U.S. patent application number 16/422739 was filed with the patent office on 2019-09-12 for reinforced septum for an implantable medical device.
The applicant listed for this patent is C. R. Bard, Inc.. Invention is credited to Kelly J. Christian, Charles L. Farnworth, Dwight T. Hibdon.
Application Number | 20190275311 16/422739 |
Document ID | / |
Family ID | 52344145 |
Filed Date | 2019-09-12 |
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United States Patent
Application |
20190275311 |
Kind Code |
A1 |
Hibdon; Dwight T. ; et
al. |
September 12, 2019 |
Reinforced Septum For An Implantable Medical Device
Abstract
An access port includes an access port body and a
needle-penetrable septum. The access port body can be of integral
single-piece construction, and can define a reservoir aligned with
an access opening. The access port body can further define an
annular groove between the reservoir and the opening. The annular
groove can have a diameter greater than a diameter of the access
opening and a diameter of the reservoir. The needle-penetrable
septum can include an upper portion disposed in the access opening
and an annular flange disposed in the annular groove. The annular
flange can extend radially outward from a lower portion of the
septum, and can have a diameter greater than a diameter of the
upper portion of the septum. The needle-penetrable septum can
further include an annular reinforcement structure disposed within
the annular flange.
Inventors: |
Hibdon; Dwight T.; (Park
City, UT) ; Christian; Kelly J.; (Draper, UT)
; Farnworth; Charles L.; (Riverton, UT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
C. R. Bard, Inc. |
Murray Hill |
NJ |
US |
|
|
Family ID: |
52344145 |
Appl. No.: |
16/422739 |
Filed: |
May 24, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14508227 |
Oct 7, 2014 |
10307581 |
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16422739 |
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14455660 |
Aug 8, 2014 |
9937337 |
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14508227 |
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12419854 |
Apr 7, 2009 |
8805478 |
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14455660 |
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11380124 |
Apr 25, 2006 |
8545460 |
|
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12419854 |
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13110734 |
May 18, 2011 |
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14508227 |
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60737466 |
Nov 15, 2005 |
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60675309 |
Apr 27, 2005 |
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61345846 |
May 18, 2010 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 6/481 20130101;
A61M 2039/0229 20130101; A61M 2005/1585 20130101; A61M 2039/0072
20130101; A61M 39/04 20130101; A61M 5/158 20130101; A61M 2039/0054
20130101; A61M 2005/325 20130101; A61M 2207/00 20130101; A61M
2209/04 20130101; A61M 2039/0045 20130101; A61M 2005/1581 20130101;
A61M 39/0208 20130101; A61M 2039/0063 20130101; Y10T 428/139
20150115; Y10T 29/49872 20150115; A61M 2205/32 20130101; A61M
2205/0266 20130101; A61M 5/3273 20130101; A61M 2039/0238
20130101 |
International
Class: |
A61M 39/02 20060101
A61M039/02; A61M 39/04 20060101 A61M039/04 |
Claims
1. An access port, comprising: an access port body of integral
single-piece construction; a reservoir defined in the access port
body, the reservoir aligned with an access opening in the access
port body; an annular groove defined in the access port body
between the reservoir and the opening, the annular groove having a
diameter greater than a diameter of the access opening and a
diameter of the reservoir; and a needle-penetrable septum,
comprising: an upper portion disposed in the access opening; an
annular flange disposed in the annular groove, the annular flange
extending radially outward from a lower portion and having a
diameter greater than a diameter of the upper portion; and an
annular reinforcement structure disposed within the annular
flange.
2. The access port according to claim 1, wherein the diameter of
the annular groove is greater than the diameter of the annular
flange.
3. The access port according to claim 1, wherein the annular
reinforcement structure is a cord formed from shape memory
material.
4. The access port according to claim 1, wherein the annular
reinforcement structure includes a plurality of discrete
segments.
5. The access port according to claim 1, wherein the annular
reinforcement structure is a continuous annular cord including a
circular cross sectional shape, and is substantially non-resilient
along an annular axis thereof.
6. The access port according to claim 5, wherein the continuous
annular cord comprises a memory shape material and is capable of
assuming a first shape configuration during placement of the
annular flange in the groove, and a second shape configuration
after at least partial placement of the annular flange in the
groove.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a division of U.S. patent application
Ser. No. 14/508,227, filed Oct. 7, 2014, now U.S. Pat. No.
10,307,581, which is a continuation-in-part of: 1) U.S. patent
application Ser. No. 13/110,734, filed May 18, 2011, which claims
the benefit of U.S. Provisional Application No. 61/345,846, filed
May 18, 2010; and 2) U.S. patent application Ser. No. 14/455,660,
filed Aug. 8, 2014, now U.S. Pat. No. 9,937,337, which is a
division of U.S. patent application Ser. No. 12/419,854, filed Apr.
7, 2009, now U.S. Pat. No. 8,805,478, which is a division of U.S.
patent application Ser. No. 11/380,124, filed Apr. 25, 2006, now
U.S. Pat. No. 8,545,460, which claims the benefit of priority to:
1) U.S. Provisional Application No. 60/737,466, filed Nov. 15,
2005, and 2) U.S. Provisional Application No. 60/675,309, filed
Apr. 27, 2005. Each of the aforementioned applications is
incorporated by reference in its entirety into this
application.
BACKGROUND
[0002] A wide variety of medical procedures require infusion of a
fluid into a patient. For example, vascular imaging technologies
may require use of a contrast media that is injected into the
patient. More specifically, computed tomography (CT) is an imaging
technology that utilizes a contrast media and may be employed for
the noninvasive evaluation and assessment of a vascular system
(i.e., CT angiography or CTA). Multidetector computed tomography
(MDCT) is one specific type of CT that may be utilized for CTA. For
proper imaging of a vascular system via CT, intravenous contrast
media injection protocols are coordinated and selected for the
anatomic area of interest.
[0003] More particularly, conventionally, a so-called "power
injector" system may be employed for injecting contrast media at a
high pressure into a peripherally inserted intravenous (IV) line.
For example, such power injectors or injection systems may be
commercially available from Medrad, Inc., a subsidiary of Schering
AG, Germany and may be marketed as STELLANT.RTM. injection systems.
Because CT procedures are often defined in terms of a desired flow
rate of contrast media, such power injection systems are, in
general, controllable by selecting a desired flow rate.
Accordingly, such power injection systems may develop pressure
(within the maximum pressure capability of the power injection
system) as is necessary to maintain the selected flow rate.
Accordingly, as may be appreciated, obstructions in the IV lines or
use of IV lines that are not structured to withstand the pressures
of a desired injection rate may cause the power injector to
generate a pressure that exceeds a suitable pressure limit for the
IV line. After intravenous injection, a bolus of contrast material,
may flow within the vascular system of the patient to the right
side of the heart, through the lungs, into the left side of the
heart, and through the remaining circulatory system. After the
bolus of contrast media is injected into the patient, portions of
the contrast media may remain in the right side of the heart. Thus,
the overall effectiveness of contrast enhancement may depend on a
multitude of factors. For example, a patient's characteristics
(e.g., body size; circulation, including cardiac output and
circulating volume, and renal function), the contrast
characteristics (e.g., volume, injection rate, iodine
concentration, etc.), and the CT technique (e.g., access and route
of administration, scan delay, scan speed, and injection pattern)
may each influence the overall degree of contrast enhancement.
[0004] By way of background, conventionally, relatively long scan
times have been accompanied by relatively long contrast media
delivery times. However, because scan times continue to decrease,
relatively fast delivery of contrast media may be desired.
Explaining further, in coronary CTA, a large enough volume of
contrast material must be administered at a sufficiently high rate
to reach and maintain a suitable concentration throughout a
selected scan time (e.g., a 15 second scan time), and within a
selected region of the anatomy (e.g., an axial scan distance of 20
cm, which may include the left ventricle and outflow tract). It
also may be desirable that contrast density values are sufficient
to facilitate the segmentation techniques used in multidimensional
post-processing. A typical contrast media used in coronary CTA may
have an iodine density of about 300 milligrams per milliliter to
about 350 milligrams per milliliter. Also, since contrast media may
be radioactive, reducing the overall quantity of contrast media
required to perform an imaging process may be advantageous.
[0005] The pressure required for contrast injection depends on many
factors, including flow rate, contrast viscosity, configuration of
infusion tubing, such as tube diameter and length, and any
obstruction or restriction to flow (e.g., kinks, curves, fittings,
compression). As mentioned above, to maintain the flow rate
required for a CT or Mill study, a power injector may generate high
pressures. Ruptures can occur when the injection pressure exceeds
the tolerance of the vascular access device(s). Other problems may
occur due to timing errors between the scan and the contrast. In
order to maximize the rapid scanning capacity of the newer vascular
imaging devices, the starting of the scanning process can be
delayed a predetermined amount of time after injection of the
contrast media has begun. If the scan starts too early, just as the
contrast is arriving at the heart, arteries can appear smaller than
they really are when the image is post-processed. On the other
hand, if scanning is delayed too long, image artifacts can arise
from diluted contrast in the cardiac veins. The window of
opportunity for optimal scans may be very small, because contrast
media circulates quickly through cardiac arteries and into cardiac
veins.
[0006] Some diagnostic or medical procedures may advantageously
employ a subcutaneous vascular access port for introducing a fluid
into the vasculature of a patient. Access portals, or ports,
provide a convenient method to repeatedly deliver medicants to
remote areas of the body without utilizing surgical procedures. The
port is implantable within the body, and permits the infusion of
medications, parenteral solutions, blood products, contrast media,
or other fluids. Additionally, the port may be used to aspirate
blood from the patient. Such access ports typically include a
cannula-impenetrable housing which encloses one or more fluid
cavities or reservoirs and defines for each such fluid cavity an
access aperture communicating through the housing. A
cannula-penetrable septum is positioned adjacent to and seals each
access aperture. An outlet stem communicates with one or more of
the fluid cavities for dispensing medication therefrom to a
predetermined location in the body of the patient through an
implanted catheter attached to the access port. Once the access
port and the catheter have been implanted beneath the skin of a
patient, quantities of fluid, such as medication, blood, etc., may
be dispensed through one such fluid cavity by, for example, a
cannula (e.g., a needle), passed through the skin of the patient
and penetrating the septum into one of the respective fluid
cavities. This medication is directed through the distal end of the
catheter to an entry point into the venous system of the body of
the patient. Further, blood may be aspirated through the
subcutaneous access port. Thus, use of an access port may allow for
vascular access without needle sticks into the vasculature of a
patient.
[0007] However, conventional access ports and attendant infusion
systems have not been suitable for performing power injection.
[0008] Particularly, the use of power injection systems in
combination with conventional vascular access ports has achieved
less than ideal results. Thus, it may be appreciated that vascular
access ports for infusion systems and infusion-related apparatuses
structured for performing power injection may be advantageous.
BRIEF SUMMARY
[0009] One aspect of the instant disclosure relates to a method of
flowing fluid through an access port. More particularly, a vascular
access port may be provided and a fluid may be caused to flow
through the access port at a rate of at least about 1 milliliter
per second. A further aspect of the instant disclosure relates to a
method of flowing fluid through an infusion set. For example, an
infusion set may be provided and a fluid may be flowed through the
infusion set at a rate of at least about 1 milliliter per
second.
[0010] One aspect of the instant disclosure relates to an access
port for providing subcutaneous access to a patient. Specifically,
an access port may comprise a housing defining an aperture for
capturing a needle-penetrable septum, wherein the housing and
septum define a reservoir. In addition, the septum may include a
tenon region wherein the housing of the access port defines a
complimentary mortise region structured for accepting at least a
portion of the tenon region of the septum. Optionally, the housing
may include a ring structure proximate to at least a portion of a
side periphery of the septum.
[0011] In one embodiment, the needle-penetrable septum is resilient
and includes a reinforcement structure that bolsters septum
placement over the fluid cavity so as to inhibit unintended
separation of the septum from the medical device when the fluid
cavity is under pressure, such as during power injection of fluid
into the fluid cavity. The reinforcement structure further assists
in preventing septum separation during other septum stress events
including insertion of a needle through the septum to access the
port fluid cavity, or removal of the needle from the septum when
access is no longer needed.
[0012] In one embodiment the septum comprises a resilient septum
body that includes a flange disposed about a perimeter thereof. A
reinforcement component is disposed in the flange for reinforcing
engagement of the flange with a corresponding groove defined about
an opening to the fluid cavity of the medical device so as to
inhibit unintended detachment of the septum from the medical
device. The reinforcement component in one embodiment includes an
annular cord disposed in the flange.
[0013] Various methods for inserting the reinforced septum into the
groove in order to sealably cover the fluid cavity are also
disclosed, including temporary deformation of the septum,
oversizing of the outer diameter of the groove, and the use of
memory shape materials for the reinforcement cord. A septum
configured as described herein can thus be secured to the access
port without the need of an additional cap or retaining ring. This
in turn enables an integral access port body of single-piece
construction to be employed, which provides simplified design and
construction.
[0014] In one embodiment, an access port may comprise a housing
defining an aperture for capturing a septum, the housing and septum
defining a reservoir. The housing and septum may be structured for
accommodating a flow rate through the reservoir of at least about 1
milliliter per second and for accommodating a pressure developed
within the reservoir of at least about 35 psi.
[0015] Another aspect of the instant disclosure relates to an
infusion set for use in subcutaneously accessing a patient. For
example, in one embodiment, an infusion set may comprise a tubing
section defining a lumen and a cannula in fluid communication with
the lumen of the tubing section. Also, the cannula may be
configured for insertion through a septum of an access port, and
the tubing section and the cannula may be structured for allowing a
fluid to flow at a rate of at least about 1 milliliter per second.
Optionally the cannula may be configured for puncturing a septum of
an access port and the tubing section and the cannula may be
structured for accommodating a pressure of at least about 400 psi.
For example, the tubing section and the cannula may be structured
for accommodating a pressure of about 600 psi.
[0016] A further aspect of the instant disclosure relates to
infusion tubing for use in accessing a vascular system of a
patient. In one embodiment, infusion tubing may comprise a
plurality of layers, wherein the tubing is structured for
accommodating a fluid flow rate of at least about 1 milliliter per
second. In one embodiment, infusion tubing may comprise a plurality
of layers, wherein at least one layer of the plurality of layers
extends beyond at least another of the plurality of layers and is
structured for forming a cannula for puncturing a septum of an
access port. In one embodiment, an infusion set for use in
subcutaneously accessing a patient may comprise a tubing section
defining a lumen and a cannula in fluid communication with the
lumen of the tubing section, wherein the cannula is configured for
insertion through a septum of an access port. The tubing section
and cannula may be structured for accommodating a pressure of at
least about 400 psi.
[0017] Another aspect of the instant disclosure relates to a method
of identifying an access port as being suitable for power
injection. More specifically, an access port including a septum may
be provided. Further, the access port may be identified as being
suitable for power injection.
[0018] Yet a further aspect of the instant disclosure relates to an
access port for providing subcutaneous access to a patient.
Particularly, an access port may comprise a housing configured for
capturing a septum, the septum configured for inserting a cannula
therethrough and into a reservoir defined within the housing and at
least one structural element configured for resisting deformation
of the septum in response to a pressure developed within the
reservoir.
[0019] In an additional aspect of the instant disclosure, a method
of operation of an access port may comprise providing a housing
configured for capturing a septum, the septum configured for
inserting a cannula (which can include a needle, a Huber needle, a
trocar with an associated cannula, or any combination thereof)
therethrough and into a reservoir defined within the housing, and
developing a pressure within the reservoir of the housing. Further,
such a method may comprise limiting deformation of the septum in
response to the pressure developed within the reservoir.
[0020] In addition, one aspect of the instant disclosure relates to
a septum comprising a gel or a viscous liquid. For example, in one
embodiment, a septum for assembly with a housing to form an access
port for providing subcutaneous access to a patient may comprise a
body including an upper surface and a lower surface and at least
one gel region positioned generally between the upper surface and
the lower surface. Another embodiment may comprise a septum for
assembly with a housing to form an access port for providing
subcutaneous access to a patient may comprise a body, a layer
formed over at least a portion of the body, and a gel region
positioned at least partially between the layer and the body.
[0021] The above-described infusion apparatuses and related methods
may be beneficially employed for effecting or facilitating power
injection processes. For instance, such methods and apparatuses may
be employed for infusing a fluid (e.g., a contrast media) at a rate
of between about 1 milliliter per second and about 5 milliliters
per second.
[0022] Features from any of the above mentioned embodiments may be
used in combination with one another in accordance with the instant
disclosure. In addition, other features and advantages of the
instant disclosure will become apparent to those of ordinary skill
in the art through consideration of the ensuing description, the
accompanying drawings, and the appended claims, or may be learned
by the practice of embodiments of the invention as set forth
hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0023] A more particular description of the present disclosure will
be rendered by reference to specific embodiments thereof that are
illustrated in the appended drawings. It is appreciated that these
drawings depict only typical embodiments of the invention and are
therefore not to be considered limiting of its scope. Example
embodiments of the invention will be described and explained with
additional specificity and detail through the use of the
accompanying drawings in which:
[0024] FIG. 1 shows an exploded, perspective view of an access port
according to the instant disclosure;
[0025] FIG. 2 shows a schematic, side cross-sectional view of the
access port shown in FIG. 1;
[0026] FIG. 3 shows a schematic, top elevation view of a cap
including a ring feature as shown in FIGS. 1 and 2;
[0027] FIG. 4 shows a schematic, top elevation view of another
embodiment of a cap including a ring feature;
[0028] FIG. 5 shows a schematic, top elevation view of a further
embodiment of a cap including a ring feature;
[0029] FIG. 6 shows a schematic, side cross-sectional view of an
implanted access port with a cannula extending through the septum
of the access port;
[0030] FIG. 7 shows a graph depicting pressures at selected regions
within an infusion system for a given flow rate;
[0031] FIG. 8 shows a schematic, side cross-sectional view of an
access port including a septum with a tenon region and a housing
with a mortise region;
[0032] FIG. 9 shows a schematic, side cross-sectional view of
another embodiment of an access port including a septum with a
tenon region and a housing defining a mortise region;
[0033] FIG. 10 shows a schematic, side cross-sectional view of a
further embodiment of an access port including a tenon region and a
housing defining a mortise region;
[0034] FIG. 11 shows a schematic, side cross-sectional view of an
access port, wherein at least a portion of a side periphery of the
septum is affixed to the housing;
[0035] FIG. 12 shows a schematic, side cross-sectional view of an
access port including a structural element extending between the
septum and the housing;
[0036] FIG. 13 shows a schematic, side cross-sectional view of an
access port including a structural element with a barbed end
positioned within the septum;
[0037] FIG. 14 shows a schematic, side cross-sectional view of an
access port including a structural element extending between an
upper surface of the septum and the housing;
[0038] FIG. 15 shows a schematic, side cross-sectional view of an
access port as shown in FIG. 14 and also including a support
element positioned adjacent to an upper surface of the septum;
[0039] FIG. 16 shows a schematic, side cross-sectional view of an
access port including a septum with an extension leg that extends
to the housing;
[0040] FIG. 17 shows a schematic, side cross-sectional view of an
access port including a septum with an extension leg comprising an
enlarged end that couples to a recessed form in the housing;
[0041] FIG. 18 shows a schematic, side cross-sectional view of an
access port including a septum in a structural element positioned
adjacent to an upper surface of the septum;
[0042] FIG. 19 shows a schematic, side cross-sectional view of an
access port including a septum and a structural element extending
laterally through the septum;
[0043] FIG. 20 shows a schematic, side cross-sectional view of an
access port including a septum and a structural element positioned
proximate to an upper surface of the septum;
[0044] FIG. 21 shows a schematic, side cross-sectional view of an
access port including a septum and a structural element positioned
proximate to a lower surface of the septum;
[0045] FIG. 22 shows a partial, top elevation view of an access
port, as shown in FIGS. 18-21, wherein structural elements are
arranged in a generally triangular pattern;
[0046] FIG. 23 shows a partial, top elevation view of an access
port, as shown in FIGS. 18-21, wherein structural elements are
arranged in two generally rectangular patterns;
[0047] FIG. 24 shows a partial, top elevation view of an access
port, as shown in FIGS. 18-21, wherein structural elements are
arranged in a first plurality of substantially parallel lines and a
second plurality of substantially parallel lines;
[0048] FIG. 25 shows a partial, top elevation view of an access
port as shown in FIGS. 18-21, wherein structural elements are
arranged as two intersecting substantially straight members;
[0049] FIG. 26 shows a partial, top elevation view of a septum
including a structural element positioned within the septum;
[0050] FIG. 27 shows a perspective view of a sectioned septum, as
shown in FIG. 26;
[0051] FIG. 28 shows a partial, top elevation view of a septum
including a plurality of structural elements;
[0052] FIG. 29 is a perspective view of an access port that serves
as one possible environment in which an embodiment of the present
disclosure can be practiced;
[0053] FIG. 30 is a cross sectional side view of a portion of an
implantable access port including a septum configured in accordance
with one embodiment;
[0054] FIGS. 31 and 32 respectively show top and cross sectional
side views of a septum configured in accordance with one
embodiment;
[0055] FIGS. 33 and 34 respectively show perspective and cross
sectional side views of an access port body configured in
accordance with one embodiment;
[0056] FIGS. 35 and 36 respectively show perspective and cross
sectional side views of an access port in accordance with one
embodiment;
[0057] FIG. 37 is a cross sectional side view of an access port
body in accordance with one embodiment;
[0058] FIG. 38 is cross sectional side view of an access port
including a septum according to one embodiment;
[0059] FIG. 39 is a cross sectional side view of an access port
including a septum according to another embodiment;
[0060] FIG. 40A-40D are cross sectional side views of possible
access port groove shapes in accordance with one embodiment;
[0061] FIGS. 41-43 are cross sectional side views showing insertion
of a septum into a groove of an access port;
[0062] FIG. 44 is a top view of a septum including a segmented cord
in accordance with one embodiment; and
[0063] FIG. 45 is a cross sectional side view of a portion of an
implantable access port including a septum configured in accordance
with one embodiment.
[0064] FIG. 46 shows a schematic, side cross-sectional view of an
access port including a septum exhibiting curvature;
[0065] FIG. 47 shows a top elevation view of one embodiment of a
septum frame;
[0066] FIG. 48 shows a schematic, side cross-sectional view of one
embodiment of a septum including the frame shown in FIG. 30 and
another material at least partially surrounding the frame;
[0067] FIG. 49 shows a schematic, side cross-sectional view of
another embodiment of a septum including a frame that is at least
partially surrounded by another material;
[0068] FIG. 50 shows a schematic, side cross-sectional view of yet
an additional embodiment of a septum including a frame that is at
least partially surrounded by another material;
[0069] FIGS. 51 and 52 show a respective schematic view of
different patterns that may be generated by radiopaque material
comprising a septum;
[0070] FIG. 53 shows a perspective view of one embodiment of an
infusion set according to the instant disclosure;
[0071] FIG. 54 shows a perspective view of another embodiment of an
infusion set according to the instant disclosure;
[0072] FIGS. 55 and 56 show a side cross-sectional view and an end
cross-sectional view of one embodiment of tubing including an inner
layer and an outer layer;
[0073] FIG. 57 shows a schematic, side cross-sectional view of
tubing including an inner layer, an outer layer, and at least one
reinforcing element;
[0074] FIG. 58 shows a schematic, side cross-sectional view of
another embodiment of tubing including an inner layer, an outer
layer, and at least one reinforcing element;
[0075] FIGS. 59 and 60 show an end cross-sectional view and a
schematic, side cross-sectional view, respectively, of tubing
including four layers;
[0076] FIGS. 61 and 62 show schematic, side cross-sectional views
of a tubing section including a plurality of layers, wherein at
least one layer of the plurality of layers extends from a distal
end of the tubing to form a slender hollow region for insertion
through a septum of an access port;
[0077] FIG. 63 shows a perspective view of one embodiment of an
infusion system configured for inserting a flexible catheter
through a septum of an access port;
[0078] FIG. 64 shows a schematic, partial, side cross-sectional
view of the infusion system shown in FIG. 63;
[0079] FIG. 65 shows a perspective view of another embodiment of an
infusion system configured for inserting a flexible catheter
through a septum of an access port;
[0080] FIG. 66 shows a schematic, partial, side cross-sectional
view of the infusion system shown in FIG. 65;
[0081] FIG. 67 shows a perspective view of the infusion system
shown in FIG. 65, wherein the insertion assembly is removed from
the hub;
[0082] FIG. 68 shows a perspective view of one embodiment of an
access port according to the instant disclosure;
[0083] FIG. 69 shows a top elevation view of the access port shown
in FIG. 68;
[0084] FIG. 70 shows a simplified representation of a transverse
cross-section of the access port shown in FIGS. 68 and 69;
[0085] FIG. 71 shows a schematic, side cross-sectional view of one
embodiment of a septum including at least one gel region;
[0086] FIG. 72 shows a schematic, side cross-sectional view of
another embodiment of a septum including at least one gel
region;
[0087] FIG. 73 shows a schematic, side cross-sectional view of a
further embodiment of a septum including at least one gel
region;
[0088] FIG. 74 shows a side cross-sectional view of a first mold
and a second mold, wherein a gel region is positioned between the
first mold and the second mold;
[0089] FIG. 75 shows a schematic, side cross-sectional view of an
embodiment of a septum including at least one chamber to capture a
gel; and
[0090] FIG. 76 shows a schematic, side cross-sectional view of an
additional embodiment of a septum including at least one gel
region.
DETAILED DESCRIPTION OF SELECTED EMBODIMENTS
[0091] Reference will now be made to figures wherein like
structures will be provided with like reference designations. It is
understood that the drawings are diagrammatic and schematic
representations of exemplary embodiments of the present invention,
and are neither limiting nor necessarily drawn to scale.
[0092] For clarity it is to be understood that the word "proximal"
refers to a direction relatively closer to a clinician using the
device to be described herein, while the word "distal" refers to a
direction relatively further from the clinician. For example, the
end of a transcutaneous catheter placed within the body of a
patient is considered a distal end of the catheter, while the
catheter end remaining outside the body is a proximal end of the
catheter. Also, the words "including," "has," and "having," as used
herein, including the claims, shall have the same meaning as the
word "comprising."
[0093] One aspect of the instant disclosure relates to vascular
access ports. More particularly, in one embodiment, the instant
disclosure contemplates that a vascular access port may be
structured for accommodating a fluid flow rate of at least about 1
milliliter per second. Further, the instant disclosure contemplates
that a vascular access port may be structured to withstand at least
about 180 pounds per square inch (psi) of pressure developed within
the reservoir defined by the septum and the access port housing. In
one embodiment, an access port may be structured for operating
within a range of pressures of about 80 psi to about 180 psi. Such
an access port may be advantageous for use in infusing a fluid into
a patient (e.g., infusing contrast media into a patient for CT or
MR imaging).
[0094] Generally, an access port may comprise a housing that
captures a septum that may be repeatedly pierced or punctured with
a hollow slender element (e.g., a cannula, or needle), which can
include a Huber needle, a trocar with a circumferentially disposed
cannula, or any other suitable access mechanism, without
limitation. The words "cannula" or "needle," as used herein,
encompass any slender element (e.g., a cannula, a needle, a trocar,
with a circumferentially disposed cannula, etc.) as known in the
art or described herein, without limitation. Such a septum may
comprise a material (e.g., silicone) that seals, under suitable
compression, passages formed by puncturing the septum with such an
access mechanism. Thus, the septum may be at least partially
compressed to facilitate closure of passages formed by puncturing
the septum with the access mechanism. The instant disclosure
contemplates that the housing and septum may be structured so that
a flow rate from the reservoir of the access port may be at least
about 1 milliliter per second without damaging the housing or
septum or compromising the structural integrity of the reservoir
(e.g., causing the septum to become separated from the
housing).
[0095] In one embodiment, an access port may comprise a cap and
base which define, in combination, a housing in which a septum may
be positioned to form a reservoir. For example, FIGS. 1 and 2 show,
respectively, an exploded perspective view and a side
cross-sectional view of an access port 50 including a base 56, a
cap 54, a septum 80, and an outlet stem 70. As shown in FIGS. 1 and
2, cap 54 and base 56, may be configured for capturing a septum 80
between cap 54 and 56. Generally, cap 54 and base 56 may
collectively form a housing 60 for capturing septum 80 and at least
partially defining reservoir 66. Explaining further, cap 54 may
include an aperture 55 through which a portion of septum 80 may
extend and base 56 may include a recess 57 configured to accept at
least a portion of septum 80. Thus, a portion of septum 80 may be
placed within recess 57 of base 56 and aperture 55 of cap 54 may be
positioned about septum 80 to collectively define a reservoir 66
within access port 50, the reservoir 66 being in fluid
communication with a lumen of outlet stem 70. In other embodiments,
a plurality of reservoirs may be collectively defined by a housing
and at least one septum, without limitation. For example, any
access port known in the art including a plurality of reservoirs
(or one reservoir) may include any aspects) of the instant
disclosure, without limitation. As shown in FIG. 1, a portion of
outlet stem 70 may be positioned within and coupled to an aperture
58 formed within base 56.
[0096] Although FIG. 1 shows that access port 50 may include an
outlet stem 70, other embodiments of access port 50 may not include
an outlet stem 70. Therefore, FIG. 2 shows access port 50 without
an outlet stem 70. Put another way, the instant disclosure
contemplates that access port 50 may, optionally, include an outlet
stem 70 or may be otherwise configured. For instance, in one
embodiment, outlet stem 70 may be formed as a part of with base 56,
if desired. In another embodiment, a catheter may be operably
coupled to the access port 50 (e.g., to aperture 58) without outlet
stem 70. In yet a further embodiment, access port 50 may simply
include at least one outlet passage (e.g., aperture 58) in fluid
communication with the reservoir 66 and extending through the
housing 60 and structured for allowing fluid flow through, if
desired. As shown in FIG. 2, a portion of septum 80 may be
positioned between cap 54 and base 56 and may be configured to
withstand, without damage or deforming to an extent that
compromises the reservoir 66 (i.e., blowing out), a selected
magnitude of pressure developed within reservoir 66.
[0097] For example, as shown in FIGS. 1 and 2, cap 54 may
optionally include a circumferential ring structure 30 that is
formed adjacent to a side periphery of septum 80. Ring structure 30
may be structured to inhibit deformation of the cap 56 in response
to a pressure developed within reservoir 66 of access port 50. As
shown in FIG. 3, in a top elevation view of cap 54, ring structure
30 may be generally circular. Further, ring structure 30 may be
substantially congruent to a side peripheral shape of septum 80 or
may exhibit a different shape than the side periphery of septum 80.
In addition, the size of ring structure 30 may be selected to
provide a selected rigidity to a region of cap 54 adjacent to of
aperture 55 of cap 54. Such a configuration may inhibit deformation
of the cap 54 in response to pressure developed within reservoir
66. For example, as shown in FIG. 2, a lateral thickness TL,
vertical thickness TV, or both may be selected for providing a
selected rigidity to a region of cap 54 adjacent to a periphery of
septum 80 (i.e., adjacent to aperture 55). In one embodiment, the
overall height H (FIG. 2) of access port 50 may be less than about
0.600 inches.
[0098] In other embodiments, ring structure 30 may be generally
rectangular, generally triangular, generally oval, generally
polygonal, or of another geometrical shape, without limitation. For
example, FIG. 4 shows a top elevation view of a ring structure 30
that is generally triangular. Further, FIG. 5 shows a generally
rectangular ring structure 30.
[0099] Explaining further, housing 60 of access port 50 may
comprise a biocompatible material such as polysulfone, titanium, or
any other suitably biocompatible material. Thus, cap 54 and base 56
may couple to one another generally along a mating line and may be
secured or affixed to one another. More particularly, in one
embodiment, both cap 54 and base 56 may comprise titanium and may
be welded, brazed, soldered, or otherwise affixed to one another.
Such a configuration may provide suitable mechanical strength for
capturing septum 80 between cap 54 and base 56. Optionally, cap 54
and base 56 may be coupled to one another by at least one fastening
element (e.g., at least one bolt, at least one screw, at least one
rivet, etc.), at least one adhesive, or a combination of such
coupling mechanisms. Similarly, in one embodiment, outlet stem 70
and base 56 may each comprise titanium and may be welded or
otherwise bonded or coupled to one another.
[0100] In further detail, FIG. 6 shows an access port 50 implanted
within a patient 67. In one embodiment, sutures may be used to
affix the access port 50 within the patient 67, if desired. After
the housing 60 is implanted in a patient 67, the upper surface of
the septum 80 may be generally flush or aligned with the surface of
the skin surface 76 of the patient 67 and may be repeatedly
punctured for creating a percutaneous passageway from the exterior
of the skin of the patient into the reservoir 66. The outlet stem
70 may create a fluid-communicative passageway extending from the
reservoir 66 and through the outlet stem 70, catheter 73, and into
the interior of the patient 67. Generally, catheter 73 may be
coupled to the outlet stem 70 for fluid communication with the
reservoir 66 and for conducting fluid to a desired remote location
from the reservoir 66 and within patient 67. In one embodiment,
catheter 73 may extend from the access port 50 to at least
partially within a vena cava of the patient. Such a configuration
may allow for infusion of a contrast media proximate to the heart
of a patient. Because such a contrast media may be harmful (e.g.,
radioactive or otherwise injurious) infusion directly into a vena
cava of a patient may reduce an overall quantity of contrast media
required to perform a selected imaging procedure.
[0101] As shown in FIG. 6, a cannula 90 may be inserted through the
septum 80 and fluid may be injected into the reservoir 66. For
example, fluid may be injected into reservoir 66 at a rate that
causes pressure (i.e., a positive pressure) to be developed within
reservoir 66. For example, a positive pressure, labeled "PR" in
FIG. 6, may develop within reservoir 66 and may act upon the
portion of septum 80 defining, in part, reservoir 66. Such a
pressure PR acting on a portion of septum 80 may develop force upon
the septum 80. Likewise, force may be developed on surfaces of the
base 56 that are acted upon by pressure Pr. In one embodiment, cap
54 may be coupled to base 56 and structured to suitably position
septum 80 and couple septum 80 to housing 60 against force applied
to the septum 80. Therefore, the septum 80, cap 54, and base 56 may
be structured for accommodating attendant forces developed by
pressure PR. In one embodiment, access port 50 may be structured
for accommodating (without damage) a pressure PR of at least about
185 psi with reservoir 66. In another embodiment, access port 50
may be structured for accommodating (i.e., without damage) a range
of pressures of about 37 psi to about 65 psi with reservoir 66.
[0102] In further detail, during power injection, a fluid flow F
may be caused to flow through cannula 90. A fluid flow rate
(depicted in FIG. 6 by arrows labeled "F") may be at least about 1
milliliter per second. In another embodiment, a fluid flow rate F
may be between about 1 milliliter per second to about 5 milliliters
per second. During power injection, a pressure Pi may be developed
within cannula 90 may be at least about 30 psi. Accordingly,
cannula 90 may be structured to withstand the forces associated
with the above-discussed pressure, flow rate, or both. As discussed
in further detail below, the cannula may comprise a portion of an
infusion set (e.g., a safety winged infusion set (SWIS)) or another
infusion system configured for use with an access port and a power
injection system, without limitation.
[0103] More particularly, FIG. 7 shows a graph depicting pressure
measurements at different locations within an infusion system
including an infusion set (as discussed in greater detail below) in
fluid communication with an access port during infusion of a fluid
at a rate of 5 milliliters per second. As shown in FIG. 7, a
pressure generally within a syringe barrel of a power injector may
be about 265 psi. Further, a pressure generally at the entrance of
an infusion set may be about 225 psi and a pressure generally
within a reservoir of an access port may be about 40 psi. Thus, the
pressure drop through an infusion set may be about 185 psi. As
shown in FIG. 7, a pressure generally at the distal end of a
catheter extending from the access port may be about 0 psi. Many
factors may influence a pressure (and a pressure drop) developed
within an infusion system (e.g., infusion set, access port, etc.)
during flow of a fluid through the infusion system, such as, for
example, fluid viscosity, tubing inner diameter (i.e., lumen
cross-sectional size), length of the flow path, and flow rate.
Accordingly, as will be appreciated by the above discussion of the
access port 50 shown in FIGS. 1-3, such access port 50 may be
structured to accommodate a selected flow rate and associated
pressure PR developed within reservoir 66 of access port 50.
[0104] In another embodiment, the septum, housing, or both may be
structured to mechanically secure or constrain at least a portion
of the septum. For example, in one embodiment, the septum may
include at least one coupling feature configured to mate or couple
with a complementary coupling feature included by the housing. For
example, male and female features (e.g., without limitation, ribs,
flanges, interlocking features, tenon and mortise type features,
tongue-in-groove features, T-slot features, dovetail features,
snap-fit features, tabs and slots or other coupling features as
known in the art) may comprise the at least one coupling feature
included by the septum and the at least one complementary feature
included by the housing, without limitation. "Tenon," as used
herein, means a projecting member for at least partial insertion
into a mortise to make a joint. "Mortise," as used herein, means a
recess, hole, groove, or slot formed within a material for
receiving at least a portion of a tenon to make a joint.
[0105] Generally, in one embodiment, the septum may include at
least one tenon region (i.e., at least one coupling feature) for
coupling to a complementary mortise region formed by the housing.
Thus, the housing may include a recess (i.e., at least one
complementary feature) for accepting at least a portion of the
tenon region of the septum. For example, FIG. 8 shows a side
cross-sectional view of one embodiment of a septum 180 including a
tenon region 270. Particularly, tenon region 270 includes tapered
surface 187 of septum 180, which may increase in height (i.e., from
lower surface 183 of septum 180) along an increasing radial
direction (i.e., relative to a radial distance from a central axis
of septum 180; that is, in a direction from rim 159 of cap 154
toward side surface 157 of base 156). Thus, as shown in FIG. 8, a
height CGMIN of septum 180 (measured at a radially innermost extent
of tenon region 270) is less than a height CGMAX of septum 180 (at
a radially outermost extent of tenon region 270). Further, tenon
region 270 may be a continuous peripheral feature (i.e., an annular
feature) of septum 180 or may comprise one or more
circumferentially separate regions, without limitation. Further, as
shown in FIG. 8, housing 160 (including cap 154 and base 156) may
generally define a complementary mortise region (e.g., a
circumferentially extending recess) for accepting at least a
portion of tenon region 270. More particularly, a complementary
mortise region may be defined by side surface 157 of base 156,
lower flange surface 273 of base 156, and tapered surface 172 of
cap 154. Such a configuration may secure, capture, or retain a
portion of tenon region 270 of septum 180 within the mortise region
of housing 160 even if a selected maximum pressure is developed
within reservoir 166 of access port 150.
[0106] In another embodiment, an access port may comprise a septum
including a tenon region including a plurality of tapered surfaces.
For example, FIG. 9 shows a schematic side cross-sectional view of
a septum 180 including a tenon region 270 comprising tapered
surface 187, tapered surface 189, and tapered surface 191. Further,
as shown in FIG. 9, housing 160 may generally define a
complementary mortise region tapered recess for accepting at least
a portion of tenon region 270. More particularly, a complementary
mortise region may be defined within housing 160 by side surface
157 of base 156, lower flange surface 273 of base 156, tapered
surface 172 of cap 154, tapered surface 193 of base 156, and
tapered surface 195 of cap 154. Such a configuration may secure,
capture, or retain at least some of tenon portion 270 of septum 180
within a tapered recess of housing 160 even if a selected maximum
pressure is developed within reservoir 166 of access port 150.
[0107] In summary, it should be understood that a portion of a
septum may comprise, generally, at least one tenon region for
coupling with a complementary mortise region formed in a housing.
In another embodiment, generally, at least a portion of a housing
may comprise a tenon for coupling with a complementary mortise
formed in a septum. As described above, a tenon region and a
complimentary mortise region may comprise one or more tapered
surfaces. In another embodiment, a tenon region and complementary
mortise region may comprise a T-slot or other nontapered geometry,
without limitation. For example, FIG. 10 shows a schematic, side
cross-sectional view of one embodiment of an access port 150
comprising a septum 180 including a tenon region 270. Further, a
complementary mortise region may be defined within housing 160 for
accepting at least a portion of tenon region 270. As shown in FIG.
10, a mortise region may be at least partially defined by an
annular extension or protrusion 203 of base 156. Such a
configuration may secure, capture, or retain at least a portion of
tenon region 270 of septum 180 within housing 160 and suitably seal
reservoir 166 even if an anticipated maximum pressure is developed
within reservoir 166. It should be further understood that any of
the tenon region and mortise region embodiments shown in FIGS. 8-10
may be described in terms of extensions, ridges, protrusions,
recesses, grooves, slots, etc., without limitation.
[0108] A further aspect contemplated by the instant disclosure
relates to coupling or affixing at least a portion of a peripheral
region of a septum to a housing. Such a configuration may maintain
the integrity of the access port during use of the access port for
infusing a fluid at a flow rate of at least about 1 milliliter per
second. For example, in one embodiment, at least a portion of a
side periphery of a septum may be affixed to at least a portion of
a housing. FIG. 11 shows a side cross-sectional view of an access
port 50 wherein at least a portion of a periphery of septum 80
adjacent to housing 60 is affixed to one or both of cap 54 and base
56 adjacent to septum 80. More particularly, as shown in FIG. 11, a
periphery of septum 80 (adjacent to cap 54 and base 56) may include
upper side region 97, upper annular region 93, lower annular region
91, and lower side region 95. Thus, in one embodiment, an adhesive,
(e.g., glue, epoxy, cement, tape, or any other adhesive as known in
the art) may affix at least a portion of one or more of upper side
region 97, upper annular region 93, lower annular region 91, and
lower side region 95 to the cap 54 or base 56, respectively. Such a
configuration may secure septum 80 to housing 60 and may provide a
relatively robust access port 50 suitable for power injection. It
should further be appreciated that affixing at least a portion of a
peripheral region of a septum may encompass affixing at least a
portion of a tenon region (of either a septum or housing) to a
mortise region (of either a housing or septum), without
limitation.
[0109] As described above, septum deformation is a design
consideration with respect to performing power injection via an
access port. Further, one aspect of the instant disclosure relates
to a septum that is structurally reinforced or otherwise limited
against deformation exceeding a selected magnitude. More
specifically, the instant disclosure contemplates that at least one
structural element may be configured to inhibit or limit
deformation of a septum of an access port in response to pressure
developed within a chamber or reservoir of the access port. Some
embodiments of an access port including at least one structural
element for limiting deformation of a septum are disclosed in U.S.
Patent Application No. 60/737,466, filed 15 Nov. 2005, the
disclosure of which is incorporated, in its entirety, by this
reference. Any of the access ports encompassed by U.S. Patent
Application No. 60/737,466 may be structured for power
injection.
[0110] In one embodiment, the instant disclosure contemplates that
a septum may be structurally coupled to a housing nonperipherally.
Put another way, one aspect of the instant disclosure relates to
coupling a nonperipheral portion of a septum to a housing of an
access port. For example, FIG. 12 shows one embodiment of an access
port 110 according to the instant disclosure including a cap 54 and
a base 56 that capture a septum 120 to form a reservoir 66.
Optionally, cap 54 may include a ring feature proximate to a
periphery of the septum, as described above. In addition, outlet
stem 70 may allow for fluid communication with reservoir 66 to
perform infusion or fluid sampling processes. As shown in FIG. 12,
a structural element 112 may extend between septum 120 and housing
60. More particularly, structural element 112 extends generally
from lower surface 121 of septum 120 to upper surface 165 of base
56. Thus, if pressure (positive/negative) is developed within
reservoir 66, structural element 112 may inhibit deflection or
deformation of lower surface 121 of septum 120 toward or away from
upper surface 165 of base 56. Generally, a structural element may
inhibit deformation of a septum in relation to one or more selected
directions (i.e., either toward or away from upper surface 165 of
base 56).
[0111] Generally, a structural element (e.g., structural element
112) may comprise any of the following: at least one wire, at least
one pin or columnar element, or at least one filament, without
limitation. Such a structural element may comprise titanium, steel
(e.g., stainless steel), polymers (e.g., DELRIN.RTM., nylon,
polyester, KEVLAR.RTM., polytetrafluoroethylene (PTFE) (expanded or
nonexpanded), polyurethane, etc.), or other materials as known in
the art. In other embodiments, a structural element may comprise a
composite, such as a fiber-reinforced matrix. In one embodiment, a
structural element may comprise fibers (glass, carbon, etc.)
dispersed or aligned within a silicone matrix.
[0112] Further, structural element 112 may be coupled to septum 120
by an adhesive, welding, snap-fitting, molding the septum 120 about
a portion of the structural element 112, otherwise imbedding a
portion of structural element 112 within septum 120, or as
otherwise suitable. Similarly, structural element 112 may be
coupled to base 56 by an adhesive, welding, or imbedding a portion
of structural element 112 within base 56. It may also be
appreciated that, optionally, structural element 112 may exhibit a
modulus of elasticity that exceeds a modulus of elasticity of
septum 120. Such a configuration may allow for structural element
112 to resist deformation of septum 120 in response to a pressure
developed within reservoir 66 (e.g., during a "power injection"
process).
[0113] FIG. 13 shows a schematic cross-sectional view of an access
port 110 according to the instant disclosure including another
embodiment of structural element 112. Particularly, as shown in
FIG. 13, structural element 112 may include a barbed end 116, which
is positioned at least partially within septum 120. Such a
configuration may couple structural element 112 to septum 120 and
may resist against deformation of the septum 120 in response to
pressure developed within reservoir 166. Furthermore, as shown in
FIG. 13, the barbed end 116 of structural element 112 may,
optionally, be pointed. Further, the point of barbed end 116 may be
oriented toward upper surface 123 of septum 120. Such a structure
may deflect a cannula that is inserted through septum 120 and
contacts barbed end 116 so that the cannula is directed away from
structural element 112. Optionally, in another embodiment,
structural element 112 may extend through base 56 and may be
affixed to lower surface 113 of base 56.
[0114] In another embodiment of an access port, a structural
element may extend through a septum. For example, FIG. 14 shows a
schematic, side cross-sectional view of an access port 110
including a structural element 112 that extends from lower surface
121 of septum 120 to upper surface 123 of septum 120. As shown in
FIG. 14, structural element 112 may also extend to upper surface
165 of base 56, to mechanically couple septum 120 to housing 60.
Optionally, structural element 112 may include at least one barb,
which may be positioned within septum 120 and configured for
coupling septum 120 to housing 60. In addition, structural element
112 may be affixed, if desired, to at least one of upper surface
123 and lower surface 121 of septum 120. As may be appreciated, it
may be advantageous for upper surface 123 of septum 120 to be
mechanically coupled to housing 60 to resist deformation of septum
120 in response to a pressure developed within reservoir 66.
[0115] The instant disclosure further contemplates that a
structural element may be employed in combination with a support
element extending over a selected area of the upper surface of the
septum. Such a support element may be positioned adjacent to an
upper surface of a septum and may be configured to contact the
upper surface of the septum with a selected surface area (e.g.,
when the septum deforms). For example, FIG. 15 shows a schematic,
side cross-sectional view of an access port 110 including a
structural element 112 that extends from housing 60 to an upper
surface 123 of septum 120. Furthermore, structural element 112 is
coupled to a support element 114, which is positioned adjacent to
upper surface 123 of septum 120. Such a configuration may provide a
selected amount of contact area between support element 114 and
upper surface 123 of septum 120. Such a selected contact area
between support element 114 and septum 120 may reduce otherwise
undesirably high stresses within septum 120 when a pressure
develops within reservoir 66 by distributing such stresses over a
selected area or region of septum 120. In addition, support element
114 may be observable (e.g., visually or by palpation) and,
therefore, may be avoided when inserting a cannula through septum
120. Additionally, the support element 114 can be used to identify
the port 110 as being power injectable.
[0116] In another embodiment of an access port, a structural
element may comprise a portion of a septum affixed to a housing of
an access port to resist deformation of the septum. For example,
FIG. 16 shows a schematic, side cross-sectional view of an access
port 110 including a septum 120, which comprises an extension leg
124 (i.e., a structural element) that is coupled to housing 60.
More particularly, as shown in FIG. 16, extension leg 124 may
extend generally from lower surface 121 of septum 120 to upper
surface 165 of base 56. Extension leg 124 may abut and may be
affixed to upper surface 165 of base 56. Such a configuration may
resist against deformation of septum 120 in response to pressure
developed within reservoir 166. In one embodiment, extension leg
124 may be substantially centered (i.e., positioned generally at a
centroid of lower surface 121) with respect to lower surface 121 of
septum 120. Substantially centering extension leg 124 with respect
to lower surface 121 of septum 120 may limit deformation of lower
surface 121 of septum 120 to a greater extent than other positions
of extension leg 124 may limit deformation of lower surface 121 of
septum 120. Additionally, it should be appreciated that while FIG.
16 shows one extension leg 124, the instant disclosure contemplates
that at least one extension leg (i.e., one or more extension legs)
may extend from or be coupled to septum 120, without limitation. In
another embodiment, at least one extension leg may be coupled to a
housing of an access port by an interference fit or a so-called
"snap-fit." More particularly, as shown in FIG. 17, extension leg
124 includes a bulbous or rounded end 125 that is configured to fit
within a recess 155 formed in base 56. Recess 155 may comprise an
opening formed in upper surface 165 of base 56 that is smaller than
a maximum lateral dimension of rounded end 125, so that rounded end
125 may be forced through such an opening and "snap" into a portion
of recess 155. Optionally, extension leg 124 may be affixed (e.g.,
adhesively affixed, welded, pinned, or affixed by other suitable
methods to recess 155 formed in base 56. Such a configuration may
couple septum 120 to base 60 of access port 110 and may resist or
limit deformation of septum 120 in response to pressure developed
within reservoir 66.
[0117] Another aspect of the instant disclosure contemplates that
at least a portion of an upper surface of a septum may be
constrained or limited in its deformation. In one embodiment, at
least one structural element may be positioned upon or adjacent to
an upper surface of a septum to limit deformation of the septum in
a direction toward the structural element. Put another way, at
least one structural element may extend laterally upon or adjacent
to at least a portion of an upper surface of a septum. For example,
FIG. 18 shows a schematic, side cross-sectional view of an access
port 110 including a septum 130 and a structural element 132
positioned adjacent to an upper surface 133 of septum 130.
Optionally, structural element 132 may be bonded or affixed to
upper surface 133 of septum 130. Structural element 132 may be
structured to resist deformation of septum 130 in a direction
generally away from reservoir 166. In one embodiment, structural
element 132 may substantially overlay or cover upper surface 133 of
septum 130. Optionally, structural element 132 may be at least
partially embedded within septum 130. In one embodiment, structural
element 132 may be penetrable by a cannula (e.g., a needle). In
another embodiment, structural element 132 may cover a selected
portion (i.e., at least a portion) of upper surface 133 of septum
130, which may allow for openings or apertures formed in structural
element 132 through which a cannula may be inserted into upper
surface 133 of septum 130. It may be appreciated that, optionally,
a modulus of elasticity of structural element 132 may exceed a
modulus of elasticity of septum 130, so that deformation of septum
130 may be inhibited to a selected degree by structural element
132. Further, although a thickness (labeled "t") of structural
element 132 is shown in FIG. 18 as being substantially uniform, the
instant disclosure contemplates that a thickness "t" of structural
element 132 may vary, without limitation. For example, thickness
"t" of structural element 132 may be maximum proximate to a
centroid of the upper surface 133 of septum 130. In addition, as
shown in FIG. 18, structural element 132 may be positioned between
cap 54 and septum 130. Structural element 132 may be affixed to one
or both of cap 54 and septum 130, if desired. For example,
structural element 132 may be adhesively affixed, welded,
mechanically fastened, or otherwise suitably coupled to one or both
of cap 54 and septum 130. Furthermore, structural element 132 may
comprise a metal (e.g., titanium, steel, etc.), a polymer (e.g.,
DELRIN.RTM. polyurethane, nylon, etc.), or any other suitable
material. In another embodiment, as discussed further below,
structural element 132 may comprise a relatively tightly woven
fabric that resists tissue ingrowth (if positioned in potential
contact with an internal cavity of the body). In a further
embodiment, a structural element 132 may comprise a substantially
fluffy or compressible polyester that may promote tissue healing of
punctures created by a cannula passing through septum 130 of access
port 110 (if positioned in potential contact with an internal
cavity of the body).
[0118] In a further embodiment, the instant disclosure contemplates
that at least one structural element may be at least partially
embedded within a septum and may extend laterally through at least
a portion of the septum. For example, FIG. 19 shows a schematic,
side cross-sectional view of an access port 110 including a septum
120 and a structural element 140 extending laterally (i.e., across
an opening in the housing 60 closed by the septum 120) through the
septum 120. As shown in FIG. 19, structural element 140 may be
affixed to housing 60 (e.g., cap 54 or base 56). More particularly,
as shown in FIG. 19, structural element 140 may be affixed to cap
154 at connection regions 147 and 143. In addition, a selected
level of tension may be developed within structural element 140, if
desired, to provide for a desired level of resistance to
deformation (i.e., flexibility) of septum 120. Such a configuration
may provide a selected degree of resistance to deformation of
septum 120 in a direction generally perpendicular to a direction of
extension of structural element 140.
[0119] In another embodiment, a structural element may be
positioned proximate to an upper surface of a septum to limit
deformation of the septum. For example, FIG. 20 shows a schematic,
side cross-sectional view of an access port 110 including a septum
130 positioned within a housing 60 and a structural element 150
positioned proximate to an upper surface 133 of septum 130. As
shown in FIG. 20, structural element 150 extends laterally over at
least a portion of upper surface 133 of septum 130. Thus,
structural element 150 may allow septum 130 to deform a selected
distance (e.g., a gap labeled "G") prior to contact with structural
element 150. Further, structural element 150 may be affixed to cap
54 and may be selectively tensioned to exhibit a selected degree of
flexibility in response to contact between septum 130 and
structural element 150. In one embodiment, structural element 150
may exhibit a flexibility or spring constant that exceeds a bulk
flexibility or spring constant of septum 130 in response to a
pressure developed within reservoir 66.
[0120] In another embodiment, a structural element may be
positioned proximate to or abutting a lower surface of a septum to
limit deformation of the septum. For example, FIG. 21 shows a
schematic, side cross-sectional view of an access port 110
including a septum 120 positioned within a housing 60 and a
structural element 170 positioned proximate to a lower surface 121
of septum 120. As shown in FIG. 21, structural element 170 may
extend laterally over at least a portion of lower surface 121 of
septum 120. Further, structural element 170 may be affixed to lower
surface 121 or septum 120 or otherwise coupled to lower surface 121
of septum 120. Thus, structural element 170 may inhibit deformation
of septum 120. Further, structural element 170 may be affixed to
base 56 (or otherwise coupled to housing 60) to provide adequate
resistance to deformation of septum 120. Optionally, structural
element 170 may be selectively tensioned to exhibit a selected
flexibility in response to forces applied to the structural element
170. Optionally, structural element 170 may exhibit a flexibility
or spring constant that exceeds a bulk flexibility or spring
constant of septum 120.
[0121] Referring to FIGS. 18-21, it will be appreciated that
structural elements 132, 140, 150, or 170 may comprise, in some
embodiments, elongated elements, such as, for instance, wire,
ribbon, thread, fibers, columnar elements, or the like.
Accordingly, such at least one elongated element may be arranged in
a selected pattern adjacent or proximate to an upper surface of a
septum. Further, in one embodiment, a structural element positioned
proximate to or abutting a lower surface of a septum, proximate to
or abutting an upper surface of a septum, or within a septum, may
comprise a mesh (e.g., a metal or plastic mesh, a fabric, a fiber
mesh, etc.). For instance, in one embodiment, a structural element
may comprise a fabric comprising fibers or threads that seal
against one another (e.g., fibers or threads coated with silicone).
Such a configuration may allow for a cannula to pass through the
fabric and for the fabric to seal about the cannula, but may also
allow for the fibers or threads to seal against one another when
the cannula is removed. In addition, it will be understood that,
based upon the instant disclosure, structural elements 132, 140,
150, or 170 as shown in FIGS. 18-21 may be arranged in a variety of
configurations.
[0122] For example, FIG. 22 shows a partial top elevation view of
one embodiment of an access port 110, as shown in FIGS. 18-21,
wherein structural elements 132, 140, 150, 170 are arranged to form
a generally triangular shape or pattern. In a further example, FIG.
23 shows a partial top elevation view of an access port 110 as
shown in FIGS. 18-21, wherein structural elements 132, 140, 150,
170 are arranged in two partially intersecting generally
rectangular shapes or pattern. In yet a further embodiment, FIG. 24
shows a partial top elevation view of an access port 110, as shown
in FIGS. 18-21, wherein structural elements 132, 140, 150, 170 are
arranged as a pattern comprising a first plurality of substantially
parallel lines and a second plurality of substantially parallel
lines, wherein the first plurality of substantially parallel lines
is substantially perpendicular to and intersects with the second
plurality of substantially parallel lines. In an additional
embodiment, FIG. 25 shows a partial top elevation view of an access
port 110, as shown in FIGS. 18-21, wherein structural elements 132,
140, 150, 170 are arranged as a pattern comprising two
substantially straight (i.e., linear) members that intersect with
one another. As shown in FIG. 25, structural elements 132, 140,
150, 170 may be substantially perpendicular to one another. As
shown in FIGS. 22-25, structural elements 132, 140, 150, 170 may be
affixed to cap 54 at selected connection regions. Such
configurations may allow for varying degrees of limitation of
deformation of a septum, while allowing ample access to a surface
of a septum for perforation by a cannula (e.g., a needle).
[0123] In another embodiment, the instant disclosure contemplates
that a structural element may be at least partially embedded within
a septum and may be in the form, configuration, or shape of a
two-dimensional or plane (e.g., a circle, ellipse, triangle,
rectangle, etc.) within the septum. For example, FIG. 26 shows a
partial top elevation view of a septum 120 and a structural element
141 extending within the septum 120. In further detail, FIG. 27
shows a perspective view of a sectioned septum 120 including a
structural element 141 embedded within the septum 120. As shown in
FIGS. 26 and 27, in one embodiment, structural element 141 may be
generally circular. More generally, one or more structural elements
141 may be at least partially embedded within a septum (e.g., a
septum 120 or 130, as discussed above), if desired. For example, a
plurality of structural elements 141 may be embedded within a
septum 120 and arranged substantially concentrically with respect
to one another, as shown in FIG. 28 in a partial, top elevation
view. Structural element 141 may be generally elongated (as shown
in FIGS. 26-28) or may, more generally, exhibit a shape and size
configured to resist deformation of the septum 120, without
limitation. Thus, it should be appreciated that one or more
structural elements 141 may embody, for example, a washer or a disk
that is frustoconical, domed, or otherwise shaped. In another
embodiment, at least one structural element 141 may form,
generally, a toroid. Further, at least one structural element 141
may exhibit at least one selected characteristic (e.g., exhibiting
a selected size, shape, elasticity, strength, etc.) to impart a
desired level of resistance to deformation (i.e., flexibility) of
septum 120. Such a configuration may provide a selected level of
resistance to deformation of septum 120 in response to a pressure
developed within a reservoir of an access port.
[0124] In one embodiment, the septum is resilient and includes a
reinforcement structure that bolsters septum placement over the
fluid cavity so as to prevent blow-out of the septum, i.e.,
unintended separation of the septum from the medical device when
the fluid cavity is under pressure, such as during pressurized
injection of fluid into the fluid cavity of an access port. Power
injection of fluids into an access port is one example of such
pressurized fluid injection, wherein fluid is injected into the
fluid cavity of the access port at a rate of about five ml per
second at a pressure of about 300 psi, for example. Other fluid
pressure scenarios are also possible.
[0125] In one embodiment, the reinforcement structure of the septum
includes an annular bead, or cord, disposed within a flange
circumventing an outer perimeter of the septum. The cord is
configured to provide for reinforced retention of the septum flange
within a groove defined about an opening of the fluid cavity of the
access port such that the septum sealably covers the fluid cavity.
So configured, the septum is secured to the access port without the
need of an additional cap or retaining ring. Indeed, in one
embodiment an integral access port body of single-piece
construction can be used, thus providing simplified design and
construction.
[0126] Reference is first made to FIGS. 29 and 30, which depict
various details regarding an implantable access port, generally
designated at 10, according to one embodiment. The port 10 includes
a body 12 including a suitable material. In one embodiment, the
port body 12 includes plastic, such as an acetyl resin for
instance, though it is appreciated that other suitable plastics and
materials can be employed for the port body, including titanium or
other metals or combinations of metals, plastics, or both. The body
12 defines a generally cylindrical fluid cavity 14 (though other
cavity shapes are possible) defined in part by a wall 16. A stem 19
in fluid communication with the fluid cavity 14 is also included so
that fluids can be passed to and from the fluid cavity.
[0127] As best seen in FIG. 30, the body 12 defines an opening 18
to the fluid cavity 14. An annular recess, or groove 20, is defined
in the wall 16 proximate the fluid cavity opening 18. The groove 20
generally defines a rectangular cross sectional shape and further
defines an outer diameter ("OD") 20A. Note that other cross
sectional shapes are possible for the groove. The groove 20 is
sized to receive therein a flange of a septum, described below.
[0128] As mentioned, and with additional reference to FIGS. 31 and
32, the access port 10 further includes a septum 22 disposed in the
opening 18 and configured to sealably cover the fluid cavity 14.
The septum 22 includes a suitable material such as silicone that
enables it to be penetrated by a needle or other cannula so as to
provide fluid access to the fluid cavity 14, such as for the
infusion into or removal of fluids therefrom. The silicone or other
suitable material included in the septum 22 also enables the septum
to be resiliently compliant.
[0129] As best seen in FIGS. 31 and 32, the septum 22 in the
present embodiment is circular and includes an annular flange 24
extending about a perimeter of the septum. The flange 24 itself
defines an outer diameter ("OD") 24A and is sized and configured to
be received within the groove 20 such that the septum 22 is
disposed in the opening 18 and sealably covers the fluid cavity 14.
So disposed, the septum 22 further defines an upper portion 22A
disposed above the flange 24, as viewed from the perspective shown
in FIG. 30.
[0130] As seen in FIGS. 30, 31, and 32, a reinforcement structure
is included in the septum 22. In particular, an annular
reinforcement bead, or cord 26, is included within the septum
flange 24. Though shown fully encapsulated by the septum flange 24,
the reinforcement cord 26 in one embodiment could be partially
exposed. It is appreciated that the reinforcement cord 26 can be
included within the septum flange 24 as shown in FIGS. 30, 31, and
32 via any one of a plurality of methods, including insert molding
of the cord into the septum, mechanical insertion into the flange
after cutting a circular slit therein followed by re-sealing of the
slit, etc. Also, the reinforcement cord shown here includes a round
cross sectional profile; it is appreciated, however, that the cord
can include other cross sectional profiles, including square,
triangular, pentagonal, polygonal, oval, twisted, slotted, spring
coiled, etc.
[0131] The reinforcement cord 26 is non-resilient along its
circular axis such that, when the flange 24 is received within the
groove 20 of the fluid cavity 14, the cord provides rigidity to the
flange and prevents deformation thereof. This in turn prevents
blow-out or unintended detachment of the septum 22 from the port
body 12, especially when the port fluid cavity 14 is under
pressurization, such as during power injection, for instance. So
configured, then, the reinforcement cord reinforces, or bolsters,
engagement of the flange with the groove of the port body.
[0132] FIGS. 33 and 34 show details of the port body 10 before
attachment of the septum 22 thereto. In one embodiment, placement
of the septum 22 in the access port 10 can include deforming the
septum, such as by partially folding in the manner shown in FIG.
35. Note that even though it is substantially non-elastic in a
direction parallel to its circular axis, in one embodiment the
reinforcement cord is capable of a limited amount of deformation in
other directions, such as the folding deformation shown in FIG. 35.
Once partially folded as in FIG. 35, the septum 22 can then be
inserted into the fluid cavity 14 via the opening 18 such that a
portion of the reinforced septum flange 24 seats within the groove
20. Portions of the flange 24 adjacent the seated portion can then
be worked into the groove 20 until the flange is completely seated
therein and the septum 22 is no longer deformed, as in FIG. 36. In
one embodiment, it is appreciated that full seating of the septum
flange occurs with the assistance of temporary pressurization
and/or depressurization of the fluid cavity.
[0133] In another embodiment, the septum can be placed in the fluid
cavity via the assistance of a placement tool to temporarily deform
the septum so as to insert its periphery into the port body groove.
In one embodiment, the tool includes a tube that radially
compresses the septum and a plunger that pushes the compressed
septum out the end of the tube and into the groove of the port
body. In another embodiment, the tool includes a funnel shaped
member in which the septum is initially disposed, and further
including a rolling rod that can be pressed along the periphery of
the septum to pass the septum periphery out of the funnel and into
the port body groove. These and other insertion tools are therefore
contemplated.
[0134] In one embodiment, the reinforcement cord 26 includes a
plastic, such as polypropylene, acetyl resin, or other plastic or
thermoplastic that includes suitable stiffness so as to prevent
buckling under hoop stress. In other embodiments, the cord can
include any suitable material such as woven or non-woven metals,
plastics, ceramics, high durometer silicones, titanium, stainless
steel, nylons, copolymers, and acrylics, etc. In yet another
embodiment, the reinforcement cord can include a silicone with a
durometer rating that renders it harder relative to a hardness of
the septum itself.
[0135] In one embodiment the reinforcement cord includes a nickel
and titanium alloy commonly known as nitinol, which is a shape
memory material. So configured, the reinforcement cord can be
initially formed and disposed within the septum while defining a
first shape configuration that facilitates relatively simple
placement of at least a portion of the septum flange into the
groove of the port fluid cavity. Such a first shape configuration
of the cord can cause a first half of the septum to assume a
partial folded shape while a second half of the septum remains
unfolded, for instance. After the unfolded portion of the septum is
seated in the groove, the septum can be heated so as to activate
the shape memory characteristic of the nitinol reinforcement cord,
which causes the cord to change shape to a predetermined second
shape configuration. In one embodiment, the second shape
configuration is a circularly flat cord configuration, such as that
shown in FIGS. 31 and 32, for instance. Shaping of the
reinforcement cord to the second shape configuration causes the
formerly folded half of the septum to flatten, which enables the
rest of the septum flange to seat into the groove and sealably
cover the fluid cavity. Thus, the septum disposed in a final flat
configuration with the entire flange is disposed within the
groove.
[0136] As mentioned, once the septum flange is fully seated within
the groove, the reinforcement cord acts as a strengthening element
to inhibit unintended removal of the septum from its position
covering the fluid cavity of the implantable access port. In
addition, in one embodiment the reinforcement cord maintains the
septum flange in place within the groove so as to enable
construction of the access port body as an integral, single-piece
component, i.e., without the need for a retaining ring or cap to
retain the septum in place. This in turn simplifies construction
and design of the access port.
[0137] Note that, though an access port is shown and described
herein, in other embodiments other implantable medical devices that
include a septum secured thereto can also benefit from the
principles of the present disclosure. As such, the present
discussion should not be intended to limit the embodiments of the
present disclosure in any way.
[0138] FIG. 37 shows that in one embodiment, the fluid cavity can
be shaped other than cylindrically. For example the side wall 16 of
the port body 12 in FIG. 37 is slanted so as to define a
frustoconically shaped fluid cavity 14. This configuration can be
employed to assist in urging the septum flange 24 to seat in the
groove 20. Other fluid cavity shapes are also possible. More
generally, it is appreciated that the top view cross sectional
shapes of the septum and fluid cavity can also vary from circular,
including oval shapes for instance.
[0139] As mentioned further above, note that the cross sectional
shape of the groove can vary from the rectangular configuration
shown in FIG. 30. For instance, in one embodiment the OD 20A of the
groove 20 can define a concave shape. In another embodiment, the
groove can include a convex, or cupped, shape as shown in FIG. 37
so as to assist in retaining the septum flange. In one embodiment,
the OD 24A of the flange 24 can be correspondingly shaped to match
the groove OD 20A. Further non-limiting examples of possible cross
sectional shapes for the groove 20 are shown in FIGS. 40A-40D.
[0140] It is appreciated that the position of the groove in the
fluid cavity can vary according to design. Moreover, the thickness
of the groove and corresponding septum flange can also vary from
what is shown and described herein. These and other variations are
therefore contemplated.
[0141] FIGS. 38 and 39 show that the size of the septum 22 can vary
from thin (FIG. 38), including a relatively thin septum upper
portion 22A to thick (FIG. 39), wherein the septum upper portion is
relatively thick. In the case of the thin septum 22 of FIG. 38, an
area of radial compression includes a majority of the thickness of
the septum, while the thick septum of FIG. 39 includes only a lower
portion of the septum thickness where radial compression is
present. Note that the cord-equipped septum discussed herein
enables a septum to be mated to the access port body without unduly
increasing the thickness of the port, thus preserving a low profile
port configuration, if desired.
[0142] FIGS. 41-43 show that, in one embodiment, the OD 20A of the
groove 20 can be greater relative to the OD 24A of the septum
flange 24 such that ease of insertion of the septum flange into the
groove is facilitated. In particular, these figures show a process
for inserting the septum into the port body including laterally
compressing the septum 22 such that its centerline CL.sub.1 is
offset from the centerline CL.sub.2 of the port body 12 while
inserting a portion of the septum flange 24 into the groove 20.
With the septum still laterally compressed, the opposing portion of
the flange 24 is inserted into the groove 20. Such insertion is
made possible due to the oversized nature of the groove OD 20A.
Once the flange 24 has been seated in the groove 20, compression of
the septum 22 is released, and the septum centers in the opening 18
such that is centerline CL.sub.1 substantially aligns with the
centerline CL.sub.2 of the port body 12.
[0143] FIG. 44 shows that in one embodiment the reinforcement cord
can include other than a continuous configuration. Indeed, FIG. 44
shows the reinforcement cord as including a plurality of
reinforcement segments 28 that are arranged in a generally circular
pattern and disposed within the flange 24 of the septum 22. These
and other reinforcement schemes are therefore contemplated. In
another embodiment, a plurality of reinforcement cords can be
included in the septum flange. FIG. 45 shows that, in one
embodiment, a septum 122 that includes no upper portion can also
include the reinforcement cord 26, thus illustrating the ability to
include a reinforcement cord in septa of varying types and
configurations.
[0144] In another aspect of the instant disclosure, a septum may
exhibit a curvature that resists deformation in response to a
pressure developed within a reservoir of an access port. For
example, FIG. 46 shows a septum 120 including a generally concave
upper surface 123 and a generally convex lower surface 121.
Explaining further, generally concave upper surface 123 and a
generally convex lower surface 121 may be exhibited by septum 120
in the absence of external forces (i.e., in an unstressed,
equilibrium state). Such a configuration may provide resistance of
the septum 120 to deformation due to a pressure developed within
reservoir 66 of access port 110, because the upper surface 123 of
septum 120 would be forced to flatten (i.e., via deformation of
septum 120) before extending beyond the upper surface of housing
60. In other embodiments, a septum may be compressed (e.g., by way
of a tenon and mortise coupling or another peripheral coupling
configuration between a septum and a housing) so that a curvature
of the septum may be reduced or eliminated when the septum is
assembled within the housing. However, such a configuration may
increase the bulk flexibility or spring constant of the septum.
Optionally, a structural element (as described above) may be
included within the septum or upon a surface of the septum and may
also be fabricated to exhibit concavity or convexity in the absence
of external forces. Such a configuration may facilitate a favorable
compressive stress field within the septum when coupled to a
housing and may enhance resistance of the septum to
deformation.
[0145] In a further configuration, a septum may include a
structural frame or skeleton and a more pliant material configured
to seal punctures created by a cannula. More specifically, a frame
may comprise a material with a shore A hardness of at least about
80. Optionally, a frame may include a plurality of whiskers,
fibers, or particles to stiffen or strengthen the frame. In one
embodiment, nylon fibers, barium sulfate, or the like may be
dispersed within a frame. Further, such a frame may be at least
partially surrounded by a more pliant material exhibiting a Shore A
hardness of about 50 or less (e.g., a Shore A hardness of about 40
to about 50). FIG. 47 shows top elevation view of a frame 178
including a plurality of spokes 179 extending from a generally
common origin or region as well as rings 181 and 185. As shown in
FIG. 47, spokes 179 in combination with one or both of rings 181
and 185 form apertures 188. According to the instant disclosure, a
relatively pliant material configured to seal punctures formed by a
cannula passing through the material may at least partially
surround such a frame 178. For instance, FIG. 48 shows a schematic
side cross-sectional view of septum 177 comprising a frame 178 and
another material 190 molded partially about frame 178. Thus,
material 190 may substantially surround spokes 179 and may extend
within apertures 188. Further, as shown in FIG. 48, ring 181 may
form a tenon region 270 for coupling with a housing (as described
above) as well as an upper septum surface 191 and a lower septum
surface 193. As may be appreciated with reference to shown in FIG.
48, during use, a cannula may pass through a continuous upper layer
of material 190 and a continuous lower layer of material 190. Such
a configuration may provide suitable sealing capability for septum
177. It will be appreciated that many variations are contemplated
by the instant disclosure. For example, FIGS. 49 and 50 show side
cross-sectional views of different embodiments of a septum 177
including a frame 178 and another material 190 at least partially
surrounding the frame 178. Thus, a frame and a material at least
partially surrounding the frame may exhibit arcuate or
substantially planar surfaces and may be formed of selected
thickness and comprising selected materials (e.g., silicone,
etc.).
[0146] In a further aspect of a septum according to the instant
disclosure, a septum may include a radiopaque material and may be
configured to form a selected pattern when an x-ray is taken
through the septum. For example, FIGS. 51 and 52 show schematic
views of patterns 199 that may be generated by correspondingly
positioned radiopaque material within a septum. Such a
configuration may be useful for identifying the access port as
being capable of accommodating particular power injection processes
or for locating the septum of an access port.
[0147] The instant disclosure further contemplates that any
infusion apparatus or device that is used in combination with an
access port for infusing fluid at a rate of at least about 1
milliliter per second may be configured accordingly. For example,
an infusion set for accessing a vascular access port may include a
needle or cannula for puncturing a septum of the access port, a
distal end for coupling to an injection apparatus, and tubing
(e.g., at least one tubing section) extending between the cannula
and the distal end. Generally, any components comprising an
infusion set may be configured to withstand a selected flow rate
and associated pressure developed by such a selected flow rate.
[0148] FIG. 53 shows one embodiment of an infusion set 310
including a base member 340, a cannula 350, a tubing section 314,
and connector 312. Tubing 314 may be affixed or otherwise coupled
to connector 312 and base 342 generally at joints 313 and 339,
respectively. Also, as shown in FIG. 53, a clamp device 316 may be
suitably configured for allowing or preventing fluid flow through
tubing 314. Further, each of the base member 340, cannula 350,
tubing section 314, and end connector 312 may be structured for
accommodating a fluid flow rate of at least about 1 milliliter per
second through the infusion set 310. In further detail, tubing
section 314 may exhibit sufficient strength for withstanding at
least about 200 psi without damage. Optionally, tubing section 314
may withstand at least about 300 psi without damage. Further a
pressure at which a portion of the infusion set bursts (i.e., a
burst pressure of the infusion set 310) may be at least about 400
psi; optionally, such a burst pressure may be at least 600 psi. In
one embodiment, tubing section 314 may be substantially optically
clear or may be at least partially transparent. In one embodiment,
generally, tubing section 314 may comprise a polymer, such as
TECOTHANE.RTM.. More specifically, tubing section may comprise a
polymer, such as TECOTHANE.RTM. 55D or a polymer, such as
TECOTHANE.RTM. 95A. For example, if tubing section 314 has an inner
diameter (i.e., a lumen) of about 0.048 inches (.+-.0.003 inches)
(i.e., 19 GA), tubing section 314 may comprise a polymer, such as
TECOTHANE.RTM. 55D. In other examples, if tubing section 314 has an
inner diameter (i.e., a lumen) of about 0.041 inches or 0.034
inches (.+-.0.003 inches) (i.e., 20 GA or 22 GA, respectively),
tubing section 314 may comprise a polymer, such as TECOTHANE.RTM.
95A. Optionally, any polymer, such as TECOTHANE.RTM. type material
may be at least substantially free of a plasticizer, such as, for
instance, Di(2-Ethylhexyl)Phthalate ("DEHP"). In one embodiment,
connector 312 may comprise polyvinylchloride ("PVC") and may be,
optionally, at least substantially free of plasticizer. The
materials disclosed above are merely examples; more generally,
tubing section 314, connector 312, base member 340, and cannula 350
may comprise any material (e.g., thermoplastic, polyurethane,
metal, etc.) suitable for providing a robust and effective infusion
set 310.
[0149] During use of the infusion set 310, a mechanical injector
may be operably coupled to connector 312 via fastening structure
311. For example, fastening structure may comprise a luer-type
connection or any other fluid connection structure. Thus, a fluid
may be flowed through the infusion set at a flow rate of at least
about 1 milliliter per second via an injection apparatus. As
discussed above, a pressure drop through the infusion set 310 may
be at least about 100 psi; optionally, a pressure drop through
infusion set 310 may be at least about 185 psi.
[0150] In another embodiment, an infusion set may include two
connectors. In one configuration, one connector may be structured
for performing power injection and another connector may be
structured for allowing syringe access. For example, FIG. 54 shows
an infusion set 309 including a base member 340, a cannula 350, a
tubing section 324, an intermediate connector 322, a tubing section
314, and an end connector 312. Tubing 314 may be affixed or
otherwise coupled to connector 312 and connector 322 generally at
joints 313 and 323, respectively. Similarly, tubing 324 may be
affixed or otherwise coupled to connector 322 and base member 340
generally at joints 325 and 329, respectively. Infusion set 309 may
be structured for fluid flow rates and pressures as discussed above
in relation to infusion set 310. Accordingly, tubing sections 314
and 324 may comprise materials (e.g., a polymer, such as
TECOTHANE.RTM. and sizes as discussed above in relation to infusion
set 310, without limitation. Similarly, connectors 312 and 322 may
comprise any materials (e.g., PVC) discussed above in relation to
infusion set 310, without limitation. As shown in FIG. 54, a clamp
device 316 may be suitably configured for allowing or preventing
fluid flow through tubing 314. Likewise, clamp device 326 may be
suitably configured for allowing or preventing fluid flow through
tubing 324. In addition, connector 312 may include a fastening
structure 311 (e.g., a luer connection, another threaded
connection, or any other fastening structure as known in the art)
for releasably affixing or coupling the connector 312 to an
injection apparatus. Also, connector 322 may include a fastening
structure 321 (e.g., a luer connection, another threaded
connection, or any other fastening structure as known in the art)
for releasably affixing or coupling the connector 322 to an
injection apparatus.
[0151] Generally, the instant disclosure contemplates that, in one
embodiment, connector 312 may be used for power injection, while
connector 322 is capped. In another embodiment, a valve mechanism
may selectively allow flow through tubing sections 314 and 324 via
fluid flow through connector 312, while preventing leakage from
connector 322. In addition, if infusion set 309 is not being used
for power injection, a cap including a septum may be coupled to
connector 322, connector 312, or both. Such a configuration may
allow for a syringe to puncture the septum and infuse medication or
remove a blood sample. Such a configuration may provide a
convenient infusion set with separate connectors for power
injection and syringe access, respectively.
[0152] In a further aspect contemplated by the instant disclosure,
tubing that is used in connection with power injection may be
structured for withstanding a selected pressure during use (e.g.,
power injection) and, optionally, may be configured to resist
kinking. Generally, the instant disclosure contemplates that tubing
may comprise a plurality of layers. In one embodiment, tubing may
comprise a relatively high strength layer and at least one
relatively flexible layer. Thus, any layers of tubing may comprise
PTFE, polypropylene, polyetheretherketone ("PEEK"), polyimide
silicone, fluorinatedethylenepropylene (FEP), perfluoroalkoxy
(PFA), ethylenetetrafluoroethylene (ETFE), polyurethane (e.g.,
thermoplastic polyurethanes, including ISOPLAST.RTM.,
TECOFLEX.RTM., TECOTHANE.RTM., CARBOTHANE.RTM., TECOPLAST.RTM., or
TECOPHILIC.RTM. type polyurethanes), or combinations of the
foregoing. In one embodiment, the layers may be bonded to one or
more adjacent layers. In another embodiment, each of the layers may
be movable or slidable relative to one or more adjacent layers.
[0153] For example, FIGS. 55 and 56 show a side cross-sectional
view and an end cross-sectional view of tubing 401 including an
inner layer 420 and an outer layer 422. Generally, at least one of
inner layer 420 and outer layer 422 may exhibit relatively high
strength and the other of inner layer 420 and outer layer 422 may
be relatively flexible or vice versa. In one embodiment, inner
layer 420 may exhibit relatively high strength and may comprise,
for example, PEEK, ULTEM.RTM., polyimide, or the like. Further,
outer layer 422 may be relatively flexible and may comprise, for
example, FEP, PTFE, PEBAX.RTM., ETFE, silicone or the like.
Conversely, outer layer 422 may exhibit relatively high strength
and may comprise, for example, PEEK, ULTEM.RTM., polyimide, or the
like, while inner layer 420 may be relatively flexible and may
comprise, for example, FEP, PTFE, PEBAX.RTM., ETFE, silicone, or
the like. Further, optionally, tubing may comprise a first layer
exhibiting a modulus of elasticity and at least another layer
exhibiting a modulus of elasticity that is less than the modulus of
elasticity of the first layer. For example, a relatively high
strength material may exhibit a modulus of elasticity of at least
about 400,000 psi. Furthermore, a relatively flexible material may
exhibit a modulus of elasticity below about 390,000 psi. In another
embodiment, at least one of layers 420 and 422 may comprise a
composite material (e.g., a composite including particulate or
fiber reinforcement). For example, in one embodiment, tubing may
comprise polyurethane or PTFE including glass or carbon reinforcing
fibers or particles. In one embodiment, each of the layers 420 and
422 may be movable or slidable relative to one or more adjacent
layers. Such a configuration may withstand a selected internal
pressure without damage to the tubing and may also resist
kinking.
[0154] In another embodiment, a reinforcing element may be
incorporated within at least one of the plurality of layers
comprising tubing. For example, FIG. 57 shows a schematic side
cross-sectional view of tubing 403 including inner layer 430 and
outer layer 432, wherein at least one reinforcing element 434 is
incorporated within outer layer 432. Optionally, at least one
reinforcing element 434 may be incorporated within any layer or
layers of a plurality of layers comprising tubing, without
limitation. As shown in FIG. 57, reinforcing element 434 may
comprise a coil, in one embodiment. One of ordinary skill in the
art will appreciate that many variations are possible, for example,
at least one reinforcing element may comprise a mesh (e.g., a wire
mesh, a fabric, a fiber mesh, etc.). In another embodiment, at
least one reinforcing member may comprise one or more elongated
members extending longitudinally within at least one layer
comprising tubing (e.g., aligned with the direction of extension of
the tubing). In another embodiment, at least one reinforcing member
may comprise one or more rings. Such a configuration may provide
radial stiffness, strength, or both to a tubing section.
[0155] Referring to FIG. 57, in one embodiment, inner layer 430 may
exhibit relatively high strength and may comprise, for example,
PEEK or polyimide. Further, outer layer 432 may be relatively
flexible and may comprise, for example, FEP, PTFE, ETFE, silicone,
or polyurethane. Further, layers 430 and 432 may have a thickness
(e.g., a radial thickness) of between about 0.005 inches and about
0.001 inches. As mentioned above, layers 430 and 432 may be bonded
to one another or may be movable (slidable, twistable, etc.) with
respect to one another. Optionally, a coating 433 may be applied to
at least a portion of exterior surface of layer 432. Such a coating
433, in one embodiment, may comprise a polymer, such as TEFLON.RTM.
and may have a thickness of between about 0.001 inches and about
0.002 inches.
[0156] In a further embodiment, FIG. 58 shows a schematic side
cross-sectional view of tubing 405, including inner layer 440 and
outer layer 442, wherein at least one reinforcing element 444 is
incorporated within inner layer 440. As shown in FIG. 58,
reinforcing element 444 may comprise a coil, in one embodiment. In
other embodiments, reinforcing element may comprise any structure
discussed above in relation to reinforcing element 434, without
limitation. In addition, in one embodiment, inner layer 440 may be
relatively flexible and may comprise, for example, FEP, PTFE, ETFE,
or polyurethane. Further, outer layer 442 may exhibit relatively
high strength and may comprise, for example, PEEK or polyimide.
Further, layers 430 and 432 may have a thickness (e.g., a radial
thickness) of between about 0.005 inches and about 0.010 inches.
Optionally, a coating 443 may be applied to at least a portion of
exterior surface of layer 442. Such a coating 443, in one
embodiment, may comprise a polymer, such as TEFLON.RTM. and may
have a thickness of between about 0.001 inches and about 0.002
inches.
[0157] In an additional embodiment, tubing may include four layers.
For example, FIGS. 59 and 60 show a cross-sectional end view and a
side cross-sectional view of another embodiment of tubing 400. More
particularly, as shown in FIGS. 59 and 60, tubing 400 includes
layers 402, 404, 406, and 408. As shown in FIG. 59, layer 402
defines a lumen 410. In one embodiment, lumen 410 may have a
substantially circular cross-sectional shape and may exhibit a
diameter of about 0.024 inches. In another embodiment, each of the
layers 402, 404, 406, and 408 may be movable or slidable relative
to one or more adjacent layers. In addition, layer 402 may comprise
a material exhibiting a relatively high tensile strength. Such a
configuration may withstand relatively high pressures within lumen
410. For example, layer 402 may comprise PEEK, polyimide, etc.
Typically, such relatively high strength materials may exhibit a
modulus of elasticity of at least about 400,000 psi. Furthermore,
each of layers 404, 406, and 408 may comprise a material that is
relatively flexible. Such layers 404, 406, and 408 may each exhibit
a tensile strength that is less than the tensile strength of layer
402. For example, each of layers 404, 406, and 408 may comprise a
fluoropolymer, PEBAX.RTM., polyethylene terephthalate ("PET"),
silicone, etc. Typically, such relatively flexible materials may
exhibit a modulus of elasticity below about 390,000 psi. However,
any layers may comprise PTFE, polypropylene, silicone, FEP, PFA,
ETFE, polyurethane (e.g., thermoplastic polyurethanes, including
ISOPLAST.RTM., TECOFLEX.RTM., TECOTHANE.RTM., CARBOTHANE.RTM.,
TECOPLAST.RTM., or TECOPHILIC.RTM. type polyurethanes), or
combinations of the foregoing, without limitation.
[0158] In a further aspect of the instant disclosure, at least one
layer comprising a tubing section may extend distally from a
slender hollow structure for accessing a reservoir of an access
port through a septum. Put another way, at least one layer may
extend from a tubing section and may be structured for puncturing a
septum of an access port. For instance, FIGS. 61 and 62 show a
schematic side cross-sectional view of tubing 400, 401, 403, 405,
and an access port 50. Tubing 400, 401, 403, 405 (as described
above) includes a slender hollow region 450. Further, slender
hollow region 450 may be relatively stiff and suited for
penetrating a septum 80 of an access port 50, as shown in FIG. 62.
Thus, a slender hollow region 450 extending from a distal end of
tubing 400, 401, 403, 405 (which comprises a plurality of layers)
may form a needle or cannula for fluid communication between a
lumen of tubing 400, 401, 403, 405, and a reservoir 66 of access
port 50. More particularly, a slender hollow region 450 may
comprise one or more layers exhibiting a relatively high strength
of relatively high-strength layers (e.g., PEEK) forming tubing 400,
401, 403, 405. In one embodiment, an innermost layer of tubing 400,
401, 403, 405 may form slender hollow region 450. Such a
configuration may be advantageous and may, for example, reduce the
complexity of manufacturing an infusion set.
[0159] Many different embodiments of vascular access apparatuses or
infusion systems may incorporate one or more aspects of the instant
disclosure. Some embodiments of a vascular access apparatuses or
infusion systems are disclosed in U.S. Patent Application No.
60/675,309, filed Apr. 27, 2005, the disclosure of which is
incorporated, in its entirety, by this reference. Any of the
infusion systems, apparatuses, or methods, taken alone or in
combination, described in U.S. Patent Application No. 60/675,309,
may be structured or otherwise suited for performing power
injection (e.g., accommodating a fluid flow rate of at least about
1 milliliter per second, without limitation).
[0160] For example, the instant disclosure contemplates that an
infusion system configured for establishing fluid communication
between a flexible tube and a reservoir of an access port may be
structured for power injection. Such an infusion system may include
a slender pointed element that facilitates placement of the
flexible tube through a septum of the access port and is removable
from the infusion system once the flexible tube is appropriately
positioned.
[0161] Particularly, FIG. 63 shows in one embodiment an infusion
system 510 in an exploded assembly view, including an insertion
assembly 520, a safety clip 530, a hub 540 flexible tubing 590,
extension tube 570, clamp device 560, and tube connector 580. In
further detail, FIG. 64 shows a partial side cross-sectional view
of infusion system 510. As shown in FIG. 64, insertion assembly 520
comprises a base 528 and a slender pointed element 522 (e.g., a
needle, a trocar, or a cannula) secured thereto. As shown in FIG.
64, slender pointed element 522 includes a pointed end 525. In a
particular embodiment, the instant disclosure may utilize a slender
pointed element having a "non-coring" pointed end (i.e., pointed
end 525 is not "open" or hollow) to avoid damaging a septum of a
port into which the slender pointed element is inserted. The
slender pointed element 522 may comprise any conventional needle,
trocar, or cannula material, such as a stainless steel (e.g., AISI
304 stainless steel), or may, in another embodiment, comprise a
relatively hard plastic. In one embodiment, base 528 may be
injection molded or otherwise formed about slender pointed element
522 to capture a portion of the slender pointed element within the
base 528, as best seen in FIG. 64. Further, base 528 may optionally
include a recess 524 structured for accommodating other mechanisms
(e.g., safety clip 530), if such a recess is desirable. Base 528
may also, optionally, include a coupling feature 526 (e.g., a
protrusion) structured for coupling to a coupling feature 544
(e.g., a recess) formed in hub 540. Hub 540, as shown in FIG. 64,
may generally include hub body 550, manifold element 561, septum
548 and cap 546. In one embodiment, hub body 550 may comprise
TECOFLEX.RTM. (e.g., such as TECOFLEX.RTM. 85A-B20). Further, hub
body 550 may define wing structures 541 and 543 (FIG. 63), which
may be configured for affixing the hub to skin of a patient (e.g.,
by taping wing structures 541 and 543 to a patient, adhesively
affixing wing structures 541 and 543 to a patient, or otherwise
affixing wing structures 541 and 543 to a patient). Wing structures
541 and 543 may be employed for manipulation of the hub, such as,
for example, when inserting the slender pointed element 522 and
flexible catheter 590 into an implanted port or when removing the
slender pointed element 522 from an implanted port. Hub body 550
may optionally include a recess 542, if such a recess is desirable.
As shown in FIG. 64, recess 542 may have a retaining lip 559 for
retaining safety clip 530 therein, while long slender element 522
is positioned through the safety clip, as discussed in further
detail hereinbelow.
[0162] Hub 540 may be structured for allowing the slender pointed
element 522 of insertion assembly 520 to pass through the hub 540
and through septum 548, which is positioned within the hub 540. Put
another way, manifold element 561 may define a plurality of
passageways and at least one septum 548 through which fluid
communication with the plurality of passageways may be
accomplished. Explaining further, a manifold element 561 may be
configured for housing septum 548 to provide a seal a port or
opening of a plenum defined by manifold element 561. Optionally, a
cap element 546 may be positioned to capture septum 548 between cap
element 546 and manifold element 561. Cap 546 may include an
aperture 547 for allowing a slender pointed element to pass
therethrough and through septum 548. Thus, slender pointed element
522 (e.g., an appropriately sized trocar, non-coring needle, or
non-coring cannula) may be inserted through and removed from septum
548 without compromising the ability of septum 548 to seal.
Further, the presence of cap 546 may allow for so-called "power
injection" to occur via manifold element 561, wherein pressures
within manifold element 561, tubing 570, and flexible catheter 590
may reach at least about 200 psi or higher. Septum 548 may be
structured according to any septum embodiments disclosed herein
(e.g., including at least one structured element, for performing
power injection, etc.), without limitation.
[0163] As shown in FIG. 64, flexible catheter 590 may be affixed to
manifold element 561 and extension tube 570 may be affixed to
manifold element 561. In one example, extension tube 570 and
flexible catheter 590 may be chemically bonded to manifold element
561. In another example, an adhesive may affix extension tube 570
to surface 552 a part of manifold element 561. Similarly, an
adhesive may affix flexible catheter 590 to inner surface 562
another port of manifold element 561. Further, the hub body 550 may
be formed (e.g., injection molded, cured, or otherwise over-molded)
over the manifold element 561 (and, optionally the septum 548, the
cap 546, or both) and at least a portion of the extension tube 570
as shown in FIG. 64. In another embodiment, the hub body 550 may be
formed over at least a portion of the flexible catheter 590, if
desired.
[0164] Generally, as mentioned above, any tubing disclosed in the
instant disclosure may comprise a portion of infusion system 510.
Further, tubing clamps and connection devices as known in the art,
may be employed for extension tubing 570, clamp device 560, and
tube connector 580.
[0165] Flexible catheter 590 may comprise any material that is
suitable for power injection. For example, in one embodiment,
flexible catheter 590 may comprise a polymer, such as
TECOTHANE.RTM. (e.g., TECOTHANE.RTM. TT1055 D). As shown in FIG.
64, flexible catheter 590 may include an elongated lumen therein.
Further, flexible catheter 590 may have, proximate to opening 593
thereof, a transition region 595 wherein a cross-sectional size
(transverse to the lumen 594) of the flexible catheter 590
increases as a function of increasing distance from opening 593.
Optionally, transition region 595 may include two distinct tapers,
although the instant disclosure contemplates more generally that at
least one taper, at least one arcuate surface, or combinations
thereof may define transition region 595. Generally, at least one
aperture (e.g., one or more than one) may be provided proximate
opening 593 that extends through the tubular body of flexible
catheter 590 and communicates with lumen 594. As shown in FIG. 64,
flexible catheter 590 may include two apertures 592 in fluid
communication with lumen 594.
[0166] As shown in FIG. 64, slender pointed element 522 may extend
through safety clip 530, through aperture 547 of cap 546, and into
flexible catheter 590. Slender pointed element 522 may be
structured for allowing fluid communication within flexible
catheter 590. More particularly, slender pointed element 522 may be
sized so as to allow for clearance between the exterior of the
slender pointed element 522 and the interior (i.e., the lumen) of
the flexible catheter 590. In one embodiment, slender pointed
element 522 may include at least one longitudinally extending
indentation (with respect to a nominal cross-sectional shape of the
slender pointed element 522). For example, slender pointed element
522 may have a pointed end 525 and may include longitudinally
extending indentations extending along (i.e., along a longitudinal
axis of) slender pointed element 522. In another embodiment,
slender pointed element 522 may be generally circular, and
longitudinally extending indentations may form a substantially
triangular cross section of the slender pointed element 522 over
the portion of the slender pointed element that they are
formed.
[0167] In a further embodiment, an infusion system may be
structured so that a slender pointed element passes through an
extension tube, a flexible catheter, or both. Explaining further,
appropriate placement and configuration of a septum may allow for a
slender pointed element to pierce or pass into an extension tube, a
flexible catheter, or both. FIGS. 65 and 66 show another embodiment
of a hub 540 including recess 542, sleeve 620, and septum 548. In
addition, at least a portion of each of extension tube 570 and
flexible catheter 590 may extend partially within hub body 550.
Further, flexible catheter 590 extends partially within extension
tube 570. Put another way, flexible catheter 590 may at least
partially overlap with extension tube 570 and vice versa. In
another embodiment, a single tubular element may extend through hub
540 and function as both the flexible catheter 590 and extension
tube 570, if desired. Further, optionally, septum 548 may at least
partially surround a portion of extension tubing 570. Such a
configuration may facilitate sealing of septum 548 upon removal of
slender pointed element 522 therefrom. Sleeve 620 may compress
septum 548 so as to facilitate sealing of septum 548 upon removal
of slender pointed element 522 from the region of the septum 620
that the sleeve 620 surrounds. Septum 548 may be structured
according to any septum embodiments disclosed herein (e.g.,
including at least one structured element, etc.) for performing
power injection, without limitation.
[0168] Further, FIG. 67 shows a perspective view of safety clip 530
positioned generally about pointed end 525 of slender pointed
element 522. Safety clip 530 includes legs 533 and 535 each having
a curved end region, respectively, and a hole 534 sized for passing
there through slender pointed element 522. In further detail,
initially slender pointed element 522 may be passed through hole
534 and between legs 533 and 535 may be positioned and configured
so as to allow the slender pointed element 522 to extend there
past. Further, when the slender pointed 522 element is positioned
therein and safety clip 530 is positioned within recess 542, safety
clip 530 may be sized so that it will fit within the retaining lip
543 (FIG. 66) of recess 542 (FIG. 66). However, legs 533 and 535
may be biased so that if the pointed end 525 of the slender pointed
element 522 is moved toward hole 534 and does not extend past the
curved end regions of the legs 533 and 535, legs 533 and 535 will
move toward one another to effectively capture the pointed end 525
of the slender pointed element 522. Safety clip 530 may comprise
any self-actuating device for capturing a pointed end 525 of a
slender pointed element 522. Such a safety clip 530 may reduce the
chance of inadvertent insertion of the slender pointed element 522
into another person, particularly the medical practitioner that is
installing and removing the slender pointed element 522.
[0169] The instant disclosure further recognizes that because the
consequences of improperly pressurizing an access port (and a
catheter affixed to the access port, if any) or an infusion set may
be problematic, it may be advantageous to provide at least one
identification attribute to components of an infusion system so
that all of such components may be suitable for withstanding an
anticipated maximum flow rate and pressure associated with a
selected infusion process. Put another way, an access port that is
configured for accommodating a flow rate of at least about 1
milliliter per second may include at least one identification
attribute. Such an at least one identification attribute may be
observed (e.g., visually, by palpation, ultrasonically,
radiographically, etc.) or otherwise detected. The term,
"identification," as used herein and in connection with any
infusion devices (an access port, infusion set, etc.), means the
ability to correlate selected information of interest with a
perceivable feature.
[0170] The instant disclosure contemplates that any of the
identification features or attributes, taken alone or in
combination, described in U.S. Patent Application No. 60/658,518,
filed Mar. 4, 2005, may identify an access port as being structured
for power injection. Also, embodiments of an access port including
at least one identification attribute are disclosed in U.S. Pat.
No. 8,177,762, the disclosure of which is incorporated, in its
entirety, by this reference. The instant disclosure contemplates
that any of the identification features or attributes, taken alone
or in combination, described in U.S. Pat. No. 8,177,762 may
identify an access port as being structured for power injection.
Further, an access port may be identified by a maximum rate at
which fluid may safely be infused. For example, at least one
identification attribute may indicate that an access port is
configured for accommodating a fluid flow rate of at least about 1
milliliter per second, without limitation.
[0171] Referring to an access port encompassed by the instant
disclosure, at least one attribute of a housing of an access port
may provide at least one identification attribute for identifying
the access port as being structured for power injection at a rate
of at least about 1 milliliter per second. In one embodiment, at
least one physical attribute (e.g., size, shape, etc.) of an access
port may identify the access port as suitable for power injection
or may identify a maximum flow rate or pressure that may be safely
accommodated by the access port.
[0172] Thus, one aspect of the instant disclosure relates to a
method of identifying an access port (e.g., subcutaneously
implanted or otherwise situated, without limitation) as being
suited for power injection. More particularly, an access port
including a septum may be provided. Further, at least one attribute
of the access port may be perceived. In addition, the
subcutaneously implanted access port may be identified as being
suitable for power injection in response to perceiving the at least
one attribute of the access port.
[0173] In one embodiment, at least one attribute for identification
may comprise at least one feature of an access port housing. In
further detail, FIG. 68 shows a perspective view of an assembled
access port 50. As shown in FIG. 68, a side periphery 295 (e.g.,
one or more side walls and, optionally, exposed surfaces of suture
plugs 291) of access port 50 may be generally triangular. Thus, cap
54 and base 56 may collectively form a generally triangular housing
60 of access port 50. Also, the instant disclosure contemplates
that side periphery 295 may taper or arcuately extend between an
upper surface 61 of cap 54 and lower surface 51 of base 56. As
shown in FIG. 68, a transverse cross section (taken in a selected
plane substantially parallel to lower surface 51, if planar, of
base 56) of access port 50 may be larger proximate to lower surface
51 of base 56 and may be relatively smaller proximate to an upper
surface of cap 54. FIG. 69 shows a top elevation view of the access
port 50 shown in FIG. 69 and illustrates a generally triangular
shape defined by side periphery 295. Additionally, FIG. 70 shows a
simplified representation of a transverse cross section of access
port 50. As shown in FIG. 70, side periphery 295 of access port 50
may define three side regions 303 that extend between associated
vertex regions 301. In addition, in one embodiment and as shown in
FIG. 70, side periphery 295 may define a substantially equilateral
generally triangular shape. As may be appreciated, side regions 303
may arcuately extend between associated vertex regions 301; thus,
side regions 303 may form "sides" of a generally triangular shape.
Further, although vertex regions 301 are rounded, it will be
appreciated that such vertex regions 301 form an intersection
between adjacent side regions 303. Accordingly, it will be
appreciated that the phrase "generally triangular," as used herein,
encompasses any generally three-sided geometry wherein adjacent
sides intersect at or within vertex regions, without limitation.
For example, "generally triangular" encompasses three-sided
polygons, circular triangles, equilateral triangles, etc., without
limitation.
[0174] Furthermore, in a further embodiment, at least one attribute
for identification may comprise a radiographic marker. More
particularly, an access port may exhibit an observable pattern,
symbol, marker, or other indicium that indicates that the access
port is structured for accommodating a particular flow rate,
pressure, or both. In another embodiment, at least one attribute
for identification may comprise a perceptible aspect, such as a
visually perceivable feature. For example, at least one color, at
least one symbol, at least one typographical character (e.g., a
letter, a number, etc.), a pattern, or any other indicium that may
be visually perceivable or otherwise perceptible may be used. In a
yet additional embodiment, an ultrasound detectable feature may be
incorporated within an access port. In a further additional
embodiment, an access port may comprise an RFID tag.
[0175] It will be appreciated that other equipment and devices
(e.g., infusion sets, tubing, injectors, etc.) may be identifiable
in relation to a suitable maximum flow rate or maximum pressure.
For example, particular infusion apparatuses may include one or
more of the above-mentioned identification attributes or features.
Such a configuration may allow for different components (e.g.,
tubing, needles, access ports, mechanical injectors, etc.) to be
matched with one another. For example, substantially similar or
matching identification attributes shared by a power injection
apparatus, an infusion set, and an access port may indicate
suitability for use with one another to perform a selected power
injection process.
[0176] Another aspect of identification of an access port may
relate to identification of a patient within which an access port
is implanted. More specifically, a patient may be provided with an
identification card that carries perceptible (e.g., visually, via
magnetic strip, bar code, manually, or by other suitable
mechanisms) information regarding an implanted port. Thus, such an
identification card may be presented to a health care worker, the
information carried by the identification card may be perceived,
and the access port may be identified. Upon identifying the access
port, characteristics of the access port may be ascertained, such
as, for instance, a maximum flow rate, a maximum pressure,
suitability for a particular procedure or procedures, etc. In
another embodiment, a wristband or bracelet may be provided to a
patient within whom an access port is implanted. In a further
embodiment, a key chain including an information carrying device,
such as, for example, a magnetic strip, a bar code, a computer
readable media or device (e.g., a compact disk, "flash" memory, a
disk drive, etc.), or any other suitable information carrying
device. In another embodiment, a sticker containing the port
information can be applied to the chart of the patient. In further
embodiments, labeling on the infusion set can be used to identify
the set as power injection compatible.
[0177] A further aspect of the instant disclosure relates to a
septum comprising a gel or viscous liquid. The term "gel," as used
herein, means a colloid with at least one solid component suspended
within at least one liquid component, wherein the solid particles
(e.g., polymer particles) are attracted or otherwise linked to one
another (e.g., entangled or cross-linked) by covalent, ionic, or
dispersion (physical) forces. Thus, in one embodiment, a gel may be
a colloid in which the solid disperse phase forms a network in
combination with the fluid continuous phase to produce a viscous or
semi-rigid sol. A gel may exhibit stress-strain behavior that is
elastic, viscoelastic, or plastic, without limitation. The term
"viscous liquid," as used herein, means a liquid exhibiting a
viscosity of about 20,000 centipoises or higher.
[0178] One or more passageways formed through a septum positioned
within a housing to form an access port may allow for leaking of
fluid through the one or more passageways if the reservoir of the
access port is pressurized. The instant disclosure contemplates
that a gel region may be generally positioned between an upper
surface of a septum and a lower surface of a septum, to facilitate
a cannula extending through the septum from the upper surface to
the lower surface to also pass through at least a portion of the
gel region.
[0179] For example, in one embodiment, a septum may include a gel
that is at least substantially surrounded by a body material. For
instance, FIG. 71 shows a schematic, side cross-sectional view of a
septum 610 including a body 612 and a gel region 620 positioned
within body 612. Gel region 620 may be structured so that a cannula
inserted through upper surface 614 and extending through lower
surface 616 will pass through a portion of gel region 620. In one
embodiment, gel region 620 may comprise a silicone gel. In another
embodiment, a gel region may comprise an initially an uncured
liquid (i.e., has a relatively low viscosity) that may be cured to
cause the liquid to form a gel. In a further embodiment, gel region
620 may comprise a viscous liquid, or a viscoelastic material.
[0180] In one example, gel region 620 may comprise an elastomer,
such as, DOW CORNING.RTM. 7-9600 Soft Filling Elastomer, Parts A
& B, which is commercially available from DOW CORNING
Corporation of Midland, Mich. In another embodiment, gel region 620
may comprise Silicone Gel MED-6340, which is commercially available
from NuSil Technology of Carpinteria, Calif. In yet a further
embodiment, gel region 620 may comprise an elastomer exhibiting a
Shore A hardness of about 20 to about 30, such as, for instance,
DOW CORNING.RTM. C6-515 Liquid Silicone Rubber, Parts A & B or
DOW CORNING.RTM. C6-530 Liquid Silicone Rubber Parts A & B,
either of which is available from DOW CORNING Corporation of
Midland, Mich. Further, optionally, body 612 of septum 610 may
comprise a silicone material with a Shore A hardness of about 50 to
about 60. In another embodiment, body 612 and/or upper surface 614
of septum 610 may comprise a silicone material with a Shore A
hardness of about 60 to about 80. Optionally, body 612 and/or upper
surface 614 of septum 610 may comprise a fluoropolymer (e.g., PTFE,
etc.) or polyurethane.
[0181] One of ordinary skill in the art will understand that, upon
removal of a cannula extending through at least a portion of gel
region 620, a passageway or channel formed through gel region 620
may rebound, recover, seal, or heal. Further, gel region 620 may
seal passageways formed through body 612 and upper surface 614. For
example, gel region 620 may inhibit or prevent fluid leakage from a
reservoir of an access port through the septum 610 when a pressure
within the reservoir exceeds an ambient pressure external to the
access port (e.g., during a power injection process, any process
for flowing a fluid through an access port as described above, or
any process for flowing a fluid through an access port as known in
the art, without limitation). In addition, gel region 620 may be
formulated and/or body 612 may be structured so that a cannula
passing through septum 610 will resist transferring or removing any
of the material comprising gel region 620 outside of a selected
boundary or envelope. In one embodiment, body 612 may be structured
to remove a material comprising gel region 620 from a cannula
passing through the body 612.
[0182] Any of the septum embodiments discussed herein may include
at least one gel region. For example, FIG. 72 shows a schematic,
side cross-sectional view of a septum 611 including a body 612 and
a gel region 620. As discussed above, gel region 620 may be
structured so that a cannula inserted through upper surface 614 and
extending through lower surface 616 will pass through a portion of
gel region 620. Such a configuration may provide a robust septum
that resists leaking even if a multitude of passages are formed
through the septum with a cannula. Furthermore, providing a septum
comprising a gel may improve a sealing ability or quality of the
septum. Accordingly, a septum including a gel material may exhibit
a reduced thickness (i.e., from an upper surface to a lower
surface) in comparison to a conventional septum. For example, FIG.
73 shows a septum 613 including a body 612 and a gel region 620,
wherein a thickness T is less than a conventional thickness of a
conventional septum. In one embodiment, a thickness T of septum 613
may be about 0.500 inches or less.
[0183] The instant disclosure contemplates a variety of different
manufacturing methods may be employed for forming a septum
comprising a gel. For example, generally, a body of a septum may be
formed to substantially surround at least one gel region or a
recess or chamber may be formed by a septum body that is filled
with a gel. In one embodiment, a gel region may be suspended within
a mold for forming a body of a septum. More particularly, FIG. 74
shows a schematic, side cross-sectional view of a first mold 652
and a second mold 654, wherein gel region 620 is positioned between
(e.g., suspended) first mold 652 and second mold 654. As shown in
FIG. 74, gel region 620 is positioned by a frame element 630, which
abuts parting surface 655 of second mold 654. As shown in FIG. 74,
frame element 630 may be positioned by pins 606. In other
embodiments, frame element 630 may be suitably positioned, without
limitation. In a particular embodiment, parting surface 653 of
first mold 652 may be positioned proximate to parting surface 655
of second mold 654 (i.e., parting surfaces 653 and 655 may be
separated by frame element 630) to form a chamber defined by cavity
658 and cavity 656. Further, a hardenable material (e.g., a curable
material, such as a curable silicone, a thermoplastic, a resin,
etc.) may be injected into the chamber and hardened. Thus, the
hardenable material may surround or encapsulate gel region 620 and
may exhibit a geometry that is complimentary to cavities 656 and
658.
[0184] Generally, frame element 630 may be coupled to or affixed to
gel region 620. In one embodiment, frame element 630 may couple or
engage at least a portion of a periphery of gel region 620. In
another embodiment, frame element 630 may be substantially planar
and gel region 620 may rest upon or may be formed upon frame
element 630. Further, in one embodiment, frame element 630 may
extend at least partially through gel region 620. Optionally, frame
element 630 may cover or extend across mold cavity 656 of second
mold 654. In one example, frame element 630 may comprise a mesh
(e.g., a metal or polymer mesh, a fabric, a fiber mesh, etc.). In
another example, frame element 630 may comprise a sheet or layer of
silicone and may be, optionally, perforated. If frame element 630
comprises a mesh or is perforated, fluid communication (of a
hardenable material) between cavity 658 and cavity 656 may occur,
which may be desirable for avoiding shifting of gel region 620
and/or frame element 630 during encapsulation. Once gel region 620
is encapsulated, selected portions of frame element 630 may be
trimmed or cut, if desired.
[0185] In another method of forming a septum including at least one
gel region, a septum body may be formed to include at least one
chamber, which may be filled with a gel. For example, FIG. 75 shows
a septum body 612 defining chamber 621. Optionally, opening 623 may
be defined by body 612. Accordingly, a gel may be introduced within
chamber 621 via the opening 623 and the opening, optionally, may be
closed. For example, an uncured gel may be introduced within
chamber 621. Further, the uncured gel may be cured by heating or by
other suitable methods. Such a configuration may form a gel region
as described above in relation to FIG. 72. In one embodiment,
chamber 621 may be formed by an air injection molding process, a
blow molding process or any other process known in the art for
creating a chamber 621 within body 612. In another embodiment, body
612 may be formed about a removable plug or filler (e.g., a
silicone plug, steel, or aluminum insert). Such a plug or filler
may be coated with a nonstick coating (e.g., TEFLON.RTM., silicone,
or any nonstick coating known in the art). Thus, chamber 621 may be
formed upon removal of the plug or filler. In other embodiments,
portions of a septum may be formed, filled with a gel (or a liquid
precursor to a gel), and bonded to one another to form a septum. In
a further embodiment, body 612 may be initially formed and may
enclose chamber 621 within body 612. In addition, body 612 may be
cut to form an opening to allow chamber 621 to be filled with a
gel. Such an opening of body 612 may be closed or sealed to capture
or form a gel region. In yet a further embodiment, a solid body may
be formed and a chamber may be formed by slicing the solid body. In
such a configuration, filling the chamber may cause the solid body
to deform to form a domed or raised region, if desired. It will be
appreciated that many different approaches may be employed for
forming a chamber 621 within body 612 and subsequently filling the
chamber with a gel.
[0186] In an additional embodiment, a septum may include a gel
region positioned between a body and a layer of material bonded to
or formed over at least a portion of the gel region and at least a
portion of the body. For example, FIG. 76 shows a schematic, side
cross-sectional view of a septum 615 including a body 632, a gel
region 620, and a layer 626. As shown in FIG. 76, gel region 620
may be positioned within a recess 633 formed in the body 632 and
layer 626 may extend over a portion of gel region 620 and a portion
of body 632. One of ordinary skill in the art will understand that
gel region 620 may be positioned or formed within recess 633 of
body 632 and then layer 626 may be formed or positioned over gel
region 620 and body 632. Further, layer 626 may be bonded (e.g.,
adhesively bonded, bonded via curing, bonded via welding, or as
otherwise known in the art) or otherwise affixed to body 632 to
capture gel region 620. In one embodiment, septum 615 may be formed
by a multiple head (e.g., a two head) injection molding apparatus.
More particularly, such a molding apparatus may be capable of
forming the body 632, forming the gel region 620 within the body
632, and forming (e.g., over molding) the layer 626 over the gel
region 620 and body 632 by suitable mold configurations and
material injections. Layer 626, in one embodiment, may comprise a
silicone-based material exhibiting a Shore A hardness of between
about 60 and about 80. Body 632, in one embodiment, may comprise a
silicone-based material exhibiting a Shore A hardness of between
about 40 and about 50. Accordingly, during use of septum 615
(installed within a housing to form an access port) a cannula may
pass through layer 626, at least a portion of gel region 620, and
body 632. Such a configuration may facilitate positioning of a
cannula extending through layer 626, at least a portion of gel
region 620, and body 632.
[0187] While certain representative embodiments and details have
been shown for purposes of illustrating aspects of the instant
disclosure, it will be apparent to those skilled in the art that
various changes in the methods and apparatus disclosed herein may
be made without departing form the scope of the instant disclosure,
which is defined in the appended claims. For example, other access
port sizes and shapes may be employed; and various other
embodiments and structures may be employed for forming at least one
identifiable feature of an access port of the instant disclosure.
The words "including" and "having," (including their variants) as
used herein including the claims, shall have the same meaning as
the word "comprising." Embodiments of the invention may be embodied
in other specific forms without departing from the spirit of the
present disclosure. The described embodiments are to be considered
in all respects only as illustrative, not restrictive. The scope of
the embodiments is, therefore, indicated by the appended claims
rather than by the foregoing description. All changes that come
within the meaning and range of equivalency of the claims are to be
embraced within their scope.
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