VASCULAR ACCESS SYSTEM FOR
S EXTRACORPOREAT TREATMENT OF BTOOD
BACKGROUND OF THE DISCLOSURE
This invention relates to the treatment of blood, and more particularly to systems and implantable devices providing direct access to the vascular system of a patient receiving estracorporeal blood treatment.
The extracorporeal treatment of blood requires that the vascular system of a subject be directly accessed, and often accessed repeatedly.
Such treatments include the removal of various 20 components or toxins, and the addition of oxygen to the blood.
For example, hemapheresis is a treatment which involves the collection of blood cells, the 25 removal of a specific blood cell type from the blood, or plasma exchange. It requires that the vascular system be tapped with, for example, a needle attached to a catheter. The blood is then circulated through an extracorporeal separating device, and then 30 returned to the vascular system via a second needle stick. Hemapheresis may be performed once or repeatedly providing that adequate time is allowed for replacement of the blood cell by the donor's bone marrow.
Another blood treatment is hemodialysis, or the removal of various chemical substances from the blood. Such substances include ingested or injected drugs, or to~ins created during normal body metabolism, the presence of which is most often due to renal impairment. Typically this treatment involves accessing the vascular system, connecting 5 the vasculature to a hemodialysis pump and filtration mechanism, and returning the cleansed blood to the vascular system.
Accessing the vascular system may be 10 achieved by temporary or permanent means, depending on the requirements of the patient. For example, methods are available to establish temporary access involving the percutaneous insertion of a single or double lumen cannula into a large vein such as the 15 subclavian, femoral, or internal jugular.
However, to provide more adequately for the chronic renal impaired patient, it is preferable to surgically rearrange the peripheral vasculature, 20 thereby creating a permanent access. The procedure usually involves connecting a large surface peripheral vein to an artery producing a fistula, or surgically creating a loop between an artery and a vein using a synthetic material such as expanded 25 PTFE. The natural fistula, normally constructed from a vein or venous graft, is preferred over the synthetic loop which is prone to complications such as infections, clotting, and leakage. In either case, the surgery involved in its creation is a 30 lengthy process, and maintaining the resulting reconstruction of the vasculature is a chronic problem. The fistula must mature or become arterialized before it can be accessed with the needles. Then, when it becomes functional, a number of complications may arise including clotting, thrombosis, infection, and infiltration of scar-forming cells. In addition, because hemodialysis i5 a chronic treatment, the required and 5 repeated needle punctures eventually weaken and destroy the arterialized vein, which, to begin with ,-is abnormally pressurized and particularly susceptible to collapse.
Cleansing of the blood alternatively may be conducted by peritoneal dialysis, a treatment which does not necessitate accessing the vascular system.
Peritoneal dialysis involves placing a dialysate solution into the peritoneal cavity of a patient via 15 a catheter. The catheter is surgically implanted such that one end is secured within the cavity and the other end is accessible by either projecting through the skin or can be accessed subcutaneously (see for example, U.S. 4,490,137). The dialysate is 20 allowed to remain in the cavity for a predetermined time to allow blood metabolites or tosins (solutes) to cross the highly vascularized peritoneal membrane and enter into the dialysate. The toxin-laden dialysate is later removed through the same 25 catheter.
However, peritoneal dialysis may not be as desirable as hemodialysis because it rids the blood of metabolities indirectly using the peritoneal 30 membrane as a filter and in fact, only 15% of patients currently receiving blood dialysis therapy undergo peritoneal dialysis.
Implantable and eztracorporeal devices are known for the infusion of medicines and drugs into the vasculature (see, e.g., U.S. Patent nos.
4,673,394, 4,704,103, 4,692,146, and 4,014,328).
5 However, such devices are not useful for estracorporeal blood treatments, as their construction does not take into account the fragile nature of blood elements which are highly susceptible to breakage, or hemolysis during transfer, intrinsic 10 clotting, and immune response.
The implantable vascular access port disclosed in U.S. Patent No. 4,673,394 includes a housing portion having a substantially right circular 15 cylinder shaped, open-faced internal chamber, and a septum spanning the open face of the chamber to establish a closed reservoir. A cylindrical, tubular cannula extends from the sidewall of the chamber for coupling the reservoir to an external catheter. With 20 such a configuration, the chamber and cannula geometries are ill-suited for the transfer of blood elements through the access port, particularly at the flow rates and pressures that are required for current hemodialysis techniques. As blood is 25 transferred through the septum and injected into the chamber, flow patterns are established which include "dead flow" pockets, particularly in the corners of the chamber. Blood cells which enter these pockets merely circulate therein or hardly move at all, and 30 never, or only after a long time, enter the flow through the cannula. Such movement or lack thereof increases the chances of coagulation of the blood.
Further, at the relatively high flow rates, cell-lysing collisions occur at the abrupt interface of the chamber and the cannula. Such collisions are both from cell-to-cell interactions within regions of turbulence and from the physical impact of cells 5 within the chamber sidewalls.
Therefore, it is an object of the present invention to provide an improved method of accessing the vascular system which is antiseptic, less 10 traumatic to the patient, and which has potential for self-access or home care.
It is another object of the invention to provide an easier, quicker method of providing a 15 vascular access which will not require maseuration before it can be used for various extracorporeal blood treatments.
It is also an object to provide an improved 20 vascular access device which can be reliably and repeatedly connected to an extracorporeal blood treatment, and which is durable and easy to use.
SUMMARY OF THE INVENTION
Briefly, the present invention is directed 5 to an implantable vascular access port for use in the e~tracorporeal treatment of blood or fractions thereof. The port includes a biocompatible housing having an internal open-faced chamber defined by a concave sidewall and a bottom wall. A septum 10 composed of a biocompatible, self-resealing, penetrable material is affi~ed to the housing and spans the periphery of the open face of the chamber.
To the housing is attached the first end of a cannula. The cannula extends laterally from the 15 housing, and has a second end adapted to receive a catheter. In addition, the cannula has internal walls defining a channel extending from its first end, along a channel a~is from a point on the lateral boundary of the chamber, to its second end. This 20 channel has a radius Rl at the first end of the cannula, and has a radius R2 at the second end of the cannula, Rl being greater than R2. Preferably, the decrease in radius of the channel frame Rl to R2 is monotoxic, and provides a smooth and continuously 25 bounded flow path.
The housing of the access port may have lock means formed adjacent to the port for releasably engaging a flange of a mating twist-lockable 30 connection. The lock means includes a region of the bounding surface of the housing defining a void region adjacent to the port exterior to the chamber.
The lock means also includes means for releasably - 20~3161 engaging the flange by a partial revolution of such connection, whereby the chamber may be placed in fluid communication with a catheter having such a mating twist-lockable connection.
In addition, the lock means may include a means for guiding the catheter connector for rotational motion about an a~is passing through the port, and further, a means for capturing the 10 connector so as to prevent its movement along that a~is when rotated.
In various embodiments of the invention, the housing of the port includes first and second body 15 members. The first member includes a sidewall and a bottom wall having a cylindrical outer side surface.
The second body member is annular (including a cylindrical inner side surface), and includes means for supporting the septum. The outer surface of the 20 first member is adapted to interfit with the inner side surface of the second member. The housing may further include two or more internal open face chambers, each of which having an affi~ed septum and an attached cannula.
In another form of the invention, an implantable vascular access system is provided whereby the vascular access port is coupled to a catheter having a central passage with radius R2 and 30 an entry port defining a flow path to the central passage along a central a~is. The coupling means detachably couples the cannula and the entry port, while selectively establishing a continuous flow path 8 ~
1 between the chamber and the central passageway, the channel axis and the central axis being coaxial.
The vascular access system may employ a catheter with a wirewound reinforcing sidewall, and with an end opposite the entry port that is beveled and/or has at least one lateral aperture adjacent thereto. The system may further include a non-coring needle adapted to selectively penetrate the septum.
Accordingly, in one of its aspects, the invention provides an implantable vascular access device including a port comprising a biocompatible housing having an internal open-faced chamber extending along a reference axis and defined by a sidewall forming a lateral boundary and being concave in the direction of said axis, and a bottom wall;
a septum affixed to said housing and spanning the periphery of the open face of said chamber, said septum including a biocompatible, self-resealing, penetrable material; and a cannula attached at a first end thereof to said housing and extending laterally therefrom, and having a second end thereof adapted to receive a catheter, said cannula further having internal walls defining a channel extending from said first end, along a channel axis from a point on said lateral boundary of, and in communcation with, said chamber, to said second end.
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g BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing and other objects of this invention, the various features thereof, as well as 5 the invention, itself, may be more fully unaerstood from the following description, when read together with the accompanying drawings in which:
FIG. 1 shows a cutaway view of an 10 implantable access port according to the invention;
FIG. 2 shows a top plan view of the access port of FIG. l;
FIG. 3 shows a sectional view along lines 3-3 of the access port of FIG. 2;
FIG. 4 shows a side elevation view of the access port of FIG. 2 as viewed from the axis of the 20 cannula;
FIG. 5 shows a side elevation of a needle for use with the access port of FIGs. 1-4;
FIG. 6 shows a side elevation view of the tip of the needle of FIG. 5;
FIG. 7 shows an end view of the tip of the needle of FIG. 5 as viewed f rom the needle axis;
FIG. 8 shows in section a catheter for use with the access port of FIGs. 1-4;
FIGs. 9A and 9B show a coupler for use with the catheter of FIG. 8;
FIG. 10 shows a bottom view of a vascular 5 access port for use with the coupler of FIGs. 9A and 9B;
FIG. 11 shows a top plan view of a portion of the access port of FIG. 10 together with a 10 catheter and coupler;
FIG. 12 illustrates the use of one embodiment of the present invention as an access system for extracorporeal blood treatment; and FIG. 13 illustrates the use of an alternative embodiment of the present invention as an access system for extra corporeal blood treatment.
DESCRIPTION OF TH~ PREFERRED EMBODIMENT
E~tracorporeal blood treatments such as hemodialysis, plasmapheresis, and hemofiltration S require high flow rates to assure adequate clearances, but at pressures low enough to avoid hemolysis and obligatory ultrafiltration.
Optimization of blood flow and pressure resistance through the access port is therefore a critical 10 factor in constructing a functional vascular access system. Other considerations include the preservation of blood vessels and blood constituents, and the minimization of access trauma and patient discomfort.
The vascular access system of the present invention has been designed with the above-mentioned criteria in mind. This system enables blood to be removed from, and returned back to the vascular 20 system of the body with minimum trauma to accessed blood vessels and blood elements. It can be heparinized to reduce the chance of coagulation therein, and closed off when not in use. In addition, the port reservoir, the catheter, the 25 coupling, and the transitions therethrough have been designed to reduce areas of reduced movement or dead space, thereby minimizing the chance that coagulation may occur.
FIG. 1 shows a cutaway pictorial view of an implantable access port 10 according to the present invention. FIGs. 2, 3 and 4 show top plan, sectional and end elevation views, respectively, of the access 203~161 port 10 of FIG. 1. Access port 10 includes a two component housing 12 defining a generally cup-shaped internal open-faced chamber 14 defined by sidewalls 16 and bottom wall 18. The open face of chamber 14 5 is closed off by a cover member (or septum) 20 which spans the periphery, or lip, of the chamber 14.
Septum 20 is formed of a biocompatible, self-resealing penetrable material, which is 10 preferably an elastomer, such as silicone rubber or late~. Septum 20 is adapted to permit access using a hypodermic needle 22 to the chamber 14.
In the illustrated embodiment, the housing 15 12 includes an outer body member 12a and an inner body member 12b. In the preferred embodiment, both body members 12a and 12b are formed of a biocompatible material, such as titanium, although surgical grade steel or other biocompatible hard 20 materials can be used. The inner body member 12b includes a generally cylindrical outer lateral surface. The outer body member 12a is generally annular and has a cylindrical inner side surface with a radius substantially matching the outer lateral 25 surface of inner body member 12b, so that the two body members interfit and may be press-fit together to form housing 12. A lip 13 captures the peripheral portion of septum 20. The outer body member 12a has apertures therein, evenly spaced about its perimeter, 30 for suturing the access port to patient tissue when implanting.
-The inner body member 12b includes the internal sidewall 16 and the bottom wall 18 which define chamber 14. The internal sidewall 16 is concave and the bottom wall is generally planar, S although there may be some minor variation. An upper lip lS of inner body member 12b supports the peripheral portion of septum 20.
A cannula 24 is attached at its pro~imal end 10 to housing 12. Cannula 24 estends laterally from housing 12. The distal end 24b of cannula 24 is adapted for receiving a catheter. The cannula 24 includes internal walls that define a fluid flow channel 25 extending from a point in chamber 14, lS through the sidewall 16 and along a channel axis 26 to the distal end 24b of cannula 24.
The channel has a radius Rl at the proximal end 24a and a radius R2 at the distal end, where Rl 20 is greater than R2. In the preferred embodiment, Rl is 3.4 mm and R2 is 2.4 mm. The decrease in radius of the channel 25 from Rl to R2 is monotonic and is localized near the pro~imal end 24a, although a more gradual change may also be used. Preferably, the 25 rate of change of radius of channel 25 and the curvature of the sidewall 16 defining chamber 14 is optimally determined to establish an efficient blood flow path between chamber 14 and the distal end 24b of cannula 24.
The needle shown in FIG. 1 is substantially the same as a Huber type non-coring needle. For blooa flow applications, the needle is 16 gauge, having an inner bore diameter of 1.19 mm. This relatively large diameter is adapted to permit relatively high flow rates of blood, for esample, S 300 cc/min.
An alternative form of needle 22 is shown in FIG. 3. This needle, shown in detail in FIGs. 5-7, includes a solid trocar (three plane) point and a 10 pair of opposed lateral ports near the point region 22a. In other embodiments, a single lateral port may be used. The needle 22 is a 16 gauge needle, having an inner bore diameter 1.19 mm, also to accommodate desired'blood flow rates. In the preferred 15 embodiment, where the height H of chamber 14 is 8 mm mm and the maximum diameter is 22 mm, the ports of needle 22 have a 1 mm diameter and are 6 mm from the tip.
With the configuration of FIGs. 2-4 and the needle of FIGs. 5-7, the flow pattern for human blood injected into chamber 14 is characterized by substantially improved flow characteristics within chamber 14 which are aimed at reduced flow separation 25 (i.e., eliminating dead flow spaces which could cause clotting), even at flow rates as high as 300 cc/min.
In FIG. 2, an implantable catheter 40 is shown with one end 40' coupled to the cannula 24 30 within a cylindrical metallic coupler 42 having a laterally extending securing tab 44 with a hole 44a.
That catheter 40 is shown in section in FIG. 8.
Catheter 40 includes an elongated, flesible tubular section 46 estending along 8 catheter a~is 40a.
Catheter 40 is straight cut at the end 40' intended for coupling to access port 10 and is bevel cut at 5 the other end 40". A plurality of ports 50 are positioned in the sidewalls of catheter 40 near end 40". In the illustrated embodiment, catheter 40 is particularly adapted for receiving human blood and transferring that blood by way of port 10 for 10 estra-corporeal processing, for esample, hemodialysis, as described in conjunction with FIG.
12 below. Since that procedure requires pumping of blood from the patient's body, the catheter section 46 includes a helically wound reinforcement wire 48 15 within its sidewalls to provide sufficient stiffness to prevent collapse during pumping and binding.
A resilient bushing 52, for example, made of silicone, is positioned over and estends from the 20 coupling end 40' of catheter section 46. The bushing 52 is adapted to position the distal end of cannula 24 (having radius R2) and the coupling end of catheter section 46 (also having radius R2) in a butt joint alignment, so that the inner walls of cannula 25 24 (defining channel 25) and the inner walls of catheter section 46 at end 40' establish a smooth and substantially continuous flow path defining surface.
In order to secure the catheter 40 to the 30 access port 10, coupler 42 is positioned over the bushing 52, compressing that bushing against the outer surface of cannula 24. Then that coupler 42 is positioned so that the hole 44a securing tab 44 overlies one of the peripheral holes in housing 12.
In use, the tab 42 may be sutured to the housing 12 through the overlying holes.
In alternate embodiment~, the coupler 42 may have a T-shaped cross-section, as shown in FIGs. 9A
and 9B (with or without tab 44) and the housing 12 may be a T-shaped void region 62 surrounding the cannula 24, as shown in FIG. 10. With this 10 configuration, the coupler 42 may be used to effect a twist lockable attachment of catheter 40 to access port 10, as illustrated in FIG. 11. The separable port and catheter assembly, enables the surgeon to be flexible as to where and how the port is implanted.
In another embodiment of the invention, the access port has two or more reservoirs in a unitary housing, each having their own individual catheters or catheter lumens attached thereto (FIG. 13).
The access system, including the access port, catheter, and coupling means, may be surgically implanted within the body (e.g., in the vasculature of the chest), such that the port is just beneath the 25 epidermis and above the musculature, and the catheter has accessed the vasculature through a major vessel such as the subclavian vein. As shown in FIG. 12, the system preferably includes both an input port 60 and a removal port 62, with catheters 64 and 66 30 attached thereto and implanted in separate locations in the vasculature (preferably the heart). The ports may accessed transdermally with a needle as described above. Upon termination of estracorporeal treatment, 20331i~1 the needle accessing the removal port 62 may be removed, followed by the removal of the input port 60-accessing needle.
S The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiments are therefore to be considered in all respects as illustrative and not restrictive, the lO scope of the invention being indicated by the appended claims rather than by the foregoing description, and all the changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.