U.S. patent number 3,866,599 [Application Number 05/219,666] was granted by the patent office on 1975-02-18 for fiberoptic catheter.
This patent grant is currently assigned to The Board of Regents of the University of Washington. Invention is credited to Curtis C. Johnson.
United States Patent |
3,866,599 |
Johnson |
February 18, 1975 |
FIBEROPTIC CATHETER
Abstract
A catheter of the fiberoptic type is disclosed for insertion
into the cardiovascular system. The catheter comprises a flexible
element with light-conducting fibers therein extending from one end
of the element to the other. A recess is provided adjacent one end
of the catheter to prevent the optical fibers from contacting a
vessel wall when the catheter is inserted therein.
Inventors: |
Johnson; Curtis C. (Lynnwood,
WA) |
Assignee: |
The Board of Regents of the
University of Washington (Seattle, WA)
|
Family
ID: |
22820220 |
Appl.
No.: |
05/219,666 |
Filed: |
January 21, 1972 |
Current U.S.
Class: |
600/342; 604/21;
604/915; 604/96.01; 356/41; 600/337 |
Current CPC
Class: |
A61B
5/0084 (20130101); A61B 5/6859 (20130101); A61M
25/0082 (20130101); A61B 5/1459 (20130101); A61B
5/0215 (20130101); A61B 5/14503 (20130101); A61M
25/0068 (20130101); A61M 25/10 (20130101); A61B
5/6853 (20130101); A61M 2025/0073 (20130101); A61M
2025/1052 (20130101) |
Current International
Class: |
A61B
5/00 (20060101); A61B 5/0215 (20060101); A61M
25/00 (20060101); A61M 25/10 (20060101); A61b
010/00 (); G01n 033/16 () |
Field of
Search: |
;128/2R,2M,2L,2.5R,2.5F,4-8,348,349B ;356/41 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
1. A catheter for insertion into the cardiovascular system
comprising an elongated flexible element having a multiplicity of
light-conducting fibers extending therethrough, a recess formed in
the distal end of the element, the recess cutting across said
fibers at an angle to the longitudinal axis of the fibers, the
distal end of the catheter preventing the light conducting fibers
from contacting said vessel wall, and an expandable sleeve located
near the distal end and on the exterior of said catheter whereby
upon expansion of the sleeve, it extends beyond said element to
further maintain a space between the distal end of the fibers and
the end of the sleeve.
Description
The invention described herein was made in the course of work under
a grant or award from the Department of Health, Education and
Welfare.
BACKGROUND OF THE INVENTION
This invention relates, as indicated, to a fiberoptic catheter for
insertion into the cardiovascular system to permit in vivo
examination of intravascular and intracardiac environments which
avoids the effects of wall artifact.
In recent years, developments in the field of fiberoptics have
enabled immediate determinations to be made of intravascular and
intracardiac blood oxygen saturation by catheterization. To make
such determinations, a catheter containing a multiplicity of
light-conducting fibers, which have their ends exposed adjacent the
lead end of the catheter, is inserted into an artery or vein to
position the ends of the fibers at a position where the
determinations are required. Rapidly alternating pulses of light
are supplied to a number of the fibers which emit light into the
blood with the light reflected from the blood carried back through
other fibers for photoelectric analysis from which determinations
of the blood's oxygen saturation are made.
It has also been proposed previously to utilize a fiberoptic
catheter which includes a lumen extending through the catheter to
permit measurements of blood pressure. Typically, such catheters
comprise a central lumen with the light-conducting fibers spaced
concentrically about the lumen in the wall of the catheter.
One of the principal disadvantages in the use of such previously
known fiberoptic catheters is the artifact which is created by
blood flow fluctuatons and blood vessel wall reflectance. To
overcome such problems, it has been proposed to utilize a metal
basket in conjunction with the catheter to protect the area around
the distal tip of the catheter where the reflectance signals
emanate. The use of such a metal basket, which may be in the form
of a wire cage, however, promotes clotting which is not only
dangerous and interferes with the normal functioning of the
cardiovascular system, but also interferes with the operation of
the fiberoptic catheter. It is highly desirable, therefore, to
provide a catheter which may be used in the determination of blood
pressure and oxygen saturation and which is capable of preventing
artifact at the distal tip and also prevents a non-injurious
surface to the blood vessel wall which minimizes the chances of
producing clotting.
SUMMARY OF THE INVENTION
The present invention is thus directed to a fiberoptic catheter
which may be inserted into the cardiovascular system without
incurring the effects of wall artifact. The catheter comprises a
flexible element which has a multiplicity of light-conducting
fibers extending therethrough and a recess at one end, whereby the
tips of the light-conducting fibers are prevented from contacting a
vessel wall during or after insertion therein.
DESCRIPTION OF PREFERRED EMBODIMENTS
In the annexed drawings:
FIG. 1 is a perspective view showing the catheter of the present
invention in conjunction with an optical connector;
FIG. 2 is a fragmentary cross-section view of the tip portion of
the catheter taken on line 2--2 of FIG. 1;
FIGS. 3 and 4 are a fragmentary section view and a section view on
line 4--4 of FIG 3, respectively, illustrating a further form of
tip construction;
FIGS. 5 and 6 are a fragmentary section view and a section view on
line 6--6 of FIG. 5 respectively showing yet another form of tip
construction;
FIGS. 7, 8, and 9 are fragmentary section views showing further
modifications of the catheter; and
FIGS. 10 and 11 are fragmentary section views illustrating the
catheter with flow direction inserts positioned therein.
Referring now more particularly to FIG. 1, a catheter, indicated
generally by the numeral 1, is shown which comprises an elongated
flexible element 2 connected at one end to an optical connector 3
through a protective sheath 4. The optical connector is a standard
item, adapted to be slidably inserted into an oximeter, and
includes a plurality of openings (not shown) in side 5 through
which infra-red and red light can be introduced into the catheter
and emitted therefrom for determinations of oxygen saturation in
the blood, as will be explained hereinafter. The connector also
includes coupling element 6 for connection to a pressure transducer
to measure pressure, there being an opening in connector 3
communicating with element 6 and the pressure lumen of the
catheter. The element 6 may also be connected to a syringe to take
a blood sample or to a saline solution to flush the catheter.
In FIG. 2, one form of tip construction of the catheter is
illustrated. The catheter includes a catheter wall 10 which
contains a multiplicity of light-conducting fibers 11 extending
therethrough from one end of the catheter to the other. The
catheter also includes a substantially central lumen 12 which
likewise extends throughout the length of the catheter for pressure
measurements and other uses to be explained. The catheter also
includes at the forward tip a recess denoted generally by 13. In
this embodiment, the recess is of a generally conical configuration
and is formed by the outer surface 14 of wall 10 extending beyond
the end of the light-conducting fibers and central lumen.
Due to the recess, when the catheter is inserted into a vessel
wall, the light-conducting fibers will not contact the vessel wall.
As explained previously, the usefulness of catheters of prior
constructions is severely limited due to artifacts created at the
distal tip of the catheter. The recess, however, holds the
light-conducting fibers away from the vessel wall and thus reduces
blood flow velocity at the tip of the fibers and minimizes velocity
artifact.
The depth of the recess has been found to be quite important. In
general, the recess, that is, the distance between the edge 14 of
the catheter wall and the forward edge of the fiberoptics, should
be from about 0.2 to about 1.5 millimeters, with the exact depth
being somewhat variable depending upon the exact tip construction
used and the diameter and configuration of the optical fibers which
are used. A depth of about 0.5 to 1.0 millimeters has been found to
be very satisfactory. The foregoing dimensions of the recess have
been derived experimentally utilizing catheters of different tip
constructions. In determining oxygen saturation, infra-red to red
light reflected by the blood and returned through the optical
fibers to the oximeter is obtained, the ratio being proportional to
the oxygen saturation in the blood. Ideally, if the catheter is
capable of accurate measurement, the ratio should remain
substantially constant in a localized area regardless of the
closeness of the catheter tip to a vessel wall, that is, the effect
of blood artifact should be eliminated. It has been found that this
is achieved with the recessed catheter of the present
invention.
Referring now to FIGS. 3 through 6, further forms of catheter tip
construction ar shown. In FIGS. 3 and 4, the catheter includes wall
20 which has a ring of light-conducting fibers 21 contained
therein. A central lumen 22 is also provided, the fibers being
disposed concentrically about the central lumen. The recess 23 is
essentially rectangular in configuration, formed by the wall of the
catheter extending beyond the end of the light-conducting fibers.
In FIGS. 5 and 6, catheter 25 includes a pressure lumen 26 which is
positioned in one segment of the catheter, while the
light-conducting fibers 27 and positioned in a second segment
opposite pressure lumen 26. A partitioning web 28 extends
throughout the length of the catheter and interconnects the two
segments. The recess 29, as illustrated, again is essentially of
rectangular configuration, although it is to be understood that the
recess may be of other shapes including a conical configuration as
illustrated in FIG. 2.
FIGS. 7, 8 and 9 illustrate further modifications of the catheter
of the present invention. In FIG. 7, the catheter 30 is
particularly suitable for use in conjunction with a needle which
would be inserted in the central pressure lumen 31 for puncturing
an artery or vein to enable the catheter to be inserted therein.
The catheter includes a tapered outer surface 32 as well as the
light-conducting fibers 33 which are tapered at the forward end 34.
The recess 35, formed between the end 36 of the catheter and end 34
of the fibers is cylindrical.
In FIG. 8, the catheter 40 includes tubular element 41 which has a
pressure lumen 42 and light-conducting fibers 43 therein, connected
by partitioning web 44 similar to the catheter illustrated in FIGS.
5 and 6. In FIG. 8, however, the catheter includes an opening or
vent 45 in the outer surface of the tube and has an expandable
sleeve 46 of neoprene rubber or other suitable thin expandable
material attached thereto by clamping rings 47 and 48, which are
positioned about the exterior of the catheter. It is to be
understood, of course, that other means can be used to attach the
expandable sleeve to the catheter including, for example, suitable
bio-compatible adhesives. In this embodiment, the ends of the
light-conducting fibers are sealed, as for example, with a plastic
or epoxy resin, since the pressure for inflation of the expandable
sleeve is introduced through such lumen and opening 45. As shown in
FIG. 8, the expandable sleeve, after inflation, resembles a balloon
and extends circumferentially about the catheter beyond the forward
tip of the same to provide recess 49. To assist in providing a
stable recess configuration and to ensure that the inflated balloon
assumes the proper position, which does not change due to blood
flow and wall forces exerted at the catheter tip, ring 48 extends
beyond the tip 50 of the catheter to serve as a stiffener for the
balloon, which extends beyond the forward edge of the catheter,
when expanded, as shown at 51 to provide a recess of the previously
indicated depth of about 0.2 to 1.5 millimeters.
When the catheter tip of FIG. 8 is used, the catheter is inserted
into the blood vessel with the expandable sleeve in the deflated
position shown in broken line. After insertion, air pressure is
admitted to the catheter through lumen 42 and air vent 45 to expand
the sleeve to the position shown in full line. As thus illustrated,
the expanded sleeve or balloon acts as an obstruction to blood flow
and generates a force on the tip of the catheter which pulls the
catheter in the direction of flow, thereby flow directing the
catheter tip along the path of flow through the heart chambers into
the pulmonary artery. This form of the catheter is highly
desirable, as acess to the pulmonary artery in many cases is a
clinical necessity. Also, since the recess is formed by the
inflated balloon, as described, a smooth non-injurious surface is
presented to the blood vessel wall.
Although a Swan-Ganz flow directed catheter, such as that available
from Edwards Laboratories Inc., has been used before, it is not a
fiberoptic catheter. Moreover, in a fiberoptic catheter, care must
be taken to avoid "balloon artifact," that is, having the balloon,
when expanded, extend too far into the volume of blood illuminated
by the fiberoptics and moving in response to flow or wall forces,
thereby introducing artifact into the reflected light measurement.
As indicated previously, ring 48 positioned as illustrated and the
shape and stiffness of the balloon 46, assist in avoiding such
problem.
In FIG 9, another form of catheter tip is shown with the catheter
55 including a plurality of flexible fingers 56 of rubber or a
suitable plastic positioned at the lead end thereof. The catheter
also includes a central lumen 57 and light-conducting fibers 58 as
in the embodiments previously discussed. The flexible fingers are
designed such that, when the catheter is inserted into the blood
vessel through a sheath or needle, the fingers assume the position
shown in broken line. After insertion into the blood vessel,
however, the fingers are unrestrained and open out into the
position shown in full line and thus provide the necessary recessed
tip configuration for artifact-free performance, the recess being
formed between the tip of fingers 56 and the forward edge of
catheter 55. Additionally, when in the unrestrained position, the
flexible fingers obstruct the blood flow and provide for flow
direction of the catheter in the manner described above with
respect to FIG. 8.
In FIGS. 10 and 11, further modifications of the catheter are
shown, where a catheter, such as that shown in FIGS. 1 through 7,
includes a flow direction insert positioned within the pressure
lumen. In FIG. 10, the catheter, denoted generally by numeral 59,
includes optical fibers 60 and a flow direction insert 61 extending
through the pressure lumen 62. The insert comprises a wire 63 and
means 64, such as resilient rubber wings, cup or bulb, on the
forward end which extend radially from the wire to provide a flared
obstruction for flow direction in the manner described above. In
FIG. 11, the flow direction insert is a balloon 65 connected to a
tubular element 66. The balloon is, of course, inflatable by
application of air pressure through the tubular element. When the
balloon is inserted within the catheter, it is partially inflated
as shown by the broken line 67, and after insertion beyond the tip
of the catheter to the desired flow direction position, the balloon
is further inflated as shown at 68 to provide the obstruction to
flow and flow direction previously discussed.
The flow direction inserts shown in both FIGS. 10 and 11 in the
operative position have the flow direction means extending beyond
the forward tip of the catheter. The advantages of the catheters of
FIGS. 10 and 11 are that flow direction of the catheter in a venous
system can be achieved by the inserts, and, when the catheter is in
the desired position within the vein, the insert can be removed. In
the FIG. 10 form, the insert would be removed simply by withdrawing
the same by pulling on wire 63. In FIG 11, the insert would be
removed by deflating the balloon 65 to the position shown in broken
line at 69 and then withdrawing the same. After the catheter has
thus been removed, the lumen is free for pressure monitoring and
sampling. The provision of the flow direction inserts thus provides
greater versatility for the catheters, since the insert would be
used only when flow direction is desired clinically and the need
for a balloon to be permanently located at the catheter tip would
thus be eliminated.
The materials of which the catheters are constructed are any of
those commonly used, including flexible plastics such as nylon,
Teflon, vinyls such as polyvinyl chloride, polyurethane and
polyethylene, or various rubber compounds. Typically, the catheter
will be 5 to 40 inches long and have an outer diameter of about 1
to 2 millimeters. The pressure lumen can vary in diameter, but
typically will be about one half to 1 millimeter in diameter.
* * * * *