CA1293897C - Peritoneal dialysis catheter - Google Patents
Peritoneal dialysis catheterInfo
- Publication number
- CA1293897C CA1293897C CA000508152A CA508152A CA1293897C CA 1293897 C CA1293897 C CA 1293897C CA 000508152 A CA000508152 A CA 000508152A CA 508152 A CA508152 A CA 508152A CA 1293897 C CA1293897 C CA 1293897C
- Authority
- CA
- Canada
- Prior art keywords
- catheter
- catheter tube
- end portion
- distal end
- flange
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/28—Peritoneal dialysis ; Other peritoneal treatment, e.g. oxygenation
- A61M1/285—Catheters therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/02—Holding devices, e.g. on the body
- A61M2025/0293—Catheter, guide wire or the like with means for holding, centering, anchoring or frictionally engaging the device within an artificial lumen, e.g. tube
Abstract
PERITONEAL DIALYSIS CATHETER
ABSTRACT
A peritoneal catheter comprises a flexible catheter tube carrying porous cuff means to facilitate permanent securance of the catheter to the abdominal wall. The catheter tube defines, in its natural, unstressed condition, a bent segment adjacent the porous cuff means. This permits the catheter to be mounted in a tunnel formed through the abdominal wall in relatively unstressed configuration, with both ends pointing downwardly toward the feet of the patient. In one embodiment, the catheter includes a flange extending circumferentially outwardly of the catheter tube adjacent to the porous cuff means. The flange extends at a nonperpendicular angle relative to the axis of the catheter tube, and the slope of the flange extends transverse the direction of the bent segment.
The angled flange, when sutured to the posterior rectus sheath, maintains the catheter tube in the desired tunnel direction within the abdominal wall, with the distal end of the catheter tube pointed properly downwardly toward the pelvic cavity.
ABSTRACT
A peritoneal catheter comprises a flexible catheter tube carrying porous cuff means to facilitate permanent securance of the catheter to the abdominal wall. The catheter tube defines, in its natural, unstressed condition, a bent segment adjacent the porous cuff means. This permits the catheter to be mounted in a tunnel formed through the abdominal wall in relatively unstressed configuration, with both ends pointing downwardly toward the feet of the patient. In one embodiment, the catheter includes a flange extending circumferentially outwardly of the catheter tube adjacent to the porous cuff means. The flange extends at a nonperpendicular angle relative to the axis of the catheter tube, and the slope of the flange extends transverse the direction of the bent segment.
The angled flange, when sutured to the posterior rectus sheath, maintains the catheter tube in the desired tunnel direction within the abdominal wall, with the distal end of the catheter tube pointed properly downwardly toward the pelvic cavity.
Description
~>J`~P~3~ 7 PERITONEAL DIALYSIS CATHETER
~:
TECHNICAL FIELD
The Tenckhoff catheter is commercially available and widely used with patients who must under~o chronic peritoneal dialysis for maintenance in the absence of normal kidney function. The catheter is made of silicone rubber, and has a pair of porous tissue attachment cuffs in spaced relation to each other, so that after implantation of the catheter into the abdominal wall, tissue grows into pores of the cuffs, for secure and permanent anchoring of the catheter in place. In the articl~ by Tenckhoff and Schechter~
entitled "A Bacteriologically Safe Peritoneal Access Device," Trans.
Am. Soc~ Artif. Intern. Organs 1968; 14:181-187, the authors disclosed their new catheter and showed an arcuate subcutaneous catheter tunnel, so that both the external and internal end segments of the catheter were generally directed in a caudal direction (i.e., downwardly~ toward~the feet of the patient~.
In the practice of~installation of such peritoneal catheters, this technique is often followed, so that both the outer end of the catheter outside of the body and lying over the skin, and ~; the inner end of the catheter within the peritoneal cavity, ~ ~ ~ typically point downwardly toward the pelvis or feet.
'': .
3~7 However, known peritoneal catneters have been molded and cured in generally straight configuration, so that their natural, unstressed configuration is a straight line, although the catheters are flexible and may be placed in other configurations.
Accordingly, peritoneal catheters of the prior art must be stressed by bending into a substantially U-shape, in order to be installed into a curved tunnel through the abdDminal wall, which holds the catheter in its downward facing, U-shaped position so that both ends of the catheter extend downwardly.
I0 Significant advantages have been found for this arrangement. For example, in currently unpublished data by authors including us, it has been statistically shown that patients who have downwardly caudally pointing outer ends of their peritoneal catheter have fewer days of catheter tunnel infection, when compared with patients whose catheter ends point either upwardly or in a sideward direction.
Currently, however, disadvantages of this arrangement also exist. First, it appears that the e1astic memory of the catheter, which urges it to assume its original, unstressed, straight configuration, can cause catheter cuffs to be expelled from the tunnel site in a slow, migratory process, This of course is most disadvantageous. Secondly, the inner end portion of the catheter ~` can migrate upwardly with greater ease, due to the internal stresses of the catheter tending to urge it straight. It is undesirable for the catheter to migrate upwardly to upper portions of the peritoneal cavity, where it is prone to omental wrapping and one way obstruction of flow through the catheter. Accordingly, there is a need to keep the inner catheter portion positioned in the lower ~ portions of the peritoneal cavity, adjacent the pelvis. There is ;~ 30 also a need to maintain the desired tunnel direction of the catheter within the abdominal wall.
In accordance with this invention, the above disadvantages are reduced by the use of a modified catheter.
-~.
' --2a-SUMMARY OF THE INVENTXON
Various aspects of this invention are as follows:
A peritoneal catheter which comprises a flexible catheter tub0 having a proximal end portion which, in use, projects outwardly from the abdominal cavity of the patient and a distal end portion which, in use, projects inwardly into the peri.toneal cavity of the patient, said catheter carrying porous cuff means to facilitate permanent securance of the catheter to the abdominal wall, the improvement comprising: said catheter tuhe defining in its natural, unstressed condition, a bent segment adjacent said porous cuff means and between the proximal end portion and the distal end portion, said bent segment, in use, extending through the subcutaneous tissue and rectus muscle of the abdominal wall, through the posterior rectus sheath and into the peritoneal cavity; and further including a fIange circumferentially surrounding said catheter tube adjacent to said porous cuff means, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube and, in use, secured against the posterior rectus sheath of the patient, the slope of said flange extending in a direction transverse the direckion of said bent segment to maintain the distal end portion pointed in a caudal direction within the peritoneal cavity of the patient while the proximal end projects,~ when viewed by an onlooker, downwardly and ak an angle relative to the midline of the patient.
A peritoneal catheter comprising a flexible catheter tube having a proximal distal end portion and a distal end portion, an exterior porous cuff positioned on said flexible catheter tube near said proximal distal end portion, an interior porous cuff positioned on said ; 3~7 -2b-flexible catheter spaced away from said exterior porous cuff toward said distal end portion, said catheter tube defining in its natural unstressed condition, a bent segment between said exterior and interior porous cuffs, and a flange circumferentially surrounding said catheter tube adjacent to said interior porous cuff, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube, the slope of said flange extending in a direction transverse the direction of said bent sagment.
DESCRIPTION OF THE INVENTION
In one aspect of this invention, a peritoneal catheter comprises a flexible catheter tube3 which may be made of silicone rubber or equivalent material. The tube has a proximal and a distal end portion. The distal end portion defines flow port means for fluid com~unication between the bore of the catheter tube and the peritoneal cavity~ The catheter also carries porous cuff means to facilitate permanent securance of the catheter to the abdominal wall.
In accordance with this aspect of the invention, the catheter tube defines, in its natural, unstressed condition, a bent segment adjacent the porous cuff means. As the result of this, the catheter can be mounted in a tunnel formed through the abdominal wall in relatively unstressed condition, with the bent segment being mounted in the tunnel. Hence, the proximal end portion of the catheter may extend outwardly from the abdominal wall and downwardly from the outer end of the tunnel, while the distal end portion of the catheter extends inwardly and downwardly from the inner end of the tunnel into the peritoneal cavity.
Because of the unstressed bent segment, the catheter of this invention occupies the desired position where both ends thereof point caudally or downwardly, while at the same time the catheter tube is in relatively natural, unstressed condition, when compared with prior art catheters which have been placed in such a position.
Thus, less urging force is present in the catheter to cause gradual expulsion of cuffs from the tunnel formed in the abdominal wall.
Also, less force is present urging the distal end portion of the catheter upwardly out of its desired position in a lower portion of the peritoneal cavity.
Additionally, the installed catheter of this aspect of invention can exhibit significantly reduced days of tunnel infection which the patient must endure, because of the downward pointing aspect of the proximal end portion of the catheter, It is believed 3~397 that downwardly pointing proximal end portions of peritoneal catheters permit improved draining from the tunnel area in the event of an infection, which can significantly reduce the severity of the infectionO Also, less contamination of the tunnel site takes place because of the migration of sweat and bacteria laden water into the tunnel area, because its outer end points downwardly along with the proximal end portion of the catheter.
It is generally preferred for the bent segment of the catheter to define an arc of 90 to 180 so that the proximal and distal end portions form an angle to each other that is supplementary to the angle of said arc. A "supplementary" angle is an angle which, when combined with the arc angle, totals 180.
AccordinglyJ if the arc of the bent segment is 120, the proximal and distal end portions will form an angle with each other of 60.
Most preferably, the bent segment defines an arc of about 120 to 170o The use of a bent segment which defines an arc makes possible the formation of a substantial angle in the catheter, as shown in the drawings, without the danger of kinking of the catheter, as might take place if a merely angled corner were used rather than an arc.
The porous cuff means on the catheter may be any conventional cuff used for tissue attachment to a catheter. While a single, porous cuFf may be used, it is preferable to use a pair of spaced, porous cuffs in the manner of the well-known Tenckhoff catheter as it is currently commercially available. One cuff, hereafter called the exterior cuff, attaches to the subcutaneous tissue near the exterior abdominal wall~ The other cuff, hereafter called the interior cuff, attaches within the rectus muscle near the posterior rectus sheath. The bent segment of the catheter, as above described, is positioned between the interior and exterior cuffs.
3~7 In another aspect of the invention, an outwardly extending flange circumferentially surrounds the catheter just below the interior cuff. The flange extends in a nonperpendicular relationship relative to the axis of the catheter tube, being slanted at an angle less than 90 relative to the axis of the catheter. When viewed in the direction of the arcuate bend in the catheter, the direction of the slope extends generally transverse the direction of the arcuate bend. Preferably, the ngle of the slope is between about 30 and 509 with the most preferred angle being about 45.
The direction of the slope of the flange maintains the desired direction of the catheter inside the tunnel formed within the abdominal wall. When the flange is sloped upwardly to the right, as viewed from the distal end leg of the catheter in the direction of the arcuate bend, the catheter is intended to maintain a r;ght tunnel implacement, as described in more detail below. When the flange is sloped upwardly to the left9 as viewed from the same perspective the tatheter is intended to maintain a left tunnel implacement, also as described in more detail below.
When the angled flange is sutured flat against the posterior rectus sheath, the desired tunnel direction of the catheter is maintained within the abdominal wall~ with the distal end of the catheter pointing in the desired caudal direction within the peritoneal cav1ty.
, . .
DESCRIPTION OF THE DRAWINGS
_ _ FigO 1 is a plan view of one embodiment of the catheter of this invention in its natural, unstressed configuration.
Fig. 2 is a generally schematic view of the catheter of Fig. 1 as it may preferably be installed in the peritoneal cavity of a patient;
Fig. 3 is a plan view of anot.her embodiment of the catheter of this invention, showing the catheter having an angled flange adjacent to the interior cuff, the catheter being intended for "right tunnel" implacement;
Fig. 4 is a side view of the angled flange of the catheter taken generally along line 4-4 in Fig. 3;
Fig. 5 is a plan view of another embodiment of the catheter of this invention, showing the catheter having an angled flange adjacent to the interior cuff, the catheter being intended for "left tunnel" implacement;
Fig. 6 is a side view of the angled flange of the catheter taken generally along line 6-6 in Fig. 5; and Fig. 7 is a generally schematic side section view oF the catheter shown in Fig. 3 implaced within the peritoneal cavity of a patient.
DESCRIPTION OF SPECIFIC EMBODIMENTS
Referring to the drawings9 catheter 10 is a peritoneal catheter generally of the design of a commercially available Tenckhoff catheter, except as otherwise described herein. Catheter 10 comprises a flexible catheter tube 12 which may be made of silicone rubber or any other desired and appropriate material.
Adjacent the distal end 14 of the catheter, a plurality of flow ports 16 are formed in the wall of the catheter, while distal end 14 : itself may be open as well9 for added flow communication between the exterior and the bore of catheter 10.
3~
Proximal end 18 defines an open bore as well for receiving typically a titanium adaptor of known design, to provide connection wi~h a transfer set or other means for flow communication with peritoneal dialysis solution containers.
A pair of cuffs 20, 22 of known designs are also provided.
Outer cuff 20 is intended to be positioned within the abdominal wall tunnel within the subcutaneous tissue about 2 centimeters from the outer skin. Cuff 22 is intended to be positioned adjacent the inner end of the abdominal tunnel, near the posterior rectus sheath. The abdominal tunnel may be formed by the surgeon when the catheter is installed in the patient's abdomen.
In accordance with this inventionJ catheter 10 defines in its natural, unstressed condition, a bent segment 24. As shownl bent segment 24 defines an arc which may most preferably extend on the order of 150-170. A catheter may be manufactured with such an unstressed bend by molding the catheter, or causing it to be - cross-linked9 while in the desired bent positionO The bent segment 24 effectively forms two legs 15 and 19 in the catheter 10, one leg ~; 15 associated with the distal end 14, and the other leg 19 associated with the proximal end 18.
Figure 2 illustrates how the catheter may be installed in the peritoneal cavity of the patient, with proximal end 18 projecting out~ardly from the outer end 30 of the tunnel 34 formed by the surgeon in the abdominal wall. Distal end 14 of the catheter projects downwardly from the inner end 32 of the tunnel formed by the surgeon. Accordingly, since bent segment 24 is not as stressed as the catheters of prior art, there is less urging force to cause the distal end portion of the catheter to migrate upwardly in the ~ peritoneal cavity.
;~ 30 It is generally preferable for tunnel 34 to be formed on one side of the patient, spaced from the midline of said patient.
Also, proximal end 18 may be positioned at a small angle to the ~2~ 7 midline of the patient. In Fig. 2, the tunnel 34 is angled so that the exposed proximal end lS is positioned, when viewed by an on-looker, slightly to the left and pointed downwardly. This is called a "right tunnel" implacement.
AltPrnately (not shown), the tunnel may be angled so that the exposed end 18 is positioned, when viewed by an on-looker, slightly to the right and pointed downwardly. This is called a "left tunnel" implacementO
A statistical analysis of the frequency and severity of infections made by a group, including us, has found that downward external tunnel implacement left or right provides the lowest number of days of tunnel infection that a patient must endure~ when compared with any other position of tunnel 34. More particularly, we found that four catheters, installed ir patients for a total of 2,136 days, in which the outer portions of the tunnels 34 extended in a direction no more than 45 away from straight down in the standing patient, resulted in no tunnel exit site infection at all.
For catheter installations having higher angles than this ~rom the straight down direction, increasing difficulties with tunnel site infection were encountered, which grew progressively worse as the angle grew larger, and was worst of all when the $unnel site exit pointed generally upwardly. Figure 2 shows an ideal placement of the catheter of this invention in the abdomen.
In Figure 3, another peritoneal ca~heter 36 is shown which embodies the features of the invention~ The catheter 36 is constructed generally like the catheter 10 shown in Fig. 1, having distal and proximal ends 14 and 18 and an intermediate bent section 24. Other structural elements which are common to Fig. 1 are also given the same reference numerals as in Fig. 1.
....
~:
TECHNICAL FIELD
The Tenckhoff catheter is commercially available and widely used with patients who must under~o chronic peritoneal dialysis for maintenance in the absence of normal kidney function. The catheter is made of silicone rubber, and has a pair of porous tissue attachment cuffs in spaced relation to each other, so that after implantation of the catheter into the abdominal wall, tissue grows into pores of the cuffs, for secure and permanent anchoring of the catheter in place. In the articl~ by Tenckhoff and Schechter~
entitled "A Bacteriologically Safe Peritoneal Access Device," Trans.
Am. Soc~ Artif. Intern. Organs 1968; 14:181-187, the authors disclosed their new catheter and showed an arcuate subcutaneous catheter tunnel, so that both the external and internal end segments of the catheter were generally directed in a caudal direction (i.e., downwardly~ toward~the feet of the patient~.
In the practice of~installation of such peritoneal catheters, this technique is often followed, so that both the outer end of the catheter outside of the body and lying over the skin, and ~; the inner end of the catheter within the peritoneal cavity, ~ ~ ~ typically point downwardly toward the pelvis or feet.
'': .
3~7 However, known peritoneal catneters have been molded and cured in generally straight configuration, so that their natural, unstressed configuration is a straight line, although the catheters are flexible and may be placed in other configurations.
Accordingly, peritoneal catheters of the prior art must be stressed by bending into a substantially U-shape, in order to be installed into a curved tunnel through the abdDminal wall, which holds the catheter in its downward facing, U-shaped position so that both ends of the catheter extend downwardly.
I0 Significant advantages have been found for this arrangement. For example, in currently unpublished data by authors including us, it has been statistically shown that patients who have downwardly caudally pointing outer ends of their peritoneal catheter have fewer days of catheter tunnel infection, when compared with patients whose catheter ends point either upwardly or in a sideward direction.
Currently, however, disadvantages of this arrangement also exist. First, it appears that the e1astic memory of the catheter, which urges it to assume its original, unstressed, straight configuration, can cause catheter cuffs to be expelled from the tunnel site in a slow, migratory process, This of course is most disadvantageous. Secondly, the inner end portion of the catheter ~` can migrate upwardly with greater ease, due to the internal stresses of the catheter tending to urge it straight. It is undesirable for the catheter to migrate upwardly to upper portions of the peritoneal cavity, where it is prone to omental wrapping and one way obstruction of flow through the catheter. Accordingly, there is a need to keep the inner catheter portion positioned in the lower ~ portions of the peritoneal cavity, adjacent the pelvis. There is ;~ 30 also a need to maintain the desired tunnel direction of the catheter within the abdominal wall.
In accordance with this invention, the above disadvantages are reduced by the use of a modified catheter.
-~.
' --2a-SUMMARY OF THE INVENTXON
Various aspects of this invention are as follows:
A peritoneal catheter which comprises a flexible catheter tub0 having a proximal end portion which, in use, projects outwardly from the abdominal cavity of the patient and a distal end portion which, in use, projects inwardly into the peri.toneal cavity of the patient, said catheter carrying porous cuff means to facilitate permanent securance of the catheter to the abdominal wall, the improvement comprising: said catheter tuhe defining in its natural, unstressed condition, a bent segment adjacent said porous cuff means and between the proximal end portion and the distal end portion, said bent segment, in use, extending through the subcutaneous tissue and rectus muscle of the abdominal wall, through the posterior rectus sheath and into the peritoneal cavity; and further including a fIange circumferentially surrounding said catheter tube adjacent to said porous cuff means, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube and, in use, secured against the posterior rectus sheath of the patient, the slope of said flange extending in a direction transverse the direckion of said bent segment to maintain the distal end portion pointed in a caudal direction within the peritoneal cavity of the patient while the proximal end projects,~ when viewed by an onlooker, downwardly and ak an angle relative to the midline of the patient.
A peritoneal catheter comprising a flexible catheter tube having a proximal distal end portion and a distal end portion, an exterior porous cuff positioned on said flexible catheter tube near said proximal distal end portion, an interior porous cuff positioned on said ; 3~7 -2b-flexible catheter spaced away from said exterior porous cuff toward said distal end portion, said catheter tube defining in its natural unstressed condition, a bent segment between said exterior and interior porous cuffs, and a flange circumferentially surrounding said catheter tube adjacent to said interior porous cuff, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube, the slope of said flange extending in a direction transverse the direction of said bent sagment.
DESCRIPTION OF THE INVENTION
In one aspect of this invention, a peritoneal catheter comprises a flexible catheter tube3 which may be made of silicone rubber or equivalent material. The tube has a proximal and a distal end portion. The distal end portion defines flow port means for fluid com~unication between the bore of the catheter tube and the peritoneal cavity~ The catheter also carries porous cuff means to facilitate permanent securance of the catheter to the abdominal wall.
In accordance with this aspect of the invention, the catheter tube defines, in its natural, unstressed condition, a bent segment adjacent the porous cuff means. As the result of this, the catheter can be mounted in a tunnel formed through the abdominal wall in relatively unstressed condition, with the bent segment being mounted in the tunnel. Hence, the proximal end portion of the catheter may extend outwardly from the abdominal wall and downwardly from the outer end of the tunnel, while the distal end portion of the catheter extends inwardly and downwardly from the inner end of the tunnel into the peritoneal cavity.
Because of the unstressed bent segment, the catheter of this invention occupies the desired position where both ends thereof point caudally or downwardly, while at the same time the catheter tube is in relatively natural, unstressed condition, when compared with prior art catheters which have been placed in such a position.
Thus, less urging force is present in the catheter to cause gradual expulsion of cuffs from the tunnel formed in the abdominal wall.
Also, less force is present urging the distal end portion of the catheter upwardly out of its desired position in a lower portion of the peritoneal cavity.
Additionally, the installed catheter of this aspect of invention can exhibit significantly reduced days of tunnel infection which the patient must endure, because of the downward pointing aspect of the proximal end portion of the catheter, It is believed 3~397 that downwardly pointing proximal end portions of peritoneal catheters permit improved draining from the tunnel area in the event of an infection, which can significantly reduce the severity of the infectionO Also, less contamination of the tunnel site takes place because of the migration of sweat and bacteria laden water into the tunnel area, because its outer end points downwardly along with the proximal end portion of the catheter.
It is generally preferred for the bent segment of the catheter to define an arc of 90 to 180 so that the proximal and distal end portions form an angle to each other that is supplementary to the angle of said arc. A "supplementary" angle is an angle which, when combined with the arc angle, totals 180.
AccordinglyJ if the arc of the bent segment is 120, the proximal and distal end portions will form an angle with each other of 60.
Most preferably, the bent segment defines an arc of about 120 to 170o The use of a bent segment which defines an arc makes possible the formation of a substantial angle in the catheter, as shown in the drawings, without the danger of kinking of the catheter, as might take place if a merely angled corner were used rather than an arc.
The porous cuff means on the catheter may be any conventional cuff used for tissue attachment to a catheter. While a single, porous cuFf may be used, it is preferable to use a pair of spaced, porous cuffs in the manner of the well-known Tenckhoff catheter as it is currently commercially available. One cuff, hereafter called the exterior cuff, attaches to the subcutaneous tissue near the exterior abdominal wall~ The other cuff, hereafter called the interior cuff, attaches within the rectus muscle near the posterior rectus sheath. The bent segment of the catheter, as above described, is positioned between the interior and exterior cuffs.
3~7 In another aspect of the invention, an outwardly extending flange circumferentially surrounds the catheter just below the interior cuff. The flange extends in a nonperpendicular relationship relative to the axis of the catheter tube, being slanted at an angle less than 90 relative to the axis of the catheter. When viewed in the direction of the arcuate bend in the catheter, the direction of the slope extends generally transverse the direction of the arcuate bend. Preferably, the ngle of the slope is between about 30 and 509 with the most preferred angle being about 45.
The direction of the slope of the flange maintains the desired direction of the catheter inside the tunnel formed within the abdominal wall. When the flange is sloped upwardly to the right, as viewed from the distal end leg of the catheter in the direction of the arcuate bend, the catheter is intended to maintain a r;ght tunnel implacement, as described in more detail below. When the flange is sloped upwardly to the left9 as viewed from the same perspective the tatheter is intended to maintain a left tunnel implacement, also as described in more detail below.
When the angled flange is sutured flat against the posterior rectus sheath, the desired tunnel direction of the catheter is maintained within the abdominal wall~ with the distal end of the catheter pointing in the desired caudal direction within the peritoneal cav1ty.
, . .
DESCRIPTION OF THE DRAWINGS
_ _ FigO 1 is a plan view of one embodiment of the catheter of this invention in its natural, unstressed configuration.
Fig. 2 is a generally schematic view of the catheter of Fig. 1 as it may preferably be installed in the peritoneal cavity of a patient;
Fig. 3 is a plan view of anot.her embodiment of the catheter of this invention, showing the catheter having an angled flange adjacent to the interior cuff, the catheter being intended for "right tunnel" implacement;
Fig. 4 is a side view of the angled flange of the catheter taken generally along line 4-4 in Fig. 3;
Fig. 5 is a plan view of another embodiment of the catheter of this invention, showing the catheter having an angled flange adjacent to the interior cuff, the catheter being intended for "left tunnel" implacement;
Fig. 6 is a side view of the angled flange of the catheter taken generally along line 6-6 in Fig. 5; and Fig. 7 is a generally schematic side section view oF the catheter shown in Fig. 3 implaced within the peritoneal cavity of a patient.
DESCRIPTION OF SPECIFIC EMBODIMENTS
Referring to the drawings9 catheter 10 is a peritoneal catheter generally of the design of a commercially available Tenckhoff catheter, except as otherwise described herein. Catheter 10 comprises a flexible catheter tube 12 which may be made of silicone rubber or any other desired and appropriate material.
Adjacent the distal end 14 of the catheter, a plurality of flow ports 16 are formed in the wall of the catheter, while distal end 14 : itself may be open as well9 for added flow communication between the exterior and the bore of catheter 10.
3~
Proximal end 18 defines an open bore as well for receiving typically a titanium adaptor of known design, to provide connection wi~h a transfer set or other means for flow communication with peritoneal dialysis solution containers.
A pair of cuffs 20, 22 of known designs are also provided.
Outer cuff 20 is intended to be positioned within the abdominal wall tunnel within the subcutaneous tissue about 2 centimeters from the outer skin. Cuff 22 is intended to be positioned adjacent the inner end of the abdominal tunnel, near the posterior rectus sheath. The abdominal tunnel may be formed by the surgeon when the catheter is installed in the patient's abdomen.
In accordance with this inventionJ catheter 10 defines in its natural, unstressed condition, a bent segment 24. As shownl bent segment 24 defines an arc which may most preferably extend on the order of 150-170. A catheter may be manufactured with such an unstressed bend by molding the catheter, or causing it to be - cross-linked9 while in the desired bent positionO The bent segment 24 effectively forms two legs 15 and 19 in the catheter 10, one leg ~; 15 associated with the distal end 14, and the other leg 19 associated with the proximal end 18.
Figure 2 illustrates how the catheter may be installed in the peritoneal cavity of the patient, with proximal end 18 projecting out~ardly from the outer end 30 of the tunnel 34 formed by the surgeon in the abdominal wall. Distal end 14 of the catheter projects downwardly from the inner end 32 of the tunnel formed by the surgeon. Accordingly, since bent segment 24 is not as stressed as the catheters of prior art, there is less urging force to cause the distal end portion of the catheter to migrate upwardly in the ~ peritoneal cavity.
;~ 30 It is generally preferable for tunnel 34 to be formed on one side of the patient, spaced from the midline of said patient.
Also, proximal end 18 may be positioned at a small angle to the ~2~ 7 midline of the patient. In Fig. 2, the tunnel 34 is angled so that the exposed proximal end lS is positioned, when viewed by an on-looker, slightly to the left and pointed downwardly. This is called a "right tunnel" implacement.
AltPrnately (not shown), the tunnel may be angled so that the exposed end 18 is positioned, when viewed by an on-looker, slightly to the right and pointed downwardly. This is called a "left tunnel" implacementO
A statistical analysis of the frequency and severity of infections made by a group, including us, has found that downward external tunnel implacement left or right provides the lowest number of days of tunnel infection that a patient must endure~ when compared with any other position of tunnel 34. More particularly, we found that four catheters, installed ir patients for a total of 2,136 days, in which the outer portions of the tunnels 34 extended in a direction no more than 45 away from straight down in the standing patient, resulted in no tunnel exit site infection at all.
For catheter installations having higher angles than this ~rom the straight down direction, increasing difficulties with tunnel site infection were encountered, which grew progressively worse as the angle grew larger, and was worst of all when the $unnel site exit pointed generally upwardly. Figure 2 shows an ideal placement of the catheter of this invention in the abdomen.
In Figure 3, another peritoneal ca~heter 36 is shown which embodies the features of the invention~ The catheter 36 is constructed generally like the catheter 10 shown in Fig. 1, having distal and proximal ends 14 and 18 and an intermediate bent section 24. Other structural elements which are common to Fig. 1 are also given the same reference numerals as in Fig. 1.
....
3~37 _9 The catheter 36 shown in Fig. 3 differs from the catheter 10 shown in Fig. 1 by the inclusion of a flange 38 which is located adjacent to and directly below the internal cuff 22~ ~he Flange 38 is intended to be sutured to the posterior slleath 40 of the rectus muscle 42~ as shown in Fig. 7.
A bead 44 is provided below the flange 38. ~he bead 44 extends within the peritoneal cavity ~again, see Fig. 7) on the side of the posterior rectus sheath 40 opposite to the flange 38.
In accordance with the invention, the flange 38 is angled in a nonperpendicular relationship relative to the axis 13 of the catheter 36. As shown in Fig. 4, the angle (designated A in FigO
A bead 44 is provided below the flange 38. ~he bead 44 extends within the peritoneal cavity ~again, see Fig. 7) on the side of the posterior rectus sheath 40 opposite to the flange 38.
In accordance with the invention, the flange 38 is angled in a nonperpendicular relationship relative to the axis 13 of the catheter 36. As shown in Fig. 4, the angle (designated A in FigO
4), measured between the axis 13 and the flange 38, is generally between about 30 and about 50. As is also shown in Fig. 4, the slope of the Flange 38, when viewed in side section in the direction of the arcuate bend 24 from the distal end leg 15 of the catheter 36, extends in a direction transverse the direction of the bend 24 of the catheter 36.
In Fig. 4, the flange 38 is shown angled sloping upwardly to the right, when viewed from the distal end leg 15 in the direction of the arcuate bend 24. In this arrangement, the catheter 36 is intended for right tunnel implacement, with the exposed proximal end 18 of the catheter 36 angled slightly to the right and pointed downwardly, when viewed by an on-looker, as shown in Fig. 7.
Another catheter 46 is shown in Figs. 5 and 6. This catheter 46~ like catheter 36, has an angled flange 48. The catheter 46 is identical to the catheter 36 (shown in Figs. 3 and 4~, except that the flange 48, when viewed from the distal end leg 15 of the catheter 46 in the direction of the arcuate bend 24, is angled sloping upwardly to the left, as shown in Fig. 6. In this arrangement, the catheter 46 is intended for left tunnel implacement, with the exposed proximal end 18 of the catheter angled slightly to the left and pointed duwnwardly9 as is shown in Fig. 2.
..
.
When sutured flat against the posterior rectus sheath 40, as shown in Fig~ 7, the angled flange 38 or 48 maintains the desired right or left tunnel direction within the abdominal wall.
Furthermore, the flange 38 or 48 maintains the distal end 14 of the catheter pointing in the desired caudal direction within the peritoneal cavity. The flange 38 or 48, coupled with the arcuate bend 24 of the catheter 36 or 46, prevents migration of the catheter during use, maintaining the catheter in the optimal relationship within the peritoneal cavity. Tunnel infection is thereby reduced, and overall patient comfort improved.
The above has been offered for illustrative purposes only, - and is not intended to limit the scope of the invention of this application9 which is as defined in the claims below.
~ , ..
In Fig. 4, the flange 38 is shown angled sloping upwardly to the right, when viewed from the distal end leg 15 in the direction of the arcuate bend 24. In this arrangement, the catheter 36 is intended for right tunnel implacement, with the exposed proximal end 18 of the catheter 36 angled slightly to the right and pointed downwardly, when viewed by an on-looker, as shown in Fig. 7.
Another catheter 46 is shown in Figs. 5 and 6. This catheter 46~ like catheter 36, has an angled flange 48. The catheter 46 is identical to the catheter 36 (shown in Figs. 3 and 4~, except that the flange 48, when viewed from the distal end leg 15 of the catheter 46 in the direction of the arcuate bend 24, is angled sloping upwardly to the left, as shown in Fig. 6. In this arrangement, the catheter 46 is intended for left tunnel implacement, with the exposed proximal end 18 of the catheter angled slightly to the left and pointed duwnwardly9 as is shown in Fig. 2.
..
.
When sutured flat against the posterior rectus sheath 40, as shown in Fig~ 7, the angled flange 38 or 48 maintains the desired right or left tunnel direction within the abdominal wall.
Furthermore, the flange 38 or 48 maintains the distal end 14 of the catheter pointing in the desired caudal direction within the peritoneal cavity. The flange 38 or 48, coupled with the arcuate bend 24 of the catheter 36 or 46, prevents migration of the catheter during use, maintaining the catheter in the optimal relationship within the peritoneal cavity. Tunnel infection is thereby reduced, and overall patient comfort improved.
The above has been offered for illustrative purposes only, - and is not intended to limit the scope of the invention of this application9 which is as defined in the claims below.
~ , ..
Claims (4)
1. A peritoneal catheter which comprises a flexible catheter tube having a proximal end portion which, in use, projects outwardly from the abdominal cavity of the patient and a distal end portion which, in use, projects inwardly into the peritoneal cavity of the patient, said catheter carrying porous cuff means to facilitate permanent securance of the catheter to the abdominal wall, the improvement comprising:
said catheter tube defining in its natural, unstressed condition, a bent segment adjacent said porous cuff means and between the proximal end portion and the distal end portion, said bent segment, in use, extending through the subcutaneous tissue and rectus muscle of the abdominal wall, through the posterior rectus sheath and into the peritoneal cavity;
and further including a flange circumferentially surrounding said catheter tube adjacent to said porous cuff means, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube and, in use, secured against the posterior rectus sheath of the patient, the slope of said flange extending in a direction transverse the direction of said bent segment to maintain the distal end portion pointed in a caudal direction within the peritoneal cavity of the patient while the proximal end projects, when viewed by an onlooker, downwardly and at an angle relative to the midline of the patient.
said catheter tube defining in its natural, unstressed condition, a bent segment adjacent said porous cuff means and between the proximal end portion and the distal end portion, said bent segment, in use, extending through the subcutaneous tissue and rectus muscle of the abdominal wall, through the posterior rectus sheath and into the peritoneal cavity;
and further including a flange circumferentially surrounding said catheter tube adjacent to said porous cuff means, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube and, in use, secured against the posterior rectus sheath of the patient, the slope of said flange extending in a direction transverse the direction of said bent segment to maintain the distal end portion pointed in a caudal direction within the peritoneal cavity of the patient while the proximal end projects, when viewed by an onlooker, downwardly and at an angle relative to the midline of the patient.
2. A catheter according to claim 1 wherein said angle of said flange is about 30° to about 50° measured from the axis of said catheter tube.
3. A catheter according to claim 2 wherein said angle is about 45°.
4. A peritoneal catheter comprising a flexible catheter tube having a proximal distal end portion and a distal end portion, an exterior porous cuff positioned on said flexible catheter tube near said proximal distal end portion, an interior porous cuff positioned on said flexible catheter spaced away from said exterior porous cuff toward said distal end portion, said catheter tube defining in its natural unstressed condition, a bent segment between said exterior and interior porous cuffs, and a flange circumferentially surrounding said catheter tube adjacent to said interior porous cuff, said flange extending at a nonperpendicular angle relative to the axis of said catheter tube, the slope of said flange extending in a direction transverse the direction of said bent segment.
Applications Claiming Priority (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US72918585A | 1985-05-01 | 1985-05-01 | |
| US729,185 | 1985-05-01 | ||
| US06/826,823 US4687471A (en) | 1985-05-01 | 1986-02-06 | Peritoneal dialysis catheter |
| US826,823 | 1986-02-06 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1293897C true CA1293897C (en) | 1992-01-07 |
Family
ID=27111821
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000508152A Expired - Fee Related CA1293897C (en) | 1985-05-01 | 1986-05-01 | Peritoneal dialysis catheter |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US4687471A (en) |
| EP (1) | EP0220288B1 (en) |
| JP (1) | JPH0657258B2 (en) |
| BR (1) | BR8606640A (en) |
| CA (1) | CA1293897C (en) |
| DE (1) | DE3689025T2 (en) |
| HK (1) | HK1007967A1 (en) |
| WO (1) | WO1986006282A1 (en) |
Families Citing this family (119)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4772269A (en) * | 1985-05-01 | 1988-09-20 | Curators Of The University Of Missouri | Peritoneal dialysis catheter |
| US4886502A (en) * | 1986-12-09 | 1989-12-12 | Thermedics, Inc. | Peritoneal access catheter |
| US4834712A (en) * | 1988-01-15 | 1989-05-30 | Corpak, Inc. | Tube fixation device |
| US4935004A (en) * | 1988-12-20 | 1990-06-19 | Henry Ford Health System | Peritoneal dialysis catheter |
| US5281231A (en) * | 1989-02-22 | 1994-01-25 | Physical Sciences, Inc. | Impact lithotrypsy |
| US5425735A (en) * | 1989-02-22 | 1995-06-20 | Psi Medical Products, Inc. | Shielded tip catheter for lithotripsy |
| US5246447A (en) * | 1989-02-22 | 1993-09-21 | Physical Sciences, Inc. | Impact lithotripsy |
| US5098413A (en) * | 1989-03-13 | 1992-03-24 | Sil-Med Corporation | Peritoneal catheter |
| US4988340A (en) * | 1989-04-26 | 1991-01-29 | Christopher Kitchin | Tubular drainage device |
| JPH0372A (en) * | 1989-05-26 | 1991-01-07 | Terumo Corp | Exchange method for container for medical treatment |
| US5084024A (en) * | 1989-12-07 | 1992-01-28 | Thermedics, Inc. | Catheter and method for relieving catheter stress |
| AU7253691A (en) * | 1990-01-08 | 1991-08-05 | Curators Of The University Of Missouri, The | Multiple lumen catheter for hemodialysis |
| US5569182A (en) * | 1990-01-08 | 1996-10-29 | The Curators Of The University Of Missouri | Clot resistant multiple lumen catheter and method |
| US5405320A (en) * | 1990-01-08 | 1995-04-11 | The Curators Of The University Of Missouri | Multiple lumen catheter for hemodialysis |
| US5209723A (en) | 1990-01-08 | 1993-05-11 | The Curators Of The University Of Missouri | Multiple lumen catheter for hemodialysis |
| CA2013877C (en) * | 1990-04-04 | 2000-09-19 | Geoffrey S. Martin | Pre-curved dual lumen catheter |
| DE4112713A1 (en) * | 1990-07-02 | 1992-01-16 | Corpak Inc | CATHETER FOR PERITONEAL DIALYSIS WITH SIDED Cuffs |
| SE9100471D0 (en) * | 1991-02-18 | 1991-02-18 | Gambro Ab | HOSE KIT PROVIDED FOR PERITONEAL DIALYSIS |
| US5171227A (en) * | 1991-04-16 | 1992-12-15 | The Curators Of The University Of Missouri | Separable peritoneal dialysis catheter |
| US5102396A (en) * | 1991-04-22 | 1992-04-07 | Bommarito Alexander A | Jejunocath and surgical pad |
| US5141499A (en) * | 1991-10-09 | 1992-08-25 | Zappacosta Anthony R | Peritoneal dialysis catheter |
| US5350358A (en) * | 1992-12-22 | 1994-09-27 | Med-Pro Design, Inc. | Bent co-axial catheter |
| JP3146332B2 (en) * | 1992-12-24 | 2001-03-12 | 允 石崎 | CAPD catheter |
| US5346471A (en) * | 1993-03-22 | 1994-09-13 | Raulerson J Daniel | Dual lumen catheter |
| US5449346A (en) * | 1993-03-25 | 1995-09-12 | The Ohio State University | Method for placement of guide tube for gastrostomy tube |
| US5308338A (en) * | 1993-04-22 | 1994-05-03 | Helfrich G Baird | Catheter or the like with medication injector to prevent infection |
| US5383866A (en) * | 1993-09-15 | 1995-01-24 | Chang; Hau H. | Occlusion ureteral catheter for retrograde pyelography |
| US5718692A (en) * | 1995-06-06 | 1998-02-17 | Twineath, L.L.C. | Self-retaining single insertion double catheter assembly and method for making double catheter systems |
| SE505125C2 (en) * | 1995-10-10 | 1997-06-30 | Gambro Ab | Catheter, especially for peritoneal dialysis |
| US6991614B2 (en) | 1995-11-07 | 2006-01-31 | Boston Scientific Scimed, Inc. | Ureteral stent for improved patient comfort |
| US6849069B1 (en) | 1995-11-07 | 2005-02-01 | Boston Scientitfic Corporation | Medical device with tail(s) for assisting flow of urine |
| US5776111A (en) * | 1996-11-07 | 1998-07-07 | Medical Components, Inc. | Multiple catheter assembly |
| US5947991A (en) * | 1997-01-07 | 1999-09-07 | Cowan; Robert K. | Single balloon device for cervix |
| BE1011244A3 (en) * | 1997-06-30 | 1999-06-01 | Bekaert Sa Nv | LAYERED TUBULAR METAL STRUCTURE. |
| DE19728489A1 (en) * | 1997-07-03 | 1999-01-07 | Huels Chemische Werke Ag | Medical device for improving the skin fixation of indwelling catheters and other transcutaneous implants with a reduced risk of infection |
| US6042561A (en) * | 1997-10-22 | 2000-03-28 | Ash Medical Systems, Inc. | Non-intravascular infusion access device |
| WO1999042156A1 (en) | 1998-02-24 | 1999-08-26 | Boston Scientific Limited | High flow rate dialysis catheters and related methods |
| US6007523A (en) | 1998-09-28 | 1999-12-28 | Embol-X, Inc. | Suction support and method of use |
| US6332892B1 (en) | 1999-03-02 | 2001-12-25 | Scimed Life Systems, Inc. | Medical device with one or more helical coils |
| US6497676B1 (en) | 2000-02-10 | 2002-12-24 | Baxter International | Method and apparatus for monitoring and controlling peritoneal dialysis therapy |
| US8251986B2 (en) | 2000-08-17 | 2012-08-28 | Angiodynamics, Inc. | Method of destroying tissue cells by eletroporation |
| US6976973B1 (en) * | 2000-10-12 | 2005-12-20 | Baxter International Inc. | Peritoneal dialysis catheters |
| US6719804B2 (en) | 2001-04-02 | 2004-04-13 | Scimed Life Systems, Inc. | Medical stent and related methods |
| US6994706B2 (en) | 2001-08-13 | 2006-02-07 | Minnesota Medical Physics, Llc | Apparatus and method for treatment of benign prostatic hyperplasia |
| US6620202B2 (en) | 2001-10-16 | 2003-09-16 | Scimed Life Systems, Inc. | Medical stent with variable coil and related methods |
| US6758836B2 (en) | 2002-02-07 | 2004-07-06 | C. R. Bard, Inc. | Split tip dialysis catheter |
| US7393339B2 (en) | 2003-02-21 | 2008-07-01 | C. R. Bard, Inc. | Multi-lumen catheter with separate distal tips |
| US20040186461A1 (en) * | 2003-03-17 | 2004-09-23 | Dimatteo Kristian | Catheter with an adjustable cuff |
| US7090654B2 (en) * | 2003-03-28 | 2006-08-15 | Sherwood Services Ag | Catheter with occlusion resistant tip |
| US7141035B2 (en) * | 2003-03-28 | 2006-11-28 | Sherwood Services Ag | Catheter with occlusion resistant tip |
| US7776005B2 (en) * | 2003-03-28 | 2010-08-17 | Covidien Ag | Triple lumen catheter with occlusion resistant tip |
| US20040243095A1 (en) | 2003-05-27 | 2004-12-02 | Shekhar Nimkar | Methods and apparatus for inserting multi-lumen spit-tip catheters into a blood vessel |
| EP1663375A4 (en) * | 2003-09-08 | 2007-04-04 | Ash Access Technology Inc | Anti-clotting indwelling catheter |
| CN1925882A (en) * | 2003-11-15 | 2007-03-07 | 梅德拉股份有限公司 | Catheter for diagnostic imaging and therapeutic procedures |
| US8992454B2 (en) * | 2004-06-09 | 2015-03-31 | Bard Access Systems, Inc. | Splitable tip catheter with bioresorbable adhesive |
| JP2005348985A (en) * | 2004-06-11 | 2005-12-22 | 直 ▲秦▼野 | Guide wire, and catheter insertion kit |
| US8323227B2 (en) | 2004-07-02 | 2012-12-04 | C. R. Bard, Inc. | Tip configurations for a multi-lumen catheter |
| US20060004316A1 (en) | 2004-07-02 | 2006-01-05 | Difiore Attilio E | Reduction of recirculation in catheters |
| US8202248B2 (en) | 2004-08-18 | 2012-06-19 | Sequana Medical Ag | Dialysis implant and methods of use |
| EP1814610B1 (en) | 2004-11-04 | 2020-05-06 | Covidien AG | Catheter insertion apparatus |
| US7976518B2 (en) | 2005-01-13 | 2011-07-12 | Corpak Medsystems, Inc. | Tubing assembly and signal generator placement control device and method for use with catheter guidance systems |
| US9126011B2 (en) * | 2006-03-24 | 2015-09-08 | Merit Medical Systems, Inc. | Anti-clotting indwelling catheter |
| US8029457B2 (en) | 2006-03-24 | 2011-10-04 | Aat Catheter Technologies, Llc | Indwelling catheter with anti-clotting features |
| EP2001542B1 (en) | 2006-03-31 | 2010-02-10 | C.R.Bard, Inc. | Catheter including arcuate transition region |
| US8876754B2 (en) * | 2006-08-31 | 2014-11-04 | Bayer Medical Care Inc. | Catheter with filtering and sensing elements |
| US20090018493A1 (en) * | 2007-07-10 | 2009-01-15 | Ash Stephen R | Implantable catheter assembly |
| CN101918066B (en) | 2007-10-17 | 2013-07-31 | 巴德阿克塞斯系统股份有限公司 | Manufacture of split tip catheters and the split tip catheters |
| US8292841B2 (en) | 2007-10-26 | 2012-10-23 | C. R. Bard, Inc. | Solid-body catheter including lateral distal openings |
| US8066660B2 (en) | 2007-10-26 | 2011-11-29 | C. R. Bard, Inc. | Split-tip catheter including lateral distal openings |
| US9579485B2 (en) | 2007-11-01 | 2017-02-28 | C. R. Bard, Inc. | Catheter assembly including a multi-lumen configuration |
| US8092415B2 (en) | 2007-11-01 | 2012-01-10 | C. R. Bard, Inc. | Catheter assembly including triple lumen tip |
| US9198733B2 (en) | 2008-04-29 | 2015-12-01 | Virginia Tech Intellectual Properties, Inc. | Treatment planning for electroporation-based therapies |
| US10117707B2 (en) | 2008-04-29 | 2018-11-06 | Virginia Tech Intellectual Properties, Inc. | System and method for estimating tissue heating of a target ablation zone for electrical-energy based therapies |
| US11272979B2 (en) | 2008-04-29 | 2022-03-15 | Virginia Tech Intellectual Properties, Inc. | System and method for estimating tissue heating of a target ablation zone for electrical-energy based therapies |
| US10245098B2 (en) | 2008-04-29 | 2019-04-02 | Virginia Tech Intellectual Properties, Inc. | Acute blood-brain barrier disruption using electrical energy based therapy |
| EP2280741A4 (en) | 2008-04-29 | 2012-06-13 | Virginia Tech Intell Prop | Irreversible electroporation to create tissue scaffolds |
| US9867652B2 (en) | 2008-04-29 | 2018-01-16 | Virginia Tech Intellectual Properties, Inc. | Irreversible electroporation using tissue vasculature to treat aberrant cell masses or create tissue scaffolds |
| US11254926B2 (en) | 2008-04-29 | 2022-02-22 | Virginia Tech Intellectual Properties, Inc. | Devices and methods for high frequency electroporation |
| US10702326B2 (en) | 2011-07-15 | 2020-07-07 | Virginia Tech Intellectual Properties, Inc. | Device and method for electroporation based treatment of stenosis of a tubular body part |
| US8992517B2 (en) | 2008-04-29 | 2015-03-31 | Virginia Tech Intellectual Properties Inc. | Irreversible electroporation to treat aberrant cell masses |
| US10238447B2 (en) | 2008-04-29 | 2019-03-26 | Virginia Tech Intellectual Properties, Inc. | System and method for ablating a tissue site by electroporation with real-time monitoring of treatment progress |
| US10272178B2 (en) | 2008-04-29 | 2019-04-30 | Virginia Tech Intellectual Properties Inc. | Methods for blood-brain barrier disruption using electrical energy |
| US9283051B2 (en) | 2008-04-29 | 2016-03-15 | Virginia Tech Intellectual Properties, Inc. | System and method for estimating a treatment volume for administering electrical-energy based therapies |
| US11638603B2 (en) | 2009-04-09 | 2023-05-02 | Virginia Tech Intellectual Properties, Inc. | Selective modulation of intracellular effects of cells using pulsed electric fields |
| US11382681B2 (en) | 2009-04-09 | 2022-07-12 | Virginia Tech Intellectual Properties, Inc. | Device and methods for delivery of high frequency electrical pulses for non-thermal ablation |
| US8903488B2 (en) | 2009-05-28 | 2014-12-02 | Angiodynamics, Inc. | System and method for synchronizing energy delivery to the cardiac rhythm |
| US9895189B2 (en) | 2009-06-19 | 2018-02-20 | Angiodynamics, Inc. | Methods of sterilization and treating infection using irreversible electroporation |
| WO2010151573A1 (en) | 2009-06-26 | 2010-12-29 | Tyco Healthcare Group Lp | Catheterization system |
| CA2715857A1 (en) | 2009-09-30 | 2011-03-30 | Tyco Healthcare Group Lp | Medical catheter having a design providing low recirculation and reversibility |
| US8425455B2 (en) | 2010-03-30 | 2013-04-23 | Angiodynamics, Inc. | Bronchial catheter and method of use |
| WO2012051433A2 (en) | 2010-10-13 | 2012-04-19 | Angiodynamics, Inc. | System and method for electrically ablating tissue of a patient |
| US20120203199A1 (en) * | 2010-11-30 | 2012-08-09 | Incumed, Llc | Method and apparatus for providing access to an internal body organ |
| WO2012088149A2 (en) | 2010-12-20 | 2012-06-28 | Virginia Tech Intellectual Properties, Inc. | High-frequency electroporation for cancer therapy |
| CA3019557C (en) | 2011-02-16 | 2020-07-21 | Sequana Medical Ag | Apparatus and methods for treating intracorporeal fluid accumulation |
| WO2013036772A1 (en) | 2011-09-08 | 2013-03-14 | Corpak Medsystems, Inc. | Apparatus and method used with guidance system for feeding and suctioning |
| US9078665B2 (en) | 2011-09-28 | 2015-07-14 | Angiodynamics, Inc. | Multiple treatment zone ablation probe |
| US8747343B2 (en) | 2011-09-30 | 2014-06-10 | Covidien Lp | Hemodialysis catheter with improved side opening design |
| US9072867B2 (en) | 2011-09-30 | 2015-07-07 | Covidien Lp | Catheter with external flow channel |
| US8585635B2 (en) | 2012-02-15 | 2013-11-19 | Sequana Medical Ag | Systems and methods for treating chronic liver failure based on peritoneal dialysis |
| US9155862B2 (en) | 2012-09-28 | 2015-10-13 | Covidien Lp | Symmetrical tip acute catheter |
| US10252023B2 (en) | 2013-01-11 | 2019-04-09 | C. R. Bard, Inc. | Curved catheter and methods for making same |
| USD748252S1 (en) | 2013-02-08 | 2016-01-26 | C. R. Bard, Inc. | Multi-lumen catheter tip |
| WO2015175570A1 (en) | 2014-05-12 | 2015-11-19 | Virginia Tech Intellectual Properties, Inc. | Selective modulation of intracellular effects of cells using pulsed electric fields |
| WO2016011091A1 (en) | 2014-07-14 | 2016-01-21 | C. R. Bard, Inc. | Apparatuses, systems, and methods for inserting split tip catheters having enhanced stiffening and guiding features |
| US10183152B2 (en) | 2014-12-12 | 2019-01-22 | Cook Medical Technologies Llc | Cinching peritoneal dialysis catheter |
| US10694972B2 (en) | 2014-12-15 | 2020-06-30 | Virginia Tech Intellectual Properties, Inc. | Devices, systems, and methods for real-time monitoring of electrophysical effects during tissue treatment |
| US10245072B2 (en) | 2015-07-10 | 2019-04-02 | Medtronic, Inc. | Extravascular medical access tools having boring tip and methods of using such tools |
| US10695089B2 (en) | 2015-07-10 | 2020-06-30 | Medtronic, Inc. | Medical tools and methods for gaining access to extravascular spaces |
| US10265098B2 (en) | 2015-10-29 | 2019-04-23 | Medtronic, Inc. | Multi-purpose medical tools and methods for gaining access to extravascular spaces in a patient |
| JP7071338B2 (en) | 2016-08-26 | 2022-05-18 | セクアナ メディカル エヌブイ | Systems and methods for managing and analyzing data generated by embedded devices |
| US10716922B2 (en) | 2016-08-26 | 2020-07-21 | Sequana Medical Nv | Implantable fluid management system having clog resistant catheters, and methods of using same |
| US10905492B2 (en) | 2016-11-17 | 2021-02-02 | Angiodynamics, Inc. | Techniques for irreversible electroporation using a single-pole tine-style internal device communicating with an external surface electrode |
| AU2018273105B2 (en) | 2017-05-24 | 2023-08-10 | Sequana Medical Nv | Direct sodium removal method, solution and apparatus to reduce fluid overload in heart failure patients |
| US11559618B2 (en) | 2017-05-24 | 2023-01-24 | Sequana Medical Nv | Formulations and methods for direct sodium removal in patients having severe renal dysfunction |
| US11179516B2 (en) | 2017-06-22 | 2021-11-23 | Baxter International Inc. | Systems and methods for incorporating patient pressure into medical fluid delivery |
| US11607537B2 (en) | 2017-12-05 | 2023-03-21 | Virginia Tech Intellectual Properties, Inc. | Method for treating neurological disorders, including tumors, with electroporation |
| US11925405B2 (en) | 2018-03-13 | 2024-03-12 | Virginia Tech Intellectual Properties, Inc. | Treatment planning system for immunotherapy enhancement via non-thermal ablation |
| US11311329B2 (en) | 2018-03-13 | 2022-04-26 | Virginia Tech Intellectual Properties, Inc. | Treatment planning for immunotherapy based treatments using non-thermal ablation techniques |
| CN115192861B (en) * | 2022-09-16 | 2022-12-16 | 山东百多安医疗器械股份有限公司 | Catheter subcutaneous tunnel fixing device with responsiveness |
Family Cites Families (14)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JPS50103194A (en) * | 1974-01-21 | 1975-08-14 | ||
| SE390886B (en) * | 1975-06-23 | 1977-01-31 | Siemens Elema Ab | CATHETER FOR SELECTIVE CORONAR ARTERIOGRAPHY OF LEFT CORONAR SPECIES |
| AU1566776A (en) * | 1975-10-22 | 1978-01-12 | Sherwood Medical Ind Inc | Post-formed catheter balloon |
| US4184497A (en) * | 1977-08-26 | 1980-01-22 | University Of Utah | Peritoneal dialysis catheter |
| JPS6052851B2 (en) * | 1977-12-28 | 1985-11-21 | 株式会社細川粉体工学研究所 | gas filtration device |
| CA1148819A (en) * | 1980-05-08 | 1983-06-28 | Gabor Zellerman | Peritoneal catheter |
| US4437856A (en) * | 1981-02-09 | 1984-03-20 | Alberto Valli | Peritoneal catheter device for dialysis |
| US4496349A (en) * | 1981-05-08 | 1985-01-29 | Renal Systems, Inc. | Percutaneous implant |
| JPS58149765A (en) * | 1981-11-27 | 1983-09-06 | フレセニウス・ア−ゲ− | Abdominal membrane cathetel |
| EP0081724B1 (en) * | 1981-11-27 | 1986-03-12 | Fresenius AG | Intraperitoneal catheter |
| JPS59203568A (en) * | 1982-06-22 | 1984-11-17 | 日本ゼオン株式会社 | Cannula |
| US4491126A (en) * | 1982-07-06 | 1985-01-01 | Wilbur D. Smith | Method and apparatus for monitoring body parts of animals |
| JPS59151969A (en) * | 1983-02-21 | 1984-08-30 | テルモ株式会社 | Cathetel |
| US4568338A (en) * | 1983-09-22 | 1986-02-04 | C. R. Bard, Inc. | Preformed catheter |
-
1986
- 1986-02-06 US US06/826,823 patent/US4687471A/en not_active Expired - Lifetime
- 1986-04-30 JP JP61502682A patent/JPH0657258B2/en not_active Expired - Lifetime
- 1986-04-30 EP EP86903088A patent/EP0220288B1/en not_active Expired - Lifetime
- 1986-04-30 BR BR8606640A patent/BR8606640A/en not_active IP Right Cessation
- 1986-04-30 WO PCT/US1986/000957 patent/WO1986006282A1/en active IP Right Grant
- 1986-04-30 DE DE86903088T patent/DE3689025T2/en not_active Expired - Fee Related
- 1986-05-01 CA CA000508152A patent/CA1293897C/en not_active Expired - Fee Related
-
1998
- 1998-06-27 HK HK98107132A patent/HK1007967A1/en not_active IP Right Cessation
Also Published As
| Publication number | Publication date |
|---|---|
| DE3689025T2 (en) | 1994-01-27 |
| HK1007967A1 (en) | 1999-04-30 |
| EP0220288A1 (en) | 1987-05-06 |
| DE3689025D1 (en) | 1993-10-21 |
| JPS62502948A (en) | 1987-11-26 |
| EP0220288A4 (en) | 1989-02-20 |
| WO1986006282A1 (en) | 1986-11-06 |
| EP0220288B1 (en) | 1993-09-15 |
| BR8606640A (en) | 1987-08-04 |
| US4687471A (en) | 1987-08-18 |
| JPH0657258B2 (en) | 1994-08-03 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| CA1293897C (en) | Peritoneal dialysis catheter | |
| US4772269A (en) | Peritoneal dialysis catheter | |
| US5141499A (en) | Peritoneal dialysis catheter | |
| EP0509715B1 (en) | Peritoneal dialysis catheter | |
| EP0346613B1 (en) | Dual-lumen catheter-connecting system | |
| US7695450B1 (en) | Multiple lumen catheter for hemodialysis | |
| US4935004A (en) | Peritoneal dialysis catheter | |
| AU601288B2 (en) | Venous return catheter | |
| US5405320A (en) | Multiple lumen catheter for hemodialysis | |
| CA1289839C (en) | Body fluid transfer device | |
| US4368737A (en) | Implantable catheter | |
| US4033353A (en) | Tracheostomy tube | |
| US5259376A (en) | Tracheostomy tube assembly | |
| US4738667A (en) | Preformed catheter assembly | |
| CA2109417C (en) | Subcutaneous access device for peritoneal dialysis | |
| US4607635A (en) | Apparatus for intubation | |
| Chait et al. | The cecostomy button | |
| ES2005373A6 (en) | Catheter. | |
| JPS58212457A (en) | Urethra cathetel | |
| Nichols et al. | A Technique for Managing Exit Site and Cuff Infection in Tenckhoffcatheters | |
| US4874370A (en) | Adapter device for irrigating the intestine | |
| CA1269004A (en) | Peritoneal dialysis catheter | |
| WO1987001293A1 (en) | Tracheostomy cannula | |
| CA1147628A (en) | Anesthesia device | |
| CN208176726U (en) | A kind of anterior urethra surgical dilator |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| MKLA | Lapsed |