace a
cassette having multiple (e.g., two, three, four, etc.) receiving
sites on which vials, ampoules and/or other containers can be
loaded, such as, for example, the cassettes depicted and discussed
herein with reference to FIGS. 1, 2, 4, 5A, 5B, 7, 8 and 14A-19F.
Thus, the various cassette embodiments disclosed herein can be used
interchangeably with one another in one or more injection systems.
As a result, the cassette can include a housing 1402, tabs,
recesses and/or other features that are similar, substantially
similar or identical to those in the multiple receiving site
cassettes disclosed herein. According to some embodiments, the
pre-filled syringe 400 comprises hyaluronic acid, plasma, red blood
cells, other cells, (e.g., stem cells and other biologics), other
separated or centrifuged blood components and/or the like. In some
embodiments, the pre-filled syringe, vial or other container
intended to be secured to the cassette 1400 can be configured for
placement in a centrifuge or other apparatus (e.g., before and/or
after being secured to the cassette 1400). Thus, once a fluid has
been centrifuged, the syringe 400 can be loaded onto the cassette
1400. Accordingly, one or more of the separated layers and/or
portions of the fluid (e.g., blood) and/or other materials
contained within the syringe 400 can be selectively delivered to or
near a target anatomical location (e.g., vessel, joint, nerve,
etc.) using the injection system.
[0327] With continued reference to FIG. 20A, a pre-filled syringe
400 or other container can be secured to the top of the cassette
1400 using one or more clips, guides and/or other devices or
features 1410, 1420. For example, the cassette 1400 can include a
pair of tabs or clips 1410 that are sized, shaped and otherwise
configured to receive the barrel 402 or other exterior surface or
portion of the syringe 400. In some embodiments, the tabs 1410
include two adjacent members that are configured to resiliently
move apart in order to maintain a syringe 400 therebetween. The
inside surfaces of the tabs 1410 can be contoured (e.g., rounded,
curved, etc.) in order to accommodate the outer shape of the
syringe barrel 402. The tabs 1410 can be sized, shaped,
resiliently-designed and otherwise adapted to receive pre-filled
syringes 400 (or other containers) of varying sizes (e.g., both
standard and non-standard), shapes and/or other configurations.
Thus, the cassette 1400 can be used to load and subsequently
deliver fluids and/or other materials from a number of different
types and sizes of syringes and other containers.
[0328] In some embodiments, the flange portion 410 at the proximal
end of the syringe barrel 402 is configured to be secured within a
recess 1420 or similar feature of the cassette 1400. For example,
as illustrated in FIG. 20A, the recess 1420 can include two channel
members forming a slot that is sized, shaped and otherwise
configured to receive the syringe's flange portion 410. In
alternative embodiments, one or more other features or members can
be used to retain the flange portion 410 and/or otherwise help
retain maintain the position of the syringe 400 relative to the
cassette 1400. As illustrated in FIG. 20A, the top surface of the
cassette housing 1402 can include one or more recessed areas 1403
underneath or near the loading area of the syringe. Such recessed
areas 1403 can facilitate loading and unloading of a pre-filled
syringe or other container to or from the cassette 1400.
[0329] With reference to FIGS. 20A and 20B, the plunger portion 420
of the pre-loaded or pre-filled syringe 400 or other container can
be configured to be slidably moved within the interior of the
barrel portion 402 to discharge fluids and/or other materials
contained therein through the outlet 404 at the syringe's distal
end. In some embodiments, the cassette 1400 comprises an actuator
member 1430 that is adapted to retain and selectively move the
plunger portion 420 of the pre-filled syringe 400. As illustrated
in FIG. 20B, the actuator member 1430 can include a main portion
1432 that is adapted to slidably move within a rail system 1440
located along the bottom surface of the cassette interior. In some
embodiments, the rail system 1440 comprises two channels 1442 that
are shaped, sized and otherwise configured to create a space
through which the main portion 1432 of the actuator member 1430 can
slide.
[0330] As illustrated in FIG. 20A, the actuator member 1430 can
comprise a riser 1434 that extends generally vertically from the
main portion 1432. In some embodiments, the riser 1434 includes a
channel or other retaining portion or shape to help secure the
plunger member 420 of the pre-filled syringe 400 or other container
loaded onto the cassette 1400. For example, as illustrated in FIG.
20A, the riser 1434 can be adapted to retain the handle or flange
portion 422 of the syringe's plunger member 420. Accordingly,
movement of the actuator member 1430 relative to the cassette
housing 1402 (e.g., within the rail system 1440) can cause the
plunger member 420 to move relative to the adjacent barrel portion
402 of the pre-filled syringe 400 or other container.
[0331] With continued reference to FIG. 20B, the actuator member
1430 can include a stem 1436 or other member that extends from the
main portion 1432 and the riser 1434, toward the rear of the
cassette 1400. In some embodiments, the stem 1436 is generally
aligned with a slot or opening 1404 along the bottom surface of the
cassette housing 1402. Accordingly, as with the cassette
embodiments discussed herein with reference to, inter alia, FIGS.
4, 8, 12A, 12B and 14A, the stem 1436 can be secured within a
pusher block of the fluid delivery module. For example, the stem
1436 can be sized, shaped and otherwise configured to replace a
plunger member is such other cassette designs. As a result, a motor
(e.g., stepper motor), other mechanically-operated movement system
and/or any other device or system of the fluid delivery module, can
advantageously manipulate the stem 1436 to selectively move the
syringe's plunger member 420 relative to its barrel portion 402. As
noted above, urging the plunger member 420 within the interior of
the barrel portion 402 helps to discharge fluids and/or other
materials contained within the pre-filled syringe 400 through its
distal outlet 404. Thus, the same motors can be used to discharge
fluids out of both the reservoirs (e.g., in a design similar to
those illustrated in, inter alia, FIGS. 8 and 14A) and a pre-filled
syringe (e.g., FIGS. 20A-20C).
[0332] According to some embodiments, the outlet 404 of the syringe
400 or other container can include a luer lock fitting and/or any
other standard or non-standard connection. For example, the outlet
404 can include a threaded connection, a flanged connection, a
snap-fit, pressure-fit or friction-fit connection and/or the like.
Thus, a handpiece assembly can be easily and quickly connected to
and/or disconnected from the outlet 404 of the pre-filled syringe
400. As discussed with other embodiments herein, the handpiece
assembly can include tubing with a fitting 260 configured to mate
with a corresponding fitting of the syringe outlet 404 (FIG.
21A-21E).
[0333] According to some embodiments, the fluids and/or other
materials being delivered from the vials, ampoules and/or other
containers to the handpiece assembly 200 are configured to be
combined prior to exiting a cassette 300. For example, the contents
of two, three or more of the vials or other containers secured to a
cassette 300 can mix with one another within a collection member, a
hub (or other junction) and/or the like, immediately or
substantially immediately downstream of the manifolds positioned
within a cassette or at any other location within the injection
system. Therefore, in some embodiments, a single-lumen tubing or
any other conduit 250 can be used to place the cassette in fluid
communication with the downstream handpiece assembly 200 (see, for
example, FIGS. 1 and 2).
[0334] With continued reference to FIGS. 1 and 2, the tubing 250 or
other conduit can include a fitting 260 that is sized, shaped and
otherwise configured to mate and connect with a corresponding
fitting along a surface of the cassette. For example, in some
embodiments, the fitting 260 comprises a standard or non-standard
luer lock fitting, a threaded connection and/or the like. In such
arrangements, the process by which the tubing 250 is connected to
the cassette (or disconnected from it) can be advantageously
facilitated (e.g., by allowing a user to quickly, securely and
conveniently attach to and detach from the cassette).
[0335] Further, since in some embodiments the fluids and/or
materials contained within the different vials or other containers
are mixed inside the cassette (e.g., before being transferred to
the tubing 250), the design of the handpiece assembly 200 can be
advantageously simplified. For example, in such arrangements, the
need for a core or similar component of the handpiece assembly 200
can be eliminated, as the flow control of the various fluid or
other material streams does not occur within the handpiece assembly
200. Relatedly, the need to provide electronic components (e.g.,
electrical power, buttons or other controllers, other control
features, etc.) in the handpiece assembly 200 can be eliminated.
Consequently, such a configuration permits the handpiece assembly
to have a simpler design, allowing it to be manufactured more
inexpensively. Due to such a relatively simplified design, the
handpiece assembly 200 can be adapted to be replaced together with
the tubing 250 and/or the cassette 300 in accordance with a desired
or required protocol (e.g., once a day, every time the type or
concentration of the medicaments loaded onto a cassette are
altered, etc.). Thus, according to some embodiments, the handpiece
assembly is disposable. This can generally facilitate the use and
maintenance of the injection system and can help improve the
hygienic and safety aspects of the treatment procedures performed
using the injection system embodiments disclosed herein.
[0336] One embodiment of tubing 250 or other conduit configured to
place a handpiece assembly 200 in fluid communication with a
cassette or other component of a fluid delivery module is
illustrated in FIGS. 21A-21E. In some arrangements, the handpiece
assembly 200 and the tubing 250 comprises a unitary structure. For
example, the handpiece assembly 200 can be integrally formed with
the tubing 250. In one embodiment, the handpiece assembly 200 and
the tubing 250 are coextruded, molded or otherwise formed during a
single manufacturing procedure. In other configurations, however,
the handpiece assembly 200 is separate and distinct from the tubing
250 or other conduit. Thus, one or more attachment devices or
methods (e.g., standard or non-standard couplings, other fasteners,
adhesives, welds, etc.) can be used to secure the tubing 250 to the
handpiece assembly 200, as desired or required.
[0337] In any of the embodiments disclosed herein, a handpiece
assembly can be partially or completely disposable, either alone or
together with the proximal tubing or other conduit that places it
in fluid communication with a fluid delivery module. Such
disposable embodiments can provide one or more benefits to the
clinician and/or the patient. For example, by discarding the entire
handpiece assembly, which may include the needle assembly and the
tubing connecting the handpiece to an upstream fluid delivery
module, the transition between procedures can be improved (e.g.,
simplified, expedited, etc.). In addition, the risk of infection,
cross-contamination and/or the like can be reduced as the need to
reuse, clean and/or otherwise prepare the handpiece assembly for a
subsequent procedure is eliminated.
[0338] As illustrated in FIGS. 21A-21E, the proximal end of the
tubing 250 can include a luer lock connection or another standard
or non-standard coupling 260 or fitting (e.g., a threaded
connection, snap fitting, friction fit fitting, etc.). Regardless
of its exact design, such a coupling 260 or fitting can be
configured to quickly and easily connect to and disconnect from a
corresponding coupling or fitting located on the cassette 300 or
other portion of the fluid delivery module 100. For example, as
depicted in the detailed view of FIG. 21D, the coupling 260 can
comprise a universal luer fitting that may be selectively secured
to a cassette. Thus, the connection of the tubing (and any other
downstream components, e.g., handpiece assembly 200) to the fluid
delivery module can be simplified. For example, according to
certain embodiments, the coupling 260 can be detached from a
corresponding coupling or fitting (e.g., luer fitting, threaded
fitting, etc.) of the cassette 300. In addition, the coupling 260
can be selectively swabbed between patients or as otherwise
required or desired. In other embodiments, one or more other
cleaning or maintenance protocols can be used to help ensure that a
required or desired level of hygiene and safety is maintained.
[0339] As noted above, in some embodiments, the different fluid
and/or other material streams being delivered from the fluid
delivery module to the handpiece assembly 200 can be mixed within
the cassette, prior entering the downstream tubing 250 and the
handpiece assembly 200. For instance, the fluids and/or other
materials can be combined in a hub, a collection member and/or the
like, depending on the particular cassette design. However, in
other arrangements, the various streams can be mixed within the
downstream handpiece assembly 200, the tubing 250 that places the
handpiece in fluid communication with the cassette and/or any other
portion or component of the fluid delivery module or the injection
system, as desired or required. In such configurations, the tubing
250 can have two or more lumens for at least part of its
length.
[0340] In embodiments where the separate fluids and/or other
materials loaded onto a fluid delivery module are mixed prior to
exiting the cassette (e.g., immediately downstream of the
manifolds), backflow prevention valves can be positioned within
each individual line immediately upstream of the mixing location.
This can help ensure that fluids and/or other materials do not
inadvertently flow backwards through the system, thereby helping to
eliminate or reduce the likelihood of undesirable
cross-contamination.
[0341] With continued reference to FIGS. 21B and 21C, a distal end
210 of the handpiece assembly 200 can include interior threads that
are adapted to engage a corresponding thread pattern (e.g.,
standard or non-standard) of a needle hub. For example, the needle
hub can be attached to the opening using a luer lock connection 214
and/or any other type of standard or non-standard coupling. Thus, a
needle can be easily secured to and removed from the distal end of
the handpiece assembly 200. This can further facilitate the
execution of an injection protocol and the required maintenance
between procedures.
[0342] The type, size (e.g., gauge), length and/or other details of
the needle that may be attached to the distal end 210 of the
handpiece assembly 200 can be selected according to the particular
application. For example, in some embodiments, the needle has a
gauge of approximately 18 G-30 G and a length of approximately 0.5
to 5.0 inches (e.g., 1.0 to 1.5 inches). However, that the gauge,
length and/or other details of the needle can be greater or smaller
than the range indicated herein, as desired or required by a
particular application.
[0343] According to some embodiments, for instance, when performing
a peripheral nerve block or other anesthesiology procedure, a
relatively short bevel needle (e.g., a needle having a tip with a
bevel of about 15.degree. to about 45.degree.) may be selected
because short bevel needles may carry a lower risk of causing nerve
injury than needles having a longer beveled tip. In some
embodiments, the bevel of the needle tip can be approximately 15,
20, 25, 30, 35, 40, 45.degree., angles between the foregoing
values, greater than about 45.degree., less than about 15.degree.,
etc., as desired or required for a particular application or
use.
[0344] In some embodiments, an injection system comprises a nerve
stimulator or similar electrical stimulation device. Such a
stimulator or other stimulation device can be electrically coupled
to a stimulation needle which can be used for delivering
anesthetics (and/or other fluids) and for selective nerve
stimulation of the patient's anatomy. During the administration of
anesthetics, electrical stimulation can be used to verify the
proximity of the needle to the target nerve, advantageously
increasing the success rate of a nerve block procedure. For
example, since stimulation of nerves elicits different muscle
responses, twitches and/or other reactions by the patient, an
electrical impulse delivered to or near the tip of the needle can
allow the anesthesiologist or other clinical performing the
procedure to determine how close the needle is relative to the
target nerve tissue. Accordingly, targeted or nearby nerve tissue
can be identified by observing the patient for the desired
corresponding muscle response.
[0345] In such embodiments that comprise a stimulation needle, the
type, size, length, and/or other details of the needle can be
selected to allow for improved nerve stimulation and delivery of
anesthetic agents. For example, the needle can be insulated over a
majority of its length and have a conductive area at the tip to
localize stimulation to the needle tip where the anesthetic will
also be delivered. As shown in the example embodiment of FIG. 21F,
a stimulation needle 291 can include a needle body 295, a handpiece
or needle hub 292, tubing 293, and a lead 297. The tubing 293
places the handpiece or needle hub 292 and needle body 295 in fluid
communication with the anesthetic source (e.g., anesthetic agents
and/or other fluids loaded onto a corresponding fluid delivery
module, via one or more fluid conduits, handpiece and/or the like,
etc.). Further, the one or more electrical leads 297 place the
handpiece, needle hub 292, needle body 295 (e.g., when no handpiece
or needle hub is used) and/or the like in electrical communication
with the stimulator. As noted, in some embodiments, the stimulation
needle and/or any other needle used in an injection system
disclosed herein can be used with or without a handpiece, hub or
other intermediate component. Thus, such needles can be directly or
indirectly coupled to a fluid conduit (e.g., tubing) and/or other
fluid passage that is in fluid communication with an anesthetic or
other fluid source.
[0346] According to some embodiments, such as, for example in the
system illustrated in FIG. 21G, an anesthetic or other type of
injection system comprises a stand alone nerve stimulator 700
operatively coupled to a fluid delivery module 100. The stimulation
needle tubing 293 can be coupled to and placed in fluid
communication with the delivery line or conduit 250 of the fluid
delivery module 100, for example, via luer fittings, other suitable
fittings, etc. The one or more stimulation needle leads 297 can be
coupled to an output 702 of the stimulator 700. In some
embodiments, the nerve stimulator 700 and fluid delivery module 100
are operatively coupled and communicate with one another via a
hardwired connection (e.g., USB, ethernet, etc.) or a wireless
connection (e.g., Bluetooth, radio frequency, etc.).
[0347] As shown in FIG. 21H, in some embodiments, a stimulator 700
can be at least partially integrated into a fluid delivery module
100 to form a single, integrated or unitary unit. In some such
embodiments, the one or more fluid conduits 250 and/or stimulator
leads 297 can be coupled (e.g., removably or permanently) to one
another (e.g., along at least a part of their lengths or other
portion). Further, along their distal end, such fluid conduits
and/or electrical leads and can be coupled to a proximal end or
other portion of a handpiece 200. Alternatively, such delivery
lines or conduits 250 and/or stimulator leads 297 can be
independent of one another. In some embodiments, the stimulation
needle body 295 can be coupled to a distal end of the handpiece
200. The handpiece 200 can be configured to place the needle body
295 in fluid communication with the delivery line 250 and in
electrical communication with the stimulator lead 297. In some
embodiments, stimulation information, for example, one or more
stimulator parameters (e.g., the strength of the electrical impulse
being provided to the needle, historical information regarding the
level of electrical impulse delivered to the needle, etc.) can be
displayed on the fluid delivery module display 130 and/or any other
output (e.g., other display, printout, etc.). In some embodiments,
information regarding the amount of electrical stimulation
delivered to the patient can be stored and saved on a memory
associated with the system (e.g., internal memory, external memory,
etc.) and/or delivered to another location (e.g., over a
network).
[0348] A nerve stimulator can be configured to provide the needle
with electrical current having an impulse amplitude in the range of
about 0 mA to about 10 mA (e.g., about 0, 0.1, 0.2, 0.3, 0.4, 0.5,
1, 2, 3, 4, 5, 6, 7, 8, 9, 10 mA, values between the foregoing,
etc.). In some embodiments, a relatively low current range, such
as, for example, 0-5 mA, can help reduce the risk of trauma to the
nerves. In some embodiments, use of a relatively higher current
intensity (for example, greater than 1.0 mA in some applications)
can result in an exaggerated muscle response or twitch and
increased discomfort for the patient. However, impulse amplitudes
greater than about 5 or 10 mA can be used in the conjunction with
the various injection system embodiments disclosed herein, as
desired or required. In some embodiments, the stimulator is
configured to compensate for variations in tissue resistance within
the patient's anatomy to supply current having a substantially or
generally constant amplitude. In some embodiments, the nerve
stimulator is configured to deliver stimulus pulses having a
duration of about 0.1 ms. A short stimulus pulse duration can
advantageously help cause motor nerve response rather than sensory
nerve response. Other pulse durations are also possible. In some
embodiments, the stimulator is configured to deliver impulses to
the needle at a frequency of 1 Hz or 2 Hz. In some embodiments, the
stimulator allows for the selection of a 1 Hz or 2 Hz pulse
frequency, for example, via a switch, button, or other controller.
In some embodiments, other pulse frequencies are also possible.
[0349] Another embodiment of a handpiece assembly 200A configured
for use with an injection system is illustrated in FIGS. 22A and
22B. As shown, the handpiece assembly 200A can include an outer
housing 204A that is configured to surround the fluid conduit 250
passing therethrough. As discussed herein with reference to other
arrangements, the fluid conduit 250 can be adapted to selectively
place a tip 210A (and downstream needle) or other distal portion of
the handpiece assembly 200A in fluid communication with the
cassette or other portion of the fluid delivery module. According
to certain embodiments, as illustrated in FIGS. 22A and 22B, the
handpiece assembly 200A is a separate item from the fluid conduit
250. However, in other embodiments, the handpiece assembly 200A and
the fluid conduit 250 are coextruded, molded or otherwise
manufactured as a unitary structure.
[0350] Another embodiment of a handpiece assembly 200B is
illustrated in FIGS. 23A and 23B. As shown, the handpiece assembly
200B can include a handpiece portion 202B having an outer housing
204B. In some embodiments, the handpiece portion 202B is
manufactured using a molding process (e.g., injection molding,
compression molding, etc.), extrusion process, thermoforming,
casting and/or other process. The handpiece assembly can comprise
one or more materials, such as, for example, thermoplastics,
elastomers, metals and/or the like. As illustrated in FIGS. 23A and
23B, the handpiece portion 202B can include a corrugated, ribbed
and/or other textured design. In some embodiments, such a
configuration can serve one or more purposes and/or provide one or
more benefits. For example, a textured design can improve the
ability of a user to grasp and manipulate the handpiece assembly,
provide an enhanced surface for attachment of control module 230 or
other device and/or the like.
[0351] With continued reference to FIGS. 23A and 23B, the handpiece
202B can include one or more holes or other openings 206B along the
outer housing 204B. Such holes 206B can extend partially or
completely through the body of the handpiece portion 202B. In some
embodiments, the holes or openings 206B are sized, shaped, oriented
and otherwise configured to receive corresponding protrusions or
other portions or features of a control module 230. Accordingly,
the openings, 206B can provide a way to more securely attach a
control module 230 and/or other device or item to the handpiece
202B. In other embodiments, a handpiece portion includes openings
having a different size, shape (e.g., oval, rectangular, irregular,
etc.), orientation and/or other characteristics, as desired or
required. Alternatively, a handpiece can include one or more other
features configured to secure a control module or other item
thereto, either in addition to or in lieu of holes or openings
206B. For example, the handpiece 202B can comprise couplings, tabs,
fittings and/or the like. In yet other arrangements, a handpiece
portion includes no openings and no other securement features or
items at all.
[0352] With continued reference to FIGS. 23A and 23B, the assembly
200B can include tubing 250B that places the handpiece portion 202B
in fluid communication with a cassette or other portion of a fluid
delivery module. Thus, one or more fluids and/or other materials
discharged from the fluid delivery module can be advantageously
delivered within a person's anatomy (e.g., to or near a nerve,
joint, organ, cavity, etc.) through a needle (not shown) secured to
the distal end 210B of the handpiece 202B. As depicted in FIGS. 23A
and 23B, the tubing 250B can enter the proximal end 211B of the
handpiece portion 202B and pass through an interior thereof. In
embodiments of the handpiece that comprise holes or other openings
206B, the tubing 250B can be visible from the exterior of the
handpiece assembly.
[0353] As discussed in greater detail herein, the tubing 250B can
include one or more flexible materials, such as, for example,
plastics, elastomers and/or the like. In other arrangements, the
tubing comprises a rigid and/or semi-rigid material (e.g., plastic,
metal, glass, other natural or synthetic materials, etc.), as
desired or required. Depending on the number of fluid and/or other
material streams that an injection system is configured to handle,
the particular cassette design being used and/or any other factors,
the tubing can include a single lumen or a multi-lumen design. For
example, for the cassette embodiments discussed herein with
reference to FIGS. 8 and 14A, single-lumen tubing can be used to
place the handpiece in fluid communication with the fluid delivery
module. A single-lumen tubing configuration can also be utilized
when a cassette is configured to receive the contents from a single
pre-filled syringe (e.g., FIGS. 20A-20C), vial, ampoule or other
container. However, in arrangements where multiple fluid and/or
other material streams are configured to be combined downstream of
the cassette or other portion of the fluid delivery module, tubing
can include two, three or more lumens, as desired or required. As
discussed herein, in some embodiments, the fluid delivery module
allows for fluids from two or more vials, ampoules, or other
containers to be delivered to the target anatomical location
simultaneously and/or sequentially. For example, such delivery can
be accomplished according to a pre-programmed injection protocol.
In some such embodiments, the tubing can have a single lumen, and
one or more fluids are expelled into the single-lumen tubing
(either directly or via a mixing chamber) during various phases of
the injection procedure according to the programmed protocol.
[0354] As discussed above and illustrated in FIGS. 23A and 23B, in
some embodiments, a handpiece assembly 200B comprises a control
module 230 that can be removably attached to the handpiece portion
202B. The control module 230 can include one or more clips 232,
234, tabs and/or other securement members that are adapted to
facilitate attachment to and detachment from the handpiece portion
202B. For example, a securement member 232, 234 can include a
protruding portion or feature that is sized, shaped and otherwise
configured to mate with a corresponding opening 206B along the
handpiece housing 204B. In the depicted embodiment, the control
module 230 includes two proximal clips or tabs 232 and two distal
clips or tabs 234. However, in other arrangements, a control module
or other removable portion or component includes more or fewer
(and/or different) securement members. Any other device and/or
method of securing the control module to the handpiece can be
used.
[0355] According to some embodiments, the control module 230
comprises one or more buttons 236 controllers and/or other
adjustment devices (e.g., knobs, dials, switches, etc.). Such
buttons or other controllers 236 can help regulate the delivery of
various fluids and/or other materials through the handpiece
assembly 200. For example, the button 236 illustrated in FIGS. 23A
and 23B can be used to activate or deactivate (e.g., ON/OFF) the
delivery of one or more fluids and/or other substances to or near a
patient's anatomical location (e.g., nerve, joint, organ, cavity,
etc.). In certain embodiments, the buttons or other controllers are
manipulated to regulate the rate of delivery (e.g., flowrate) of
one or more medicaments and/or other materials being transferred
through the handpiece assembly 200. As discussed in greater detail
herein, in embodiments where the fluid delivery module is in data
communication with one or more other components or devices (e.g.,
ultrasound devices, radio frequency spectroscopy devices, other
imaging devices or systems, etc.), one or more buttons 236 or other
controllers on the control module 230 and/or other portions of the
injection system can be used to help regulate the operation of such
systems. For example, one or more buttons or other controllers of a
control module can be used to capture an ultrasound image or video
while a target anatomical space (e.g., nerve, joint, organ, etc.)
is being located and/or while one or more fluids or other materials
are being injected into a target anatomical location.
Alternatively, the buttons or other controllers can be used to vary
one or more other aspects of an imaging system, such as, for
example, zoom, resolution, contrast, brightness and/or the like. In
some embodiments, a control module 230 includes additional, fewer
and/or different buttons, knobs, levers and/or other control
devices that permit a user to control one or more aspects of the
injection system.
[0356] With continued reference to FIGS. 23A and 23B, the buttons
236 or other controllers of the control module 230 can be used to
initiate and/or terminate a particular injection procedure. Thus,
once a particular injection protocol has been selected by a user
(e.g., through the display or other interface of the fluid delivery
module), pressing the button 236 and/or otherwise manipulating
another controller can regulate one or more aspects of the delivery
of fluids and/or other materials through the handpiece assembly.
For example, by pressing or manipulating the button 236 once, the
injection procedure can be initiated. In some embodiments,
additional manipulation of the button 236 can terminate or
temporarily pause the procedure. In yet other embodiments,
manipulation of the button or other controller can alter the
flowrate, sequence and/or any other aspect of an injection
procedure.
[0357] According to certain embodiments, a control module 230
and/or any other portion of a handpiece assembly or injection
system comprises one or more two-mode or other multi-mode buttons
and/or other controllers. Pressing or otherwise manipulating such a
button can commence or terminate (e.g., in an alternating pattern)
the delivery of one or more fluids and/or other materials through
the assembly. Alternatively, the handpiece assembly 200B can
include one or more other types of buttons or controllers. In some
arrangements, the buttons 236 are configured to permit the user to
select between two, three or more different settings. In other
embodiments, a button is of the multi-depth type (e.g., dual-depth,
tri-depth, etc.), enabling a user to selectively press the button
to two or more distinct depths or other levels. Each distinct depth
or level can correspond to a particular setting (e.g., flowrate,
selection of which fluids or other materials to deliver, etc.). For
example, pressing the button to the first level can cause the
desired fluid and/or other material to be conveyed at the maximum
or minimum rate. Further, continuing to press the button to
subsequent lower levels can cause the rate of delivery to increase,
decrease or terminate. In other embodiments, the handpiece assembly
comprises multi-depth buttons that do not include distinct depths,
such as, for example, a rheostat. Thus, a particular setting (e.g.,
flowrate) can be varied based on the depth to which a button is
depressed.
[0358] In other arrangements, the control module 230 comprises one
or more buttons 236 that have only two positions, but which are
configured to permit a user to select between three or more
different settings. For example, an injection system can be adapted
to sequentially move between different flowrate settings (e.g.,
high-medium-low-off, vice versa, etc.) every time such a button is
pressed.
[0359] In addition, a control module 230 and/or another portion of
a handpiece assembly 200B can comprise other types of controllers,
either in lieu of or in addition to buttons. For example, the
handpiece assembly can include a roller ball, a roller wheel, a
dial, a knob, a modulating switch or other device and/or the like.
Regardless of their exact configuration and design, such control
devices can enable a clinician or other user to regulate the
delivery of fluids and/or other materials from the fluid delivery
module to a patient. As discussed, the various fluids and/or other
materials loaded onto a cassette or other portion of a fluid
delivery module can be delivered through the handpiece assembly
200B simultaneously and/or sequentially, as desired or required.
For example, a user can pre-select a desired injection protocol,
which includes the rate of delivery, the sequence of delivery, the
volume or other amount to be delivered and/or other details for
each medicament, other fluid and/or other substance used in a
particular treatment. Thus, a user simply has to press, release or
otherwise manipulate the button 236 (or other controller) of the
control module 230 in order to initiate, terminate, pause or
otherwise alter the preselected protocol.
[0360] In relation to any of the embodiments disclosed herein, an
injection system can be configured to transfer one, two or more
anesthetic, other pharmaceutical or medicaments, other fluids
and/or other materials from a fluid delivery module to or near a
nerve or other targeted anatomical location sequentially and/or
simultaneously, in accordance with a specific delivery protocol.
For example, a protocol can require that, for some time period,
fluids A and B (e.g., loaded in separate loading areas of a
cassette or other portion of a fluid delivery module) be delivered
to a nerve simultaneously. Further, during a separate sequential
delivery stage, which may occur either before or after the
simultaneous delivery, the injection protocol can cause fluid A to
be delivered to the patient before fluid B. Fluids A and B can
differ from one another in a variety of ways, including in the
formulation or type of drug or other material, in strength,
concentration or dosage (e.g., thus, fluids A and B can comprise
the same formulation but a different concentration) and/or the
like. Thus, an injection system can be configured to deliver two or
more drugs, medicaments and/or other fluids or materials
sequentially, simultaneously or both sequentially and
simultaneously, depending on the specific injection protocol being
used by the clinician.
[0361] As discussed herein, an injection system can be configured
to deliver one, two or more anesthetics, other drugs or medicaments
and/or any other substances sequentially and/or simultaneously
through single-lumen tubing. In some such embodiments, a user may
wish to deliver one, two or more medicaments (e.g., anesthetics)
during different delivery stages with limited mixing of the
medicaments. Thus, a cassette or other portion of a fluid delivery
module can be loaded with two or more drugs and an inert fluid such
as saline. The user can then use saline and/or other fluid to flush
the tubing between delivery of different drugs or as otherwise
desired or required. Further, one or more of the loading areas of a
cassette can be placed in fluid communication with a manifold
system and/or a fluid line that is in fluid communication with
separate fluid containers. Thus, the injection system can be used
with one or more larger anesthetic or other fluid sources than
would otherwise be possible by simply loading a standard or
non-standard drug vial to the cassette or other portion of the
injection system.
[0362] In other embodiments, such buttons and/or other controllers
236 can be used to select which fluids or other materials, or
combinations thereof, are to be directed through the handpiece
assembly 200B. In other embodiments, the controllers are configured
to control the rate of delivery (e.g., flowrate) of such fluids
and/or other substances to a patient. In still other arrangements,
the buttons control one or more other aspects of the injection
procedure (e.g., the sequence of delivery, an ultrasound or other
imaging device that is in data communication with the injection
system, etc.).
[0363] In other embodiments, one or more buttons 236 of the control
module 230 are adapted to guide the user through one or more
user-interface screens on the display or graphic user interface
(GUI) 130, 130A (FIGS. 1 and 2) on the fluid delivery module. Thus,
the buttons 236 and/or other controllers located on the control
module 230 or otherwise associated within a handpiece assembly 200B
can be used to make selections through one or more menus or the
like.
[0364] In any of the embodiments disclosed herein, a control module
can be connected to the fluid delivery module of the injection
system using a radio frequency (RF) or other wireless connection
(e.g., Bluetooth, Wi-Fi, etc.). However, the control module 230 can
be configured to communicate with the fluid delivery module and/or
any other component of the injection system using a hardwired
connection, either in addition to or in lieu of a wireless
connection. The control module 230 can comprise one or more
disposable or rechargeable batteries (e.g., standard or
non-standard batteries, battery packs, etc.). In some embodiments,
the batteries of the control module are configured to be recharged
when the control module 230 is placed within or near a docking
station or other recharging location (e.g., of the fluid delivery
module, other portion or component of the injection system, etc.).
In some embodiments, batteries (e.g., standard or non-standard
batteries, battery packs, etc.) configured to power the control
module 230 can be removed from the control module before being
recharged (e.g., by placement in or near a recharging device or
location). Such batteries (not shown) can be positioned within an
interior portion of the control module 230. In some embodiments,
the fluid delivery module or another component of the injection
system comprises a docking station that is adapted to recharge a
battery using electromagnetic induction, simple charging (e.g.,
using a DC or AC connection), pulse charging and/or any other
charging method or device. Thus, in some arrangements, the
batteries within the control module 230 can be permitted to
recharge when the handpiece assembly is not in use. Alternatively,
the control module 230 can be configured to draw its power from one
or more other sources, such as, for example, a DC or AC hardwired
connection and/or the like. In yet other embodiments, an injection
system comprises two or more control modules 230, allowing one or
more modules to be recharged while the handpiece assembly 200B is
being utilized.
[0365] In addition to batteries, an interior portion of the control
module 230 can include circuitry, indicator lights (e.g., LEDs)
and/or any other component or feature. For example, the control
module 230 can include one or more indicator lights that provide
information to the clinician or other user of the assembly prior
to, during and/or following an injection procedure. For example, an
LED or other indicator light can be configured to light up when the
battery power of the module is above or below a particular
threshold level (e.g., adequately charged, in need of charging,
etc.). Alternatively, the brightness, color and/or other
characteristics of the indicator light can be configured to change
in response to certain conditions. For instance, the properties of
the light can vary based on the strength of the battery, on the
signal strength of the wireless connection (e.g., RF, Bluetooth,
etc.) between the control module 230 and the fluid delivery module
and/or another component of the injection system and/or any other
aspect associated with the injection system.
[0366] With continued reference to FIG. 23A, the distal end 210B of
the handpiece 202B can be configured to removably receive a needle
assembly 290. As shown, a luer lock connection or other standard or
non-standard fitting at the distal end 210B of the handpiece 202B
can be adapted to receive a corresponding hub or base portion 294
of the needle assembly 290. The needle 296, which distally extends
past the hub 294, can include a gauge of 18 G-30 G and a length of
about 0.5 to 5.0 inches (e.g., 1.0 to 1.5 inches). However, in
other embodiments, the gauge, length and/or other details of the
needle can be greater or smaller than the range indicated above, as
desired or required by a particular application. Further, the
needle can comprise surgical-grade stainless steel and/or any other
suitable material (e.g., other metals, alloys, etc.).
[0367] Following an injection procedure, if a user wishes to
discard the handpiece assembly 200B, he or she can easily and
conveniently remove the control module 230 from the handpiece
portion 202B. The control module 230 can be subsequently attached
to another (e.g., new, sterile, etc.) handpiece assembly before
initiating a new treatment protocol. However, in any of the
embodiments disclosed herein, or equivalents thereof, the transfer
of fluids and/or other materials from a fluid delivery module
(e.g., cassette) to and through the handpiece assembly need not
include a control module that attaches to the handpiece portion.
For example, a clinician or other user of the injection system can
control the flow of fluids and/or other materials through the
injection system using a foot pedal, buttons or controllers located
along or near the fluid delivery module or on another component or
portion of the system and/or the like. Alternatively, such button
or controllers are directly incorporated into a unitary handpiece
design. In other embodiments, the injection procedure is controlled
using a separate device that is in data communication with the
injection system (e.g., a separate computer, handheld device,
Smartphone, etc.), using audible commands and/or the like, as
desired or required. In some embodiments, such a separate device is
not located in close proximity to one or more components of the
injection system.
[0368] Another embodiment of a disposable handpiece assembly 200C
configured for use with an injection system is illustrated in FIG.
24. As shown in FIGS. 26A-27C and discussed in greater detail
herein, the handpiece assembly 200C can be sized, shaped and
otherwise adapted to removably receive a control module 230' along
its handpiece portion 202C.
[0369] With reference to FIG. 24, the handpiece 202C can comprise
one or more rigid, semi-rigid and/or flexible materials, such as,
for example, plastics, elastomers, metals, other natural or
synthetic materials and/or the like. In addition, the handpiece can
be manufactured using a molding process (e.g., injection molding,
compression molding, etc.), an extrusion process, thermoforming,
casting and/or other method. As discussed herein with reference to
other embodiments, the handpiece assembly 200C can be configured to
attach to and disconnect from a fluid delivery module (e.g., a
cassette) and/or another component of the injection system using a
luer lock connection or another quick-connect fitting or coupling
(e.g., threaded connection, snap-fit connection, friction-fit
connection, flanged connection, etc.). Thus, in disposable
arrangements, the handpiece assembly 200C can be attached and/or
removed from the rest of the injection system with relative ease
and quickness. This can advantageously permit a clinician to
complete a treatment procedure in less time, and thus, to perform
more procedures and treat more patients during a particular time
period. As noted herein, in some embodiments, the handpiece portion
202C, the tubing 250C and other portions of the assembly 200C are
disposable, allowing a clinician or other user to discard and
replace the handpiece assembly 200C between patients and injection
procedures.
[0370] With continued reference to FIG. 24, the handpiece assembly
200C can include tubing 250C that places the handpiece portion 202C
(and thus, the needle assembly 290 that is configured to removably
attach to the distal end 210C thereof) in fluid communication with
a fluid delivery module (e.g., cassette) and/or other portion of
the injection system. As shown in FIG. 24 and discussed with
reference to other embodiments herein, the distal end 210C of the
handpiece 200C can include a luer connection or another standard or
non-standard coupling (e.g., having a threaded, snap-fit,
friction-fit, flanged, clipped and/or other type of connection).
Accordingly, the hub 294 or other proximal portion of the needle
assembly 290 can include a corresponding fitting or connection,
allowing the needle assembly 290 to be quickly attached to and/or
removed from the handpiece portion 202C.
[0371] As illustrated in FIGS. 24, 25A and 25B, the tubing 250C
(e.g., single lumen, multi-lumen, etc.) can pass through an opening
along the proximal end 211C, at least partially through an interior
of the handpiece portion 202C. In some embodiments, the tubing 250C
is routed along or near a centerline of the handpiece interior.
Alternatively, however, the tubing 250C is not routed along or near
the centerline of the handpiece interior. For example, the tubing
250C can be oriented along or near the handpiece housing 204C or
any other surface or area. One or more supports, guides or other
members can be used to maintain the desired position of the tubing
250C relative to the handpiece interior.
[0372] With continued reference to FIGS. 25A and 25B, the tubing
250C can be maintained within the handpiece 202C using, among other
things, one or more tight-fit connections 256C. For example, in the
illustrated embodiment, the tubing 250C is secured to the interior
of the handpiece 202C using a single tight-fit connection 256C
along the distal portion of the handpiece. Alternatively, the
tubing 250C can be secured to the handpiece using additional
tight-fit connections and/or any other type of attachment method or
device (e.g., tabs, fasteners, welds, adhesives, hot melt
connections, etc.). As depicted in FIGS. 25A and 25B, the tubing
250C can be attached to the handpiece 202C using an adhesive 254C.
In some embodiments, the adhesive 254C comprises a UV adhesive
and/or another type of adhesive selected to be compatible with both
the tubing 250C and handpiece 202C materials. For example, UV
adhesive 254C can be used to bond the tubing 250C to a handpiece
portion 202C comprising polycarbonate. In some embodiments, the
tubing 250C can be attached to adjacent interior surfaces of the
handpiece 202C at two or more locations, as desired or required.
Further, as illustrated in FIG. 25B, in one or more portions of the
handpiece, a clearance fit 257C can exist between the outside of
the tubing 250C and the interior surfaces of the handpiece.
[0373] In other embodiments, the handpiece comprises a different
type of thermoplastic and/or another material (e.g., metal, alloy,
elastomeric material, a composite, other synthetic or natural
material, etc.), either in lieu of or in addition to polycarbonate.
For example, one or more portions of the handpiece portion 202C can
include polyethylene, polypropylene and/or other plastics.
According to some embodiments, all or some of the handpiece portion
202C is overmolded on the tubing 250C. Alternatively, as discussed
in greater detail herein, one or more other manufacturing methods
can be used to make the tubing 250C, the handpiece 202C and the
other components and portions of the handpiece assembly 200C, such
as, for example, extrusion, thermoforming, injection molding, other
molding methods, casting and/or the like.
[0374] With continued reference to FIGS. 25A and 25B, the handpiece
202C can include one or more windows 208C or other openings along
its outer housing 204C. As shown, such openings 208C can provide
access to the tubing 250C routed through the handpiece and/or any
other interior components or portions of the handpiece. In some
embodiments, the windows or openings 208C can facilitate
manufacturing and/or assembly of the handpiece assembly 200C. For
example, the opening 208C can provide an access point for supplying
an adhesive 254C (e.g. a UV adhesive) to the tubing/handpiece
interface. In some embodiments, such openings 208C can provide a
location to which a removable control module or other device can be
secured to the handpiece portion 202C.
[0375] As shown in FIGS. 25A and 25B, the distal end 210C of the
handpiece 202C can include a coupling 220C that includes a luer
lock or other fitting (e.g., configured to selectively receive and
mate with a corresponding feature of a needle assembly). As
discussed in greater detail below with reference to FIGS. 27A and
27B, the distal coupling 220C can include one or more orientation
rails 222C, 224C, protrusions and/or other features adapted to
generally align with and engage corresponding recesses or other
features of a control module or other device designed to removably
secure to the handpiece portion 202C.
[0376] With reference to FIG. 26A, a control module 230' can be
sized, shaped and otherwise configured to secure to the outside of
the handpiece 202C. As discussed with reference to other
arrangements herein, the control module 230' can include one or
more buttons 236' and/or other controllers that allow a clinician
or other user to regulate the delivery of fluids and/or other
materials from the fluid delivery module (e.g., cassette) into a
target location within a patient's anatomy (e.g., to or near a
nerve, joint, organ, cavity, etc.). For example, the buttons and/or
other controllers 236' can selectively initiate, terminate, pause
or otherwise alter the delivery of fluids and/or other materials
during an injection procedure.
[0377] According to some embodiments, in order to properly secure
it to the handpiece 202C, the control module 230' is adapted to
slide over the handpiece (e.g., from the handpiece's proximal end
211C). As illustrated in FIG. 26A, the bottom surface of the
control module's main portion 238' can comprise a concave,
contoured or generally curved shape that defines a
partially-circular open channel or space 239'. In some embodiments,
the shape of the curved bottom surface of the control module 230'
matches or substantially matches the exterior curved shape of the
handpiece portion 202C. Thus, the distal end 231' of the control
module 230' can be positioned along the proximal end 211C of the
handpiece 202C and can be slidably moved along the handpiece 202C
toward its distal end 210C. In some embodiments, the proximal end
211C of the handpiece portion 202C can include a tapered portion
214C to facilitate insertion of the control module 230' over the
proximal end of the handpiece portion 202C. In addition, as
discussed with reference to FIGS. 25A and 25B, the tapered portion
214C and/or any other portion of the handpiece 202C can include one
or more windows or openings to permit access to the interior of the
handpiece 202C. Such access openings can facilitate the
manufacturing or assembly of the handpiece (e.g., insertion of UV
or other adhesives to bond the tubing 250C to the handpiece), to
examine the tubing 250C and/or for any other purpose.
[0378] As illustrated in FIGS. 24 and 26A, the handpiece assembly
200C can include one or more clips 216C or other members or
features that extend along the exterior surface of the handpiece
portion 202C. In some embodiments, such a clip 216C can form a
unitary structure with adjacent portions of the handpiece 202C.
Alternatively, the clip 216C or other member or feature can be a
separate item that is attached to the handpiece using one or more
connection devices or methods (e.g., adhesives, fasteners, hot melt
connections, welds, etc.). As shown in FIGS. 24 and 26A, the clip
216C can extend outwardly along its detached end 217C. In some
embodiments, the clip 216C is ordinarily (e.g., when not subjected
to any forces) resiliently biased in such an outward position.
However, the clip 216C can be configured to move inwardly (e.g., to
generally align with adjacent surfaces of the handpiece exterior
housing 204C) when subjected to a sufficiently large
inwardly-directed radial force. As discussed in greater detail
below, the clip 216C can help securely maintain the position of a
control module and/or other device relative to the handpiece.
[0379] With reference to FIGS. 26A and 26B, as the control module
230' is slidably advanced over the handpiece portion 202C, one or
more proximal engagement members 244' of the control module 230'
can exert a force on the clip 216C. In some embodiments, the
engagement member 244' will contact and move the clip 216C (e.g.,
against an external resilient or biasing force). Consequently, the
clip 216C can be urged inwardly, in the direction of the handpiece
interior and toward the adjacent surfaces of the handpiece exterior
surface or housing 204C. If the control module 230' is advanced
sufficiently far relative to the handpiece 202C, the engagement
members 244' of the control module will move past the clip 216C, as
illustrated in FIG. 26B. As a result, the clip 216C can resiliently
return to its normal, radially-extended position, which, in some
embodiments, causes the clip 216C to abut against a distal end
surface of the control module's engagement members 244'. Such a
configuration can help maintain the control module 230' to the
handpiece portion 202C, as the contact between the clip 216C and
control module 230' (e.g., the engagement members 244' and/or
another portion or member) generally prevents the control module
230' from retracting relative to the handpiece.
[0380] In addition, the control module 230' can be aligned with and
secured to the handpiece 202C using one or more other members or
features. For example, as illustrated in FIGS. 27A and 27B, the
distal coupling 220C of the handpiece 202C can comprise one or more
orientation rails 222C, 224C, protrusions and/or other features
adapted to generally align with and engage corresponding recesses
241', 243' or other features of a control module (and/or any other
device configured to removably secure to the handpiece assembly).
In the illustrated embodiment, the coupling 220C comprises a main
or central orientation rail 222C and a pair of adjacent rails 224C
positioned on either side of the main rail 222C. In other
arrangements, however, the quantity, shape, size, spacing,
orientation and/or other details regarding the orientation rails
222C, 224C or other alignment or securement protrusions or features
can vary. As best illustrated in FIG. 27B, the distal end of the
control module 230' can include slots or recesses 241', 243' that
are sized, shaped and otherwise configured to receive the
corresponding rails 222C, 224C of the coupling 220C. The various
slots or recesses 241', 243' can separate the distal end of the
control module 230' into two or more wings, tabs or other portions
240', 242'. Accordingly, with the use of the distal orientation
rails 222C, 224C and the proximal clip 216C (as well as
corresponding features of the control module), the handpiece 202C
can help ensure that the control module 230' is both properly
aligned with and secured to the handpiece assembly 200C. In
alternative embodiments, one or more other devices and/or methods
of removably or permanently securing the control module to (and/or
aligning it with) the handpiece can be used, as desired or
required.
[0381] FIG. 27C illustrates a perspective view of yet another
embodiment of a control module 230'' that is sized, shaped and
otherwise configured to secure to the outside of the handpiece
202C. As shown, the control module 230'' can be relatively large so
that it extends across most or all of the length of the handpiece
202C. In addition, the control module 230'' can comprise a
thickness (e.g., diameter or other cross sectional dimension) that
facilitates grasping and maneuvering of the handpiece assembly. As
with other arrangements disclosed herein, the control module 230''
can include one or more buttons 236'' and/or other controllers that
allow a clinician or other user to regulate the delivery of fluids
and/or other materials from the fluid delivery module (e.g.,
cassette) into a target location within a patient's anatomy (e.g.,
to or near a nerve, joint, organ, cavity, etc.).
[0382] Another embodiment of a handpiece assembly 200D configured
to be removably secured to a fluid delivery module or another
component or portion of an injection system is illustrated in FIG.
28. As discussed with reference to other arrangements disclosed and
discussed herein, the assembly 200D can include a handpiece portion
202D and tubing 250D configured to place the handpiece portion in
fluid communication with an upstream fluid delivery module (not
shown). The proximal end of the tubing 250D can comprise a luer
lock or other standard or non-standard fitting 260D that is sized,
shaped and otherwise adapted to selectively mate and attach to a
corresponding fitting or coupling of the fluid delivery module
(e.g., cassette) or other component or portion of the injection
system. Further, the distal end 210D of the handpiece 202D can
include a standard or non-standard fitting or coupling (e.g., luer
lock) configured to removably receive a needle assembly (not
shown).
[0383] As discussed with reference to various embodiments herein, a
handpiece assembly of an injection system can allow a user to
selectively deliver one, two or more different medicaments, other
fluids and/or other materials into a patient's anatomy through a
single needle. In some embodiments, a clinician uses one or more
buttons and/or other controllers positioned on the handpiece
assembly to control the delivery of the various fluids and/or other
materials through the assembly. A user can manipulate such buttons
or other controllers to modify one or more aspects of the injection
procedure (e.g., initiating or terminating an injection procedure,
which fluids are being delivered, sequence of delivery, flowrate,
etc.) while continuing to grasp and manipulate the handpiece
assembly. Accordingly, in some embodiments, a user executes a
desired procedure without taking his or her hands off the handpiece
assembly.
[0384] As discussed herein, two or more different fluid and/or
other material streams can be combined within a cassette and/or any
other location upstream of a handpiece assembly. Alternatively,
however, a handpiece assembly can be configured to permit two or
more different fluids and/or other materials to be transferred to
or near a needle without prior mixing or cross-contamination of the
various streams. Thus, in some embodiments, the different fluids
and/or other substances are mixed just prior to entering the needle
assembly at the distal end of a handpiece. As discussed in greater
detail herein, the various fluid or other material streams can be
mixed at a distal end of the clip (e.g., a common or collection
area), at or near the interface between the clip and the disposable
tip and/or at any other location. In certain situations, the
effectiveness of an injection may be enhanced if the contact time
between the various fluids and/or other substances being delivered
into a patient is reduced or minimized (e.g., for various chemical,
biological and/or other reasons). Relatedly, the handpiece assembly
can be adapted to prevent backflow of fluids and/or other materials
being transferred therethrough. This can help reduce the likelihood
of cross-contamination or inadvertent mixing of the various
medicaments and other substances. For example, as discussed, the
handpiece can include various valves (e.g., duckbill valves,
combination duckbill/umbrella valves, other check valves, etc.)
and/or other backflow prevention devices.
[0385] In some embodiments, the handpiece assembly includes buttons
and/or other controllers that are used to operate another device,
such as, for example, an ultrasound device or another imaging
system. Such buttons or other controllers can be included either in
lieu of or in addition to the buttons and controllers on the
handpiece (or a removable control module) for the operation of the
injection system itself. Thus, a clinician or other user can
advantageously control the operation of an ultrasound or other
imaging device and/or any other system using only the handpiece
assembly. As a result, the clinician can control and complete an
injection procedure while continuing to hold the handpiece assembly
(e.g., without the use of any other device or system). Accordingly,
this can help improve the safety and accuracy of a procedure as the
user is permitted to operate various systems during an injection
while continuing to hold and manipulate the handpiece assembly.
[0386] In addition, as discussed in greater detail herein,
configuring different devices and systems to interface with one
another during an injection procedure can provide additional
benefits. For example, information about the delivery of fluids
and/or other substances (e.g., the volume of each medicament
delivered, the volume of each medicament remaining, the flowrate of
medicament through the handpiece, etc.) can be incorporated into
the same visual display with the graphics of an ultrasound or other
imaging technology. As discussed in greater detail herein, this can
further facilitate the execution of an injection procedure. In
addition, such a configuration can improve record-keeping, billing
and other functions that are related to the administration of a
medical procedure.
[0387] According to some embodiments, as illustrated in FIGS.
29A-29D, the handpiece assembly 202E can have a relatively simple
design. For example, in the depicted embodiment, the handpiece
assembly 202E comprises a rigid or semi-rigid main portion 203E
(e.g., a tubular portion) that extends between two couplings (e.g.,
a distal coupling 220E and a proximal coupling 222E). In other
embodiments, however, the main or tubular portion 203E is at least
partially flexible. For instance, the main portion 203E can be an
extension of the delivery line or conduit 250E that places the
handpiece assembly 202E in fluid communication with a cassette or
other portion of an injection system. In some embodiments, the main
or tubular portion 203E comprises one or more polymeric materials
(e.g., polyethylene, other medically-suitable plastics, etc.).
However, the main portion 203E can include one or more other types
of materials, either in addition to or in lieu of polymers, such
as, for example, metals (e.g., stainless steel), alloys, rubber or
elastomers, wood or paper-based materials, glass, other synthetic
or natural materials and/or the like, as desired or required.
[0388] With further reference to FIG. 29A, the coupling, fitting or
other connection 220E located along the distal end 210E of the
handpiece assembly 202E can comprise a luer fitting or some other
standard or non-standard fitting or coupling. Such a fitting or
coupling can be of the quick-connect type to facilitate the
securement of a needle assembly (not shown) thereto. In addition,
in some embodiments, the handpiece assembly 202E additionally
comprises a proximal coupling 222E that can generally serve as an
interface (e.g., an attachment point or area) between the main
portion of the handpiece assembly 202E and the fluid tubing or
conduit 250E to which the handpiece is connected.
[0389] As illustrated in FIGS. 29B-29D, in order to improve its
grasping and/or handling characteristics, a handpiece assembly 202E
can comprise an outer housing or shell 204E positioned partially or
completely around the main or tubular portion 203E. The housing or
shell 204E can effectively increase the diameter and/or other
transverse dimension of the handpiece assembly 202E. In some
embodiments, housings or shells of various sizes, shapes and/or
other configurations can be provided to enable a user to customize
the handpiece assembly 202E to his or her own preferences (e.g., to
accommodate the user's hand size, type of procedure being
performed, etc.).
[0390] According to some embodiments, the tubular portion 203E of
handpiece assembly 202E through which fluids pass can be configured
for placement within a recess, slot and/or other opening on (or
within) the outer housing or shell 204E. For example, in the
embodiment depicted in FIGS. 29B-29D, the tubular portion 203E is
sized to snugly fit within a longitudinal recess (e.g., slot,
opening, etc.) of the outer housing 204E. In some embodiments, the
tubular portion 203E is sized, shaped and otherwise configured to
friction fit, pressure fit and/or snap fit within the recess or
other opening of the outer housing 204E. Thus, the tubing portion
203E can be easily and quickly secured to and detached from the
outer housing or shell 204E during use. In certain arrangements,
therefore, the outer housing 204E can be reused (e.g., with or
without sterilization and/or other cleaning requirements) with
several different tubing portions 203E.
[0391] Thus, according to some embodiments, the handpiece assembly
202E of an injection system can comprise a relatively simple
design. For example, as discussed herein, the handpiece can simply
be an extension of the tubing or other fluid line that place the
needle (e.g., extending from a distal end of the handpiece
assembly) in fluid communication with a cassette, a fluid delivery
module and/or other portion of the injection system. In some
embodiments, therefore, the handpiece assembly does not comprise a
separate housing or shell and/or other components. In one
embodiment, the handpiece assembly comprises a stylus or main
portion that has approximately the same shape, diameter and/or
other characteristics as the fluid conduit or line that
hydraulically connects the handpiece assembly to the needle that is
inserted within the patient's anatomy.
[0392] As discussed herein with reference to other embodiments, a
handpiece assembly 202E can comprise a control module 230E that can
be removably attached to and detached from adjacent portions of the
assembly. For example, as illustrated in FIGS. 29E-29G, a removable
control module 230E can be configured to releasably secure to a
tubing portion 203E of the handpiece assembly 202E. The control
module 230E can include one or more clips 240E, 242E, tabs and/or
other securement members that are adapted to facilitate attachment
to and detachment from the tubing portion 203E. For example, a
securement member can include a protruding portion or feature that
is sized, shaped and otherwise configured to mate with an outer
surface of the assembly's tubular portion 203E. In the depicted
embodiment, the control module 230E includes two proximal clips or
tabs 240E and two distal clips or tabs 242E. However, in other
arrangements, a removable control module or other removable portion
or component of the assembly includes more or fewer (and/or
different) securement members. In other arrangements, one or more
other devices and/or methods of securing the control module to the
handpiece can be used.
[0393] According to some embodiments, the control module 230E
comprises one or more buttons 237E, 238E, 239E controllers and/or
other adjustment devices (e.g., knobs, dials, switches, etc.). Such
buttons or other controllers can help regulate the delivery of
various fluids and/or other materials through the handpiece
assembly 202E. The controller 230E can comprise an "ON/OFF" button
237E and one or more other buttons, such as, for example, a "HI"
button 238E, a "LO" button 239E and/or the like. Accordingly, such
buttons or other controllers can be used to activate or deactivate
(e.g., ON/OFF) the delivery of one or more fluids and/or other
substances to or near a patient's anatomical location (e.g., nerve
tissue, joint, organ, cavity, etc.). In certain embodiments, the
buttons or other controllers are manipulated to regulate the
sequence (e.g., which fluids/materials are delivered through the
handpiece assembly, whether various fluids/materials are delivered
sequentially or simultaneously, etc.), the rate of delivery (e.g.,
flowrate) of one or more medicaments and/or other materials being
transferred through the handpiece assembly 202E and/or the
like.
[0394] As discussed in greater detail herein, in embodiments where
the fluid delivery module is in data communication with one or more
other components or devices (e.g., ultrasound devices, radio
frequency spectroscopy devices, other imaging devices or systems,
etc.), one or more buttons 236E or other controllers on the control
module 230E and/or other portions of the injection system can be
used to help regulate the operation of such systems. For example,
one or more buttons or other controllers of a control module can be
used to capture an ultrasound image or video while a target
anatomical space (e.g., nerve tissue, joint, organ, etc.) is being
located and/or while one or more fluids or other materials are
being injected into a target anatomical location. Alternatively,
the buttons or other controllers can be used to vary one or more
other aspects of an imaging system, such as, for example, zoom,
resolution, contrast, brightness and/or the like. In some
embodiments, a control module 230E includes additional, fewer
and/or different buttons, knobs, levers and/or other control
devices that permit a user to control one or more aspects of the
injection system.
[0395] With continued reference to FIGS. 29E-29G, the buttons 236E
or other controllers of the control module 230E can be used to
initiate and/or terminate a particular injection procedure. Thus,
once a particular injection protocol has been selected by a user
(e.g., through the display or other interface of the fluid delivery
module), pressing the button 236E and/or otherwise manipulating
another controller can regulate one or more aspects of the delivery
of fluids and/or other materials through the handpiece assembly.
For example, by pressing or manipulating a button 236E once, the
injection procedure can be initiated. In some embodiments,
additional manipulation of a button 236E can terminate or
temporarily pause an injection procedure. In yet other embodiments,
manipulation of a button or other controller can alter the
flowrate, sequence and/or any other aspect of an injection
procedure.
[0396] According to certain embodiments, a removable control module
230E and/or any other portion of a handpiece assembly or injection
system comprises one or more two-mode or other multi-mode buttons
and/or other controllers. Pressing or otherwise manipulating such a
button can commence or terminate (e.g., in an alternating pattern)
the delivery of one or more fluids and/or other materials through
the assembly. Alternatively, the handpiece assembly 202E can
include one or more other types of buttons or controllers. In some
arrangements, the buttons 236E or other controllers are configured
to permit the user to select between two, three or more different
settings. In other embodiments, a button is of the multi-depth type
(e.g., dual-depth, tri-depth, etc.), enabling a user to selectively
press the button to two or more distinct depths or other levels.
Each distinct depth or level can correspond to a particular setting
(e.g., flowrate, selection of which fluids or other materials to
deliver, etc.). For example, pressing the button to the first level
can cause the desired fluid and/or other material to be conveyed at
the maximum or minimum rate. Further, continuing to press the
button to subsequent lower levels can cause the rate of delivery to
increase, decrease or terminate. In other embodiments, the
handpiece assembly comprises multi-depth buttons that do not
include distinct depths, such as, for example, a rheostat. Thus, a
particular setting (e.g., flowrate) can be varied based on the
depth to which a button is depressed.
[0397] In other arrangements, the control module 230E comprises one
or more buttons 236E and/or other controllers that have only two
positions, but which are configured to permit a user to select
between three or more different settings. For example, an injection
system can be adapted to sequentially move between different
flowrate settings (e.g., high-medium-low-off, vice versa, etc.)
every time such a button is pressed.
[0398] In addition, a removable or detachable control module 230E
and/or another portion of a handpiece assembly 202E can comprise
other types of controllers, either in lieu of or in addition to
buttons. For example, the handpiece assembly can include a roller
ball, a roller wheel, a dial, a knob, a modulating switch or other
device and/or the like. Regardless of their exact configuration and
design, such control devices can enable a clinician or other user
to regulate the delivery of fluids and/or other materials from the
fluid delivery module to a patient. As discussed, the various
fluids and/or other materials loaded onto a cassette or other
portion of a fluid delivery module can be delivered through the
handpiece assembly 200E simultaneously and/or sequentially, as
desired or required. For example, a user can pre-select a desired
injection protocol, which includes the rate of delivery, the
sequence of delivery, the volume or other amount to be delivered
and/or other details for each medicament, other fluid and/or other
substance used in a particular treatment. Thus, a user simply has
to press, release or otherwise manipulate a button 236E (and/or
other controller) of the control module 230E in order to initiate,
terminate, pause or otherwise alter the preselected protocol.
[0399] Another embodiment of a handpiece assembly 2200 configured
for use with an injection system is illustrated in FIG. 30A. As
shown, the handpiece assembly 2200 can comprise a core 2210, a clip
assembly 2240 and a tip 2280 having a needle 2290 along its distal
end. A delivery line 2250 comprising one or more different conduits
2251 can be used to place the handpiece assembly 2200 in fluid
communication with the cassette 300 and/or another portion of the
fluid delivery module 100. In one embodiment, the tip 2280 is
replaced after each injection (e.g., immediately following removal
of the needle 2290 from the anatomy). Further, the clip assembly
2240 can be replaced when the type and/or dosage of the
medications, formulations and/or other materials being delivered
through the handpiece assembly 2200 are modified. As discussed, in
some embodiments, the clip assembly 2240, the delivery line 2250
and the cassette 300 can be supplied and replaced as a single
system or kit as desired or required.
[0400] The handpiece assembly 2200 can be adapted to allow a
clinician or other user to easily grasp and manipulate it during an
injection procedure. As such, the diameter, length, other
dimensions and/or other characteristics of the handpiece assembly
2200 can be advantageously selected to achieve the desired
functional and/or aesthetic goals. Further, the handpiece assembly
2200 can include a shape, other features (e.g., finger grooves,
tactile members or outer surface, etc.) and/or the like to further
enhance its ergonomic and/or other properties. According to some
arrangements, the approximate diameter and total length (e.g., not
including the needle 2290) of the handpiece assembly 2200 are
approximately 5 to 6 inches and approximately 0.5 to 0.7 inches,
respectively. In addition, the various components of the handpiece
assembly 2200, including the core 2210, clip 2240, tip 2280 and the
like, can be manufactured using one or more materials that are
durable and otherwise suitable to withstand the forces and wear and
tear to which the handpiece assembly 2200 may be exposed. For
example, in several embodiments, the handpiece assembly 2200
comprises plastics, other polymeric materials, metals, alloys
and/or any other synthetic or natural materials.
[0401] In some embodiments, the clip assembly 2240 is replaced
according to a particular schedule or protocol. For instance, the
clip assembly 2240 (and, in certain arrangements, the delivery line
and the cassette together with the clip assembly) can be replaced
following a predetermined number of injection procedures, following
a predetermined volumetric amount of fluids and other materials
passing through the clip assembly 2240, based on a predetermined
time frequency (e.g., once a day, once every four hours, etc.)
and/or according to some other set of rules, as desired or required
by the particular application or use. In some arrangements, the
core 2210 is advantageously configured to not contact any fluids
and/or other materials being conveyed through the handpiece
assembly 2200. As a result, the same core 2210 can be used
repeatedly without the need to replace or clean it. However, it
will be appreciated that even such a core 2210 may need to undergo
frequent cleaning (e.g., sterilization), calibration and/or other
maintenance procedures. Each component of such a handpiece assembly
2200 is discussed in greater detail herein.
[0402] FIGS. 30C and 30D illustrate different views of the core
2210 included in the handpiece assembly 2200 of FIGS. 30A and 30B.
As shown, the core 2210 can comprise a control portion 2220 having
one or more buttons 2222, 2224, 2226, controllers and/or other
adjusting devices (e.g., knobs, dials, switches, etc.). In
addition, the control portion 2220 can include one or more
indicator lights 2228 and/or any other feature that provides
information to the user regarding the operation of the assembly
2200 and/or the injection system.
[0403] The buttons 2222, 2224, 2226 and/or other control features
of the core 2210 can help regulate the delivery of various fluids
and/or other materials through the handpiece assembly 2200. For
example, such buttons 2222, 2224, 2226 can be used to activate or
deactivate (e.g., ON/OFF) the supply (and/or withdrawal) of fluid
or other substances to or from an area surrounding a nerve, nerve
bundle or other nerve tissue, an intra-articular space or other
anatomical location. In certain arrangements, the buttons or other
controllers are manipulated to regulate the rate of delivery (e.g.,
flowrate) of one or more medicaments and/or other materials being
transferred through the handpiece assembly. As discussed, in other
embodiments where the fluid delivery module is in data
communication with one or more other components or devices (e.g.,
ultrasound devices, radio frequency spectroscopy devices, other
imaging devices or systems, etc.), buttons or other controllers can
be used to also regulate the operation of such systems. For
example, as discussed in greater detail herein, the buttons or
other controllers of a handpiece assembly can be used to capture an
ultrasound image or video while a target anatomical space (e.g., a
nerve, joint, organ, etc.) is being located and/or while one or
more fluids or other materials are being injected into a target
anatomical location. Alternatively, the buttons or other
controllers can be used to vary one or more other aspects of an
imaging system, such as, for example, zoom, resolution, contrast,
brightness and/or the like. In some embodiments, a handpiece
assembly includes additional, fewer and/or different buttons,
knobs, levers and/or other control devices that permit a user to
control one or more aspects of the system.
[0404] With continued reference to FIG. 30A, each of the buttons
2222, 2224, 2226 along the outside of the core 2210 can be
configured to correspond to one of the medications and/or other
materials which are loaded onto the fluid delivery module 100 and
which can be selectively delivered from to the handpiece assembly
2200. For instance, each such medication, other fluid or the like
can be associated with a particular color, shape, pattern, design,
scheme, texture, other identifying feature and/or the like. Thus,
in some embodiments, the color, shape or pattern of the buttons
2222, 2224, 2226 is configured to match a corresponding
characteristic of the medications and/or other materials that are
loaded onto the fluid delivery module (e.g., positioned on the
nests or loading areas of the cassette). By way of example, one of
the buttons 2222 on the core can be yellow. In addition, the user
may have selected yellow to also correspond to a particular type of
therapeutic agent (e.g., steroid) which is loaded onto the cassette
and which may be selectively delivered from the fluid delivery
module to the handpiece assembly 2200. In another embodiment, the
buttons are textured in a manner that permits a clinician or other
user who handles the handpiece assembly to identify the various
buttons without having to look at them. For example, the buttons
can include a raised or recessed pattern (e.g., a "plus" or "minus"
sign, dots, a rectangle, circle, other geometric design, other
discernable pattern and/or the like). Thus, by pressing the
appropriate button 2222, the user can commence, terminate, speed
up, slow down and/or otherwise adjust the delivery of a therapeutic
agent and/or other fluid or substance to the patient.
[0405] According to certain embodiments, a handpiece assembly 2200
comprises one or more two-mode or other multi-mode buttons and/or
other controllers. Pressing or otherwise manipulating such a button
can alternately commence or terminate the delivery of one or more
fluids and/or other materials through the assembly. Alternatively,
the handpiece assembly 2200 can include one or more other types of
buttons or controllers. In some arrangements, the buttons are
configured to permit the user to select between two, three or more
different settings. In other embodiments, a button is of the
multi-depth type (e.g., dual-depth, tri-depth, etc.), enabling a
user to selectively press the button to two or more distinct depths
or other levels. Each distinct depth or level can correspond to a
particular setting (e.g., flowrate, selection of which fluids or
other materials to deliver, etc.). For example, pressing the button
to the first level can cause the desired fluid and/or other
material to be conveyed at the maximum or minimum rate. Further,
continuing to press the button to subsequent lower levels can cause
the rate of delivery to increase, decrease or terminate. In other
embodiments, the handpiece assembly comprises multi-depth buttons
that do not include distinct depths, such as, for example, a
rheostat. Thus, a particular setting (e.g., flowrate) can be varied
based on the depth to which a button is depressed.
[0406] In other arrangements, the core 2210 of the handpiece
assembly comprises one or more buttons that have only two
positions, but which are configured to permit a user to select
between three or more different settings. For example, an injection
system can be adapted to sequentially move between different
flowrate settings (e.g., high-medium-low-off, vice versa, etc.)
every time such a button is pressed.
[0407] As discussed, a core 2210 or other portion of a handpiece
assembly can comprise other types of controllers, either in lieu of
or in addition to the buttons. For example, the handpiece assembly
2200 can include a roller ball, a roller wheel, a dial, a knob, a
modulating switch or other device and/or the like. Regardless of
their exact configuration and design, such control devices can
enable a clinician or other user to regulate the delivery of fluids
and/or other materials from the fluid delivery module to a patient.
As discussed, the various fluids and/or other materials can be
delivered through the handpiece assembly simultaneously or
sequentially, as desired or required. For example, the buttons
and/or other controllers can be used to select which fluids or
other materials, or combinations thereof, are to be directed
through the handpiece assembly. In other embodiments, the
controllers are configured to control the rate of delivery (e.g.,
flowrate) of such fluids and/or other substances to a patient. In
still other arrangements, the buttons control one or more other
aspects of the injection procedure (e.g., the sequence of delivery,
an ultrasound or other imaging device that is in data communication
with the injection system, etc.).
[0408] In other arrangements, the buttons 2222, 2224, 2226 on the
handpiece assembly 2200 are adapted to guide the user through one
or more user-interface screens on the display or graphic user
interface (GUI) on the fluid delivery module. Thus, the buttons
2222, 2224, 2226 can be used to make selections through one or more
menus or the like.
[0409] According to some embodiments, the handpiece assembly 2200
is connected to the fluid delivery module of the injection system
using one or more hardwired connections. However, the handpiece
assembly 2200 can be configured to communicate with the fluid
delivery module and/or any other component of the injection system
using a wireless connection, such as, for example, radio frequency
(RF), Wi-Fi, Bluetooth and/or like, either in addition to or in
lieu of a hardwired connection. As discussed herein, the handpiece
assembly 2200 can comprise a battery that is configured to be
recharged when the handpiece assembly is positioned within a
corresponding docking station of the fluid delivery module. Such a
battery (not shown) can be positioned within an interior portion of
the core 2210. The docking station can be adapted to recharge the
battery using electromagnetic induction, simple charging (e.g.,
using a DC or AC connection), pulse charging and/or any other
charging method or device. Thus, in some arrangements, the battery
within the core is permitted to recharge when the handpiece
assembly is positioned within a docking station of the fluid
delivery module. Alternatively, the handpiece assembly 2200 may
draw its power from one or more other sources, such as, for
example, a DC or AC hardwired connection and/or the like.
[0410] As discussed, an interior portion of the core 2210 can
include a battery, circuitry, indicator light 2228 (e.g., LED)
and/or any other component or feature. As illustrated in FIGS. 30C
and 30D, the core 2210 can include one or more indicator lights
2228 that provide information to the clinician or other user of the
assembly prior to, during and/or following an injection procedure.
For example, the light 2228 can be configured to light up when the
battery of the assembly is above or below a particular threshold
level (e.g., adequately charged, in need of charging, etc.).
Alternatively, the brightness, color and/or other characteristics
of the indicator light 2228 can be configured to change in response
to certain conditions. For instance, the properties of the light
2228 can vary based on the strength of the battery, on the signal
strength of the wireless connection (e.g., radio frequency, RF,
Bluetooth, etc.) between the handpiece assembly and the fluid
delivery module or other component of the system and/or the
like.
[0411] In other embodiments, an indicator light 2228 is activated
(e.g., lights up, begins to flash, changes color, etc.) as a
warning to the user. For example, the triggering event for such an
activation can include a low battery level, the presence of air or
other gas within a fluid delivery conduit, excessive back-pressure
encountered during the delivery of a fluid or other material within
the anatomy, low fluid level within a reservoir of the fluid
delivery module, some other breach and/or the like. According to
certain embodiments, the core 2210 or other portions of the
handpiece assembly 2200 includes a small display (e.g., LCD) that
is configured to provide information to the user in the form of
text, graphics and/or the like, either in addition to or in lieu of
one or more indicator lights 2228.
[0412] Consequently, the inclusion of the various electronic and/or
other components and features within a single core 2210 or other
portion of the handpiece assembly 2200 provides a number of
benefits. As discussed, such configurations can permit a clinician
or other user to control some or all aspects of an injection
procedure without having to take his or her hands off the handpiece
assembly 2200. In addition, a single handpiece assembly 2200 can be
adapted to control one or more other devices or systems which are
used during the execution of injection procedures. For example, the
buttons or other controllers of the handpiece assembly can be used
to advantageously regulate an ultrasound device or other imaging
system. Although the inclusion of electrical and control components
within the relatively limited space of a core 2210 is challenging,
the convenience and other benefits associated with using a single
handpiece to control some, most or all aspects of an injection
procedure can be beneficial.
[0413] As described in greater detail herein, a touchscreen display
or other graphic user interface which is either attached to the
fluid delivery module or operatively connected to it can be used to
regulate, at least in part, the function of the handpiece assembly
2200 and/or other components of the injection system. In other
embodiments, a separate handheld device, instrument and/or other
device or system can be used to control the handpiece assembly 2200
and/or other components of the injection system. For example, such
a control device or other instrument can include separate power,
control and/or instrumentation wires that are molded within or
otherwise positioned relative to the separate device. In some
embodiments, the separate control device is configured to attach to
(e.g., snap or otherwise mount to) or otherwise secure to the
handpiece assembly 2200 using one or more types of connection
devices and/or methods.
[0414] Moreover, other devices and methods of controlling one or
more aspects or components of the injection system can be used,
either in addition to or in lieu of the devices and methods
specifically disclosed herein. In some embodiments, the injection
system includes a foot pedal or other user-actuated lever or
control. Alternatively, the injection system can comprise control
features that are configured to respond to a clinician's or other
user's voice commands or prompts, such as, for example, "START,"
"STOP," "INJECT/DELIVER," "ASPIRATE," "INCREASE FLOWRATE,"
"DECREASE FLOWRATE," "CHANGE MODE/SEQUENCE" and/or the like. It
will be appreciated that an anesthesiology, articular or other
injection system can include any combination of controls or other
features described herein, as desired by the user or required by a
particular application.
[0415] In some embodiments, the shape of the core housing 2214 and
other graspable portions of the handpiece assembly 2200 are
configured to be ergonomically correct or are otherwise designed to
facilitate the handling and manipulation of the handpiece assembly
2200. Further, as discussed in greater detail herein, the core 2210
can be configured to quickly and easily attach to and detach from
one or more other subcomponents of the handpiece assembly 2200,
such as, for example, the clip assembly 2240 and the tip 2280.
[0416] FIGS. 31A-31D illustrate various views of one embodiment of
a clip assembly 2240 configured to be used in a handpiece assembly
2200. As shown, the clip assembly 2240 can include a ring 2242 at
or near its distal end. In some arrangements, the distal end of the
clip assembly 2240 comprises a recessed surface 2243 to which a tip
2280 can be removably secured (FIGS. 29A and 29B). Further, a
central portion of the recessed surface 2243 can include an outlet
opening 2248 into which an inlet portion of the tip 2280 may be
positioned. In addition, the interior and/or exterior of the ring
2242 can comprise one or more tabs 2246 and/or recesses 2244 to
help secure the clip assembly 2240 to the tip 2280, the core 2210
and/or any other portion of the handpiece assembly 2200.
[0417] With continued reference to FIGS. 31A-31D, the clip assembly
2240 can include a main body 2256, which in some embodiments is
configured to at least partially define an exterior surface of the
handpiece assembly 2200. At the proximal end of the main body 2256,
the clip 2240 can include one or more elongate members 2258 that
are sized, shaped and otherwise adapted to mate with corresponding
portions of the core 2210 (FIGS. 30C and 30D). For example, the
elongate members 2258 can slide within corresponding slots 2215
(FIG. 30C) of the core 2210. In the illustrated arrangement, at
least one of the elongate members 2258 comprises a locking tab 2259
that is adapted to snap into a matching hole 2216 (FIG. 30C) along
the outer surface of the core 2210. Thus, if the elongate members
2258 are inserted sufficiently far into the corresponding slots
2215 of the core 2210, the locking tab 2259 of the clip 2240 will
resiliently engage the matching hole 2216 of the core 2210.
Consequently, the clip 2240 can be advantageously locked relative
to the core 2210. In order to separate the clip 2240 from the core
2210, the locking tab 2259 can be pressed inwardly so that the tab
2259 disengages from the matching hole 2216.
[0418] As illustrated in FIGS. 31A-31C, the clip 2240 can include a
channel 2260 or other portion that is configured to receive the
delivery line 2250. As discussed herein with reference to other
components, the delivery line 2250 can include one, two or more of
the individual conduits 2251A-2251C that are in fluid communication
with the outlets of the various cassette manifolds. Thus, in some
arrangements, the channel 2260 of the clip 2240 is preferably sized
and shaped to accommodate all the individual conduits 2251A-2251C
of the delivery line 2250. In other embodiments, as illustrated
herein with reference to, inter alia, FIGS. 4, 8 and 14A, the
various fluids and/or other materials being injected into the
anatomy can be combined within the fluid delivery module (e.g.,
upstream of a luer lock or other outlet fitting of a cassette or
other portion of the fluid delivery module). Thus, for such
arrangements, a single-lumen delivery line 2251 can be used to
selectively deliver the fluid and/or other material streams to the
handpiece assembly 2200. Consequently, the design of the clip 2240
and/or other portions of the assembly 2200 illustrated herein can
be modified accordingly.
[0419] One embodiment of the manner in which the individual
conduits 2251A-2251C of the delivery line 2250 are attached to the
clip 2240 is illustrated in FIGS. 32A-32C. As shown, the conduits
2251A-2251C can be routed to a main coupling 2262. In the depicted
arrangement, the main coupling 2262 comprises a generally
triangular shape and is adapted to fit within a corresponding
recessed area 2257 of the main body 2256. As best illustrated in
FIGS. 32A and 32C, a duckbill valve 2264 (or other type of backflow
prevention valve or device) can be positioned immediately
downstream of the main coupling 2262. Thus, fluids and/or other
materials passing through the passages of the main coupling 2262
are not permitted to reverse direction through the main coupling
2262. This helps ensure that there is no cross contamination of the
individual conduits 2251A-2251C upstream of the main coupling
2262.
[0420] Another embodiment of the connection of individual conduits
2251A-2251C in the clip 2240' is illustrated in FIGS. 33A-34C. As
with the clip 2240 of FIGS. 32A-32C, the depicted arrangement
includes a main body 2256 that can be selectively attached to
and/or removed from the core 2210. However, as discussed in greater
detail below, there are some variations in the manner in which the
conduits 2251A-2251C are connected to the distal end of the clip
2240'. As best illustrated in the views of FIGS. 34A-34C, the
conduits 2251A-2251C can separate from each other a short distance
upstream of a multi-piece coupling 2270. The coupling 2270 can
include an inner portion 2274 fitted within an outer portion 2272
located immediately downstream of the inner portion 2274. According
to some embodiments, a duckbill valve 2276 or other backflow
prevention valve or device can be positioned in the fluid path of
each conduit 2251A-2251C, generally between the outer and inner
portions 2272, 2274. Thus, as discussed above with reference to
FIGS. 32A-32C, the valves 2276 can help prevent cross-contamination
of the individual conduits 2251A-2251C when fluids and/or other
materials are moving through the clip 2240'. In the illustrated
embodiments, once they have passed through the duckbill valves
2276, such fluids and/or other materials enter a common chamber
2277 or collection chamber 2277 located at the distal end of the
outer portion 2272. Accordingly, fluids and/or other materials can
exit the outlet opening 2248 (FIGS. 31A and 31D), toward a tip 2280
attached at the distal end of the ring 2242.
[0421] According to some configurations, the inner portion 2274
comprises one or more prongs 2275 that are adapted to secure to
corresponding areas of the main body 2256. Thus, the inner portion
2274 and other components of the coupling 2270 can be conveniently
attached to the rest of the clip 2240. It will be appreciated that
one or more other devices or methods can be used to secure the
coupling 2270 to the clip 2240. Further, as shown in FIGS. 33A and
33B, a closure 2266 can be used to completely or partially cover
the interior of the channel 2260 through which the delivery line
2250 is routed.
[0422] The delivery line 2250A-2250E can include one, two or more
different conduits or lumens. Accordingly, the depicted
arrangements can advantageously provide a simple design for
conveying two or more different types of fluids and/or other
materials through a single member. For example, the handpiece
assembly 2200 in fluid communication with the fluid delivery module
using only a single multi-lumen tubular member. In addition, the
internal configuration and overall design of the clip 2240 and/or
other portions of the handpiece assembly 2200 can be improved by
using such a multi-lumen delivery line, especially where available
space within the clip or other portion of the handpiece assembly is
limited.
[0423] Single-lumen or multi-lumen delivery lines 2250 can be
manufactured using one or more methods (e.g., extrusion, injection
molding, etc.) and/or one or more suitable materials (e.g., rubber,
polymeric materials and/or the like). In some embodiments, the
delivery lines are at least partially transparent or translucent so
that an optical sensor can detect the presence of undesirable air
or other gas bubbles passing therethrough. The materials used in
the manufacture of the delivery lines and other portions of the
injection system that may come into contact with medications,
formulations and/or any other materials being injected into the
anatomy preferably satisfy all regulatory standards and
requirements (e.g., medical-grade quality, FDA regulations, etc.).
According to some embodiments, the inner diameter of each lumen of
the delivery line is approximately 0.01-0.04 inches (e.g., 0.030
inches). However, the inner diameter can be greater than 0.04 or
smaller than 0.01, as desired or required.
[0424] The structural integrity, diameter, other dimensions,
materials of construction, durability, flexibility, pH resistance,
chemical/biological resistance, temperature resistance and/or other
characteristics of the delivery line or other conduits used in the
injection system can be advantageously selected for the particular
application. For example, the delivery line or other conduit can be
manufactured from medical-grade silicone, polymers, glass,
stainless steel, copper and/or the like.
[0425] Further, the delivery line or other conduit can be
configured so it adequately resists the fluids and/or other
materials which it may contact. Further, such delivery lines or
conduits can be advantageously adapted to withstand the pressures
(e.g., positive, negative/vacuum, etc.) to which they may be
exposed. Also, in some embodiments, the lines or conduits are
configured to withstand a minimum of 2 pounds of joint tensile
strength. However, in other embodiments, the structural
characteristics of the delivery lines, conduits and/or other
components of the system can be different. As discussed, some or
all of the conduits used in the injection system can be constructed
or otherwise assembled as a single unit. For hygienic, regulatory
and/or other purposes, the delivery lines and other conduits can be
sterile and disposable.
[0426] As discussed herein, a clinician can regulate the operation
of the fluid delivery module and/or any other component of the
injection system using one or more controllers. Such controllers
can include one or more buttons, dials, knobs and/or the like. In
some embodiments, the controllers can be permanently or removably
attached to a handpiece assembly (e.g., a part of a control module,
a core, etc.). Alternatively, the controller can be located on a
device, component or portion that is not part of a handpiece
assembly. For example, such controllers can be provided along the
fluid delivery module, an imaging wand and/or the like. In yet
other embodiments, as illustrated in FIG. 35, the controller
comprises a foot pedal 1500 that can be regulated by the
clinician's foot. For example, the clinician or other user can
press or release the foot pedal 1500 in order to regulate the
delivery of fluids from the injection system to a patient's
anatomy. As discussed herein, by pressing or otherwise moving the
foot pedal 1500 or other controller, an injection sequence can be
initiated, terminated, paused and/or otherwise modified (e.g.,
increase or decrease flow rate, change the sequence of fluid
delivery, etc.), as desired or required. The foot pedal or other
controller can be operatively connected to a fluid delivery module
and/or another component or portion of the injection system using
one or more hardwired and/or wireless connections (e.g., RF,
Bluetooth, Wi-Fi, etc.).
[0427] In some embodiments, the controller comprises a foot pedal
assembly that comprising two or more separate pedals. Such pedals
can be situated immediately adjacent to one another or can be
separated from each other by one or more separation members (e.g.,
baffle, other non-movable portion, etc.), as desired or required.
In a fluid delivery system configured to deliver two or more fluids
(e.g., anesthetics, steroids, other agents, medicaments or drugs
and/or saline or another inert fluid capable of flushing delivery
tubing, etc.), each pedal can correspond to and control delivery of
a different fluid. In other words, each pedal can be configured to
operatively the delivery of medicaments and/or other fluids from a
single (or a group) of containers loaded onto the fluid delivery
module or other portion of the injection system. Accordingly, the
user can easily and conveniently switch between different fluids by
releasing and depressing different pedals. For example, the user
may depress a first pedal to deliver a drug A (e.g., an anesthetic
agent) and a second pedal to deliver saline to flush the delivery
tubing or to deliver a different medicament or fluid. In other
embodiments, a foot pedal assembly can comprise three or more pedal
(e.g., a third pedal can be used to deliver a third medicament or
fluid). Alternatively, the user may choose to deliver drug B after
drug A without flushing the tubing between the different drugs. Any
other delivery sequence, scheme or protocol can be used to
selectively delivery the various anesthetics, medicaments and/or
other fluids loaded onto an injection system, as desired or
required.
[0428] As discussed in greater detail herein, the use of a
disposable handpiece assembly can offer several advantages. For
example, such a configuration can improve the hygiene and general
safety of an injection system. Further, the complexity and expense
of a multi-piece handpiece assembly having various buttons, other
controllers and/or other electrical features can be eliminated.
Consequently, the handpiece assembly can be conveniently replaced,
along with the tubing, the cassette and/or any other portions of
the injection system that come in contact with fluids and other
materials being delivered to a patient. Relatedly, the cleaning and
other maintenance procedures associated with an injection system
are simplified.
[0429] According to certain embodiments, the handpiece assembly,
the tubing and the cassette are replaced according to a specific
time frequency (e.g., once a day, twice a day, etc.), whenever the
properties (e.g., type, concentration, etc.) of the various fluids
and/or other materials being injected to patients are modified
and/or based on some other protocol or requirements. The needle
assembly attached to the distal end of the handpiece assembly is
replaced between patients.
[0430] As noted above, according to some arrangements, the delivery
of fluids and/or other materials from the fluid delivery module to
the handpiece assembly, and thus to the patient, is controlled by
the user using a foot pedal or some other controller. For example,
in one embodiment, a foot pedal is connected to the fluid delivery
module using a hardwired (e.g., USB, ethernet, etc.) or a wireless
connection (e.g., Bluetooth, radio frequency, etc.), as desired or
required. In order to commence, pause or terminate a particular
procedure, the physician, nurse, technician or other user can
selectively press or depress such a foot pedal, button or other
controller. In some arrangements, the pedals, buttons or other
controllers are configured to permit the user to select between
two, three or more different settings. In other embodiments, a foot
pedal is of the multi-depth type (e.g., dual-depth, tri-depth,
etc.), enabling a user to selectively press the pedal to two or
more distinct depths or other levels. Each distinct depth or level
can correspond to a particular setting (e.g., flowrate, selection
of which fluids or other materials to deliver, etc.). For example,
depressing the pedal or other controller to the first level can
cause the desired fluids and/or other materials to be injected at
the maximum or minimum rate. Further, continuing to press the pedal
to subsequent lower levels can cause the rate of delivery to
increase, decrease or terminate. In other embodiments, such pedals
do not include distinct depths, such as, for example, a rheostat.
Thus, a particular setting (e.g., flowrate) can be varied based on
the depth to which a foot pedal or other controller is
depressed.
[0431] In embodiments, where the user is not able to control the
injection sequence of the various fluids and/or other materials
loaded onto a fluid delivery module, the system may be programmed
for a desired protocol prior to the commencement of a procedure.
Thus, a user can program the injection system (e.g., using the
touchscreen or other entry device) to deliver one, two or more
medicaments and/or other substances, either simultaneously,
sequentially or individually, according to a desired sequence.
Subsequently, the user can initiate, pause, terminate and otherwise
control such a protocol using a foot pedal or some other
controller.
[0432] According to certain embodiments, the injection system can
be advantageously configured to detect the presence of air or other
gas bubbles within one or more of the conduits of the cassette or
other portion of the system. Once one or more bubbles are detected,
the injection system can be configured to terminate the injection
procedure, provide a warning to the clinician or other user and/or
take any other action. According to some embodiments, the air or
other gas bubbles are purged from the system before the injection
procedure can be resumed. For example, a predetermined volume of
fluid and/or other substance being conveyed in the conduits where
air or gas was detected can be wasted or otherwise sacrificed to
ensure that it has been eliminated from the system.
[0433] In one embodiment, air bubbles are detected by the optical
sensors, mechanical sensors, pressure sensors, ultrasonic sensors,
capacitance sensors, or combinations thereof. However, in other
arrangements, the presence of air bubbles is detected using a
pressure transducer of the fluid delivery module's drive system. A
pressure measurement taken along the back side of the drive system
can help determine if air or other fluids are present within any of
the conduits or other hydraulic components of the system.
[0434] As discussed in greater detail below, FIGS. 39A-39J and
40A-40T illustrate various screenshots of a touchscreen display of
the fluid delivery module that can be advantageously configured to
permit a clinician or other user to control and/or view the status
of a delivery of medications and/or other fluids or materials
loaded onto the fluid delivery module. In the embodiments
illustrated herein, the fluid delivery module is adapted to receive
up to three vials or other containers, the contents of which may be
selectively delivered through a handpiece assembly as described in
greater detail herein. However, in other embodiments, the
anesthesiology, articular and/or other delivery system may include
more or fewer vials or other containers, as desired or
required.
[0435] According to some embodiments, a fluid delivery module
and/or any other component of an injection system can be
selectively configured to integrate or cooperate with one or more
other devices, such as, for example, an ultrasound device or
system, another type of imaging device or system, a nerve
stimulator and/or other devices. As a result, a physician or other
user can more accurately determine the location of the needle as it
is being inserted into a patient's anatomy. In such arrangements,
data, images and/or other information regarding the injection
procedure can be provided to the user on a display of the fluid
delivery module, on a display of an ultrasound or other imaging
device, a separate display and/or as otherwise required or desired.
Regardless of the level of integration between the injection
system, an imaging device and/or another device or system,
providing important data, images and other information in a single
display can advantageously permit a user to more efficiency and
effectively execute an injection procedure.
[0436] FIGS. 36A and 36B illustrate one embodiment of such an
integrated set-up, in which the fluid delivery module 100 is
operatively connected to an ultrasound or other imaging device 500.
The fluid delivery module 100 can be configured to communicate with
the imaging device 500 using one or more hardwired (e.g., USB,
Ethernet, other cables, etc.) and/or wireless (e.g., radio
frequency, Bluetooth, etc.) connections. As shown, once operatively
connected to each other, one or both of the displays 130, 530 can
be configured to provide data, images and/or other information
obtained by both the injection and the imaging systems. In the
illustrated embodiment, the imaging system's display 530 is
configured to show the status (e.g., volume of a fluid delivered,
volume of a fluid remaining within the cassette, pressure,
flowrate, etc.) of the injection procedure in addition to an
ultrasound image.
[0437] Thus, either or both displays 130, 530 can be configured to
simultaneously provide information regarding both the imaging and
the injection aspects associated with a particular procedure.
Accordingly, a clinician can use a single display of the fluid
delivery module or other portion of an injection system to help
perform an injection procedure. Further, in some embodiments, color
Doppler technology can be used to permit a clinician or other user
to visualize the various steps of an injection procedure in real
time. As discussed in greater detail herein, such screenshots and
other images can be saved for billing, recordkeeping and/or other
evidentiary purposes.
[0438] Another embodiment of an injection system 100 operatively
coupled to an imaging (e.g., ultrasound) device or system 500B is
illustrated in FIGS. 36C and 36D. In the depicted arrangement, the
injection system 10 comprises a fluid delivery module 10 that can
be removably positioned on a tray or other platform 552 of a cart
550. As shown, the cart 550 can include wheels 558 or other devices
that allow it to be easily and conveniently moved to a desired
location. In addition, the cart 550 can include one or more other
trays 554, platforms and/or other features to further enhance its
storage capabilities and overall functionality. The ultrasound or
other imaging device 500, which in some embodiments includes a
display 530B, can also be secured to the cart 550.
[0439] As illustrated in FIGS. 36C and 36D, the display 530B and/or
any other component or portion of the imaging device 500B can be
mounted on a pivotable support member 570. In some embodiments, the
support member 570 comprises one or more arms 572, 574, 576 that
can be moved relative to each other (e.g., using hinges, joints,
etc.) to position the display 530B and/or other portions or
components of the imaging device 500B in a desired location or
orientation. In some embodiments, as illustrated in FIGS. 36C and
36D, the cart 550 can be configured to receive a printer 560 or
other output device. For example, as discussed with reference to
FIGS. 38A and 38B herein, such a printer can be used to generate a
report or summary of an injection or other treatment procedure. A
different embodiment of a cart 550' configured to retain a fluid
delivery module 100, a printer 560, other devices, components or
portions of (or operatively coupled to) an injection system is
illustrated in FIG. 36E.
[0440] One embodiment of an ultrasound or other imaging wand
configured for use with an injection system is illustrated in FIGS.
36F and 36G. As shown, the wand 500 can include a main body 510 and
a head 514 that is configured to contact the patient's skin during
the imaging procedure. In addition, the wand 500 can include one or
more buttons 504, 506, 508, knobs, levers, switches and/or other
controllers that allow the clinician to operate one or more aspects
of the imaging system and/or the injection system. For example, the
buttons and/or other controller can be configured to adjust or
capture an ultrasound or other type of image. In some embodiments,
the buttons are configured to regulate the injection of fluids
and/or other materials through the handpiece assembly 200 (e.g.,
initiate or terminate an injection procedure, alter the flowrate or
sequence of delivery, etc.).
[0441] Accordingly, a clinician or other user can control various
aspects of an injection procedure through a single device.
Alternatively, the handpiece assembly 200 can include one or more
buttons, knobs and/or other adjustment devices or controllers that
are adapted to control the delivery of fluids and/or other
materials through the handpiece assembly 200 and the operation of
an imaging system, either in lieu of or in addition to button or
controllers on the imaging wand. As discussed herein, this can
advantageously permit a user to locate a targeted anatomical space
(e.g., a nerve, joint, an organ, a cavity, etc.), control the
delivery of one, two or more different fluids and/or substances to
such a targeted space and/or regulate one or more other aspects of
an injection procedure without having to remove his or her hands
from the handpiece assembly 200. In other embodiments, both the
injection and imaging systems are controlled by buttons or other
adjustment devices located on the fluid delivery module 100 (e.g.,
touchscreen display), another portion of the injection system
and/or a separate device, either in lieu of or in addition to
buttons located on the handpiece assembly 200 and/or the imaging
wand 500.
[0442] As noted above, incorporating imaging technologies (e.g.,
ultrasound, radio frequency spectroscopy, CT, MRI, etc.) into an
injection system that is also configured to selectively transfer
fluids and/or other materials into or out of a targeted anatomical
location can facilitate an injection/aspiration procedure for a
clinician or other user. In some embodiments, an imaging-enabled
injection system can facilitate execution of a particular injection
procedure. In addition, such devices and systems can enable an
injection procedure to be completed with fewer clinicians and other
resources. For example, when a separate imaging device is utilized,
two or more physicians or clinicians are typically needed to
properly and safely complete the procedure. As illustrated in the
embodiment of FIG. 36G, a clinician or other user can perform an
injection procedure by manipulating an imaging (e.g., ultrasound,
radio frequency spectroscopy, etc.) wand 500 in one hand to locate
the targeted anatomical location (e.g., nerve tissue, toe, foot,
knee, other joint, etc.), while simultaneously handling the
handpiece assembly 200 in the other hand to selectively transfer
fluids or other materials to (or from) such location.
[0443] Consequently, incorporating imaging technologies into the
anesthesia, articular or other injection system can offer a number
of advantages. For example, such a combination unit can be operated
using a single power supply. In addition, such a configuration can
be operated using a single logic board, computer chip or other
processor. Further, as discussed, the combination unit can allow a
clinician to use "multi function" buttons and controls. For
instance, a button, soft key or other adjustment device can be used
to control both an ultrasound unit (or other imaging or location
device) and the injection system.
[0444] As discussed, in any of the embodiments disclosed herein, a
target nerve, intra-articular and/or other location or other
anatomical space can be located using one or more imaging
techniques, such as, for example, ultrasound, fluoroscopy, CT, MRI
and/or the like. Ultrasound technology uses sound waves of a
particular frequency to image internal structures (e.g., tissue,
organs, nerve bundles or related tissue, joints, etc.). In some
arrangements, pulsed and/or continuous sound waves can be directed
to the area of interest using one or more transducers. Redirected
sound waves that bounce off anatomical structures are detected by
the transducers or other devices (e.g., wand 500). These data can
then be processed to generate an image or other visual display of
the targeted area.
[0445] Ultrasound transducers and other components used to locate a
desired anatomical location can be directly or indirectly
incorporated into a fluid injection system. For example, in some
embodiments, a separate ultrasound probe or wand is used to
visually confirm the location of the needle relative to the target
location (e.g., a nerve, joint or intra-articular space, an organ,
etc.). The ultrasound equipment can be configured to operate either
continuously or intermittently during the course of the procedure,
as desired or required. In other embodiments, an ultrasound
transducer and/or other ultrasound devices is incorporated directly
into one or more components of an injection system. For instance, a
small ultrasound transducer can be positioned at or near the tip of
the delivery or aspiration needle. The ultrasound transducer can be
placed in data communication with a processing apparatus and/or
other components using one or more hardwired and/or wireless
connections. In addition, the injection system can be configured so
that the imaging results are advantageously viewed on the display
130 (FIG. 1) of the fluid delivery module.
[0446] Thus, as the needle is inserted into the body, a physician
or other clinician can accurately detect the position of the distal
end of the needle. Such imaging techniques can be used alone or in
conjunction with one or more other locating methods or devices. For
example, in one embodiment, tissue response measurements can be
used to locate a target nerve, intra-articular and/or other
location or space. In other embodiments, ultrasound and/or other
imaging technologies are used to locate a targeted anatomical
location (e.g., nerve tissue, joint, etc.). In other embodiments,
both tissue response measurements and ultrasound and/or other
imaging technologies are used to locate nerve tissue or another
target anatomical location. In still other embodiments, one or more
other nerve, joint or other anatomical location locating methods or
devices can be used, either in lieu of or in addition to methods,
systems and methods disclosed herein.
[0447] As discussed herein, in some embodiments, nerve stimulation
can be used alone or in combination with ultrasound or another
imaging technique to detect the needle position and locate the
target nerve. As noted above, for example, the delivery of an
electrical impulse to the needle can provide at least some
confirmation or assurance to the anesthesiologist or other
clinician that the needle is appropriately positioned relative to
targeted nerve tissue. In other words, the patient's reaction to
such an impulse can allow the clinician to determine whether the
needle is either too far or too close in proximity to nerve tissue
(e.g., based on the patient's twitching or other physical or
neurological response).
[0448] FIG. 37A illustrates one embodiment of an integrated system
or set-up in which the fluid delivery module 100 is operatively
connected to a nerve stimulator 700 and an ultrasound display 530.
The fluid delivery module 100 can be configured to communicate with
the nerve stimulator 700 and the ultrasound display 530 using one
or more hardwired (e.g., USB, Ethernet, other cables, etc.) and/or
wireless (e.g., radio frequency, Bluetooth, etc.) connections. In
some embodiments, the nerve stimulator 700 is directly or
indirectly operatively connected to an imaging device (e.g.,
ultrasound device) and/or a component thereof (e.g., display or
other output 530). For example, a hardwired or wireless connection
can be established directly between the electrical stimulation
device and the imaging device (and/or the imaging device's output).
In other embodiments, such components are operatively coupled to
each other through one or more intermediate components or devices
(e.g., a fluid delivery module, a display, a computing device or
other central processing unit, a network, etc.), as desired or
required. Once operatively connected to each other, one, two or
more displays 130, 530 associated with an integrated anesthetic or
other injection system can be configured to provide data, images
and/or other information obtained by the injection, imaging, and
nerve stimulator systems as discussed in greater detail herein.
[0449] In some embodiments, ultrasound imaging is particularly
advantageous because it permits real-time visualization of nerve,
tissue, a joint and/or other target location. By way of example, in
one embodiment, the delivery module and system include an
ultrasound device using a broadband curved array transducer working
at about 2-5 MHz and a broadband linear array working at about 4-7
MHz. Imaging errors can be kept at a minimum by taking the linear
array for measurements. Curved array may be desirable and used for
better penetration depth.
[0450] Several embodiments of the present application provide a
system and method of using ultrasound guidance to inject fluids
into small spaces (e.g., joints, organs, etc.). Further, ultrasound
and other imaging technologies can assist in the visualization of
internal structures (e.g., bones, nerves, joints, organs, other
tissue, etc.) within the anatomy. Thus, such imaging technologies
can be used to visually display the orientation of the needle with
respect to such internal structures. Consequently, ultrasound can
assist a user in correctly positioning and directing the needle
during an injection and/or aspiration procedure.
[0451] In addition, a contrast media can be used with the
ultrasound devices and methods described herein to further enhance
the user's ability to verify the location of the needle tip
relative to the targeted anatomical location (e.g., nerve tissue,
joints, organs, etc.). This can provide additional assurances that
the medication, other fluid and/or other substances are being
delivered to the desired location within the patient being treated.
A contrast media can also be used in embodiments where aspiration
of a fluid or other material is desired. For example, if
acceptable, a contrast media can be delivered to or near the
desired location. Then, once placement of the aspiration needle has
been confirmed, the fluid module can be used to aspirate as
required. In some embodiments, if the aspiration procedure is
therapeutic in nature (e.g., being used to relieve pressure within
the targeted anatomical location), the use of contrast media may be
acceptable. However, in one or more other circumstances, the use of
contrast media may not be acceptable or desirable. For example, if
the purpose of the aspirating is to withdraw a fluid for diagnostic
reasons (e.g., testing the extracted fluid sample), initially
injecting a contrast media or other substance may contaminate the
desired sample.
[0452] In some embodiments, once a user has located the target
nerve via ultrasound or other imaging guidance, nerve stimulation,
and/or other techniques, the user may further confirm the location
of the needle tip via aspiration or the creation of negative
pressure within the needle. In some embodiments, as discussed in
greater detail herein, such an aspiration is not intended to
actually remove any bodily fluids from the patient's anatomy.
Instead, the clinician draws back a sufficient volume of native
bodily fluids and visualizes such fluids (e.g., via his or her
naked eye, via another visualization device, etc.) to ensure that
the tip of the needle has been properly and safely positioned with
the patient's anatomy. For example, in some embodiments, an
aspiration that is negative for blood can help confirm that the
needle is not improperly located within a blood vessel.
Accordingly, the anesthesiologist or other clinician can then begin
a slow, incremental injection of the anesthetic and may repeat
aspiration periodically during the injection to check for
blood.
[0453] According to some embodiments, aspiration of native bodily
fluids can be accomplished manually, automatically (e.g., with the
assistance of the fluid delivery module or other mechanical,
pneumatic or other component associated with the system) and/or
both manually and automatically (e.g., partially automatically).
Thus, any injection system disclosed herein can be configured to
allow for aspiration, for example by placing a stopcock in the
tubing connecting the cassette 300 to the needle and connecting a
syringe to the stopcock. The embodiment illustrated in FIG. 37B
comprises a stopcock 800 that is positioned between and couples the
delivery line 250 and the needle 291, needle tubing 293 and/or any
other handpiece, hub or similar assembly. In some embodiments, at
least one section or portion of the delivery line or conduit 250
comprises a branch having a stopcock assembly 800. Thus, in such an
embodiment, the conduit 250 is configured to connect the stopcock
800 to a handpiece assembly.
[0454] With further reference to FIG. 37B, a syringe 802 or other
device can be coupled to the stopcock 800. In some embodiments, the
stopcock comprises a luer or other standard or non-standard
coupling or fitting that allows for easy connection to and
disconnection from the branch. For example, in a first position,
the stopcock 800 allows fluid to freely flow from the cassette,
through the conduit 250, 293, and through the needle to the
patient. When the stopcock 800 is adjusted to a second position,
however, flow from the cassette and delivery line 250 tubing is
prevented from passing through the stopcock. A syringe 802 or other
manual or automatic device can be attached to the fitting
associated with the branch and stopcock, and when actuated, can be
used to create negative pressure within the syringe body,
stimulation needle tubing 293 (or other tubing), and needle. The
negative pressure causes fluid from within the patient's body
proximate to the needle tip to be drawn through the needle and into
the tubing 293. The user can observe the fluid withdrawn into the
tubing 293 for the presence of blood and/or other target fluid.
[0455] In some embodiments, the syringe 802 and/or plunger can be
coupled to a fluid delivery module 100 so that the plunger can be
withdrawn and aspiration performed via mechanical, hydraulic,
pneumatic, and/or other device or method. For example, as discussed
herein, the fluid delivery module comprises or is operatively
coupled to one or more mechanical, pneumatic and/or other devices
that assist in delivering anesthetics and/or other fluids to a
target anatomical location of a patient. The mechanical advantage
provided such devices and/or features can be used to advantageously
draw fluids from the anatomy for inspection as discussed herein.
For instance, in one embodiment, one or more plungers or other
movable devices are retracted relative to the interior of a fluid
reservoir (e.g., within a cassette), thereby creating a negative or
vacuum pressure within the needle and the fluid conduit that
connects the needle to the fluid delivery module. Regardless of how
such aspiration is conducted (e.g., manually, automatically,
combination thereof, etc.), in some embodiments, the
anesthesiologist or other clinician, after viewing the native
bodily fluid, can reverse the pressure within the system so that
such bodily fluids are returned within the patient's anatomy.
[0456] As discussed herein, a fluid delivery module, a nerve
stimulator or other electrical stimulation device, an ultrasound
device (and/or other imaging device) and/or other component of an
injection system can be operatively connected to one another. In
some embodiments, one or more displays associated with the various
components of the system (e.g., a fluid delivery module display
130, an imaging system display 530, etc.) can be configured to
provide data, images and/or other information obtained by the
injection, imaging, and nerve stimulator systems.
[0457] According to some embodiments, for example, such data,
images and/or other information can be provided as an overlay on
the ultrasound image as shown in the screenshot of FIG. 38C. Each
fluid (e.g., anesthesia agent) and/or other fluid or material
loaded on the fluid delivery module can be schematically
represented by a syringe, vial, other container or image on the
display 530. Further, the volume or other amount of each type of
medication or formulation remaining within (and/or delivered from)
the cassette or other portion of the fluid delivery module for
injection into a patient can be graphically, schematically,
numerically or otherwise represented on the screenshot. For
example, the syringes, vials or other images representing the
various medicaments and/or other materials loaded onto a fluid
delivery module can be shown filled with the remaining volume of
fluids and/or other materials. As fluids and/or other materials are
delivered into an anatomy, a line representing the level of each
syringe or other container can move to reflect the change in volume
for a corresponding fluid and/or other material. Accordingly, the
anesthesiologist, clinician or other user can be advantageously
permitted to closely and accurately monitor the status of an
injection procedure. As shown in FIG. 38C, the volumes or other
amounts of each medication or formulation delivered and remaining
can also be numerically displayed.
[0458] In addition, the display can be configured to provide
information regarding the pressure at or near the distal end of the
needle, either while the needle is being delivered to the target
anatomical location (e.g., a nerve), while fluids and/or other
materials are being delivered to such a location during the course
of an injection procedure, during an aspiration procedure and/or
the like. According to some arrangements, in part for patient
safety, the fluid delivery module is configured to accurately
measure and regulate the flowrate and/or pressure of a medication,
fluid or other material being delivered to the target anatomical
location. Thus, the system can comprise pressure and/or flow
measurement devices (e.g., pressure transducers, flowmeters, etc.).
Pressure sensing devices can be used to ensure that the positive
pressure (or vacuum during aspiration) created by the transfer of
anesthetics, other medicaments, compositions, fluids and/or other
materials within the anatomy does not exceed a particular threshold
level.
[0459] Accordingly such pressure monitoring features can help
prevent or reduce the likelihood of damage occurring to the patient
being treated using the injection system. Such an internal force
measurement system can be configured to automatically shut off the
fluid transfer device (e.g., movement of the stepper motor, other
pump, etc.) when the discharge pressure exceeds a maximum level
(e.g., about 3 psi, pressures greater than about 3, 4, 5, 10, 15
psi, more than 15 psi). In other arrangements, the fluid delivery
module includes one or more visual and/or audible alarms or other
features to promptly alert the user than a threshold pressure has
been attained, either in lieu of or in addition to any automatic
shut-off mechanism. For example, the clinician or other user can
track real-time pressure and/or flowrate data on corresponding
portions of the display during an injection procedure. Other types
of feedback that indicates position or placement to a user may also
be used (e.g., mechanical or tactile feedback). Such safety
features can be included in any of the embodiments of the modules
or systems disclosed herein.
[0460] The display 530 can be configured to provide information
regarding dynamic pressure measurements during the procedure, the
maximum pressure measured during the procedure, and/or a history of
the pressure measurements over the duration of the procedure. A
pressure indicator 650 can include a scale 652 and a caret 654 that
indicates the current pressure on the scale 652. In some
embodiments, the scale 652 can include zones indicated by different
colors. For example, a "safe" pressure zone (e.g., from 0 to 10 PSI
as shown in FIG. 38C) can be indicated by green, a "warning" zone
(e.g., from 10 to 20 PSI) can be indicated by yellow, and a
"danger" zone (e.g., from 20 to 30 PSI) can be indicated by red.
The pressure indicator 650 can also include a maximum pressure
indicator 656 that indicates the highest pressure that has been
encountered during the procedure. Other scales, indicators, colors,
and/or ranges, etc. are also possible. For example, the display 530
can be configured to show a graphical representation of pressure
over time during the course of the procedure. In some embodiments,
the display can be configured to provide a readout of the history
of pressure and/or volume over the entire duration of the injection
after the completion of the procedure. As noted herein, such data
regarding pressure measurements can be saved (e.g., in an internal
or external memory) and/or forwarded to one or more systems,
networks and/or the like, as desired or required.
[0461] In some embodiments, the display 530 is configured to
provide information regarding nerve stimulation, either in addition
to or in lieu of other data (e.g., pressure, volume
delivered/remaining, patient name, physician/facility name,
date/time, stimulation level, etc.). With continued reference to
FIG. 38C, a stimulator output 660 can be included on the ultrasound
display. The stimulator output 660 can indicate, for example,
dynamic current measurements (0.20 mA in FIG. 38C), maximum current
(1 mA), impulse frequency (2 Hz), impulse duration (0.10 ms),
and/or resistance (1.0 k.OMEGA.). As shown in the example
integrated system of FIG. 37A, a stimulator 700 can be coupled to a
fluid delivery module 100, which is in turn coupled to an
ultrasound or other imaging display 530. Output data from the
stimulator 700 can therefore be transmitted to the fluid delivery
module 100, which can transmit the data to the ultrasound or other
imaging display 530. Alternatively, in some embodiments, the
stimulator 700 can be directly coupled to the imaging display 530.
In some such embodiments, a delivery procedure could be performed
without a fluid delivery module 100.
[0462] Integrating imaging, nerve stimulation, and/or aspiration
capabilities into an injection system can facilitate execution of
an anesthesia procedure for a clinician or other user. Such an
integrated system can enable an injection procedure to be completed
with fewer clinicians and other resources. Incorporating pressure
indicators, stimulator output, and/or other information into an
ultrasound or other image overlay can also facilitate the
procedure. Such an integrated heads up display can allow the
clinician or other user to easily monitor multiple factors and
parameters without having to turn away from the imaging
display.
[0463] As discussed herein, in some embodiments, data and other
information regarding the types, volumes or other amounts, dosages
and/or other details of the various medications and/or other
substances administered during a particular injection procedure, as
displayed to the user in a touchscreen or other interface, are
automatically stored within a memory of the fluid delivery module,
another component or portion of the injection system or an external
processor or network with which the injection system is in data
communication. In addition data and information related to
ultrasound or other imaging procedures that were conducted can also
be saved for later processing (e.g., documentation, billing, etc.)
or retrieval. Such data and information can include actual
ultrasound images, details regarding the imaging equipment used,
the extent to which a particular imaging device was used and/or the
like.
[0464] In addition, as discussed, other details related to a
specific procedure can also be recorded, maintained and linked to a
delivery sequence of various medicaments and/or other substances.
For example, the injection system can be configured to receive and
maintain the name of the patient, the date and time that the
procedure was performed, the duration of the procedure, the
physicians, clinicians and/or other personnel that participated in
the preparation and/or execution of the procedure, the disease or
condition being treated, specific treatment codes and other
administrative information and/or the like. Such data collection
capabilities can assist with billing, insurance processing, patient
record keeping, generation of reports, reordering of medicaments
and other injectable materials and/or other functions. In some
embodiments, such records or summaries (e.g., printouts, electronic
file, etc.) can be included in or otherwise connected with (e.g.,
physically, electronically, etc.) a patient's file or chart. In
addition, the use of the summaries or reports can provide one or
more additional benefits to a user. For example, such summaries and
reports can improve the economic return on an injection procedure
for the service provider by leveraging the relatively favorable
reimbursement of the corresponding ultrasound-guided (or other
imaging-guided) procedures.
[0465] According to some embodiments, an injection system includes
a printer, another output device, memory and/or the like to help
memorialize the details associated with a specific injection
procedure. As noted herein, the corresponding output resulting from
such recordkeeping can assist with billing, insurance processing,
patient record keeping, generation of reports and/or the like. In
addition, such printouts or alternative forms of output (e.g.,
electronic reports) can memorialize the details of a particular
procedure, serving as evidence of what was performed (e.g., which
and how much of each medicament and/or other substance was
injected, the sequence of delivery, visual confirmation via an
ultrasound or other imaging technology of the needle location and
other details of the injection, etc.), to whom the injection was
administered, who performed the injection procedure, when and where
the procedure was executed and/or the like. As noted above, such
summaries can be provided on a paper printout (e.g., a printer that
is incorporated with or operatively coupled to an injection
system), electronic form (e.g., a summary generated as a pdf, an
image or some other standard or non-standard viewable format, etc.)
and/or the like.
[0466] FIGS. 38A and 38B illustrate embodiments of reports or
summaries 600A, 600B that can be generated in relation to the
execution of a particular injection procedure. Such reports or
summaries 600A, 600B can comprise paper printouts, electronic files
and/or the like, as desired or required. As shown, the report or
summary 600A, 600B can include one or more images 602A, 602B of the
patient's nerve tissue or adjacent structure or organs, joint or
other targeted anatomical location. Such images can be generated
using ultrasound or other imaging technologies. In some
embodiments, the images 602A, 602B provide visual confirmation of
the location of the injection system's needle in relation to the
patient's anatomy. In addition, the images 602A, 602B can provide
details related to the injection of fluids and/or other materials
to or near the targeted nerve, joint or other anatomical location.
For example, Doppler or other technologies can be used to verify
that the various fluid and/or other material streams were properly
delivered to the patient.
[0467] With continued reference to FIGS. 38A and 38B, the summary
or report 600A, 600B can also include images and/or text 604A, 604B
related to the prescribed or selected injection protocol (e.g.,
types and volumes of medicaments and/or other materials), the
details of the actual injection procedure that was performed (e.g.,
which and how much of each medicament and/or other materials were
actually delivered), the back-pressure or resistance against which
the injection was performed and/or the like. In some embodiments,
the reports or summaries 600A, 600B include additional data and
other information, such as, for example, the name of the clinician
and/or facility 612A, 612B, the name and/or other personal
information of the patient 614A, 614B, the date and time the
treatment procedure was initiated and completed 616A, 618A, 616B,
618B, the details (e.g., type, dosage, volume, etc.) regarding the
drugs, medicaments and/or other materials delivered to the patient
during the injection procedure 622A, 622B, the total volume of
fluids and/or other materials that were actually delivered to the
patient 624A, 624B and/or the like. In addition, the summary or
report can include one or more locations 630A, 630B for the
signature, date and/or other information to be completed by a
clinician, a witness or any other person associated with the
administration of the injection procedure. In other embodiments,
the summary or report 600A, 600B can be customized according to the
user's specific desires and requirements. Thus, the summary or
report 600A, 600B can include more or less (and/or different) data
and information than provided in the illustrated embodiments.
[0468] FIGS. 39A-39J and 40A-40T illustrate various screenshots of
a touchscreen display 130 of the fluid delivery module 100 (e.g.,
FIG. 1) that can be advantageously permit a clinician or other user
to control the delivery of one or more medications and/or other
fluids or materials loaded onto the fluid delivery module. As
discussed in greater detail herein, the fluid delivery module can
be adapted to receive up to three vials or other containers, the
contents of which may be selectively delivered through a downstream
handpiece assembly. However, in other embodiments, the injection
system is configured to receive more or fewer than three vials
and/or other containers, as desired or required.
[0469] With reference to the screenshots illustrated in FIGS.
39B-39H and 40C-40R, a touchscreen display can provide flowrate
and/or other data for each type of medication, formulation and/or
other fluid or material loaded onto the fluid delivery module. For
example, the contents of the vial or other container positioned on
a first nest or loading area of the fluid delivery module (and
subsequently placed in fluid communication with the handpiece
assembly as discussed herein) can be visually and schematically
represented on the on the display.
[0470] In some embodiments, other data or information about the
fluids and/or other materials that are loaded onto a fluid delivery
module can be provided on the screenshots. For example, information
about the name of the composition and/or other fluid or material
can be provided. In other arrangements, a code (e.g., NDC) and/or
other identifier about the particular medication or formulation
loaded onto the fluid delivery module can be displayed. Further, as
discussed in greater detail herein, the vials, ampoules, syringes
and/or other containers secured to the cassette or other portion of
the fluid delivery module can be configured to be automatically or
manually identified (e.g., using an identification flag or other
member, using a barcode scanner or other identification device
positioned along the cassette or outside of the fluid delivery
module, etc.). Thus, information detected by such devices (e.g.,
type of medication, dosage or concentration, manufacturer,
expiration date, etc.) can be advantageously provided on the
display of the fluid delivery module. In addition, other data or
other information can also be included on the display, such as, for
example, imaging data for locating the distal end of the needle,
date, time, name of the patient, name of the physician or other
clinician performing the procedure and/or the like, as desired or
required.
[0471] The touchscreen display can include up and down arrows
(e.g., see FIGS. 39B, 39D, 40C-40F, 40K, 40L, 40O and 40P)
associated with each type of medication, formulation and/or other
fluid or material to be delivered to a patient in a scheduled
injection procedure. Thus, a clinician or other user can select the
volume, mass and/or other amount of a particular substance that
should be delivered within a targeted anatomical location for an
injection procedure. The volume or other amount selected at any
particular time can be displayed in a corresponding area of the
display. In addition, as shown in some of the depicted screenshots,
the total volumetric or other amount of fluids and/or other
materials to be delivered within an anatomy for a particular
injection procedure can also be displayed.
[0472] According to some embodiments, the touchscreen display
offers a convenient way of modifying a particular protocol using
the up and down arrows. In addition, the touchscreen display can
include one or more softkeys or other buttons (e.g., "FLUID
SET-UP", "SYSTEM SET-UP", "CASSETTE REMOVAL", "DATE TIME", "MENU",
"OK", etc.) that enable a user to input desired settings (e.g.,
maneuver through the various screens) and/or adjust the details
associated with a specific injection procedure.
[0473] Once the details of a desired injection protocol have been
entered, a user can use the buttons and/or other control devices
positioned along the exterior of the handpiece assembly (e.g.,
either incorporated as a part of a core design, included as part of
a removable control module, etc.) or other component of the system
to selectively deliver one or more of the medications, formulations
and/or other fluids or materials to a patient. In other
embodiments, as discussed herein, a foot pedal is used to regulate
the delivery of fluids and/or other materials to a patient.
[0474] In some embodiments, a clinician or other user presses a
button of the handpiece assembly 2200 (e.g., FIGS. 30A and 30B) to
deliver the internal contents of a first vial or other container
corresponding to that button. Thus, a name, number or other
identifier (e.g., shape, color, graphic, etc.) on the display of
the fluid delivery module can match or substantially match an
identifier on or near the corresponding button of the handpiece
assembly. Thus, a clinician or other user can easily determine
which button or other controller of the handpiece assembly should
be pressed or otherwise manipulated to deliver a particular
medication, formulation and/or other fluid or material into a
patient's anatomy.
[0475] Alternatively, a clinician or other user initially programs
the details of a desired injection protocol using the fluid
delivery module. For example, the clinician can select which fluids
to deliver, in which order to deliver them (e.g., whether delivery
of fluids and/or other materials will be sequential or
simultaneous), the volume or other amount of each fluid and/or
other material to be injected and/or the like. After the clinician
has entered the necessary data and other information, he or she can
use a button, foot pedal and/or any other controller or device to
start or stop the injection procedure. In some embodiments, as
discussed in greater detail herein, the button, foot pedal and/or
other controller can advantageously permit a user to speed up or
slow down the injection procedure, to pause the procedure, to
operate an ultrasound or other imaging device operatively coupled
to the injection system and/or perform any other function or task,
as desired or required.
[0476] In order to stop delivering such a fluid or other material
to the patient, the physician can release a corresponding button,
foot pedal and/or other controller (or press such a button again).
Accordingly, the screenshot information provided on the display can
be used to control the manner in which medications, formulations
and/or other fluids or materials are delivered to a patient. The
display can be configured to change to a different screenshot
(e.g., FIGS. 39G, 39H, 40H-40L, 40N and 40R) during the delivery
phase of the various fluids and/or other materials. As discussed in
greater detail herein, a button or other controller can be located
on the handpiece assembly. For example, a handpiece assembly can
include one or more buttons as part of core design (e.g., FIGS. 30A
and 30B). Alternatively, one or more buttons can be included on a
control module that is configured to removably attach to a
handpiece assembly (e.g., FIGS. 23A-27B). In yet other embodiments,
a foot pedal (e.g., FIG. 35) and/or any other type of controller
can be used to regulate the flow of fluids and/or other materials
from an injection system to a patient's anatomy.
[0477] In some embodiments, two or more medications, formulations
and/or other fluids or materials can be combined and delivered
together through the handpiece assembly by pressing a single button
and/or other controller (e.g., permanently or removably located on
a handpiece assembly, a foot pedal, the fluid delivery module, any
other component of the injection system, a separate device or
system, etc.). In some embodiments, a single button or other
controller can be used to simultaneously or sequentially delivery
two or more fluid and/or other material streams to a patient.
[0478] With continued reference to the screenshots of FIGS. 39A-39J
and 40A-40T, once a user chooses to deliver two or more different
medications, formulations and/or other fluids or materials using a
single button or other controller, the display can be configured to
visually assign a single button number to such a combination.
Further, the windows or other portions of the screenshot displaying
the volume or other amount of the corresponding medications,
formulations and/or the like can be visually combined (e.g., using
a larger window or area) in order to make it clear that such
materials will be delivered simultaneously.
[0479] According to some embodiments, the rate of delivery of the
medications, formulations and/or materials being simultaneously
delivered is adjusted so that the desired volumes or other amounts
of such materials expire at the same time for a particular
injection procedure. In other words, the rate of delivery of the
first fluid can be slow relative to the rate of delivery of the
second fluid so that the first fluid and the second fluid are used
up at the same time or approximately the same time during an
injection procedure. Alternatively, the rate of delivery of the
fluids and/or other materials that are simultaneously delivered
through the handpiece can be adjusted so that one or some of the
fluids or materials are used up before the others. As discussed in
greater detail herein, one or more aspects of a delivery procedure
can be customized, as desired or required by the clinician.
[0480] In some embodiments, the clinician or other user can program
the injection system so that three or more medications,
formulations and/or other fluids or materials loaded onto the fluid
delivery module are delivered using a single button of the
handpiece assembly, a foot pedal and/or any other controller. Such
fluid and/or other material streams can be delivered simultaneously
or sequentially, in accordance with a desired protocol.
[0481] According to some embodiments, each fluid and/or other
material loaded onto the fluid delivery module can be schematically
represented by a syringe, vial, other container or image on the
screenshots. Further, the volume or other amount of each type of
medication or formulation remaining within the cassette or other
portion of the fluid delivery module for injection into a patient
can be graphically represented on the screenshot. For example, the
syringes, vials or other images representing the various
medicaments and/or other materials loaded onto a fluid delivery
module can be shown filled with the remaining volume of fluids
and/or other materials. As fluids and/or other materials are
delivered into an anatomy, a line representing the level of each
syringe or other container can move to reflect the change in volume
for a corresponding fluid and/or other material. Accordingly, the
clinician or other user is permitted to graphically follow the
status of the injection procedure. As shown in the various
screenshot embodiments provided herein, the volume or other amount
of each medication or formulation can also be numerically displayed
within corresponding windows or other portions of the screenshots.
A screenshot can also provide information relating to the total
volume of fluids and/or other materials delivered into an anatomy
during an injection procedure.
[0482] In addition, the display can be configured to provide
information regarding the pressure at or near the distal end of the
needle, either while the needle is being delivered to or near the
target anatomical location (e.g., a nerve tissue, joint, etc.) or
while fluids and/or other materials are being delivered to such a
location during the course of an injection procedure. According to
some arrangements, in part for patient safety, the fluid delivery
module is configured to accurately measure and regulate the
flowrate and/or pressure of a medication, fluid or other material
being delivered to the target anatomical location. Thus, the system
can comprise pressure and/or flow measurement devices (e.g.,
pressure transducers, flowmeters, etc.). Pressure sensing devices
can be used to ensure that the pressure or vacuum created by the
discharge of the medications, compositions, fluids and/or other
materials within the anatomy does not exceed a particular threshold
level. This can help prevent or reduce the likelihood of damage
occurring to the patient being treated using the injection system.
Such an internal force measurement system can be configured to
automatically shut off the fluid transfer device (e.g., movement of
the stepper motor, other pump, etc.) when the discharge pressure
exceeds a maximum level (e.g., 3 psi). In other arrangements, the
fluid delivery module can include a visual and/or audible alarm or
other similar feature to alert the user than a threshold pressure
has been attained, either in lieu of or in addition to any
automatic shut-off mechanism. For example, the clinician or other
user can track real-time pressure and/or flowrate data on
corresponding portions of the display during an injection
procedure. Other types of feedback that indicates position or
placement to a user may also be used (e.g., mechanical or tactile
feedback). Such safety features can be included in any of the
embodiments of the modules or systems disclosed herein.
[0483] As shown in FIGS. 39A-39J and 40A-40T, the screenshots can
comprise various graphical and/or numeric portions that are adapted
to provide data and other information to the user, either before or
during an injection procedure. In addition, the display can include
softkeys, buttons and/or other data input devices that permit a
user to adjust and customize an injection procedure as desired or
required. For example, the screenshots can assist a user to set up
the injection system (e.g., update the time and date, inform the
system that a cassette is being replaced, etc.).
[0484] Non-limiting examples of injection procedures that may be
performed using the various embodiments of systems, devices and
methods disclosed herein (or equivalents thereof) are provided
below. It should be noted that these examples are provided to
simply demonstrate only some of the features and/or other details
of injection systems, devices and methods discussed and illustrated
herein. As such, the following examples or any other portion of the
specification or figures should not be used to limit the present
application in any manner.
[0485] The flowchart in FIG. 41 schematically illustrates one
non-limiting example of a sequence 1000 for delivering anesthetics,
other medications, formulations and/or other fluids or substances
to a target anatomical site (e.g., a joint, an organ, etc.) for
performing, e.g., a regional anesthesia or other procedure using an
injection system in accordance with the embodiments disclosed
herein. A touchscreen or other visual display of a fluid delivery
module or other portion of the system can be configured to
initially display 1010 a logo, the time, date, patient and/or
physician identifying information, hospital or facility name or
logo and/or any other image, design or other alpha-numeric text.
However, in other embodiments, such a display is configured to not
display anything at all. In fact, the fluid delivery module may not
include a display at all.
[0486] With continued reference to FIG. 41, a physician, clinician
or other user can prepare the system 1014 for the subsequent
delivery of fluids into a patient. For example, as discussed in
greater detail herein, a cassette (or other portion of the fluid
delivery module) can be positioned within a corresponding recess or
other portion of a fluid delivery module. If a cassette is already
secured to the fluid delivery module, the user may need to replace
it with a new cassette. In some embodiments, used needle
assemblies, handpiece assemblies, delivery lines, other conduits,
clips and/or any other components or portions of the injection
system are removed and replaced. For example, the clinician or
other user can secure an appropriately sized (e.g., length,
diameter, etc.) and configured (e.g., a stimulation needle that is
insulated over the majority of its length with a conductive tip)
sterile needle assembly to the distal end of the handpiece device
(e.g., using a luer lock or other standard or non-standard
connection or fitting). As discussed in greater detail herein, the
entire handpiece assembly (e.g., including the handpiece portion
and the upstream tubing that connects to the fluid delivery module)
can be replaced between patients. In arrangements having a
removable control module, the clinician can reposition the control
module to the new handpiece assembly prior to use.
[0487] As discussed in greater detail herein, a handpiece assembly,
a needle assembly, a cassette and/or any other component of the
injection system can be replaced between injection/aspiration
treatments or procedures. Thus, in accordance with standard
practices, cross-contamination of fluids and/or other materials
(e.g., between different patients) can be prevented. In some
embodiments, assuming that there is no need to change the
medications or other materials loaded within the delivery module
(e.g., no changes in types or dosages), replacement of only the
handpiece assembly or the needle assembly can advantageously permit
a clinician to quickly and easily perform injection procedures in
many different patients. For example, in some embodiments, a
physician can perform injection procedures in 20-40 or more
different patients per day without having to replace the cassette
and/or any other portion of the handpiece assembly. Therefore, for
practical reasons, a clinician can dedicate a particular delivery
module to a specific combination of medications or other substances
so that he or she only needs to replace the handpiece assembly
and/or the tip between uses, depending on the particular injection
system embodiment being utilized.
[0488] In other embodiments, where the type, dosage or other
characteristics of the medications or other substances secured
within the loading area of the delivery module change, the
clinician or other user may also be required to replace the
cassette, clip, delivery line or other conduits and/or any
component, subcomponent or portion of the injection system that may
contact the medications, formulations and/or other fluids or
materials being delivered within an anatomy. Thus, as discussed
with respect to the various embodiments disclosed herein, certain
components and portions of the injection system (e.g., the
handpiece assembly, fluid delivery module, etc.) can be
advantageously configured to be easily and quickly removed and
replaced as desired or required (e.g., between injection
procedures, when the characteristics of the medications and/or
other materials being injected are modified, according to some
predetermined schedule, etc.). The foregoing disclosure regarding
the replacement of handpiece assemblies, needle assemblies, tips,
clips, delivery lines, other conduits and/or the like can be
applied to any embodiments disclosed herein or variations
thereof.
[0489] Once the injection system has been adequately prepped, the
clinician can select 1018 the details of the particular injection
procedure to be performed. For example, in some embodiments, the
clinician uses the interactive menus provided on a display of the
fluid delivery module or other component of the system to choose
one of various protocols already recognized by the injection system
(e.g., saved within the memory of the fluid delivery module). In
other arrangements, the clinician enters the details (e.g., types,
volumes or other amounts, dosages and/or other information)
regarding the medications, formulations and/or other materials to
be injected into a patient. Thus, a clinician or other user can
customize a particular injection protocol, as desired or required.
In some embodiments, the injection system is configured to save the
details of the various injection protocols, thereby allowing a
clinician or other user to access them in the future (e.g., for
purposes of repeating the same injection protocol, for record
keeping and/or for any other purpose). For example, in some
embodiments, an interactive menu allows for selection of a
particular clinician. A menu can then allow for selection of a
particular nerve, procedure, and/or other information. The
injection system may then be able to retrieve a particular
injection protocol that the clinician prefers for that particular
nerve or procedure. Such data and other information can be shared
with another network (e.g., the hospital's or other faculty's main
network, the internet, etc.).
[0490] Next, the clinician or other user can secure 1022 one or
more vials containing the medications, formulations and/or other
fluids or materials to a cassette, another portion of the fluid
delivery module and/or the like in preparation for a desired
injection procedure. For example, each vial or other container can
comprise anesthetics (e.g., ropivacaine, mepivacaine, ropivacaine
with epinephrine, mepivacaine with epinephrine, dextrose (D5W), or
any other suitable anesthetic) or other pain-relieving medications
(e.g., Lidocaine, other slow or fast acting anesthetics, etc.)
steroids (e.g., Depo-Medrol.RTM., methylprednisolone acetate,
etc.), hyaluronic acid, saline, pharmaceutical compositions, other
medications or drugs, cells (e.g., stem cells and other biologics),
liquid and non-liquid fluids and flowable materials, nanoparticles,
cement, microbeads and/or combinations of such fluids and other
materials. In any of the embodiments disclosed herein, an
anesthetic or intra-articular injection can include the selective
delivery of three different drugs into a patient.
[0491] In some embodiments, the vials, ampoules, syringes and/or
other containers are secured to a nest, loading area or other
receiving area of the fluid delivery module (e.g., cassette).
Alternatively, the vials can be positioned along a different
portion of the fluid delivery module or other component of the
injection system, as desired or required.
[0492] According to some arrangements, the vials or other
containers secured to the fluid delivery module or other portion of
the system are optionally verified 1026 to confirm that the
characteristics (e.g., type, dosage, volume, expiration date, etc.)
of the medications, formulations and/or other fluids or materials
that will be delivered into a patient are in accordance with the
intended protocol. This can improve the safety and accuracy of the
injection procedure, as the likelihood of delivering incorrect
substances to a patient is advantageously eliminated or
reduced.
[0493] Confirmation of the medications and/or other materials
contained within the vials secured to the fluid delivery module or
other portion of the injection system can be performed manually or
automatically. As a result, when a vial is secured to the fluid
delivery module, a reader or other identification device can be
configured to automatically detect the contents of such a vial. In
other arrangements, the fluid delivery module or other portion of
the injection system comprises a barcode scanner, RFID reader or
other device adapted to identify a machine-readable machine code
(e.g., barcode or other textual code, color or graphical pattern,
etc.) and/or the like. In still other embodiments, the clinician or
other user manually confirms the contents of a vial or other
container. For such systems, a user may be required to enter
certain data and/or other information about the vials or other
containers into one or more components of the injection system. For
instance, a user can use a touchscreen, a keypad or keyboard or
other data entry device to input the NDC, the name of the
medication and/or any other information, to confirm the identity of
the vials and/or the like.
[0494] With continued reference to the example injection procedure
that is schematically illustrated in FIG. 41, the clinician can
then transfer 1030 all or some of the medications, formulations
and/or other materials contained in the vials or other container to
an interior portion of the fluid delivery module or other component
of the injection system. For example, as discussed in greater
detail herein, the internal contents of such vials or other
containers can be conveyed to syringes or other reservoirs within a
cassette or other portion of the fluid delivery module. Once within
such reservoirs, one or more of the various medications and/or
other materials can be selectively administered into a patient
through a downstream handpiece assembly.
[0495] In any of the embodiments disclosed herein, a preliminary
priming step may precede any transfer of fluids within or out of
the injection system. For example, such a priming step can be used
to transfer fluids and/or other materials from a vial to an
internal reservoir of a cassette, from a cassette reservoir to the
handpiece assembly and/or the like. In addition, in order to ensure
that no gas bubbles are injected into a patient, the injection
system can be configured to expel a certain volume of fluids and/or
other materials before an injection procedure is commenced. One or
more other ways of detecting potentially dangerous gas bubbles
within a cassette, a conduit and/or other portions of the injection
system can be used.
[0496] In some embodiments, before any medications and/or other
materials can be injected into a patient, the needle at the distal
end of the handpiece assembly is accurately positioned at or near
targeted nerve tissue, joint, etc. In some embodiments, imaging
techniques can be used to locate 1034 such a targeted location.
Alternatively, one or more other devices or methods can be used to
accurately position the needle within a patient's body. For
example, as discussed in greater detail herein, the injection
system can comprise ultrasound, radio frequency spectroscopy and/or
other imaging capabilities to assist in accurately positioning the
needle of the handpiece assembly within the anatomy of a patient.
Additionally, nerve stimulation can be used to confirm location of
the needle near the targeted nerve tissue or other portion of the
anatomy. Incorporating imaging technologies (e.g., ultrasound,
radio frequency spectroscopy, CT, MRI, etc.), nerve stimulation,
and/or other locating techniques into an injection/aspiration
system can facilitate the injection and/or aspiration procedures
for a physician or other clinician. For example, as noted herein,
such injection systems can permit a single user to conduct the
entire procedure alone. After locating the target nerve via
ultrasound, nerve stimulation, and/or other techniques, the user
can use aspiration or negative pressure to confirm that the needle
is not within a blood vessel (indicated by an absence of blood
during aspiration).
[0497] In other embodiments, locating the targeted anatomical
location (e.g., nerve, joint) comprises measuring one or more
tissue characteristics at or near the tip or distal end of the
needle being inserted into the anatomy. Each type of nerve area,
intra-articular space, or other anatomical location can be
associated with a particular tissue response range within which the
tissue response value at the distal end of the needle should be.
Thus, as the needle is advanced through skin, subcutaneous tissue
and/or other anatomical layers, the tissue response value at or
near the tip of the needle may fluctuate. In one embodiment, the
tissue response value at the needle tip decreases as the needle
enters into the desired intra-articular space or other portion of
the anatomy that comprises a cavity or similar structure (e.g., an
organ). Therefore, the system can be configured to instruct the
user to advance the needle until the tissue response value drops
below a specific threshold level.
[0498] In some embodiments, an optical fiber, electrode or other
type of sensing device can be located at or near the distal end of
the needle. A processor of the delivery module can be programmed or
otherwise configured so when a tissue response value is measured,
received or detected by the corresponding sensor (e.g., optical
fiber, electrode, etc.), the fluid delivery module can determine
whether the targeted anatomical area has been reached. The delivery
module can be configured to indicate relevant information regarding
the needle's position using one or more devices, components or
methods, such as, for example, via the touchscreen or other display
(e.g., visual readouts, charts, etc.), via audible indicia (e.g.,
tones, voice commands, etc.) and/or the like.
[0499] A display of the fluid delivery module (e.g., touchscreen,
LCD screen, other monitor, etc.) can be configured to provide a
textual and/or graphic representation of the tissue response value,
its rate of change and/or any other details related to locating an
area surrounding a nerve, an intra-articular space or other
anatomical location. For example, the tissue response value at or
near the tip of the needle can be displayed as the actual value (as
text) or as a chart or graph (e.g., X-Y plot, a circular target
chart, etc.).
[0500] After the needle has been properly positioned within a
patient, the clinician can initiate delivery 1038 of one or more
medications, formulations and/or other fluids or materials, as
required by a particular injection protocol. As discussed, the
clinician can use the buttons or other controllers on the handpiece
assembly or other portion of the injection system to accurately
control the delivery of a particular fluid or material stream into
the patient. The buttons can be located on a removable control
module, on a core and/or any other portion or component of the
handpiece assembly. In other embodiments, a button and/or other
controller used to regulate the delivery of fluids and/or other
materials through the injection system can be included in a foot
pedal, on the fluid delivery module, on another portion or
component of the injection system, on an imaging wand operatively
coupled to the injection system and/or any other device or
system.
[0501] The incorporation of mechanically (e.g., using a stepper
motor), hydraulically, pneumatically or differently driven delivery
of medications, formulations and/or other fluids or materials from
the fluid delivery module to the patient can facilitate the
execution of an injection procedure. For example, a physician or
other clinician can simply use one or more buttons or other
controllers (e.g., on a control module, core, other portion of a
handpiece assembly, touchscreen of fluid delivery module, imaging
wand, etc.) to accurately deliver a volume or other amount of a
particular substance to or near nerve tissue or another targeted
anatomical location. This can be particularly helpful when the
manual delivery of such fluids and/or other materials could be
difficult, strenuous, repetitive or otherwise problematic. A
relatively high and persistent force and effort may be required by
the physician or other clinician to deliver one or more medicaments
and/or other substances to a targeted anatomical location. This can
be particularly problematic when attempting to inject dense,
viscous or high-solids fluids or other materials to small joints
(e.g., toes, fingers, midfoot joints, etc.) or another high
back-pressure locations within an anatomy (e.g., to or near bones,
certain organs, etc.). Thus, at least some of the embodiments of
the injection systems, devices and methods disclosed herein permit
the delivery of one or more medicaments and/or other materials from
a fluid delivery module to a target anatomical location within a
patient without the need to push or exert the necessary force or
effort to physically administer such substances. Consequently, the
clinician or other user can dedicate more of his or her time and
effort in accurately locating a nerve, joint or other targeted
anatomical location and executing the desired injection
procedure.
[0502] As discussed, the clinician can selectively deliver 1042 one
or more other fluid and/or material streams into a patient, either
alone or concurrently with the delivery of another stream. In some
embodiments, this is accomplished by pressing or otherwise
manipulating buttons or other controller on the handpiece assembly
or another portion of the injection system. Alternatively, a single
button or other controller can regulate the sequential or
simultaneous delivery of all fluid and/or other material streams
from the fluid delivery module to a patient's anatomy. Further, the
injection system can be configured so that operation of such a
button or other controller causes two or more different fluid
and/or material streams to be simultaneously delivered through the
needle. Screenshots (e.g., FIGS. 39A-39J and 40A-40T) visually
provided on a display (e.g., of a fluid delivery module) or other
output device can assist the clinician with selecting an injection
protocol and/or executing an injection procedure.
[0503] According to some embodiments, a treatment procedure
comprises the injection of a volume of an anesthetic and/or a
steroid (Depo-Medrol.RTM.) after a volume of a first medication
(e.g., Lidocaine or another anesthetic or pain-relieving
medication) has been injected into the targeted area. In other
arrangements, one or more other fluids and/or other materials
(e.g., hyaluronic acid, saline, pharmaceutical compositions, cells,
nanoparticles, cement, microbeads, etc.) can be contained within
one or more of the vials or other containers loaded onto the
cassette or other portion of the fluid delivery module, either in
lieu of or in addition to the anesthetics, pain-relieving
medications and steroids, as required or desired. In one
embodiment, an intra-articular injection can include the selective
delivery of three different drugs into a patient, a corticosteroid,
a short-acting anesthetic and a long-acting anesthetic. In
alternative embodiments, more or fewer (or different) medicaments.
Further, one or more anesthetic agents and/or other materials can
be included in a particular injection protocol. According to some
embodiments of injection modes or sequences, two or more of the
various medications, other fluids and/or other materials loaded
onto a fluid delivery module can be delivered simultaneously with
one another or sequentially.
[0504] Once the desired volumes or other quantities of medications,
formulations and/or other substances have been delivered, the
clinician can remove the needle from the patient and terminate the
procedure 1046. However, in other embodiments, one or more
additional treatment steps or procedures may remain after the
delivery of the desired medications and/or other substances.
Depending on the particular embodiment being utilized, the
handpiece assembly, the needle assembly, the tip and/or any other
component of the injection system (e.g., cassette, vials or other
containers, clip, delivery line, etc.) can be properly discarded
1050 to reset 1054 the system in preparation for a subsequent
injection procedure.
[0505] In any of the embodiments disclosed herein, certain cleaning
protocols can be used to help prevent or reduce the likelihood of
viral ingress or other forms of contamination. For example,
whenever a removable component is detached from a corresponding
fitting or area of the injection system, a user may need to clean
the exposed surfaces (e.g., swab, wipe, etc.) with one or more
materials (e.g., wipes or swabs comprising isopropanol, other
alcohols, sterilizing agents, disinfectants and/or the like). In
some embodiments, for example, a clinician or other user can swab,
wipe or otherwise clean the exposed recess of a fluid delivery
module (e.g., when a cassette is being replaced), a core (e.g.,
when a clip is being replaced), the distal end of a handpiece
assembly (e.g., when a needle assembly is being replaced), the nest
or receiving areas (e.g., when a vial, ampoule, syringe or other
container is being replaced) and/or the like.
[0506] To assist in the description of the disclosed embodiments,
words such as upward, upper, bottom, downward, lower, rear, front,
vertical, horizontal, upstream, downstream have been used above to
describe different embodiments and/or the accompanying figures. It
will be appreciated, however, that the different embodiments,
whether illustrated or not, can be located and oriented in a
variety of desired positions.
[0507] Although several embodiments and examples are disclosed
herein, the present application extends beyond the specifically
disclosed embodiments to other alternative embodiments and/or uses
of the inventions and modifications and equivalents thereof. It is
also contemplated that various combinations or subcombinations of
the specific features and aspects of the embodiments may be made
and still fall within the scope of the inventions. Accordingly, it
should be understood that various features and aspects of the
disclosed embodiments can be combine with or substituted for one
another in order to form varying modes of the disclosed inventions.
Thus, it is intended that the scope of the present inventions
herein disclosed should not be limited by the particular disclosed
embodiments described above, but should be determined only by a
fair reading of the claims that follow.
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