CA2112394C - Splittable sheath assembly and method for using - Google Patents
Splittable sheath assembly and method for usingInfo
- Publication number
- CA2112394C CA2112394C CA002112394A CA2112394A CA2112394C CA 2112394 C CA2112394 C CA 2112394C CA 002112394 A CA002112394 A CA 002112394A CA 2112394 A CA2112394 A CA 2112394A CA 2112394 C CA2112394 C CA 2112394C
- Authority
- CA
- Canada
- Prior art keywords
- lead
- sheath
- catheter
- introducer sheath
- valve
- 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 - Lifetime
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
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
- A61M25/0668—Guide tubes splittable, tear apart
-
- 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
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/062—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof used with a catheter
-
- 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
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
-
- 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
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/064—Slit-valve
-
- 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
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
Abstract
A splittable hemostatic valve (14) and introducer sheath (12) is provided for introductions of leads or catheters through the valve and sheath combination (10) into a vein or artery. Because of the hemostatic valve (14), this sheath (12) can remain in the vein throughout the operation with easier lead manipulation, especially in dual lead insertions, without bleeding, risk of air embo-lism or repeated sheath insertion related trauma. A side arm (18) to the hemostatic valve cage provides continuous fluid drip in order to prevent clot formation in the lumen of the sheath (12). At the point in the operation where the introducer sheath (12) and hemostatic valve (14) must be removed from the lead or catheter, score lines (36, 34) are employed to split or separate the introdu-cer sheath (12) and valve (14) a part so that the sheath (12) and valve (14) are removed from the implanted lead or catheter without sliding either the sheath (12) or valve (14) over the free end of the lead or catheter. The hemostatic valve is made in two separate parts (16a, 16b) which include a fluid-tight seal to facilitate splitting of the valve.
Description
W~/0094, PCr/US92/05666 21~23~4 spLrrrALr F S~ AS5EM13LY AND ~q~OD ~ U5ING
Bs.h~ of the Invention 10 1. Fze~l of rJ~e Invenrion ~ The invention re~ates to the field of p~rl~m*i~f~r leads and catheters and methods for irlsertion of the sa~ne, and in particular to leads used in veins such as in cnnn~ nn with p:~r~m:llrPr procedures such as p~r~n~ lead insertion.
1~ 2 Descnprion of ~l~e PriorArr There are many medical ~.u.~lu c~ which require a puncture and ~ i1-.,. IC1 ~ion of an artery or vein for various purposes.
In the prior art process of p~-~u~ u~ puncture, a guidewire is introduced into the vessei through a hûllow needle. The ne~dle is withdrawn leaving the 20 gLudeviire in the vessel. A TEFLON dilator and venouS sheath assembly are then advanced in a rotary motion over the guidewire into the vessel. The TEFLON dilator and the gludewire are then removed leaving the flexible sheath in the vessel. At this point, various typeS of catheters or leads are inserted using the sheath as a conduit to avûid tearing or further trauma to the vessel wall.
In the case where a p r-m~ r lead must be ~ y inserted into the patient, the p~rAm~ r is ~ implanted in the patient and the lead, which cxtcnds from thc p7r~m~ r into the heart chatnber7 remairls p~ "~ y disposed through the vcssel wall and irl the vessel lumerL A sheath is nevertheless used in ordcr to guide ir~sertion of the lead into veirl lumcrL but must be removed leaving the 30 lead in place. However, the sheath cannot simpiy, in all cases, be slipped over thc *~rade Mark .
WO 93~0094~ PC~I,'S92~5666 ~ 2 21~239~
exterior end of the pacemaker le~d which may be provided with a special r~rTnin~Tinn for c nnn~rinn to the r~^~nnrliro~
In this case, the prior art has devised a rlumber of spiittable or peel away sheqths. The sheath is sc-nred so that it is withdrawn by splitting or peeling it off from S the p~roTn~ catheter. See Philip O. Littleford, et al, "The American Jourr~al of Cardiology," Vol. 43, pp. 980-982 (May 1979); Littleford, "Apparatus and Method for ~nserting an Electrode," U.S. Patent 4,166,469 (1979); Littleford, "Method fo}
TnSerting Pacemaker Electrodes and the Like,~ U.S. Patent 4,243,050 (1981) and Littleford, "Split Sleeve Introducers for Pacemaker Electrodes and the Like," U.S.
Patent 4,345,606 (1982); Osborne, "Tear Apart Cannula," U.S. Patent Reissue 31,855 (1985), a reissue of U.S. Patent 4,306,562 (1981); Boarini et al., ~Peelable Catheter vrith Securing Ring and Suture Sleeve," U.S. Patem 4,411,654 (1983); Moorehead.
"Medic 1 Layered Peel Away Sheath and Methods," U.S. Paterlt 4,983,168 (1991). Asplittable cannula is also taught by Kousai et al., "Medical Tool Introduction Cannula arld Method of M~nllf~lrnlrin,o the Same," U.S. Patent 4,883,468 (1989).
However, in each of these prior art sheath ~cc~nnhli~s~ once the sheath has been inserted the sheath provides a passage for the free ow of blood. In praaice a cionifirr~nt amount of bleeding may occur at the operation site, which requires constant mopping and cleaning. The ainount of loss of blood during an operation may begin to have a negative impaa upon the patient.
Secondly, in addition to the sheath assembly providing an open passage for the loss of blood, the sheath assembly also provides an open passage for the introduction of air imo the vein. The Lu~d~ L introduction of air into the blood system causes air embolism in the patient and its cnncl~qll~rlr negative effects.
Thirdly, clotting may be formed in the lumen of the sheath if the sheath remains in for a prolonged time, and this may cause embolism to the lung and itscnnCo~ nt negative effeas.
Because of the three problems above, the prior art splittable sheath has to be removed as soon as the lead is introduced into the vessel lumen, although it is very desirable IO retain the sheath in place ~1UUU~hUUL operation because the lead can be m~nir~ t~d much easier without iu~ .C from other existing lead or tissue friaion and can be exchanged freely viithoul repeated sheath insertion trauma.
When the catheter or lead is introduced in the sheath, a certain amount of blood leakage will occur between the catheter and the sheath walls. The prior art has also devised h.-nnr)ct~rir valves which provide a seal around the catheter introduced through the sheath. One such sheath and h~`mnct~tir valve is ~ r,~ d and marlceted by Cordis Corp. of Miami, Florida as the UNISTASIS valve in the Cordiscatheter sheath introducer. Another example is m ln~f~rn~ed by Bard of Billerica, t~ Trade Mark C
WO 93~00r~4~ PCr~US~ZJOS6~o 3 2~239~
M~ hl-c.-ttc as the 5F E~MAQ~1ET introducer. A h~ ri~ valve combirLed viith a splittable sheath is alsa illustrated in Schiff, "Inrroducer Assernbly for Intra-Aortic Balloorls and the I ike Iu.ul,uuldhn~, a Sliding, Blood-Tight Seal," U.S. Patent 4,473,067 (1984).
HoweYer, all the prior arl h .""~I .,;r valve structures, eYen when combined with a splittable sheath, such as shown by Schiff, are irLlegral ûr rigid units, which dû
not split and must be rcmoved by sliding alûrlg th~ end of the catheter. In the case of Schiff, the sheath is splil in order to d~lU~JlidL~ly positiorL the balloon catheter.
However, after the balloon dU~iUUIdaLy procedure is rnmrl~t~ the entire catheter is removed so that at no point is the h ".,~ ;r YalYe entirely removed from the catheter nor rleed it be.
What is needed ther~ is some type of sheath and YalYe system w_ich can be used in c~ with our Yessel iuhu~u~ a, w_ich introducers can then remain in place without risking undue bleeding, air embolism, or clotting while retaining the adYantages of an introducer sheath for free lead exchange and easier lead m~nirlll:~tinn - - Brief Summary of the In ~en~ion The inVentiOn is a sheath assembly for use with a lead or catheter ~u~
2û an introducer sheat~ and a h . .~ valve coupled to the introducer sheath. T_eh~-Tnn~t~Ti~ YalYe and iuLIu~luC~l sheath are atranged and corlfigured to permitintroduction of at least one lead or catheter Lh~ luuu~ll. An element is provided tO
perrnit remoYal of the h~ r;~ valve and introducer sheath from the calheler disposcd ~ luuu~ without reauiring the introducer sheath and h~mnst:lTic Yalve 25 to be remoYed from a~ end of the catheter. A side arm is connected to the h. ".~ valYe cage and provides .~ fluid drip in order to preVenl clot formation irl the sheatn lumcn.
As a result, the assembly rnay safely remain in the Yessel lumen Ll-~ uu~llo~l~ t_e operation without cllhst~nti~l bleeding, risk of air embolisr~ clotting, or need of 30 repeated sheath insertion for lead exchange.
The element for p~.l uLLI~g remoYal of t_e h ".~ YalYe and introducer sheath is a elemeM for splitting the introducer sheath and h~mnct~ti~ valve awayfrom the lead or cat_eter w_ich is disposed th~ uu~
Altcl.~Li~ , the element for permitting removal of the introducer sheath and 35 the h~mnct~tir valve is a element for peeling away the introducer sheath and h, rnncr~tir valve from the lead or catheler disposable Ll~ du UUYII.
* Trade Mark Wo 93~00947 ` ~ PCI /US92105666 4 ~ 39~
In the illustrated ~ o~ i the element for permitting remova~ of the h. ~ valve and introducer sheath is a score line defined in the h~mr~ tir valve and introducer sheath along which the ~ - valve and introducer sheath may be separated. The score line comprises a pair of lines defined in the h~mr-ct~tir valve 5 and introducer sheath. The pair of score lines are d;qmPtrir~lly opposed from each other on the h~mnctqti~ valve and introducer sheath. The score line is disposed along the 1. ~ ",1 .~1 Iength of the h~mrlctqtir valve and introducer sheath. The score line defined into the introducer sheath is aligned with the score line defined into the k.., ...~ valve.
The introducer sheath and h~mrct:ltir valve are integrally formed and the element for permitting removal of the valve and sheath permits removal of the valve and sheath as an integral body from the catheter disposed Ll~ L~ uul;l1.
In another -mho~iim.~nt the introducer sheath and h~mostqti~ valve are separate body portions coupled to each other and the element for permitting removal 15 of the valve and sheath from the lead or catheter allow separate removal of the h~mrctqtir valve and sheath from the lead or catheter.
The hpn~oct:ltic valve is self sealing. The h~mllct~tir valve and sheath are arranged and configured to ailow the insertion IL. I~ uu~, ~ of multiple leads or catheters. The i~ ;r valve further comprises an iuL~ us sidearm assembly.
20 The element for permitting removal of the h~n~-ctqtir valve and sheath leaves the sidearm assembly intact.
The invention is aiso rh~rqrt~ri7Pd as a method of percutaneous sheath lead or cath~l~e.i~Lio~ LU~ illg the steps of disposing an introducer sheath and hrmrct~tir valve coupled to the introducer sheath into a body lumen. At least one 25 lead or catheter is disposed through the valve and introducer sheath into the body lumen. The lead or catheter is sealed within the 1.... ,..~ ;r valve to preveM bleeding and introduction of air into the body lumen with riicrncitirm of the lead or catheter therein. The h~moct~tir valve and introducer sheath is removed while leaving thelead or catheter in place witkin the body lumen without sliding either the introducer 30 sheath or h~nnrct~tic valve over an end of the lead or catheter. As a result, implanted leads or catheters r~ay be disposed into the body lumen without bleeding, risk of air embolism, clotting or requiring the end of the lead or catheter to have a structure to permit removal of the sheath and valve thereover.
The step of removing the sheath and lead or catheter comprises the step of 35 splitting the sheath and valve along a i~neihlriin~l length of the sheath and valve and disposing the lead or catheter radially through the lrm~ihlriin:ll split.
-..
W~93J00947 2 1 1 2 3 9 ~ PCI/US92/05666 -More particularly, the step of splitting the sheath and valve comprises a step of splitting the sheath arld valve along a score line by manually tearing the sheath and valve apart along the score line.
The step of tearing the sheath and valve along a score line further comprises 5 tearing the sheath and valve along a pair of l~,.,~: 1;,.~11.~ defined score lines in the sheath and valve. The step of tearing the valve and sheath along a pair of score lines comprises in turn the step of tearing the valve and sheath along diametrically opposing l~ lly defined score lines in the valve and sheath ,~,*,c~ ly.
The invention is still further . ~ r- ;~- d as an i~ JlU._Iu~ in an introducer 10 sheath and valve assembly for ~ of pacemaker leads ~ an element for splitting the inhroducer sheath. The sheath has a l~n~ihl-lin~l axis. The element for splitting allows manual separation of the sheath along the lr~n~ihlrlin~l axis. An other element for separating the h. .~ ;r valve perrnits removal of thevalve from the lead without n~ removal of the valve over an end of the 15 lead. As a result, the sheath can remain in place Lllluu~ uu~ the operation with the advantage of free lead exchange and easier lead . -,.il.,.lAI;r l~ without bleeding, air embolism, clotting and repeated sheath related trauma for possible lead exchange.
The invention is also a sheath assembly in which the element for permitting removal of the hPmnct~tir valve and introducer sheath is a two-part body ~
20 the hf mnct~tir valve. The two-part body is made in two separate body portions. The body portions define an element for sealing the body portions together when the two body parts are joined with each other to form the h~oml~ct:~tic valve.
The hPm~ct~tir valve comprises a resealable mf~mhr:~nf The element for permitting the removal of the h~-mr~ tir valve and introducer sheath comprises a cut 25 in the in resealable membrane to facilitate parting of the membrane wherein the body portions are pulled apart.
The cut is a Y-shaped cut extending partially through the, ,~ I-IlI'lllf The r~li"" of the Y-shaped cut is positioned ~I~lu~Lu~lt~ near the center of the ,....,.I.I,.,.r with one leg of the Y extending toward the periphery of the Ill.,lUI,l~C in 30 a direction along which the membrane will be separated when the portions are pulled apart.
The element for sealing the body portions together comprises a U U~~ Li~l sealing lip on each of the body portions. The sealing lip on one bodyportion ~"..r,.,."i ,~ with the sealing lip on the other body portion to make the 35 hf mrct~tir valve fluid-tight when the body portions are temporarily joined together.
The sealing lip on one body portion is an inner ~ ul~Jf~ ial sealing lip, and the sealing lip on the other body portion is an outer ~iu~ulllL~ idl sealing lip. The .. . .. . . . . . . .. _ _ _ _ _ _ _ _ w0 93/00947 2 1 1 ~ ~ 9~ Pcr/US92/05666~
inner and outer Cil~u~l~..Lial sealing lips conforln with each other to seal thel;r ., -~ valve.
The body portions further comprise at least one band of cn~uu~ lLia~ tape wound around the t~vo-body portions to temporarily maintain the body portions 5 together and to maintain tbe inner and outer .i.~uu...~ sealing lips in a sealed cu~ Liuu.
The inner and outer sealing lips tightly slip-fit together to maintain the twû
body portions L~ JUI~ joined to comprise the hPn~st~tir valve until pried apart.The body portion having one of the ~,il LULl~ sealing lips forms a lid and 10 the body portion having the other one of the ~ u~ idl sealing lips forms an enclosure having one open side. The body portion forrning the lid joins the bodyportiorl forming the enclosure to provide a temporarily fluid-tight h~mnsts~tir Yalve body.
In one Pmho-limPnt thè inner ~ ,u-ur~,leuLial sealing lip forrns a tongue and 15 wherein the outer ~ uu~ l sealing lip forms a groove. The tongue is tightly slip-fit into the groove to form a sealed ~ 1. between two the bûdy portions.
The sheath assèmbly further comprises a recess defmed in one of the body portions to allow insertion of a flat blade therein to pry apart the two body portions.
In another emhorlimPnt the inner and outer cil~ULur~ idl sealing lips lock 20 together by ~ " .~ with each other to seal the hemostatic valve.
In another ~--budi u~ the inner ciu~uLur~ l sealing lip has a knife edge and the outer ~ ,uuL~ ial sealing lip has a cavity defined therein ~ r..""~, to the knife edge of the other sealing lip. The knife edge and cavity mate to form the seal of the hPmnct~tir valve. The knife edge has an enlarged head. The enlarged 25 head is snap-fit into a ~ r(~ e~l~u~ u.,lll defined in the cavity to lock the knife edge in the cavity.
The imvention is also a method for p~l~uLdLl~uu~ ~LI.~ Ii~Li~ll in which during the step of removing the h~mnct~tir valve, the hl~mnct~ti~ valve is comprised of two body portions. The body portions are separately provided to form the 30 hPmnct:~ti~- valve and are t~ u~o-~,lily joined together to form a complete body of the hPmnct~tir valve. The body portions are pulled apart to split the h~omnct~ti~ valve.
The invention is better visualized by now turning tû the following drawings wherein like elements are referenced by like numerals.
-w~ 93/00947 ~ 1 ~ 2 3 94 PCIIUS9~105666 sr,er r of the Drawings Figure I is a partially cutaway side view of a splittable introducer sheath devised according to the invention.
Figure 2 is an ~ of the splittable valve portion shown in Figure 1 5 wherein a lead or catheter has been disposed through the valve.
Figure 3 is a r~ar ll~u~y.,~,~iv~ view of the valve and sheath ~..,.ll.;-. .lir.,.~ of Figures 1 and 2 showing an ~ ,-l,o-l;,--- -1 of diametric Ir~n~jh~ ol score lines.
Figure 4 is a simplified side elevational view of an additional ~ ,.I.o~l;., .1 of the invention.
Figure 5 is a side cross-sectional view in enlarged scale of selected cut-away portions of the h ..."1~ valve and sheath of Figure 4.
Figure 6 is a y~ iv~ view of the diaphragm of the h~mr~ct~ti~ valve of hgure 5 shown in isolation of all remaining elements.
Figure 7a and b is a y~ lal cross-sectional view of the valve of Figures 4 and 5 as seen through sectional line 7-7 of Figure 5. Figure 7a shows the valve body assembled and closed with tape as shown in Figure 4, while Figure 7b shows the tape removed and valve body halves separated.
Figure 8 shows another ~ ,.I.o~ of the valve body in perpendicular cross-sectional view as would be seen through section line 7-7 of Figure 5.
Figure 9a is another ~-mhorlim~nt of the valve body wherein a tongue and groove ~r)nn~c~on and pop-out inr~,-nt:ltir,n is provided. Figure 9b is the sideelevational of the valve body, the perpendicular cross s~iollal of which is shown in Figure 9a as seen through section lines 9a-9a of Figure 9b.
Figure 10 is another ~."l,o.l;..,...l of the valve body as seen in the 25 p~ di~.llar cross s_~Lioll~l view as would be seen through section line 7-7 of Figure 5.
The invention and its various ~ ..,l.o.l;...~ may now be llnrlf~ rctood by turning to the following detailed .1f - . ;1.1;....
Deta~led r of the P~eferred F
An improved h~mrlct:ltit- valve and introducer sheath is provided for introductions of leads or catheters through the valve and sheath ~ l'r~ into a vessel or artery. At the point in the operation where the introducer sheath and 35 h~-moctotir valve must be removed from the lead or catheter, which must remain imrlontf rl means are employed to split or separate the introducer sheath and valve 21~ 2~94 WO 93/0094~ Pcr/Us92/05666 apart so that the sheath and valve are removed from the implanted lead or catheter without the necessity of sliding either the sheath or valve over the free end of the lead or catheter. The h~ valve is made in two separate parts which include a fluid-tight seal to facilitate splitting of the valve. In this manner, any lt ~ 'tiOI~ which may be provided on the free end of the lead or catheter, such as a terminal for to a p ~^~m~ r, will not interfere with the optimal use of the introducer sheathand l-- -"~ ;r valve.
A splittable introducer sheath and valve assembly, generally noted by reference numeral 10 in Figure 1, is depicted in partially cutaway side view. Valve 10 and sheath assembly 10 comprise a splittable sheath 12 commected, coupled or extending from a splittable h~mr~ct~tir valve assembly 14. Valve assembly 14 in tum is comprised of a valve body 16, an ih~ uu5 sidearm 18 with a sideaml of valve 20.
The details of the design of sidearm valve 20 and to a certain extent sidearm 18 are largely inrrmc~-rl l~nti~l to the present rnvention and therefore will not be further 15 described except insofar a necessary to illustrate the invention. Hemostatic valve assembly 14 is shown in Figure 1 in cutaway view exposing the interior of valve 16 which includes a valve m~mhr~n~ 22. The details of valve assembly 14 again are not critical to an lln~ "ll;"~ of the invention, but in the preferred ,",l~t-li-". .-1 valve ,.,~...l,.,..,t 22 is a self-healing membrane through which a lead or catheter may be introduced without leakage between membrane 22 and leads or lead 24 such as shown in the partially cutaway view of Figure 2 depicted in expanded scale. Valve body 16 in the illustrated embodiment is comprised of two sections 16a and b which are bonded together after assembly.
In the depiction of Figure 1, a conventional dilator 28 is shown as disposed through valve assembly 14 and sheath 12 having a tapered tip 30 extending from the distal end 32 of sheath 12. As in the conventional m~thrldrl~ y described above in rr,nn~rtir,rl with p~ UL~ tOu5 sheath lead or cathclt~ io~, the artery or vessel is punctured with a needle into which a g udewire is placed. The needle removed andthen dilator and sheath assembly 12 advanced on the guidewire rnto the vessel. The g~udewire will extend through valve assembly 14 and be sealed by means of membrane 22. The guidewires and TEFI ON dilator are then removed leaving the flexible sheath assembly 10 in place. However virtually no bleeding occurs since the entire assembly is sealed by self-healing .,...l.,,.,.r 22. At this point one or more leads or catheters as suggested in Figure 2 can be introduced, removed and 35 reirLtroduced and m~nirlll~t~d without any significant possibility of bleeding, clotting, risk of air embolism or repeated sheath insertion related trauma since once insened sheath assembly 10 is in place regardless of the number of leads or catheters insened and removed throughout the operation.
.. .. . . . ~ .. , . . .. . . , _ _ = _ ~1123~4 ~v~93~009~7 PCl J~lS921D5666 In addition, since sealing of leads or catheters 24 and 26 is Pff~ t~d by 111` I-IlI~lllf 22 of valve assembly 14, valve body 16 and at least a portion of sheath 12 may be made larger than normal to allow a more loose fit between the interior surfaces of introducer sheath assembly 10 and leads or catheters 24 and 26, since 5 blood sealing between the lead or catheter and sheath 12 is not required. This allows leads or catheters 24 and 26 to be introduced and removed from introducer sheathassembly 10 with less friction or ...,.,.f~ with assembly 10 and with each other.
Therefore the lead can be """, ,- l~t~ much easier.
The detailed CUl~ U~LlUII of sheath 12 and valve assembly 14 as previously 10 implied is not critical to the invention, at least to the extent of whether sheath 12 and valve assembly 10 must be separate or integral parts or how they may be connected with each other. Therefore, it must be expressly llnr~r~tr)od that valve assembly 14 and sheath 12 may be fabricated according to any structure or out of any material now known to the art or later devised without departing from the spirit and scope of 15 the invention. For example, sheath 12 may be integrally molded or cast with valve assembly, may be a&esively affixed thereto, may be compression fitted, slip fit,threaded, or cormected in arly marmer desired to valve assembly 14 consistent with the teachings of the present invention.
Figure 3 illustrates in enlarged scale a rear perspective view of introducer 20 sheath assembly 10. According to the invention, both valve assembly 14 and sheath 12 are splittable or have a peel away construction. Agam, the detailed nature bywbich such splittable structure is ;~ rd or how peel-away feature is realized isnot critical to the invention. Any method now known or later devised by which such sheaths 12 and valve assemblies 14 may be split or separated may be employed and25 are c ~ f d as being within the scope of the invention.
In the illustrated ~...I,odiul~llL, sheath 12 and valve assembly 14 are shown asintegrally fabricated and having a pair of Inneitl-~lin~l score lines 34 and 36 defined along their axial length. Score lines 34 and 36 are shown as being ~ mf-trir~llyopposed from each other across the cross section of introducer sheath 10.
30 LL~a~ uu~ sidearm 18 is depicted in Figure 3 as being disposed between score lines 34 and 36 interlying surface between them. Score lines 34 and 36 are shown as having a V-shaped cross section but have such a shape and depth as to permit the entirelength of introducer sheath 10 to be manually separated. lt is l.l...t- ~ d that at the end of the operation the physician will grasp opposing flange portions 38 and 40 35 to peel them apart while pulling out the sheath and holding the lead. This will cause valve body 16 to tear along a section line depicted by dotted lines 42 through the body of valve assembly 14. Both body portions 16a and b may be scored to facilitate this tearing. In addition the bonding of the body portions 16a and 16b assists in tearing wo 93/00947 ~ 2 ~ ~ 2 3 9 ~ PCr/US92/05666 10 ~
thc inner body portion as the outer body portion is being tom along its ~;Ullc*JUI~dlUg tear line. The portions become through the bonding as a single body and the frachure or tear ulu~ c,~leS from the outer body portion through the inner body portion.
M~mhr:~nP 22 has a weak line or score line and can easily be removed from the lead.
In the illustrated ~ "l,o~i: . l flanges 38 and 40 are formed in two halves having diametrically opposing slots 44 and 46 aligned with score lines 34 and 36defined into valve body 16. However, it is entirely possible that score lines 34 and 36 will be continued through flanges 38 and 40 to provide deep scores instead of open slots 44 and 46.
In any case, valve body 16 is peeled apart with separation continuing through any transition portion 48 between valve body 16 and sheath 12 and on along the lr~n~ihl~iin~l length of sheath 12. Sheath 12 is then removed and peeled followed by additional removal of sheath 12 from the punchure site and peeling of the removed portiorls until the entire valve and introducer sheath assembly 10 of Figure 1 has been split and removed from the lead or catheter, which is then p. . .,~ ly implantedinto the puncture site and with which the ~UIIUUIIdhl~; tissue makes a blood tight seal.
The h~Tnnct~ti~- valve and sheath 10 as seen in Figure 1 is shown in an altemative ~ . ~.o l;..,..l and side elevational view in Figure 4. In the ~ ,.l.o~ of Fic~ure 4, splittable l...-...~ valve assembly 14 is integrally molded or made 20 separable from splittable sheath 12 and fitted at its proximal end with a dilator head fitting 50. Dilator head fitting 50 as shown in enlarged view in Figure 5 is secured tû
valve assembly 14 by means of a l:uu.~ iu~l Luer lock 52. The score line 34 on sheath 12 continues along sheath 12 into split body portions 14a and 14b which comprise the body of valve assembly 14. Valve membrane 22, disposed within valve25 assembly 14, is also provided with a Y-shaped incision 54 as best depicted in the p~ ivc view of Figure 6 to facilitate opening and tearing of -.~..,I,-~c æ when valve body halves 14a and 14b are separated.
Tn the ~mhQ~im nt of Figure 4, valve halves 14a and 14b are t~ ul~ily fixed together by means of tearable single-sided adhesive tape 56. The binding of the body portions and the k . .~cl~l;r lu~.~lanc need not be ~ sh~rdy since the device is used at low pressures, 5-10 mm Hg and its use is typically of only 10-30 minutes duration. The long leg of the Y shape incision into or through " ~r ., .1,1 " . ~r 22 may or may not extend to the periphery of membrane æ as may be needed to facilitate its tearing or cutting.
The practicing physician may then take a scalpel and easily cut tape 56 along the split line 34 and valve assembly 14 thereby separating the valve body portions 14a and 14b. As described above with the body portions 14a and 14b separated, sheath12, which is integral, is then readily split along score line 34.
-- .. .. . . .. . .. . .. . _ _ _ _ ~93/00947 ~ ~ ~ 2~ ~4 PCr/US9i/os666 Valve body 14 may be m~nllf~tllred from valve body portions 14a and 14b in a number of alternative forms. One ...l.o~ is shown in Figure 7a amd 7b wherein valve body 14 is generally split into two halves, an upper half 14b and a lower half 14a. Lower half 14a is provided with an interior ~ Li.~Lidl lip 58a which 5 slip fits into an exterior ci-~ --lidl lip 58b defined in upper body half 14b. The two body halves, 14a and 14b, as shown in Figure 7, which is a perpendicular cross-sectional view taken through section lines 7-7 of Figure 5, are then held together using tape 56. Once the tape is cut, the two body halves may then be manually separated as depicted in Figure 7b. While ;~cc~mhl~(l however, valve assembly 1410 provides a water-tight or blood-tight valve assembly.
Another ~mh~riimPnt of the body of valve assembly 14 is depicted in the p_.lu~n~ lar cross-sectional view of Figure 8 as would also be seen through section line 7-7 of Figure 5. In the .-mho~lim~nt of Figure 8, lower body portion 14a comprises a rectangular box, while upper body portion 14b is formed like a lid 15 covering and seals the box-shape of body portion 14a. In the ~,~I.o~ .e..~ of Figure 8, the outer ~il.u.~ ,ial seal 60a is provided on the lower body portion 14a while the inner .;-~ ..Li,ll seal 60b is defined on the upper lid body portion 14b, which is the ~ l reverse of the ~ ...l n-l;---- .: of Figure 7.
Figures 9a and 9b illustrate yet another ."l.o.l;..-~ .l in which lower body portion 14a again defines a box-like shape and is coupled to upper body portion 14b acting as a lid, the two portions comprising an interior tongue and groove snap-fit seal. In the embodiment of Figure 9a, which is a perpendicular cross ~ iUlldl view as would be seen through section lines 7-7 of Figure 5, a groove 62a is defined in lower body portion 14a while a maling tongue 62b is provided in upper lip portion 14b. Along the side of valve assembly 14 is a cut-out recess G4 in a least one position along hne 34 wherein the surgeon can insert a scalpel or tool to pry body portions 14a and 14b apart. Thus, it is "), . ~ r d that at least in the ~ u~ of Figures 9a and 9b, if not other ones of the e ~ û~ l l . " shown, that the need for tape 56 may be L y in that the body portions will fit tightly together by virtue of their snap fit. The ~ ",,,.,. .l will then be affected by prying them apart, with the assistance, if necessary, of a recess 64 as depicted in Figures 9a and 9b.
Yet another . .,l-o.l;,.,- ..l of valve body 14 is depicted in ~ u~,J~dh,~llar cross-sectional view of Figure 10, again as would be seen through section line 7-7 of Figure 5. In the ~ ,.l.o,l;", 1l of Figure 10, separation between body portions 14a and 14b 35 occurs generally along the mid-portion of lateral sides 66 of valve body 14 and are defined by providing a knife edge seal 68 in the one body portion, such as lower body portion 14a, and a ~.(."~("".;,.~ groove 70 in the opposing body portion, such upper portion 14b. Again, portions 14a and 14b may be held together by an exterior tape 56 _ _ . _ , . . . . . . . .. . _ .. . . _ . _ _ _ _
Bs.h~ of the Invention 10 1. Fze~l of rJ~e Invenrion ~ The invention re~ates to the field of p~rl~m*i~f~r leads and catheters and methods for irlsertion of the sa~ne, and in particular to leads used in veins such as in cnnn~ nn with p:~r~m:llrPr procedures such as p~r~n~ lead insertion.
1~ 2 Descnprion of ~l~e PriorArr There are many medical ~.u.~lu c~ which require a puncture and ~ i1-.,. IC1 ~ion of an artery or vein for various purposes.
In the prior art process of p~-~u~ u~ puncture, a guidewire is introduced into the vessei through a hûllow needle. The ne~dle is withdrawn leaving the 20 gLudeviire in the vessel. A TEFLON dilator and venouS sheath assembly are then advanced in a rotary motion over the guidewire into the vessel. The TEFLON dilator and the gludewire are then removed leaving the flexible sheath in the vessel. At this point, various typeS of catheters or leads are inserted using the sheath as a conduit to avûid tearing or further trauma to the vessel wall.
In the case where a p r-m~ r lead must be ~ y inserted into the patient, the p~rAm~ r is ~ implanted in the patient and the lead, which cxtcnds from thc p7r~m~ r into the heart chatnber7 remairls p~ "~ y disposed through the vcssel wall and irl the vessel lumerL A sheath is nevertheless used in ordcr to guide ir~sertion of the lead into veirl lumcrL but must be removed leaving the 30 lead in place. However, the sheath cannot simpiy, in all cases, be slipped over thc *~rade Mark .
WO 93~0094~ PC~I,'S92~5666 ~ 2 21~239~
exterior end of the pacemaker le~d which may be provided with a special r~rTnin~Tinn for c nnn~rinn to the r~^~nnrliro~
In this case, the prior art has devised a rlumber of spiittable or peel away sheqths. The sheath is sc-nred so that it is withdrawn by splitting or peeling it off from S the p~roTn~ catheter. See Philip O. Littleford, et al, "The American Jourr~al of Cardiology," Vol. 43, pp. 980-982 (May 1979); Littleford, "Apparatus and Method for ~nserting an Electrode," U.S. Patent 4,166,469 (1979); Littleford, "Method fo}
TnSerting Pacemaker Electrodes and the Like,~ U.S. Patent 4,243,050 (1981) and Littleford, "Split Sleeve Introducers for Pacemaker Electrodes and the Like," U.S.
Patent 4,345,606 (1982); Osborne, "Tear Apart Cannula," U.S. Patent Reissue 31,855 (1985), a reissue of U.S. Patent 4,306,562 (1981); Boarini et al., ~Peelable Catheter vrith Securing Ring and Suture Sleeve," U.S. Patem 4,411,654 (1983); Moorehead.
"Medic 1 Layered Peel Away Sheath and Methods," U.S. Paterlt 4,983,168 (1991). Asplittable cannula is also taught by Kousai et al., "Medical Tool Introduction Cannula arld Method of M~nllf~lrnlrin,o the Same," U.S. Patent 4,883,468 (1989).
However, in each of these prior art sheath ~cc~nnhli~s~ once the sheath has been inserted the sheath provides a passage for the free ow of blood. In praaice a cionifirr~nt amount of bleeding may occur at the operation site, which requires constant mopping and cleaning. The ainount of loss of blood during an operation may begin to have a negative impaa upon the patient.
Secondly, in addition to the sheath assembly providing an open passage for the loss of blood, the sheath assembly also provides an open passage for the introduction of air imo the vein. The Lu~d~ L introduction of air into the blood system causes air embolism in the patient and its cnncl~qll~rlr negative effects.
Thirdly, clotting may be formed in the lumen of the sheath if the sheath remains in for a prolonged time, and this may cause embolism to the lung and itscnnCo~ nt negative effeas.
Because of the three problems above, the prior art splittable sheath has to be removed as soon as the lead is introduced into the vessel lumen, although it is very desirable IO retain the sheath in place ~1UUU~hUUL operation because the lead can be m~nir~ t~d much easier without iu~ .C from other existing lead or tissue friaion and can be exchanged freely viithoul repeated sheath insertion trauma.
When the catheter or lead is introduced in the sheath, a certain amount of blood leakage will occur between the catheter and the sheath walls. The prior art has also devised h.-nnr)ct~rir valves which provide a seal around the catheter introduced through the sheath. One such sheath and h~`mnct~tir valve is ~ r,~ d and marlceted by Cordis Corp. of Miami, Florida as the UNISTASIS valve in the Cordiscatheter sheath introducer. Another example is m ln~f~rn~ed by Bard of Billerica, t~ Trade Mark C
WO 93~00r~4~ PCr~US~ZJOS6~o 3 2~239~
M~ hl-c.-ttc as the 5F E~MAQ~1ET introducer. A h~ ri~ valve combirLed viith a splittable sheath is alsa illustrated in Schiff, "Inrroducer Assernbly for Intra-Aortic Balloorls and the I ike Iu.ul,uuldhn~, a Sliding, Blood-Tight Seal," U.S. Patent 4,473,067 (1984).
HoweYer, all the prior arl h .""~I .,;r valve structures, eYen when combined with a splittable sheath, such as shown by Schiff, are irLlegral ûr rigid units, which dû
not split and must be rcmoved by sliding alûrlg th~ end of the catheter. In the case of Schiff, the sheath is splil in order to d~lU~JlidL~ly positiorL the balloon catheter.
However, after the balloon dU~iUUIdaLy procedure is rnmrl~t~ the entire catheter is removed so that at no point is the h ".,~ ;r YalYe entirely removed from the catheter nor rleed it be.
What is needed ther~ is some type of sheath and YalYe system w_ich can be used in c~ with our Yessel iuhu~u~ a, w_ich introducers can then remain in place without risking undue bleeding, air embolism, or clotting while retaining the adYantages of an introducer sheath for free lead exchange and easier lead m~nirlll:~tinn - - Brief Summary of the In ~en~ion The inVentiOn is a sheath assembly for use with a lead or catheter ~u~
2û an introducer sheat~ and a h . .~ valve coupled to the introducer sheath. T_eh~-Tnn~t~Ti~ YalYe and iuLIu~luC~l sheath are atranged and corlfigured to permitintroduction of at least one lead or catheter Lh~ luuu~ll. An element is provided tO
perrnit remoYal of the h~ r;~ valve and introducer sheath from the calheler disposcd ~ luuu~ without reauiring the introducer sheath and h~mnst:lTic Yalve 25 to be remoYed from a~ end of the catheter. A side arm is connected to the h. ".~ valYe cage and provides .~ fluid drip in order to preVenl clot formation irl the sheatn lumcn.
As a result, the assembly rnay safely remain in the Yessel lumen Ll-~ uu~llo~l~ t_e operation without cllhst~nti~l bleeding, risk of air embolisr~ clotting, or need of 30 repeated sheath insertion for lead exchange.
The element for p~.l uLLI~g remoYal of t_e h ".~ YalYe and introducer sheath is a elemeM for splitting the introducer sheath and h~mnct~ti~ valve awayfrom the lead or cat_eter w_ich is disposed th~ uu~
Altcl.~Li~ , the element for permitting removal of the introducer sheath and 35 the h~mnct~tir valve is a element for peeling away the introducer sheath and h, rnncr~tir valve from the lead or catheler disposable Ll~ du UUYII.
* Trade Mark Wo 93~00947 ` ~ PCI /US92105666 4 ~ 39~
In the illustrated ~ o~ i the element for permitting remova~ of the h. ~ valve and introducer sheath is a score line defined in the h~mr~ tir valve and introducer sheath along which the ~ - valve and introducer sheath may be separated. The score line comprises a pair of lines defined in the h~mr-ct~tir valve 5 and introducer sheath. The pair of score lines are d;qmPtrir~lly opposed from each other on the h~mnctqti~ valve and introducer sheath. The score line is disposed along the 1. ~ ",1 .~1 Iength of the h~mrlctqtir valve and introducer sheath. The score line defined into the introducer sheath is aligned with the score line defined into the k.., ...~ valve.
The introducer sheath and h~mrct:ltir valve are integrally formed and the element for permitting removal of the valve and sheath permits removal of the valve and sheath as an integral body from the catheter disposed Ll~ L~ uul;l1.
In another -mho~iim.~nt the introducer sheath and h~mostqti~ valve are separate body portions coupled to each other and the element for permitting removal 15 of the valve and sheath from the lead or catheter allow separate removal of the h~mrctqtir valve and sheath from the lead or catheter.
The hpn~oct:ltic valve is self sealing. The h~mllct~tir valve and sheath are arranged and configured to ailow the insertion IL. I~ uu~, ~ of multiple leads or catheters. The i~ ;r valve further comprises an iuL~ us sidearm assembly.
20 The element for permitting removal of the h~n~-ctqtir valve and sheath leaves the sidearm assembly intact.
The invention is aiso rh~rqrt~ri7Pd as a method of percutaneous sheath lead or cath~l~e.i~Lio~ LU~ illg the steps of disposing an introducer sheath and hrmrct~tir valve coupled to the introducer sheath into a body lumen. At least one 25 lead or catheter is disposed through the valve and introducer sheath into the body lumen. The lead or catheter is sealed within the 1.... ,..~ ;r valve to preveM bleeding and introduction of air into the body lumen with riicrncitirm of the lead or catheter therein. The h~moct~tir valve and introducer sheath is removed while leaving thelead or catheter in place witkin the body lumen without sliding either the introducer 30 sheath or h~nnrct~tic valve over an end of the lead or catheter. As a result, implanted leads or catheters r~ay be disposed into the body lumen without bleeding, risk of air embolism, clotting or requiring the end of the lead or catheter to have a structure to permit removal of the sheath and valve thereover.
The step of removing the sheath and lead or catheter comprises the step of 35 splitting the sheath and valve along a i~neihlriin~l length of the sheath and valve and disposing the lead or catheter radially through the lrm~ihlriin:ll split.
-..
W~93J00947 2 1 1 2 3 9 ~ PCI/US92/05666 -More particularly, the step of splitting the sheath and valve comprises a step of splitting the sheath arld valve along a score line by manually tearing the sheath and valve apart along the score line.
The step of tearing the sheath and valve along a score line further comprises 5 tearing the sheath and valve along a pair of l~,.,~: 1;,.~11.~ defined score lines in the sheath and valve. The step of tearing the valve and sheath along a pair of score lines comprises in turn the step of tearing the valve and sheath along diametrically opposing l~ lly defined score lines in the valve and sheath ,~,*,c~ ly.
The invention is still further . ~ r- ;~- d as an i~ JlU._Iu~ in an introducer 10 sheath and valve assembly for ~ of pacemaker leads ~ an element for splitting the inhroducer sheath. The sheath has a l~n~ihl-lin~l axis. The element for splitting allows manual separation of the sheath along the lr~n~ihlrlin~l axis. An other element for separating the h. .~ ;r valve perrnits removal of thevalve from the lead without n~ removal of the valve over an end of the 15 lead. As a result, the sheath can remain in place Lllluu~ uu~ the operation with the advantage of free lead exchange and easier lead . -,.il.,.lAI;r l~ without bleeding, air embolism, clotting and repeated sheath related trauma for possible lead exchange.
The invention is also a sheath assembly in which the element for permitting removal of the hPmnct~tir valve and introducer sheath is a two-part body ~
20 the hf mnct~tir valve. The two-part body is made in two separate body portions. The body portions define an element for sealing the body portions together when the two body parts are joined with each other to form the h~oml~ct:~tic valve.
The hPm~ct~tir valve comprises a resealable mf~mhr:~nf The element for permitting the removal of the h~-mr~ tir valve and introducer sheath comprises a cut 25 in the in resealable membrane to facilitate parting of the membrane wherein the body portions are pulled apart.
The cut is a Y-shaped cut extending partially through the, ,~ I-IlI'lllf The r~li"" of the Y-shaped cut is positioned ~I~lu~Lu~lt~ near the center of the ,....,.I.I,.,.r with one leg of the Y extending toward the periphery of the Ill.,lUI,l~C in 30 a direction along which the membrane will be separated when the portions are pulled apart.
The element for sealing the body portions together comprises a U U~~ Li~l sealing lip on each of the body portions. The sealing lip on one bodyportion ~"..r,.,."i ,~ with the sealing lip on the other body portion to make the 35 hf mrct~tir valve fluid-tight when the body portions are temporarily joined together.
The sealing lip on one body portion is an inner ~ ul~Jf~ ial sealing lip, and the sealing lip on the other body portion is an outer ~iu~ulllL~ idl sealing lip. The .. . .. . . . . . . .. _ _ _ _ _ _ _ _ w0 93/00947 2 1 1 ~ ~ 9~ Pcr/US92/05666~
inner and outer Cil~u~l~..Lial sealing lips conforln with each other to seal thel;r ., -~ valve.
The body portions further comprise at least one band of cn~uu~ lLia~ tape wound around the t~vo-body portions to temporarily maintain the body portions 5 together and to maintain tbe inner and outer .i.~uu...~ sealing lips in a sealed cu~ Liuu.
The inner and outer sealing lips tightly slip-fit together to maintain the twû
body portions L~ JUI~ joined to comprise the hPn~st~tir valve until pried apart.The body portion having one of the ~,il LULl~ sealing lips forms a lid and 10 the body portion having the other one of the ~ u~ idl sealing lips forms an enclosure having one open side. The body portion forrning the lid joins the bodyportiorl forming the enclosure to provide a temporarily fluid-tight h~mnsts~tir Yalve body.
In one Pmho-limPnt thè inner ~ ,u-ur~,leuLial sealing lip forrns a tongue and 15 wherein the outer ~ uu~ l sealing lip forms a groove. The tongue is tightly slip-fit into the groove to form a sealed ~ 1. between two the bûdy portions.
The sheath assèmbly further comprises a recess defmed in one of the body portions to allow insertion of a flat blade therein to pry apart the two body portions.
In another emhorlimPnt the inner and outer cil~ULur~ idl sealing lips lock 20 together by ~ " .~ with each other to seal the hemostatic valve.
In another ~--budi u~ the inner ciu~uLur~ l sealing lip has a knife edge and the outer ~ ,uuL~ ial sealing lip has a cavity defined therein ~ r..""~, to the knife edge of the other sealing lip. The knife edge and cavity mate to form the seal of the hPmnct~tir valve. The knife edge has an enlarged head. The enlarged 25 head is snap-fit into a ~ r(~ e~l~u~ u.,lll defined in the cavity to lock the knife edge in the cavity.
The imvention is also a method for p~l~uLdLl~uu~ ~LI.~ Ii~Li~ll in which during the step of removing the h~mnct~tir valve, the hl~mnct~ti~ valve is comprised of two body portions. The body portions are separately provided to form the 30 hPmnct:~ti~- valve and are t~ u~o-~,lily joined together to form a complete body of the hPmnct~tir valve. The body portions are pulled apart to split the h~omnct~ti~ valve.
The invention is better visualized by now turning tû the following drawings wherein like elements are referenced by like numerals.
-w~ 93/00947 ~ 1 ~ 2 3 94 PCIIUS9~105666 sr,er r of the Drawings Figure I is a partially cutaway side view of a splittable introducer sheath devised according to the invention.
Figure 2 is an ~ of the splittable valve portion shown in Figure 1 5 wherein a lead or catheter has been disposed through the valve.
Figure 3 is a r~ar ll~u~y.,~,~iv~ view of the valve and sheath ~..,.ll.;-. .lir.,.~ of Figures 1 and 2 showing an ~ ,-l,o-l;,--- -1 of diametric Ir~n~jh~ ol score lines.
Figure 4 is a simplified side elevational view of an additional ~ ,.I.o~l;., .1 of the invention.
Figure 5 is a side cross-sectional view in enlarged scale of selected cut-away portions of the h ..."1~ valve and sheath of Figure 4.
Figure 6 is a y~ iv~ view of the diaphragm of the h~mr~ct~ti~ valve of hgure 5 shown in isolation of all remaining elements.
Figure 7a and b is a y~ lal cross-sectional view of the valve of Figures 4 and 5 as seen through sectional line 7-7 of Figure 5. Figure 7a shows the valve body assembled and closed with tape as shown in Figure 4, while Figure 7b shows the tape removed and valve body halves separated.
Figure 8 shows another ~ ,.I.o~ of the valve body in perpendicular cross-sectional view as would be seen through section line 7-7 of Figure 5.
Figure 9a is another ~-mhorlim~nt of the valve body wherein a tongue and groove ~r)nn~c~on and pop-out inr~,-nt:ltir,n is provided. Figure 9b is the sideelevational of the valve body, the perpendicular cross s~iollal of which is shown in Figure 9a as seen through section lines 9a-9a of Figure 9b.
Figure 10 is another ~."l,o.l;..,...l of the valve body as seen in the 25 p~ di~.llar cross s_~Lioll~l view as would be seen through section line 7-7 of Figure 5.
The invention and its various ~ ..,l.o.l;...~ may now be llnrlf~ rctood by turning to the following detailed .1f - . ;1.1;....
Deta~led r of the P~eferred F
An improved h~mrlct:ltit- valve and introducer sheath is provided for introductions of leads or catheters through the valve and sheath ~ l'r~ into a vessel or artery. At the point in the operation where the introducer sheath and 35 h~-moctotir valve must be removed from the lead or catheter, which must remain imrlontf rl means are employed to split or separate the introducer sheath and valve 21~ 2~94 WO 93/0094~ Pcr/Us92/05666 apart so that the sheath and valve are removed from the implanted lead or catheter without the necessity of sliding either the sheath or valve over the free end of the lead or catheter. The h~ valve is made in two separate parts which include a fluid-tight seal to facilitate splitting of the valve. In this manner, any lt ~ 'tiOI~ which may be provided on the free end of the lead or catheter, such as a terminal for to a p ~^~m~ r, will not interfere with the optimal use of the introducer sheathand l-- -"~ ;r valve.
A splittable introducer sheath and valve assembly, generally noted by reference numeral 10 in Figure 1, is depicted in partially cutaway side view. Valve 10 and sheath assembly 10 comprise a splittable sheath 12 commected, coupled or extending from a splittable h~mr~ct~tir valve assembly 14. Valve assembly 14 in tum is comprised of a valve body 16, an ih~ uu5 sidearm 18 with a sideaml of valve 20.
The details of the design of sidearm valve 20 and to a certain extent sidearm 18 are largely inrrmc~-rl l~nti~l to the present rnvention and therefore will not be further 15 described except insofar a necessary to illustrate the invention. Hemostatic valve assembly 14 is shown in Figure 1 in cutaway view exposing the interior of valve 16 which includes a valve m~mhr~n~ 22. The details of valve assembly 14 again are not critical to an lln~ "ll;"~ of the invention, but in the preferred ,",l~t-li-". .-1 valve ,.,~...l,.,..,t 22 is a self-healing membrane through which a lead or catheter may be introduced without leakage between membrane 22 and leads or lead 24 such as shown in the partially cutaway view of Figure 2 depicted in expanded scale. Valve body 16 in the illustrated embodiment is comprised of two sections 16a and b which are bonded together after assembly.
In the depiction of Figure 1, a conventional dilator 28 is shown as disposed through valve assembly 14 and sheath 12 having a tapered tip 30 extending from the distal end 32 of sheath 12. As in the conventional m~thrldrl~ y described above in rr,nn~rtir,rl with p~ UL~ tOu5 sheath lead or cathclt~ io~, the artery or vessel is punctured with a needle into which a g udewire is placed. The needle removed andthen dilator and sheath assembly 12 advanced on the guidewire rnto the vessel. The g~udewire will extend through valve assembly 14 and be sealed by means of membrane 22. The guidewires and TEFI ON dilator are then removed leaving the flexible sheath assembly 10 in place. However virtually no bleeding occurs since the entire assembly is sealed by self-healing .,...l.,,.,.r 22. At this point one or more leads or catheters as suggested in Figure 2 can be introduced, removed and 35 reirLtroduced and m~nirlll~t~d without any significant possibility of bleeding, clotting, risk of air embolism or repeated sheath insertion related trauma since once insened sheath assembly 10 is in place regardless of the number of leads or catheters insened and removed throughout the operation.
.. .. . . . ~ .. , . . .. . . , _ _ = _ ~1123~4 ~v~93~009~7 PCl J~lS921D5666 In addition, since sealing of leads or catheters 24 and 26 is Pff~ t~d by 111` I-IlI~lllf 22 of valve assembly 14, valve body 16 and at least a portion of sheath 12 may be made larger than normal to allow a more loose fit between the interior surfaces of introducer sheath assembly 10 and leads or catheters 24 and 26, since 5 blood sealing between the lead or catheter and sheath 12 is not required. This allows leads or catheters 24 and 26 to be introduced and removed from introducer sheathassembly 10 with less friction or ...,.,.f~ with assembly 10 and with each other.
Therefore the lead can be """, ,- l~t~ much easier.
The detailed CUl~ U~LlUII of sheath 12 and valve assembly 14 as previously 10 implied is not critical to the invention, at least to the extent of whether sheath 12 and valve assembly 10 must be separate or integral parts or how they may be connected with each other. Therefore, it must be expressly llnr~r~tr)od that valve assembly 14 and sheath 12 may be fabricated according to any structure or out of any material now known to the art or later devised without departing from the spirit and scope of 15 the invention. For example, sheath 12 may be integrally molded or cast with valve assembly, may be a&esively affixed thereto, may be compression fitted, slip fit,threaded, or cormected in arly marmer desired to valve assembly 14 consistent with the teachings of the present invention.
Figure 3 illustrates in enlarged scale a rear perspective view of introducer 20 sheath assembly 10. According to the invention, both valve assembly 14 and sheath 12 are splittable or have a peel away construction. Agam, the detailed nature bywbich such splittable structure is ;~ rd or how peel-away feature is realized isnot critical to the invention. Any method now known or later devised by which such sheaths 12 and valve assemblies 14 may be split or separated may be employed and25 are c ~ f d as being within the scope of the invention.
In the illustrated ~...I,odiul~llL, sheath 12 and valve assembly 14 are shown asintegrally fabricated and having a pair of Inneitl-~lin~l score lines 34 and 36 defined along their axial length. Score lines 34 and 36 are shown as being ~ mf-trir~llyopposed from each other across the cross section of introducer sheath 10.
30 LL~a~ uu~ sidearm 18 is depicted in Figure 3 as being disposed between score lines 34 and 36 interlying surface between them. Score lines 34 and 36 are shown as having a V-shaped cross section but have such a shape and depth as to permit the entirelength of introducer sheath 10 to be manually separated. lt is l.l...t- ~ d that at the end of the operation the physician will grasp opposing flange portions 38 and 40 35 to peel them apart while pulling out the sheath and holding the lead. This will cause valve body 16 to tear along a section line depicted by dotted lines 42 through the body of valve assembly 14. Both body portions 16a and b may be scored to facilitate this tearing. In addition the bonding of the body portions 16a and 16b assists in tearing wo 93/00947 ~ 2 ~ ~ 2 3 9 ~ PCr/US92/05666 10 ~
thc inner body portion as the outer body portion is being tom along its ~;Ullc*JUI~dlUg tear line. The portions become through the bonding as a single body and the frachure or tear ulu~ c,~leS from the outer body portion through the inner body portion.
M~mhr:~nP 22 has a weak line or score line and can easily be removed from the lead.
In the illustrated ~ "l,o~i: . l flanges 38 and 40 are formed in two halves having diametrically opposing slots 44 and 46 aligned with score lines 34 and 36defined into valve body 16. However, it is entirely possible that score lines 34 and 36 will be continued through flanges 38 and 40 to provide deep scores instead of open slots 44 and 46.
In any case, valve body 16 is peeled apart with separation continuing through any transition portion 48 between valve body 16 and sheath 12 and on along the lr~n~ihl~iin~l length of sheath 12. Sheath 12 is then removed and peeled followed by additional removal of sheath 12 from the punchure site and peeling of the removed portiorls until the entire valve and introducer sheath assembly 10 of Figure 1 has been split and removed from the lead or catheter, which is then p. . .,~ ly implantedinto the puncture site and with which the ~UIIUUIIdhl~; tissue makes a blood tight seal.
The h~Tnnct~ti~- valve and sheath 10 as seen in Figure 1 is shown in an altemative ~ . ~.o l;..,..l and side elevational view in Figure 4. In the ~ ,.l.o~ of Fic~ure 4, splittable l...-...~ valve assembly 14 is integrally molded or made 20 separable from splittable sheath 12 and fitted at its proximal end with a dilator head fitting 50. Dilator head fitting 50 as shown in enlarged view in Figure 5 is secured tû
valve assembly 14 by means of a l:uu.~ iu~l Luer lock 52. The score line 34 on sheath 12 continues along sheath 12 into split body portions 14a and 14b which comprise the body of valve assembly 14. Valve membrane 22, disposed within valve25 assembly 14, is also provided with a Y-shaped incision 54 as best depicted in the p~ ivc view of Figure 6 to facilitate opening and tearing of -.~..,I,-~c æ when valve body halves 14a and 14b are separated.
Tn the ~mhQ~im nt of Figure 4, valve halves 14a and 14b are t~ ul~ily fixed together by means of tearable single-sided adhesive tape 56. The binding of the body portions and the k . .~cl~l;r lu~.~lanc need not be ~ sh~rdy since the device is used at low pressures, 5-10 mm Hg and its use is typically of only 10-30 minutes duration. The long leg of the Y shape incision into or through " ~r ., .1,1 " . ~r 22 may or may not extend to the periphery of membrane æ as may be needed to facilitate its tearing or cutting.
The practicing physician may then take a scalpel and easily cut tape 56 along the split line 34 and valve assembly 14 thereby separating the valve body portions 14a and 14b. As described above with the body portions 14a and 14b separated, sheath12, which is integral, is then readily split along score line 34.
-- .. .. . . .. . .. . .. . _ _ _ _ ~93/00947 ~ ~ ~ 2~ ~4 PCr/US9i/os666 Valve body 14 may be m~nllf~tllred from valve body portions 14a and 14b in a number of alternative forms. One ...l.o~ is shown in Figure 7a amd 7b wherein valve body 14 is generally split into two halves, an upper half 14b and a lower half 14a. Lower half 14a is provided with an interior ~ Li.~Lidl lip 58a which 5 slip fits into an exterior ci-~ --lidl lip 58b defined in upper body half 14b. The two body halves, 14a and 14b, as shown in Figure 7, which is a perpendicular cross-sectional view taken through section lines 7-7 of Figure 5, are then held together using tape 56. Once the tape is cut, the two body halves may then be manually separated as depicted in Figure 7b. While ;~cc~mhl~(l however, valve assembly 1410 provides a water-tight or blood-tight valve assembly.
Another ~mh~riimPnt of the body of valve assembly 14 is depicted in the p_.lu~n~ lar cross-sectional view of Figure 8 as would also be seen through section line 7-7 of Figure 5. In the .-mho~lim~nt of Figure 8, lower body portion 14a comprises a rectangular box, while upper body portion 14b is formed like a lid 15 covering and seals the box-shape of body portion 14a. In the ~,~I.o~ .e..~ of Figure 8, the outer ~il.u.~ ,ial seal 60a is provided on the lower body portion 14a while the inner .;-~ ..Li,ll seal 60b is defined on the upper lid body portion 14b, which is the ~ l reverse of the ~ ...l n-l;---- .: of Figure 7.
Figures 9a and 9b illustrate yet another ."l.o.l;..-~ .l in which lower body portion 14a again defines a box-like shape and is coupled to upper body portion 14b acting as a lid, the two portions comprising an interior tongue and groove snap-fit seal. In the embodiment of Figure 9a, which is a perpendicular cross ~ iUlldl view as would be seen through section lines 7-7 of Figure 5, a groove 62a is defined in lower body portion 14a while a maling tongue 62b is provided in upper lip portion 14b. Along the side of valve assembly 14 is a cut-out recess G4 in a least one position along hne 34 wherein the surgeon can insert a scalpel or tool to pry body portions 14a and 14b apart. Thus, it is "), . ~ r d that at least in the ~ u~ of Figures 9a and 9b, if not other ones of the e ~ û~ l l . " shown, that the need for tape 56 may be L y in that the body portions will fit tightly together by virtue of their snap fit. The ~ ",,,.,. .l will then be affected by prying them apart, with the assistance, if necessary, of a recess 64 as depicted in Figures 9a and 9b.
Yet another . .,l-o.l;,.,- ..l of valve body 14 is depicted in ~ u~,J~dh,~llar cross-sectional view of Figure 10, again as would be seen through section line 7-7 of Figure 5. In the ~ ,.l.o,l;", 1l of Figure 10, separation between body portions 14a and 14b 35 occurs generally along the mid-portion of lateral sides 66 of valve body 14 and are defined by providing a knife edge seal 68 in the one body portion, such as lower body portion 14a, and a ~.(."~("".;,.~ groove 70 in the opposing body portion, such upper portion 14b. Again, portions 14a and 14b may be held together by an exterior tape 56 _ _ . _ , . . . . . . . .. . _ .. . . _ . _ _ _ _
2~12~
wO 93/00947 ' PC~r/US92/05666 or may have a snap-fit facilitated by an expanded head 72 below knife edge 78 which is ~.. ~ .. ~ .. 1 t~ ~A by a snap-fit ~ r.. r, ." . ,; "~ interior shape of grooYe 70.
It must be llnAPr~tn~d that many other ~ ...1.~.1;".~ ~ may be devised by which the body portion of valve assembly 14 may be ,.-,~.,r~ d as separate halves andS then be tc.L.I.u..uil~ joined together with or without the aid of an exterior fastening means such as tape, friable spots of adhesive disposed in the joints between body portions 14a and 14b, or various ~ JIc;aai~ fitting seals, some of which have been depicted by way of il~ tinn in Figures 7-10.
M~my alterations and m~Aifi~s~tionc may be made by those having ordinary 10 sl~ll in the art without departing from the spirit and scope of the invention.
Therefore, it must be expressly l,. A~ ~luod that the illustrated ~ A;,.,- .I has been shown only for the purposes of example and should not be taken as limiting the invention which is defined by the following claims. The following claims are thus to be read as not only literally including what is set forth by the claims but also to 15 include all equivalent elements for ~,rO~ .g c~-hct~ntisllly the same function in al~ct~nti~lly the same way to obtain ~Ihct~nti~lly the same result even though not identical in other respects to what is shown and described in the above illustration.
. . .
wO 93/00947 ' PC~r/US92/05666 or may have a snap-fit facilitated by an expanded head 72 below knife edge 78 which is ~.. ~ .. ~ .. 1 t~ ~A by a snap-fit ~ r.. r, ." . ,; "~ interior shape of grooYe 70.
It must be llnAPr~tn~d that many other ~ ...1.~.1;".~ ~ may be devised by which the body portion of valve assembly 14 may be ,.-,~.,r~ d as separate halves andS then be tc.L.I.u..uil~ joined together with or without the aid of an exterior fastening means such as tape, friable spots of adhesive disposed in the joints between body portions 14a and 14b, or various ~ JIc;aai~ fitting seals, some of which have been depicted by way of il~ tinn in Figures 7-10.
M~my alterations and m~Aifi~s~tionc may be made by those having ordinary 10 sl~ll in the art without departing from the spirit and scope of the invention.
Therefore, it must be expressly l,. A~ ~luod that the illustrated ~ A;,.,- .I has been shown only for the purposes of example and should not be taken as limiting the invention which is defined by the following claims. The following claims are thus to be read as not only literally including what is set forth by the claims but also to 15 include all equivalent elements for ~,rO~ .g c~-hct~ntisllly the same function in al~ct~nti~lly the same way to obtain ~Ihct~nti~lly the same result even though not identical in other respects to what is shown and described in the above illustration.
. . .
Claims (47)
1. A sheath assembly for use with a lead or catheter comprising:
an introducer sheath;
a hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introductionof at least one lead or catheter therethrough;
means for permitting removal of said hemostatic valve and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve to be removed from an end of said lead orcatheter, whereby said assembly may remain in a vein throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.
an introducer sheath;
a hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introductionof at least one lead or catheter therethrough;
means for permitting removal of said hemostatic valve and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve to be removed from an end of said lead orcatheter, whereby said assembly may remain in a vein throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.
2. The assembly of claim 1 wherein said means for permitting removal of said hemostatic valve and introducer sheath is a means for splitting said introducer sheath and hemostatic valve away from said lead or catheter which is disposed therethrough.
3. The assembly of claim 1 wherein said means for permitting removal of said introducer sheath and said hemostatic valve is a means for peeling away said introducer sheath and hemostatic valve from said lead or catheter disposable therethrough.
4. The assembly of claim 1 wherein said means for permitting removal of said hemostatic valve and introducer sheath is a score line defined in said hemostatic valve and introducer sheath along which said hemostatic valve and introducer sheath may be separated.
5. The assembly of claim 4 wherein said score line comprises a pair of score lines defined in said hemostatic valve and introducer sheath.
6. The assembly of claim 5 wherein said pair of score lines are diametrically opposed from each other on said hemostatic valve and introducer sheath.
7. The assembly of claim 4 wherein said score line is disposed along the longitudinal length of said hemostatic valve and introducer sheath.
8. The assembly of claim 7 wherein said score line defined into said introducer sheath is aligned with said score line defined into said hemostatic valve.
9. The assembly of claim 1 wherein said introducer sheath and hemostatic valve are integrally formed and wherein said means for permitting removal of said valve and sheath permits removal of said valve and sheath as an integral body from said lead or catheter disposable therethrough.
10. The assembly of claim 1 wherein said hemostatic valve is self sealing.
11. The assembly of claim 1 wherein said hemostatic valve and sheath are arranged and configured to allow the insertion therethrough of multiple leads or catheters.
12. A sheath assembly for use with a lead or catheter comprising:
an introducer sheath;
a hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introductionof at least one lead or catheter therethrough;
means for permitting removal of said hemostatic valve and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve to be removed from an end of said lead orcatheter, whereby said introducer sheath and hemostatic valve are separate body portions coupled to each other and wherein said means for permitting removal of said valve and sheath from said lead or catheter disposable therethrough allow separate removal of said hemostatic valve and sheath from said lead or catheter, wherein said assembly may remain in a vein throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.
an introducer sheath;
a hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introductionof at least one lead or catheter therethrough;
means for permitting removal of said hemostatic valve and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve to be removed from an end of said lead orcatheter, whereby said introducer sheath and hemostatic valve are separate body portions coupled to each other and wherein said means for permitting removal of said valve and sheath from said lead or catheter disposable therethrough allow separate removal of said hemostatic valve and sheath from said lead or catheter, wherein said assembly may remain in a vein throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.
13. A method of percutaneous sheath lead or catheterization comprising the steps of:
disposing an introducer sheath and hemostatic valve coupled to said introducer sheath in a body lumen;
disposing at least one lead or catheter through said valve and introducer sheath into said body lumen;
sealing said lead or catheter within said hemostatic valve to prevent bleeding and introduction of air into said body lumen with disposition of said lead or catheter therein;
continuously introducing fluid through a sidearm disposed in said hemostatic valve downstream from said valve to continuously flush said introducer sheath to prevent coagulation in said introducer sheath; and removing said hemostatic valve and introducer sheath while leaving said lead or catheter in place within said body lumen without sliding either said introducer sheath or hemostatic valve over an end of said lead or catheter, whereby implanted leads or catheters may be disposed into said body lumen without bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma for lead exchange or requiring said end of said lead or catheter to have a structure to permit removal of said sheath and valve thereover.
disposing an introducer sheath and hemostatic valve coupled to said introducer sheath in a body lumen;
disposing at least one lead or catheter through said valve and introducer sheath into said body lumen;
sealing said lead or catheter within said hemostatic valve to prevent bleeding and introduction of air into said body lumen with disposition of said lead or catheter therein;
continuously introducing fluid through a sidearm disposed in said hemostatic valve downstream from said valve to continuously flush said introducer sheath to prevent coagulation in said introducer sheath; and removing said hemostatic valve and introducer sheath while leaving said lead or catheter in place within said body lumen without sliding either said introducer sheath or hemostatic valve over an end of said lead or catheter, whereby implanted leads or catheters may be disposed into said body lumen without bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma for lead exchange or requiring said end of said lead or catheter to have a structure to permit removal of said sheath and valve thereover.
14. The method of claim 13 where said step of removing said sheath and lead or catheter comprises the step of splitting said sheath and valve along a longitudinal length of said sheath and valve and disposing said lead or catheterradially through said longitudinal split.
15. The method of claim 14 where said step of splitting said sheath and valve comprises a step of splitting said sheath and valve along a score line by manually tearing said sheath and valve apart along said score line.
16. The method of claim 15 where said step of tearing said sheath and valve along a score line further comprises tearing said sheath and valve along apair of longitudinally defined score lines in said sheath and valve.
17. The method of claim 16 where said step of tearing said valve and sheath along a pair of score lines comprises the step of tearing said valve and sheath along diametrically opposing longitudinally defined score lines in said valve and sheath respectively.
18. An improvement in an introducer sheath and valve assembly for implantation of pacemaker leads comprising:
means for splitting said introducer sheath, said sheath having a longitudinal axis, said means for splitting allowing manual separation of said sheath along said longitudinal axis; and means for separating said valve assembly separately from splitting of said sheath to permit removal of a lead or catheter disposed through said valve from said valve without necessitating removal of said valve over an end of said lead or catheter, whereby bleeding, risk of air embolism, clotting and repeated sheath insertion related trauma from lead exchange is substantially avoided.
means for splitting said introducer sheath, said sheath having a longitudinal axis, said means for splitting allowing manual separation of said sheath along said longitudinal axis; and means for separating said valve assembly separately from splitting of said sheath to permit removal of a lead or catheter disposed through said valve from said valve without necessitating removal of said valve over an end of said lead or catheter, whereby bleeding, risk of air embolism, clotting and repeated sheath insertion related trauma from lead exchange is substantially avoided.
19. An improvement in a hemostatic valve for use with a lead or catheter and a splittable introducer sheath, said hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introduction of at least one lead or catheter therethrough,said improvement comprising means for permitting removal of said hemostatic valve from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve to be removed from an end of said lead orcatheter, wherein said introducer sheath and hemostatic valve are separate body portions coupleable to each other and wherein said means for permitting removal of said valve and sheath from said lead or catheter disposable therethrough allow separate removal of said hemostatic valve and sheath from said lead or catheter,whereby said assembly may remain in a vein throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.
20. An assembly for use with a guidewire for vascular implantation of a lead or catheter, said guidewire being disposed into said vascular system through a hollow needle, said needle for invasively entering said vascular system and characterized by an inner diameter, said assembly comprising:
an introducer sheath through which said lead or catheter is introduced into a vascular system, said introducer sheath being disposed into said vascular system under the guidance of said guidewire, said guidewire being removed from said vascular system after disposition therein of said introducer sheath;
a fluid tight hemostatic valve subassembly coupled to said introducer sheath, said lead or catheter being introduced into said vascular system throughsaid hemostatic valve subassembly and introducer sheath; and means for permitting removal of said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath an hemostatic valve subassembly to be removed from an end of said lead or catheter after said lead or catheter is disposed into said vascular system under the guidance of said introducer sheath, whereby said assembly may remain disposed in part in said vascular system to allow free lead exchange, easier lead manipulation within said introducer sheath, to avoid the risk of air embolism or trauma from repeated lead exchange and sheath insertion.
an introducer sheath through which said lead or catheter is introduced into a vascular system, said introducer sheath being disposed into said vascular system under the guidance of said guidewire, said guidewire being removed from said vascular system after disposition therein of said introducer sheath;
a fluid tight hemostatic valve subassembly coupled to said introducer sheath, said lead or catheter being introduced into said vascular system throughsaid hemostatic valve subassembly and introducer sheath; and means for permitting removal of said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath an hemostatic valve subassembly to be removed from an end of said lead or catheter after said lead or catheter is disposed into said vascular system under the guidance of said introducer sheath, whereby said assembly may remain disposed in part in said vascular system to allow free lead exchange, easier lead manipulation within said introducer sheath, to avoid the risk of air embolism or trauma from repeated lead exchange and sheath insertion.
21. The assembly of claim 20 further comprising a dilator, said dilator being disposed through said introducer sheath for supporting said introducer sheath as said introducer sheath is disposed into said vascular system, said dilator and sheath being guided by said guidewire after said needle is removed therefrom, which guidewire has previously been disposed in said vascular system.
22. The assembly of claim 21 where said lead or catheter, dilator and sheath have a diameter greater than said inner diameter of said needle.
23. The assembly of claim 20 wherein said hemostatic valve subassembly comprises membrane means for providing a fluid tight seal with said lead or catheter within said hemostatic valve subassembly to prevent the flow of fluid past said membrane means in either direction within said hemostatic valve subassembly, and a peel-away valve housing for providing a fluid tight enclosurearound said membrane means.
24. The assembly of claim 23 wherein said membrane means can be peeled away from said lead or catheter.
25. The assembly of claim 24 wherein said membrane means is peeled away simultaneously with said peel-away valve housing.
26. The assembly of claim 24 wherein said membrane means is peeled away separately from said peel-away valve housing.
27. A method for using a guidewire for vascular implantation of a lead or catheter comprising the steps of:
invasively entering said vascular system with a hollow needle, said needle characterized by an inner diameter;
disposing said guidewire into said vascular system through a hollow needle;
removing said needle from said vascular system leaving said guidewire disposed therein;
disposing an introducer sheath and dilator into a vascular system under the guidance of said guidewire;
removing said guidewire and dilator from said vascular system after disposition therein of said introducer sheath;
disposing said lead or catheter through said introducer sheath and a fluid tight hemostatic valve subassembly coupled to said introducer sheath into said vascular system, said lead or catheter being guided into said vascular system by said introducer sheath and being fluid sealed within said introducer sheath by said hemostatic valve subassembly; and removing said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve subassembly to be removed from an end of said lead or catheter, whereby said assembly may remain disposed in part in said vascular system to allow free lead exchange, easier lead manipulation within said introducer sheath, to avoid the risk of air embolism, or trauma from repeated lead exchange and sheath insertion.
invasively entering said vascular system with a hollow needle, said needle characterized by an inner diameter;
disposing said guidewire into said vascular system through a hollow needle;
removing said needle from said vascular system leaving said guidewire disposed therein;
disposing an introducer sheath and dilator into a vascular system under the guidance of said guidewire;
removing said guidewire and dilator from said vascular system after disposition therein of said introducer sheath;
disposing said lead or catheter through said introducer sheath and a fluid tight hemostatic valve subassembly coupled to said introducer sheath into said vascular system, said lead or catheter being guided into said vascular system by said introducer sheath and being fluid sealed within said introducer sheath by said hemostatic valve subassembly; and removing said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve subassembly to be removed from an end of said lead or catheter, whereby said assembly may remain disposed in part in said vascular system to allow free lead exchange, easier lead manipulation within said introducer sheath, to avoid the risk of air embolism, or trauma from repeated lead exchange and sheath insertion.
28. The method of claim 27 further comprising the step of disposing a dilator through said introducer sheath for supporting said introducer sheath as said introducer sheath is disposed into said vascular system, and wherein said dilator and sheath is guided by said guidewire after said needle is removed, which guidewire has previously been disposed in said vascular system.
29. The method of claim 28 where said steps of disposing said lead or catheter, dilator and sheath disposes into said vascular system disposes a lead or catheter, dilator and sheath having a diameter greater than said inner diameter of said needle.
30. The method of claim 28 wherein said step of disposing said lead or catheter through said introducer sheath and said fluid tight hemostatic valve subassembly comprises the steps of disposing said lead or catheter through a membrane means for providing a fluid tight seal with said lead or catheter within said hemostatic valve subassembly to prevent the flow of fluid past said membrane means in either direction within said hemostatic valve subassembly, and disposing said lead or catheter through a peel-away valve housing which provides a fluid tight enclosure around said membrane means; and where said step of removing said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough without requiring said introducer sheath and hemostatic valve subassembly to be removed from an end of said lead or catheter comprises the step of peeling away said valve housing.
31. The method of claim 30 further comprising the step of peeling away said membrane means from said lead or catheter.
32. The method of claim 31 wherein said step of peeling away said membrane means is performed simultaneously with said step of peeling away said valve housing.
33. The method of claim 31 wherein said step of peeling away said membrane means is performed separately from said step of peeling away said valve housing.
34. An assembly for vascular implantation of a lead or catheter, into a vascular system through a hollow needle, said needle for invasively entering said vascular system and characterized by an inner diameter, said assembly comprising:
an introducer sheath through which said lead or catheter is introduced into said vascular system;
a fluid tight hemostatic valve subassembly coupled to said introducer sheath, said lead or catheter being introduced into said vascular system throughsaid hemostatic valve subassembly and introducer sheath; and means for permitting removal of said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough by tearing said hemostatic valve and introducer sheath apart without causing blood splattering or blood aerosol dispersal.
an introducer sheath through which said lead or catheter is introduced into said vascular system;
a fluid tight hemostatic valve subassembly coupled to said introducer sheath, said lead or catheter being introduced into said vascular system throughsaid hemostatic valve subassembly and introducer sheath; and means for permitting removal of said hemostatic valve subassembly and introducer sheath from said lead or catheter disposed therethrough by tearing said hemostatic valve and introducer sheath apart without causing blood splattering or blood aerosol dispersal.
35. The assembly of claim 34 further comprising a dilator, said dilator being disposed through said introducer sheath for supporting said introducer sheath as said introducer sheath is disposed into said vascular system.
36. The assembly of claim 35 where said lead or catheter, dilator and sheath have a diameter greater than said inner diameter of said needle.
37. The assembly of claim 34 wherein said hemostatic valve subassembly comprises membrane means for providing a fluid tight seal with said lead or catheter within said hemostatic valve subassembly to prevent the flow of fluid past said membrane means in either direction within said hemostatic valve subassembly, and a peel-away valve housing for providing a fluid tight enclosurearound said membrane means.
38. The assembly of claim 37 wherein said membrane means can be peeled away from said lead or catheter.
39. The assembly of claim 38 wherein said membrane means is peeled away simultaneously with said peel-away valve housing.
40. The assembly of claim 38 wherein said membrane means is peeled away separately from said peel-away valve housing.
41. A method for vascular implantation of a lead or catheter comprising the steps of:
invasively entering said vascular system with a hollow needle, said needle characterized by an inner diameter;
disposing an introducer sheath and dilator into a vascular system;
removing dilator from said vascular system after disposition therein of said introducer sheath;
disposing said lead or catheter through said introducer sheath and a fluid tight hemostatic valve subassembly coupled to said introducer sheath into said vascular system, said lead or catheter being guided into said vascular system by said introducer sheath and being fluid sealed within said introducer sheath by said hemostatic valve subassembly; and tearing said hemostatic valve subassembly and introducer sheath apart from said lead or catheter disposed therethrough blood splattering or blood aerosol dispersal.
invasively entering said vascular system with a hollow needle, said needle characterized by an inner diameter;
disposing an introducer sheath and dilator into a vascular system;
removing dilator from said vascular system after disposition therein of said introducer sheath;
disposing said lead or catheter through said introducer sheath and a fluid tight hemostatic valve subassembly coupled to said introducer sheath into said vascular system, said lead or catheter being guided into said vascular system by said introducer sheath and being fluid sealed within said introducer sheath by said hemostatic valve subassembly; and tearing said hemostatic valve subassembly and introducer sheath apart from said lead or catheter disposed therethrough blood splattering or blood aerosol dispersal.
42. The method of claim 41 further comprising the step of disposing a dilator through said introducer sheath for supporting said introducer sheath as said introducer sheath is disposed into said vascular system.
43. The method of claim 42 where said steps of disposing said lead or catheter, dilator and sheath disposes into said vascular system disposes a lead or catheter, dilator and sheath having a diameter greater than said inner diameter of said needle.
44. The method of claim 42 wherein said step of disposing said lead or catheter through said introducer sheath and said fluid tight hemostatic valve subassembly comprises the steps of disposing said lead or catheter through a membrane means for providing a fluid tight seal with said lead or catheter within said hemostatic valve subassembly to prevent the flow of fluid past said membrane means in either direction within said hemostatic valve subassembly, and disposing said lead or catheter through a peel-away valve housing which provides a fluid tight enclosure around said membrane means; and where said step of tearing said hemostatic valve subassembly and introducer sheath apart from said lead or catheter disposed therethrough comprises the step of peeling away said valve housing.
45. The method of claim 44 further comprising the step of peeling away said membrane means from said lead or catheter.
46. The method of claim 45 wherein said step of peeling away said membrane means is performed simultaneously with said step of peeling away said valve housing.
47. The method of claim 45 wherein said step of peeling away said membrane means is performed separately from said step of peeling away said valve housing.
Applications Claiming Priority (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US07727191 US5125904B1 (en) | 1991-07-09 | 1991-07-09 | Splittable hemostatic valve sheath and the method for using the same |
| US727,191 | 1992-06-26 | ||
| US905,045 | 1992-06-26 | ||
| US07/905,045 US5312355A (en) | 1991-07-09 | 1992-06-26 | Splittable hemostatic valve and sheath and the method for using the same |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2112394A1 CA2112394A1 (en) | 1993-01-21 |
| CA2112394C true CA2112394C (en) | 1997-04-22 |
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ID=27111469
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002112394A Expired - Lifetime CA2112394C (en) | 1991-07-09 | 1992-07-06 | Splittable sheath assembly and method for using |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US5312355A (en) |
| EP (2) | EP0593685B1 (en) |
| JP (1) | JP2001527425A (en) |
| AT (1) | ATE189774T1 (en) |
| CA (1) | CA2112394C (en) |
| DE (1) | DE69230689T2 (en) |
| ES (1) | ES2146588T3 (en) |
| WO (1) | WO1993000947A1 (en) |
Families Citing this family (176)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5766151A (en) * | 1991-07-16 | 1998-06-16 | Heartport, Inc. | Endovascular system for arresting the heart |
| EP0631793A1 (en) * | 1993-06-30 | 1995-01-04 | Cook Incorporated | Splittable hemostatic valve and method of use with a splittable introducer sheath |
| US6277107B1 (en) | 1993-08-13 | 2001-08-21 | Daig Corporation | Guiding introducer for introducing medical devices into the coronary sinus and process for using same |
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| US4883468A (en) | 1987-04-08 | 1989-11-28 | Terumo Kabushiki Kaisha | Medical tool introduction cannula and method of manufacturing the same |
| US4772266A (en) * | 1987-05-04 | 1988-09-20 | Catheter Technology Corp. | Catheter dilator/sheath assembly and method |
| DE3721288C1 (en) * | 1987-06-27 | 1989-06-22 | Sterimed Gmbh | Sealing cuff for a catheter |
| US4921479A (en) * | 1987-10-02 | 1990-05-01 | Joseph Grayzel | Catheter sheath with longitudinal seam |
| US4960412A (en) * | 1988-04-15 | 1990-10-02 | Universal Medical Instrument Corp. | Catheter introducing system |
| DE3834600C1 (en) * | 1988-10-11 | 1989-12-21 | B. Braun Melsungen Ag, 3508 Melsungen, De | Puncturing and introduction device for elongate articles |
| US4983168A (en) | 1989-01-05 | 1991-01-08 | Catheter Technology Corporation | Medical layered peel away sheath and methods |
-
1992
- 1992-06-26 US US07/905,045 patent/US5312355A/en not_active Expired - Lifetime
- 1992-07-06 EP EP92919181A patent/EP0593685B1/en not_active Expired - Lifetime
- 1992-07-06 ES ES92919181T patent/ES2146588T3/en not_active Expired - Lifetime
- 1992-07-06 AT AT92919181T patent/ATE189774T1/en not_active IP Right Cessation
- 1992-07-06 JP JP50237393A patent/JP2001527425A/en not_active Ceased
- 1992-07-06 WO PCT/US1992/005666 patent/WO1993000947A1/en active IP Right Grant
- 1992-07-06 CA CA002112394A patent/CA2112394C/en not_active Expired - Lifetime
- 1992-07-06 EP EP99114016A patent/EP0948970A3/en not_active Withdrawn
- 1992-07-06 DE DE69230689T patent/DE69230689T2/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| DE69230689T2 (en) | 2000-10-26 |
| CA2112394A1 (en) | 1993-01-21 |
| EP0593685A4 (en) | 1995-06-28 |
| ATE189774T1 (en) | 2000-03-15 |
| US5312355A (en) | 1994-05-17 |
| WO1993000947A1 (en) | 1993-01-21 |
| DE69230689D1 (en) | 2000-03-23 |
| JP2001527425A (en) | 2001-12-25 |
| EP0948970A3 (en) | 1999-12-29 |
| ES2146588T3 (en) | 2000-08-16 |
| EP0948970A2 (en) | 1999-10-13 |
| EP0593685B1 (en) | 2000-02-16 |
| EP0593685A1 (en) | 1994-04-27 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKEX | Expiry |