CA2175474A1 - Instrument, system, kit and method for catheterization procedures - Google Patents

Abstract

A system and method of catheterization, includes a needle (22), a "Y" chamber (27), a syringe or other chamber (46), a dilator, a sheath (80), a protective sleeve (92), and a shock sheath (100). This introduces a comprehensive, uniform and universal approach to catheterization. Discriminatory methods of treatment using the invention are described. Particular attention has been paid to current problems in catheterization and the prevention of transmission of communicable diseases from patient to practitioner and vice versa (e.g., the risk of contracting the HIV virus is substantially reduced using this system and method). The discriminatory treatment of diseases, in particular, cancer, is now rapid, safe and in some instances, novel. The invention makes possible substantial reductions in the cost of health care while improving the efficiency of diagnosis and treatment. The invention allows the practitioner to perform simultaneous diagnosis and treatment of diseases using the same procedure, regardless of their location in or on the body. The number and duration of hospitalization is minimized, and the quality of life and length of survival for the patient is improved.

Description

~ WO ~5/12427 2 1 7 5 47 4 PC~IUS9~1/12482 INSTRUMENT, SYSTEM, KIT AND METHOD FOR
CATHETERI~ZATION PROCEDURES
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is related to a co-pending United States Patent Application, entitled "INSTRUMENT, SYSTEM, KIT AND METHOD
FOR CATHETERIZATION PROCEDURES," Serial Number 08/146,495, filed November 1, 1993.
TECHNICAL FIELD OF THE INVENTION
The present invention relates to instruments and methods in the health-care industry and, in particular, to a universal instrument for the introduction of a catheter, device or substance into, for the withdrawal of tissue or material from, and for the diagnosis or treatment of any part of a body or body cavity and more particularly, a human body.

WO 95112427 C A 2 1 7 ~ 4 7 4 PCTI~S9.1/12~82 DEFINITIONS AND TERMINOLOGY
The following terms used herein shall be defined as:
Universal usage shall mean having one or more of the following capabilities:
- may be used anywhere in or on a human body or animal body;
- may be used for diagnosis or treatment of disease;
- may be used for L~ ul~y or permanent de~ices; and - may be used by health-care personnel in many different fields of human and animal health-care.
D~ .y:
- treatment is focused on the diseased part(s) of the body;
Disease:
- all altered states of body and mind; and - all processes leading to altered states of body and/or mind.
Substance means any ma~ter, including but not limited to:
( hPm~thPrapeutic agents;
- antibiotics;
- genes;
- antibodies;
- radioactive seeds;
- oxygen;
- mPfli~-~rion~;
- fluids.
Catheterization means a procedure wherein any tissue, material, structure or substance in a body is entered.
Catheter means a device for insertion into a tissue or material within a body or body cavity, said instrument ~u ~ g one or more lumens.

~ WO 95/124Z7 2 1 7 5 4 7 4 PCTIUS94112482 (~th~t~ri7~tion device:
- shall mean any instrument used before, during or after a procedure in order to facilitate catheterization.
Catheterization site:
- means any spot or area where a catheter or r~th~t~ri7~tir,n device enters or leaves tissue or material.
Comprehensive "l:~lUlll~,.IL shall mean either that:
- all necessary components are included in the instrument; or - all or selected components may be used depending on the r~thrt~ri7~tirln site and depending upon the purpose of r~th, t~ri7~tir,n Device shall mean any tool, instrument or m~rh:lnicm which is inserted through the catheterization site including, but not limited to, a catheter or r~th~t~ri7~tir n device, ~hether pacing leads, monitoring systems, instruments for biopsy, or wires for conduction of heat or cold.
Diagnosis means detection of a condition of a tissue, material, structure or substance of a body, including but not limited to:
- angiograms of all typcs;
- obtaining specimens for study (e.g., blood, pleural fluid, tissues, etc.); - obtaining pressure measurements (e.g., Swan Ganz catheter);
and - insertion of radioactive and other materials.
Treatment means acting upon a tissue, material, structure or substance of a body, including but not limited to:
- drainage (e.g., pus, urine, other fluuds and sllhst~nrr~);
- infusion k.g., fluids, chemicals and other sllhstlnc~); and - radloactive seeds and other materials or s1lhst~nr~

WO 95/12427 C ~ ~ 1 7 5 4 7 4 PCT/US94/12482 Target tissue or material shall mean any tissue or material, conduit rnnr:lining such tissue or materi.al or conduit cormected to such tissue or material wherein said tissue or material is to be accessed.
The present invention:
- irlcludes device, irlstrument, system, kit or methodology described and claimed herein.
Guide-wire shall mean an elongated rlthPtPri7~tinn device, tool or device for guiding a catheter or other catheterization device, and shall include:
- tool or device to allow sampling of tissue or material (e.g., a biopsy forceps);
- tool or device to allow tteatment of tissue or material (e.g., wire for rr,nr~llrtinn in hyperthermia or freezing).
"Y" chamber:
- a device having a first chamber with an opening for comml.nir~ting with target tissue or material (as Ihrough an interposed needle, dilator, infuser tube or the like) and more than one other chamber rnmmllnir~ring with the first chamber.
Hub:
- site of ~tt~rhmPnt of a proximal end of a needle to any other device or rnnnPcting system. A hub may form a "Y" chamber.
Distal:
- shall mean toward the target tissue or material, i.e., generally away from the operator during a r~rhPtPri7~rinn procedure.
Proximal:
- shall mean away from the target tissue or material, i.e., generally toward the operator during a ~thPteri7~rinn procedure.

wo 95/12427 ' 2 ~ 7 5 4 7 4 ~CT~JS9411~48~
BACKGROUND OF THE INVENTION
In its simplest and earliest form, previously an instrument for catheterization was a tubular object used to drain noxious material (e.g., pus) from the body. The instrument had a distal end, generally sharp, to allow 5 penetration of tissue or of a body structure, a tubular shaft with a lumen, and an open proximal end to allow drainage and introduction of other substances and devices. This instrument has evolved to a plethora of devices (e.g., needles, catheters of different types, cannulae, and biopsy tools, etc.) for catheterization of structures. Each of these has its own specific use(s), l0 method of irlse~tion, problems and complications.
C~thi~tf~ri7:~tion of a blood vessel will be used as an illustration.
Catheters for blood vessels were initially developed for insertion into peripheral vessels, those which the practitioner could see and/or feel, e.g., onthe dorsum of the hand or along the arm. With advances in medicine, it 15 became necessary to catheterize larger blood vessels, many of which were neither visible nor palpable. This required a change in the procedure of catheterization. Several special-purpose catheters and insertion kits (describedhereinafter) have become available for the diagnosis and treatment of medical problems and diseases. However, many problems still exist both during and 20 after catheterization. It is one object of this invention to correct many of these problems, examples of which are described below.
There is no catheterization system available which is universal, i.e.:
- has a universal procedural method;
- can be used to catheterize almost all structures, regardless of the site 25 in/on the body;
- can be used for diagnosis and treatment in all parts of the body using the same procedure.

WO 95/12427 C ~1 1 7 5 4 7 4 PCTIUS94/12482 It is a further object of the present invention to be comprehensive, eff1cient and to fill this void.
The present invention rectifies old problems and eliminates or reduces some of the newer ones (e.g., risk of AIDS by tr~ncmiccil n of the HIV virus from patient to practitioner or vice-versa). Moreover, the invention described here can provide a universal system, device and methodology for r~th~t~ri7~ti~n procedures. It can be used to provide ~licrrimin~tr~ry forms of treatment. Such treatments are more efficient and less toxic to the patient because they are focused on the target site. This system requires fewer hospit~li7~ti~-nc, is less expensive and more humane.
It is more efficient in diagnosis and allows appropriate treatment to be initiated during the same procedure.
For example, prior blood vessel ~thf~tf-ri7~tion, and more particularly, catheterization of a subclavian vein in a human body requires the following steps:
1) The skin is cleansed with the solution of choice.

2) The ~n~Pcth~ti~ is locally infiltrated.

3) The anatomic landmarks are identified again.
~) The vessel is blindly punctured using a hollow needle with attached syringe.
5) "Flash-back" of blood is observed in the syringe.
6) The syringe is detached from needle so that a guide-wire can be introduced through the hub of the needle.
7) The needle is withdrawn, leaving the guide-wire in place.
8) An incision is made in skin at the site of the guide-wire in the skin.
9) A dilator is introduced over the guide-wire through skin into the blood vessel. This makes a passage in the tissues so that the catheter can 5l1hc~ql1~-ntly be introduced with ease.

.

10) The dilator is threaded back out over the guide-wire.
11) A catheter is threaded over the guide-wire into the blood vessel.
12) The guide-wire is removed, leaving the catheter in place.
13) The infusion lines are attached to the ports of the catheter.
14) The catheter is secured to the skin.
15) Dressing is applied. ~)ressing changes are done under sterile rr,n~itiC~n.c every 2-3 days depending on the protocol.) PROBLEMS
Given the state of the art, the following problems can occur during catheterization. These problems have been corrected by the invention herein sllhmittr~l Previously, the practitioner was often required to manipulate the syringe and needle while detaching one from the other. This maneuver can dislodge the needle tip from the lumen of the blood vessel. When this problem occurs, it is necessary to re-attach the syringe to the needle and re-enter the lumen of the blood vessel as evidenced by the "flash-back" of blood into the syringe. Besides being time-cr~nCllmin~ and rru~L~dLillg for both the patient and the practitioner, this problem exposes the patient to the trauma and risks of multiple punctures. One difficulty is that there is no 'Iflash-back" during the insertion of a guide-wire. Hence damage to the blood vessel arld/or the adjacent structures with its attendant morbidity and mortality is more frequently observed in such a scenario.
When the syringe is detached from the needle and the proximal end or hub of the needle is open to air, there is a potential risk of air embolism, which may be asymptomatic, but can also be fatal.
These problems continue today. U.S. Patent Nos. 4,935,008,

4,280,503, 4,655,750, and 4,525,157 have attempted to address the problem of passing a guide-wire without leaving the hub of the needle open to air. They are, however, very limited in that:

WO 95/12427 C A 2 1 7 ~ 4 7 4 PCT/US94/12482 - only one guide-wire or device can be inserted and the device has only specific applications so that it is not universal - "flash-back" cannot be observed - none of the problems subsequently discussed are addressed.
Blood flows out of the hub of the needle and there is contact between the patient's blood and practitioner/team members. Although gloves are worn by all members of the team, "breaks" in gloves are well-known. Hence there is no guarantee of protection ag~unst the trAncmicci~n of ~r)mm~lnifAhl~ disease-causing agents (e.g., HIV, hepatitis, etc.). Moreover,guide-wires that are available are of a length that often require the practitioner to feed part of the said wire outward while trying to thread the catheter. Thus, Ihe practitioner is again in contact with potentially infected material. TrAncmicci-m of a r~mmllni~Ahle disease is obviously a concern.
Use of surgical gloves is routine, but is not a guarantee against ~ntAminAti~n (In the invention herein submitted, at NO time is there contact between any tissue or body fluid of the patient and practitioner.
Moreover, no part of the device introduced into the body of a patient is handled directly by the Practitioner.) In the invention herein cllhmitt~rl the patient and practitioner are protected from being ~(7~ I by each other.
Air embolism can also occur with only a guide-wire in place using the traditional method of rAth ~t~ri7Ation The present invention rectifies this problem.
Many kits have a guide-wire with a "j" tip. This requires a "feeder"
~5 or "straightener" to be attached at the hub of the needle so that the "j" tip is straightened temporarily, thus allowing the guide-wire to be inserted through the needle. This process can be troublesome and the "feeder"
becomes unsterile as it falls off the sterile field. In addition, the needle tip can get dislodged from the lumen of the blood vessel. The present invention rectifies the problem.
Another problem frequently encountered during insertion of the guide-wire is thal the direction of the bevel or other directional characteristic of the needle is not known. Hence the wire can travel in a direction other than that desired by the practitioner. This results in i~dpp~ rid~e positioning of the g ude-wire and . ~ ly~ of the catheter. A second r~th~tPri7~ti~n procedure and/or fluoroscopy is then required for the correct placement of the catheter. This requires the use of additional equipment which subjects the patient to radiation and increases the cost of treatment.
The catheter is normally secured to the skin directly (i.e., there is ~ommllnir~ti~n between skin tissue and the target tissue or material). In the example of a blood vessel r~thrt~ri7ltirm procedure, the blood stream and the skin are in fluid crlmml~nir~tion along the exterior surface of the catheteras long as the catheter is in place). The skin is a ~I~ntin1lin~ source of infection, local or systemic, which can lead to many problems resulting in continued hospitalization and even death. U.S. Patent No. 4,327,723 attempts to combat the problem of infection by the use of a Protective Shield. However, the protective shield does not cover the catheter and introducer entirely so that both still remain in contact with skin. Therefore, the source of infection (i.e., skin to catheter/introducer to bloodstream) is still present and infection continues to be a problem. A catheter is often inserted through the lumen of an introducer. This method has the following potential problems:
- Clot can form around the catheter if a side-port is not being used.
Clot is a good medium for bacterial growth. Hence there is a likelihood of infection.
- ~ U~ly, dextrose-rich fluids are infused through a side-port and bathe the catheter. This also assists bacterial growth. The problem of skin WO9~/12427 1~ A 2 1 7 5 ~ 7 4 PCT/US91112482 to catheter to bloodstream infection has not been successfully addressed, prior to the present invention, regardless of whether an introducer is used.
Another problem is that multiple physical maneuvers and manipulations and their attendant difficulties and drawbacks are required to achieve catheterization. U.S. Patent No. 4,995,866 attempts to reduce the number of maneuvers required by c~mhinin~ the needle and a dilator.
However, this is "blind instr~lmPnt~ti~n ~' and the distal end of the dilator can easily penetrate the back wall of the target vessel resulting in potentially serious problems.
The following problems can occur after ~thPtpri7~ti~n~ the correction of which is also an object of the present invention:
1) Local and systemic infections, as described above, can contirlue to result as long-as the catheter is in place and the entry site remains exposed to the skin.
2) Multiple dressing changes are required with currently available r~thPtPri7~tion devices. Infection can be introduced into the patient by the practitioner and vice-versa during dressing changes and/or during use of the catheterization device, despite the use of sterile techniques. Infection, in particular, is of grave concern today because:
a) There is a large number of immune compromised patients in the patient population.
b) The cost of medical care in the treatment of infections and resultant problems is significant and soaring.
c) Results of attempted treatment of infections in this population are still poor.
Another problem is that it is not possible to clean the skin that is in contact with the catheterization device without touching said device and hence damaging the integrity of said device. It is possible to actually introduce infection during dressing changes.

~ WO 95/12427 2 ~ i 5 7 ~ PCTIUS94111481 Another problem occurring during dressing changes is that catheters are likely to be inadvertently dislodged from an optimal position.
Repositioning and ctlmPtimPC even the insertion of a new catheter is required. In a critically ill patient, these procedures can be disastrous. U.S.
Patent No. 4,327,723 purports to allow repositioning of the catheter in a sterile cllv;lu~ . However, this is only temporary because the catheter cannot be adequately immobilized in the new position.
Clearly, all these problems contribute to increasing health-care costs.
Several problems that occur dl1r;n,~ and after ~thPtPri7~til~n have also been corrected by the present invention.
Infusions of incompatible agents cannot be administered through the same port. U.S. Patent No. 4,327,723 describes an introducer to be used ~iml1lt~nP~-llcly with a pressure-m-lnit~-rin~ catheter. This introducer has only one side-port for infusion. Frequently, this side-port is the only avenue for administering medications or fluids while the m~mitl-rin~ catheter (e.g.
Swan Ganz) is being positioned. This is clearly a problem because large volumes of fluid need to be administered cimlllt~nPously, because some fluids are in~l~mr~sihle with each other and because some fluids need ports ~Ipci~n~tPd for their specific use only. Moreover, it is necessary to have a "~ ci~n~tPd" port, for e~ample, for ~ hyper~limPnt~ri-)n. This generally requires inserting another catheter or converting a "pressure monitoring" line into a port for this use. Neither of these options is optimal. Venous access is limited and one of the most LU~L1dL;11g situations for the practitioner and patient is to have no more access sites available.
Problems pertaining to the diagnosis of disease using catheterization include inability to diagnose (e.g. in~llffi~iPnt tissue for diagnosis; tissue obtained is not from the diseased area). Multiple ~l U~ dUI t:~, including open surgery, are required, the patient is subjected to repeated trauma and risks, and valuable time and money are wasted.

WO 95112427 ~ A 2 1 7 5 4 7 4 PCTIUS91/12482 Treatment of many diseases is non-discriminatory (i.e., medications are introduced syslemically int() the bloodstream so that all parts of the body, whether diseased or not, are exposed to these sllhst~nrrc) For example, a large number of agents used in the treatment of cancer are very

5 toxic. The amounts of these medications that are administered are relatively large due to their subsequent dilution in the body. Were these agents adminislered primarily to target sites, smaller amounts of the therapeutic agents ~ ould be required with less toxicity and "healthy" parts of the body would nol be damaged.
Furthermore, with prior systems, devices and methods, diagnosis and treatment of diseases (e.g., cancer) is not possible during the same procedure and requires use of a large number of instruments which s~lhst~nri~lly differ from each olher in shape or function.
Disrrimin ltrlry treatment of diseases is frequently used for lesions on the surface of the body only. Diseases located within a body cavity often require treatment using "open" surgical~ dul~ (e.g., interstitial radiation) and/or systemic mPr~ir~tirnc Treating the "target" organ without exposing the rest of the body to the toxic side-effects of current agents (e.g., rhPmrJthPrapy for cancer) is clearly preferable.
This principle has been applied in the past on a limited basis.
However, there are still many associated problems.
U.S. Patent No. 4,192,302 provides a ~ ory method for treatment of liver cancer. A complex shunt is described to isolate the target organ from the rest of the circulation. The shunt treats the blood from the target organ with a chemotherapeutic agent extracorporeally, and then detoxifies the blood before returning it to the general circulation. This procedure requires hospitalization and a major operation each time treatment is ad~ L~I~d. The high cost is clearly a disadvantageous factor, but more importantl~, Ihe patient is exposed to repeated morbidity and possible W095/12427 21 7 5 4 7 llt PCTIUS94112482 mortality and spends valuable time in the hospital away from the family.
U.S. Patent No. 5,069,662 also describes a discriminatory treatment of liver cancer. The method described is virtually identical to that described in U.S.
Patent No. 4,192,302. The only difference is that catheters are inserted fluoroscopically rather than during an open surgical procedure.
C(ll~se(~ ly, this procedure also requires multiple hospit~ tir,n~ and exposes the patient to risks every time the procedure is used (e.g., thrombosis of a vessel, bleeding, damage to the blood vessel such as rlicc~-rtir,n, etc.).
External radiation has its own well-known complications. Interstitial radiation is used but for lesions within a body cavity, an "open" surgical procedure is necessary. For exarnple, U.S. Patent No. 4,763,671 addresses local hyperthermia and interstitial radiation. However, an open operation is necessary.
To the best of my knowledge, there is no patent, device or system of catheterization that:
1) deals with the critical problem of tr~ncnniccir~n of cr,mml.nir~hl~
diseases from patient to practitioner or vice-versa;
2) allows diagnosis and treatment of diseases regardless of the site of the disease during the same procedure;
3) is universal;
4) is comprehensive;
5) allows ~ i",i~l~rory treatment of diseases regardless of site of disease and involves minimal, if any, hospitalization followed by subsequent treatments at home;

6) allows repositioning and flrm immobilization of a catheter in its new position in a sterile c:llVilOIIIII.~I~ without compromising the integrity of said catheter;

7) allows multiple separate ports for infusions while inserting mr,nitr,rin~ catheters or other tools through the same access site;

WO9~/12427 G A2 1 '5 4 7 4 PCT/IIS94112482 ~

8) corrects important sources of infection;

9) allows the practitioner to know the direction of the bevel of the needle or other directional characteristic or position-sensitive feature at all times;

10) allows the practitioner to observe "flash-back" continuously during maneuvers;

11) allows the insertion of more than one device at the same site without the risk of air embolism;

12) is time and cost-efficient (i.e., the process of cath~trri7~tir,n should take less than one minute);

13) has a system of immohili71tion such that catheters cannot be d~lL~llLly displaced or "pulled out". ~This problem is significant and, in a critical patient, can mean the difference between life and death.
In summary, there is a clear need for a simple device, system and method of r~th~trri7~ti~ n which is universal, comprehensive and deals with all of the above issues. The various features of the invention submitted in the application achieve various ones of these advantages individually and in combination. The invention also introduces rli~rrimin ltr,r~r treatment for the patient, lowers morbidity and mortality, and allows therapeutic options at low cost.

~ WO 95/12427 2 1 7 ~ 4 7 4 PCTIUS94112482 Sl~MMARY OF TEIE INVENTION
The present invention provides for a comprehensive universal instrument and a unified methodology for catheterization to address many of the problems during and after ~th~t~ri7~ti~n as already discussed in detail 5 under the BACKGROUND OF THE IN~'ENTION. The instrument includes a needle, syringe or other chamber, "Y" chamber, guide-wire, dilator, sheath, shock sheath, protective sleeve, or c--mhin~ti-)nc thereof, depending on the site and purpose of ~th!~t/~ri7~tion Methods of and devices for immobilization are described. M~-tho~ lf\gy and instruments for 10 , l i c~rim in ~t~ry treatment of disease using embodiments of said il~stl u~ L are described. These instruments and methods are universal and introduce safe and easy r~th~t~ri7~tif~n using minimally invasive procedures k.g., lap~l vs~u~y and thoracoscopy) . The problems or prior systems, devices and methodologies as identified above have been corrected or reduced by the 15 present invention. The instrument sllhst~nti~lly corrects problems associatedwith ~th~t~ri7~ti~n and allows safe discriminatory treatment of diseases, e.g., cancer. The instrument(s) and method(s) introduce safe and easy r~thf-t~ri7ltion using minimally invasive procedures, e.g., I~ )a~o~y~
thoracoscopy.
Unique aspects, features and/or components of the present invention include the following:
- a needle which is suitably marked with indicia to indicate the beveled edge or other directional characteristic or position-sensitive feature of the needle, even when a distal portion of the needle is not visible to the practitioner;
- a needle having one or more lumina to allow the simultaneous insertion or withdrawal of sllhst~n~-c or devices at the same puncture si~e;

WO 95/12-~27 C ~l 2 1 7 5 4 7 4 PCT/US94112482 ~

- a "Y" chamber which allows the practitioner to obser~e "flash-back" in a syringe or other viewable chamber while allowing the introduction or removal of a guide-wire, catheter, radiation seeds, biopsy instrument, tools, systems, medicines or other devices or 5 substances;
- a syringe or chamber which allo~s the practitioner to observe "flash-back", and to withdraw and to infuse sl.hit~n~Pc - a guide-wire of sufficient length so that the practitioner does not come into contact with any part of the wire that has already been in the catheterized system (e.g., bloodstream). Often the practitioner inserts the guide-wire into the system and then moves it "out" before threading the calheter, thus ''touching" potentially ~ont~min~
wire;
- a dilator ~hich is incorporated over a needle to allow dilation of tissues for easy insertion of subsequent devices, and particularly devices used in a ~thPtPri7~titln procedure. This dilator may be p,c,~l r ~ ly tapered so t~lat dilation occurs in a plO~ v~ manner.
In one embodiment, the dilator has a wall with a lumen, which can be inflated to allo~ dilation at the discretion of the practitioner.
The dilator has tabs for easy maneuverability. In a further preferred embodiment, a dilator is provided with a valve, self-sealing plug, grommet or other sealing device;
- a sheath is preferably incorporated over a dilator. The sheath is suh~t~nti~lly shorter than the dilator and has tabs to allow ease of movement and subsequent securing of the sheath to the skin. In a preferred embodiment of a combination ~thPtPri7lti~m instrument, the sheath does not ~ommllni~rP with the target ~th~tPri7P~1 tissue or material; but, rather serves as a shield between the skin and the target tissue and any catheter system;

WO 95/12427 2 1 7 5 ~ 7 4 l~C'rlUS9~1248~

- An alternative sheath has a self-sealing plug, grommet, or other sealing device which prevents unwanted flow of substances - therethrough and which may also incorporate a bactericidal agent;
- a "shock" sheath is uniquely provided with multiple lumens or ports separated from each other to allow one or more ~thPtPri7~ti~n devices to pass th~ uu~ while sealingly allowing other lumens to ~f mmllni~tP to and from the target tissue or material without u~wr~ with the other ~thPtPri7lrion device or devices. The "shock" sheath is advantageous especially in emergency situations where multiple ports may be required immP~ tPly for the reasons deswribed in the BACKGROUND OF THE INVENTION;
- a protective sleeve which is preferably pre-assembled on a catheter or device used for catheterization, but which in an alternative embodiment may be secured around the catheter or device used for ~thPtPri7~tion after such device is inserted into the target tissue or material. This is not the mode of construction today and practitioners are familiar with the Lu~LI~l;ng situation where they have omitted the step of its assembly. The protective sleeve preferably incorporates the entire catheter, including the port limbs and the sheath, leaving only the tabs of the sheath exposed to allo~
fixation (i.e., immobilization). The protective sleeve may be in one or two sections and allows repositioning and firm immobilization of the catheter in different positions while m:lint~ining sterility at all times. The protective sleeve is easily modified for use over a guide-wire or other r~thPtPri7~titln device or tool. The catheter is protected at all times. Hence, ~fmt~min ltion and catheter damage should be virtually Plimin~tP~

WO 95/lZ427 C A 2 1 7 5 ~ 7 4 PCT/I~S9 ~112482 BRIEF DESCRIPTION OF THE DRAWINGS
For a more complete understanding of the present invention and for further advantages thereof, reference is now made to the following DESCRIPTION OF THE PREFEl~RED EMBODIMENTS taken in 5 conjunction with the ac~ulllpdlly;ll~ claims and drawings in which:
Figure 1 is a perspective view of one embodiment of the present instrument;
Figure 2 is a sectional view taken generally along sectional lines 2-2 of Figure 1;
Figure 3 is a sectional view taken generally along sectional lines 3-3 of Figure 2;
Figure 4 is a perspective view of another preferred embodiment of the present invention incorporating a catheter on a needle, wherein said embodiment is particularly rPc~-mmPnflPfl for use with minimally invasive procedures and also for ~ frimin~tf~ry treatment of disease;
Figure 5 is a partial seaional view taken parallel to the needle axis generally along seaional lines 5-5 of a part of the instrument depicted in Figure 4, ~ l;a;llg a needle, guide-wire, dilator and catheter (shown in phantom lines);
Figure 6 is an enlarged seaional view taken generally along seaional Iines 6-6 of the instrument depiaed in Figure 4;
Figure 7 is a seaional view taken perpendicular to the needle axis generally along sectional lines 7-7 of the instrument depicted in Figure 4;
Figure 8 is a partial section view depiaing an alternative embodiment of an instrument similar to that shown in Figure 5 wherein the catheter has a plurality of prongs;

W(~ 95/12427 PCTIUS9~112482 Figure 9 is an enlarged partial plan view of another embodiment of r~th~rrri7~tir,n ;nstrument wherein a plurality of prongs of the catheter have side-holes;
Figure lOa is a perspective view of the protective sleeve of the present invention;
Figure lOb is a perspective view of the protective sleeve in a collapsed position;
Figure lOc is a perspective view of the protective sleeve in an extended position with its adjustable length bridge;
Figure lOd is a pel~)C~,~iVt~ view of the protective sleeve with its adjustable length bridge in a collapsed position;
Figure lOe is a sectional view of a preferred embodiment of the protective sleeve of the present invention wherein a coiled section is included;
Figure lOf is a sectional view of another embodiment of the protective sleeve;
Figure 11 is an enlarged view of another embodiment of the dilator shown in Figures 1 or 4;
Figure 12 is a sectional view of the "shock" sheath of the present invention;
Figure 13 is a side view of an adaptation of the protective sleeve for use with a "shock" sheath and a catheter cimlllt~nrr,usly;
Figure 14 is a side view of one embodiment of the invention showing a guide-wire, dilator and sheath in place so that the sheath is secured to the skin and does not cr~mml-nir:~tr with the target tissue (i.e., the blood vessel in the case shown.);
Figure 15 is a side view of another embodiment of the invention, including a protective sleeve which ,~nrr,mr~Ccrc a catheter connected to a 5llhr~lt~nrous reservoir;

WO 9511Z427 C ~ 2 ~ 7 J 4 7 4 PCT/US9-1/lZ482 Figure 16 is a side schematic view of an embodiment of the instrument in Figure 15 wherein the satheter includes a balloon and the 5llh~lltlnPQus reservoir has a septum creating two non-comml.nir~tin~
chambers in the reservoir;
Figure 17 is a partial side view of a preferred embodiment of the present invention ~ 1P-I particularly for use endoscoFically and also for . l;~,;, l l ", ~ y treatment;
Figure 18 is a partial sectional view of yet another embodiment of the invention that can be used for chemotherapy or the insertion of radioactive seeds or other sllhst~n~Pc Figure 19 is a schematic partial sectional view of an embodiment of the invention that can be used for the insertion of a catheter fnnt~inin~
radioactive seeds or a catheter for ,.I",;..i~, ;"~ cllhst~n~c (e.g., chemotherapy and :mtihinti~c);
Figure 20 is a sectional view of the catheter of Figure 19 in place and extending the entire depth of the tumor. Note that any number of such catheters may be inserted in different planes through the tumor mass.
Figure 21 is a sectional view of an PmhorlimPnt of the invention that can be used for the insertion of a wire to induce hyperthermia or freeze a tumor;
Figure 22 is a sectional side view of the wire of Figure 21 in place in the tumor;
Figure 23 is a partial sectional side view of an embodiment of a sheath in place according to the present invention;
Figure 24 is a partial sectional side view of an alternative embodiment of a sheath wherein the sheath has a lumen and a side-port;
Figure 25 is a partial sectional side view of another alternative embodiment of a sheath wherein the sheath includes a balloon;

wo 95112427 ~ ~ ~ 5 ~ ~ 4 PCT/IJS941124~2 Figure 26 is a partial sectional top view of the sheath depicted in Figure 25 taken along line 26`26;
- Figure 27 is a partial section side view of a preferred embodiment of a connector system for use according to the invention;
Figure 28 is a partial section side view of another embodiment of the connector system depicted in Figure 27;
Figure 29 is a partial sectional side view of a part of the connector depicted in Figure 28;
Figure 30 is a schematic sectional side view of one embodiment of the invention showing a needle and dilator combination where the needle is inserted in the lumen of a blood vessel; and Figure 31 is a schematic sectional side view of the system of Figure 30 in which the needle is being withdrawn.

WO 95/12427 ~ ~1 2 1 7 5 4 7 4 PCT/U594112482 DETAILED DESCRIPTION OF THE PREFERRED E~BODIMENTS
The embodiments presen{ed are for illustrative purposes only and do not, in any way, limit the scope of the invention. In particular, anyone skilled in the art can make numerous modifications using the proposed instrument, system, and methodology.
Referring simultaneously to Figures 1, 2, 3 and 4, the present catheterization instrument is illustrated, and is generally identified by the numeral 20. Instrument 20 includes a needle 22 having a distal end 22a and a proximal or rear end 22b. Needle 22 can be constructed, for example, of stainless sleel or similar material and includes a sharpened (preferably beveled) side 24 of needle end 22a. End 22b of needle 22 is interconnected to a hub 26. As illustrated in Figure 1, hub 26 includes indicia 28 to indicate a position of a directional charaaeristic such as the direction of beveled side 24 or other position-sensitive feature of needle 22. Indicia 28 assists the practitioner in locating the position of beveled side 24 or the directional or position-sensitive characteristic of needle 22, while needle 2 2 is inserted into a target tissue or material, such as a blood vessel, which is not visible to or palpable by the practitioner (e.g., subclavian vein - a large blood vessel located under the collarbone in the chest).
Needle 22 in the embodiment shown in Figures 14 includes a first lr~n~itll~lin~l bore or lumen 30 and a second l~m~it11rlinal bore or lumen 32.
Although lumens 30 and 32 are illustrated in Figure 2, it will be understood that the present invention can be utilized with any number of lumens (including one) depending upon the number of guide-wires, tools, devices or sllhcrlnr~ to be inserted through the needle at a single punature site. First lumen 30 and second lumen 32 originate at beveled side 24 in a parallel relationship, with first lumen 30 and second lumen 32 being separated from each other by an interior wall 34 of needle 22. Lumens 30 and 32 are of wo gS/12427 ~3 PCTIUS9~112482 sufficient internal diameter to allo~ passage of guide-wires, or other devices or substances u3ed in various procedures in the health-care field.
- Lumen 30 is preferably the same cross-sectional shape, for example, rectilinear, along the entire length of needle 22 and has its terminus 30a at hub 26 of needle 22. Lumen 32 is also preferably the same cross-sectional shape, for example, rectilinear, along the sllh~t~nti~ ngitll~lin~l length of needle 22, with its terminus 32a diverging at an angle from first lumen 30 at hub 26 thereby forming a side arm 38 of needle 22 Hub 26 thereby physically connects the lumens at a Y. Hub 26 may itself be a "Y" chamber 27 connected to any hub of any needle.
Where it is desired to use several lumens (i.e., more than two) with the needle 22, additional side arms can be utilized in a hub similar to hub 26 such that additional guide-wires or tools can be inserted through needle 22.
Hub 26 in a preferred embodiment is constructed of plastic or similar material. Hub 26 is concentrically attached to needle 22 at end 22b and side arm 38 in a manner known and used for the ~tt~hm~nt of hub casings of single lumen needles. Hub 26 includes an imernal bore 40 which is contiguously aligned with first lumen 30. Hub side arm 38 includes an internal bore 42 which is contiguously aligned with second lumen 32.
Preferably, a portion of the material of hub 26 is Lldll:~/dl~ adjacent internal bores 40 and 42 so that the content of internal bores 40 and 42 can be observed.
Bore 40 of hub 26 increases in diameter at bore expansion 44, such that end 40a of bore 40 is adapted to removably engage a syringe barrel or other reversibly aspiratable chamber 46. Preferably, syringe barrel 46 has a piston 46a and is ~onn~ct~hl~ to hub 26, for example, by using the inverted frusto-conically shaped aperture 48. Normally, syringe or chamber 46 is used to obser~e "flash-back" and for withdrawal, aspiration and introduction of W095/12427 ~ A 2 ~ 75474 ~ '/[IS94/12482 substances to the ~lth~tPri7ed site through lumen 30. Syringe or chamber 46 is always in c/~mmllni~tion with lumen 30 so that there is an u~ L~Ilu~ed c~mmllni~ricn with the catheterized site. Similarly, bore 42 terminates in an inverted frusto-conically shaped aperture 50 formed in side arm 38 to facilitate the insertion of a guide-wire 52 into bore 42 and second lumen 32 of needle 22.
Bore 42 of side arm 38 is engaged by a valve, grommet or other sealing device 60, which can be constructed of rubber or similar material, and is retained by locking bead 62 of hub 26. Valve, grommet or sealing device 60 is adapted to be pierced and penetrated by guide-wire 52 (other instrument, tool or device) thereby allowing insertion of guide-wire 52 through valve, grommet or self-sealing device 60 and into bore 42 of second lumen 32 which self-sealing grommet prohibits the entry of air into or escape of substances from the ~th~t~ri7P~ site punctured by beveled end 24 of needle 22.
An important aspect of the present instrument 20 is the use of a dilator 70 having ends 70a and 70b. Dilator 70 is tapered at end 70a to approximately the diameter of end 22a of needle 22 and gradually increases in diameter throughout its length to end 70b. Tapering allows a gradual transition in si_e to ~fcomrlich pl~ lcS~;Vc dilation of the opening in the blood vessel (synonymous with ally ~th~tl~rj7~1 site in this pr~nt~ti~n) and adjacent tissues with subsequent easy insertion of the catheter.
It is lrr~ l that end 70b of dilator 70 include ~ ings or tabs 72 to allow easy ~ u-~uvcl~bilit~- of dilator 70 along the guide-wire 52 and along the needle 22 (this latter may be moved out of position depending on the preference of the practitioner). Any standard design for wings or tabs can be used. Dilator 70 fits snugly over needle 22 to ensure that there is no trauma to tissue or material as a result of a sudden transition in si_e.

WO 9~/12427 PCTIUS94/12482 In a preferred embodiment, dilator 70 terminates at end 70a approximately 0.5 to 1.5 cm. from end 22a of needle 22. It is understood - that, in general, both the design and length of the dilator can be varied. An important feature of the present invention is the use of a sheath 80 having ends 80a and 80b. Sheath 80 is cil.ul.. rt.t.. Lially disposed around dilator 70 and e~tends from end 70b of dilator 70 to a position between ends 70a and 70b of dilator 70. One embodiment includes wings 82. Other embodiments such as tabs, or other projecting structures allowing grasping and maneuvering of the sheath or through which sutures are passed, can also 10 be used to imm~hili7~ the sheath, as by affixing it to the skin 200. It will be noted with reference to Figures 14 and 15 below that, unlike dilator 70, sheath 80 makes no contact whatever with the target tissue or material at the ~th.~tPri7~o~1 site ( e.g., bloodstream 206). The sheath 80 facilitates correcting two major problems encountered during and after ~ :~th~t.ori7 ~ti~n infection 15 and air embolism. Infection is virtually ~!imin~tf~fl because the sheath 80 is not in direct contact with the bloodstream 206 and the catheter 90, inserted through the sheath 80 into the bloodstream 206, is not in contact with skin 200 at any time. As shown in Figures 10a and 10b, sheath 80 preferably has a valve, grommet or other self-sealing device 86 which prevents air embolism 20 while the guide-wires, catheters or other devices are inserted, withdrawn or held in place during the proceSs of (~th.~t~ri7~tion Moreover, leaving the sheath 80 in place after removal of a catheter 90 allows the portion of tract from bloodstream 206 to sl.hc~ltlnP~us tissue 202 to heal. Thus, when the sheath 80 is removed, the only remaining tract extends from skin 200 to 25 subcutaneous tissue 202. Hence, the potential for air embolism is virtually ~limin~tP~!
Referring now to Figures 10a and 10b, another important component of the submitted invention is a protective sleeve 92 which may be pr~cc~mhl~-d with a catheter 90. The sheath 80 and its parts as already described includes a valve, grommet or self-sealing device 86 through which a catheter 90 is passed. The catheter has a distal end 90a and two ports 90b and 90c. The protective sleeve 92 is, in this instance, made of a synthetic soft material capable of bein,, I'accordioned.'' This sleeve 92 fits cil~ulllr~lcllLially over the sheath 80 just distal to the tabs 82 of sheath 80 using any sealing mrrh~ni~m known in the industry (e.g., an "O" ring at location 94a). It is recommended that the space between tabs 82 and location 94a be the least amount consistent with known m~nl1f~rtllring techniques.
Protective sleeve 92 is bonded distally to the ends of the catheter ports 90b and 90c at points 94b and 94c leaving only the actual ports (i.e., access sites)exposed. These ports are kept capped and sterile using well-known methods.
The protective sleeve 92 covers the entire system outside the patient's skin 200 with the exception of the tabs 82 for fixation of sheath 80. As discussed earlier, these tabs 82 and sheath 80 are not in communication with the ~rh~rPri7~1 target tissue or material, such as at area 206 and cannot become a source of infection of the target tissue or material.
Another novel feature of this invention is the use of multiple tabs.
Tabs 96a and 96b on protective sleeve 92 are situated distally (i.e., toward sheath 80). Tabs 96a' and 96b' are located proximally on protective sleeve 92 (i.e., nearer the entry ports 90b and 90c of catheter 90). Several embodiments can be used. For example, as shown in Figures lOc and lOd, each tab may have an "eye" 97a and 97a' allowing the passage of a suture to d~lo~dllld~e the "accordioned" length of the protective sleeve 92. The skin to which the eyes 97a and 97a' are secured, in combination with applied sutures can serve as an adjustable length bridge therebetweem Alternatively, a m~rhanir~l bridge structure 93 may be used for adjusting the length of sleeve 92 and mainrainin~ a desired length. Thus, tab 96b is attached to tab 96b' using bridge 93 which is a bridge whose length can be varied selectively. Tab 96;1 can be attached to tab 96a~ using an identical device or WO 9S/12427 PCTIUS9~112482 2 t 75~ ~4 both eyes 97 and a bridge 93 might be provided on opposite sides to allow the medical professional to choose which device to use. Alternative ", ~ of AttA~hmrnt might also be used, such as a clip of adjustable length.
Figure lOd shows the protective sleeve 92 "accordioned" or adjusted to a shorter length as catheter 90 is maneuvered further into the body. The catheter 90 has been repositioned and immohili7.o~1 in its new position, IllA,llIA; ,,,~ complete sterility in the process. As shown, tab 96a is now closer to tab 96a' and tab 96b is closer to tab 96b'. Another feature that can be easily added is the bonding, or attaching by any other means, of the proteive sleeve 92 to the catheter 90 at site 98. To illustrate further, when the catheter is used in a body cavit~, there is the possibility of the catheter getting kinked. In such a situation, the material of the protective sleeve 92 can be such that the practitioner can mold the form or shape of protective sleeve 92 and decide exactly how he or she wishes the catheter to lie.
It is possible to make this protective sleeve 92 in two parts such that one half is already attached to the sheath 80. This is shown in Figure 13.
Protective sleeve 92a at least partially ~nr~7mr~CC~C shock sheath 100, which serves to r~lmmllni~At~ with target tissue while a sheath 90 specifically shields the skin from ~ ,"g with the target tissue. Shock sheath 100 may also include side-ports 106a and 108a which sealingly project partially through protective sleeve 92a. Protective sleeve 92b covers the catheter 90.
However, I believe that the protective sleeve 92 as described earlier is easier for the praitioner to use.
Another preferred embodiment of a dilator 70 is shown in Figure 11.
The dilator 70 has a distal end 70a and a proximal end 70b. Dilator 70 includes a lumen 76. There is a side-port 78 which cr~mmllnir-At~C with Iumen 78a, which is situated along and outside lumen 76. A flexible wall 79a exterior to lumen 78a may be dilated with air, water or other substance to WO 95/12427 ~ A 2 1 7 5 4 7 4 PCT/I~S9~/12482 ~

an extent ~Pt~rmin~fl by the prac~itioner. Lumen 78a will preferably extend circumferentially around and along the ~utside of lumen 76 as at 78b so that an entire circumferential wall 79b can be expanded in diameter through inflation. It is suggested that such an expansion or dilation maneuver be 5 performed after the needle 22 has been optimally situated and a guide-wire inserted. This ensures dilation of tissues only when the practitioner is sure that he or she is ready to insert the catheter or tool. In addition, the practitioner can use the same system without regard to the size of the instrument to be inserted.
Yet another important component of the inYention is a "shock sheath" 100. Figure 12 is a sectional view of a "shock sheath" 100 and shows a distal end lOOa and a proximal end lOOb. A valve, grommet or other self-sealing device 102 is shown through which a tool (e.g., Swan Ganz catheter) may be passed into an isolated lu:men 10~ of shock sheath 100. A side-port 106a preferably ~mmllni~t~ only with its own separate lumen 106b. This lumen 106b may have one or more distal holes 106c and preferably has multiple side holes 106c on the outside wall distally to allow the infusions of large volumes of fluids. Similarly, there is another side-port 108a which ~(lmml.ni~rf-~ with lumen 108b. Preferably, the lumen 108b is not in 20 cf~mm--ni~ti~ n with any other lumen and has multiple holes 108c situated distally. The separateness helps to eliminate the possibility of any cross-c~-nt~min~ti~n from the contents of one lumen to the other. Note that Figure 12 is only illustrative. If desired, any number of such side-ports and lumens may be incorporated. The lumens may be situated If)n~itll~lin~lly or 25 circumferentially to each other. When the shock sheath 100 is used, the protective sleeve 92 used will preferably have two parts, 92a and 92b, so that the shock sheath 100 and the catheter 90 are protected against cross-c~ntlmin~ti-~n also. This device will function according to the principles already described under the description of protective sleeve 92.

Wo 95/12427 PC'rlU59~1112482 21 7~74 Figure 13 illustrates the use of proteaiYe sleeve 92, sheath 80, and shock sheath 100. The shock sheath 100 may have tabs 101 which are easily - incorporated on the proximal end (i.e., the side towards the practitioner).
Antiseptic, bactericidal and other agents may be used to coat or be 5 incorporated into either part of the system or the whole system.
Procedure for Catheterization Referring to Figures 1, 2 13, and 14, a ~:lth~ t~ ri~ti~n procedure using the inventive devices, systems, and methods may be more fully understood. The practitioner positions the needle 22 such that the indicia 10 28 allow him or her to determine the direction in which the guide-wire 52 exits the needle tip 22a. This feature is important because it allows the practitioner to determine the initial course the guide-wire 52 will take in the lumen of the vessel 206 (e.g., the subclavian vein) and dictates the direction of the catheter. Guide-wire 52 pierces valve, grommet or sealing device 60 and passes into hub 26, which hub 26 may be a "Y" chamber 27. The wire exits the needle tip 22a by passing through bore 42 into lumen 32. The practitioner can observe flash-back in "Y" chamber 27 or preferably syringe 46 or another ~Idn~a~ chamber 46 throughout this procedure.
The instrument is moved out proximally so that the guide-wire is left in the lumen of the blood vessel and the needle tip removed from the lumen of said blood vessel, thus sllhst~nti~lly ~limin lrin~ the risk of damage to theblood vessel by illa.l~ needle motion.
The dilator 70 and sheath 80 are maneuvered cimlllr~n~ously along the guide-wire 52, which guide-wire extends into blood vessel lumen 206.
Dilator 70 is pushed into vessel 206 and sheath 80 is maneuvered below the skin to a position short of the target catheterization tissue 206. The needle 22 with the attached syringe 46 is removed from the puncture site. Tabs 82 of sheath 80 are secured to the skin 200, as by suturing (shown in Figure 14), WO 95/12427 C A 2 1 7 5 4 7 4 PCT/IJS94112482 ~

or with another securing mPrhs)nicm as will be described below with reference to Figures 23 and 25.
The dilator 70 is removed and a catheter 90, or other r~thPrPri7~tion device, preferably with the protective sleeve 92 therearound is "threaded~
5 over the g ude-wire 52 into the target tissue or material 206. The protective sleeve 92 is secured to sheath 80 at 94a as shown in Figure 10a. Tab 96a of protective sleeve 92 is attached to tab 96a' and tab 96b to tab 96b~ at a desired adjusted length. A small dressing may be applied or a little tincture benzoin sprayed around the skin puncture area. This methodology provides 10 a ,~ plr L~ll ,;vc, safe, and efficient system. For instance, subclavian veinr~thPtPri71tion using this procedure should take less than one minute tO
perform after the proper site of r~thPtPri7~tirrn is ~etPrminp~l as by observing"flash-back." Further care of the catheter and r~thPtPri7~tion site is safe withthe risk of ;lld.l~lL. ,~ "pulling out" of the catheter 5~-h~t~nti~11y decreased15 due to the system of immobilization. The site is also infection-free because sheaths and protective sleeves shield the target tissue and the catheter or other r~thPtPri7~tion device from contact with the ski from "touching"
during s~lhcpqupnt handling. It is now possible to cleanse the skin adjacent and immPr~i~tPly around the r~thPtPri7~tir,n site without the danger of the 20 catheter coming into contact with cleansing agents, which agents often damage the catheter. The procedure is ecrnomir~l because it is quickly rrlmrlichP~I with a ~u~ device or kit.
Definitive diagnosis of many diseases is obtained by performing a biopsy on target tissue or materials. Often the practitioner obtains a sample 25 from the target tissue in two steps. The practitioner first aspirates the site to be sure it is the target tissue and not a blood vessel in this case. Once this is ascertained, the lesion is biopsied. Using instrument 20, the target tissue or material, such as at a lesion is entered with the needle 22 and syringe or chamber 46 is used for observing "flash-back." If no blood is observed, a W ~/IZ427 PCTJUS9S112482 ~ og ~ 7~

biopsy forceps is introduced through the side arm 38 of the "Y" chamber 27 (as was guide-wire 52 above) and a sample of tissue is obtained and withdrawn with the biopsy forceps. There are many different catheterization devices, such as a variety of biopsy instruments available to 5 choose from. Certainly, it is easy for one skilled in the field to modify an existing biopsy forceps or other catheterization device to fit into instrument 20.
The discriminatory treatment of diseases means treatment in which the agent for treatment is ~-~minictrred either into a conduit situated close to10 the diseased tissue part or organ, and/or directly into the diseased tissue. For example, an intracavitary cancer in the abdomen or chest may be the target tissue for ~licrrimin~tnry treatment. Surgical instrument 20 can be used without open surgery, i.e., with minimally invasive procedures, to catheterize a specific blood vessel entering the cancerous organ or even a particular 15 blood vessel entering the specific part of the organ with cancer. Figure 17 shows one preferred embodiment of the invention. Needle 22 is used to puncture the blood vessel and "flash-back" is ascertained using the syringe or chamber 46 as before. Guide-wire 52 is inserted into the lumen of the blood vessel, needle 22 may be withdrawn from said blood vessel, and the catheter 20 90 is threaded immr~ trly into the lumen of the blood vessel. The "Y"
chamber 27 and the syringe or chamber 46 ~ hich are used as described above are not depicted in Figure 17 for clarity. A catheter 90 which preferably has side holes 160 is preferably placed over the needle 22 at the start of the procedure by ~hich the catheter is inserted into the cancerous target tissue 25 or material. This preliminary step is accomplished by inserting needle 22 through an aperture 110 on the side wall of the catheter, which aperture 110 preferably includes a valve, grommet or sealing device 111. Aperture ~10 may also be a functional side hole of the catheter after it is in place. It is recom . ended that the aperture 110 be located close to the distal tip of the WO 95/12427 C"L\ ); 7 5 4 7 4 PCTIUS9~/12482 ~
catheter. This embodiment is particularly r~ mm~n~l~d for use endoscopically (e.g., ld~dlus.u~;cally). In this application, the catheter may be attached to a subcutaneous port of a type which may be available and through which therapeutic agents may be instilled in the port as desired 5 without any need for s.lhscq.~Pnt hospitalizations for surgical procedures.
In a preferred embodi~nent for ~ UI y treatment, it is advantageous to use dilator 70 to push the catheter off needle 22 so that the catheter remains in the target tissue after withdrawing needle 22, as will be discussed below in referring to Figures 4 and 5. This procedure requires 10 minimal, if any, hospirlli7~til-n, is safe, efficient, d;s~l;lll;lld~ory, and allows treatment at home.
Figure 18 illustrates the use Qf an alternative embodiment of instrument 2û in providing r~i~rrimin~rory treatment by inserting the therapeutic agent directly into the target tissue or material such as a 15 cancerous lesion, rather than through blood vessel circulation of the therapeutic agent. The lesion or other tissue or material is punctured with the needle 22, lack of "flash-back" is observed in syringe or chamber 46.
Radiation seeds 112 are inserted through the "Y" chamber 27 in lieu of guide-wire 52 for i~nrifirltif~n of proper target tissue. This procedure may be 20 repeated at different sites on and in the tumor. The location and particularly the depth ûf the needle 22 is a position-sensitive feature. It is an aspect of the invention that the needle 22 have indicia marked, as with graduation marks, along its length and particularly along a proximal portion so that the practitioner may observe the depth of the needle 22. This inf~rm~tion 25 together with known dimension of the target tissue or material makes the procedure safe and efficient. Typically, varying the depth at different sites within the tumor mass is adv.lllLa~,~uus for complete treatment. The insertion of the radiation seeds 112 can be accomplished in several ways and includes (a) maneuvering them along the lumen 32a with a wire or other WO 95/12427 PCTIIJS9~1248~
2~5~7~

instrument or (b) using an ejection gun at 126 to displace the seeds through the "Y" chamber and needle. If the latter is the preferred method, this invention may be used with multiple needles 22 as shown in Figure 18.
Referring to Figures 19 and 20, if the practitioner desires to insert a catheter containing radioaaive seeds 112 into a tumor 300, this is easily done using this invention by following the steps outlined above. Instead of guide-wire 52, a catheter (~ont~inin~ radioactive seeds 112 is inserted. Once again, several catheters can be inserted separately or simultaneously.
Figure 4 shows an alternative embodiment of an instrument 20, wherein a catheter 90 is circumferentially disposed around a needle 22 and in place of dilator 70, a s~lhst~ntillly tubular member 70' is used as a "pusher~" Hence, the term "pusher member." Figure 5 shows a sectional view of the part of the instrument wherein the catheter is incorporated on the needle. Figure 6 is a sectional view of that pari of the instrument in Figure 4 Taken along section lines 6-6 wherein the catheter is incorporaled on the needle. ~igure 7 is a sectional view of that part of the instrument in Figure 4 taken along section lines 7-7 wherein the pusher member is incorporated on the needle and the catheter is seen adjacent to this part of the ;IIS~lU~ . This alternative preferred embodiment is particularly advantageous for C~th!~T~ri~ti~n performed using minimally invasive plUU~dUI~:S such as Idl,alu~..",y and thoracoscopy, where it is understood that the components of the invention are of sufficient lengths for insertion into a particular body cavity, organ, other structure or material.
For illustrative purposes, consider catheterizing a blood vessel (e.g., 25 the hepatic artery) located within the abdominal cavity. This catheterization can be accomplished in two ways using current methods:
- using an open surgical procedure to visualize and cathe~erize the blood vessel, or WO 95/12427 ~ ` C A 2 1 7 5 4 7 4 PCT/IJS9~112~82 r~th~ott~ri7in~ the said vessel by entering the arterial system at a distant point (e.g., femoral artery) and then threading the catheter into the blood vessel with the help of various guiding syslems, including, for example, fLuoroscopy.
(See BACKGROUND OF THE INVENTION for a detailed discussion of the associated problems.) Using the i~ Ulll~ depicted fn Figure 4, the practitioner can now safely, easily and quickly ~lth~t~ri7~ the blood vessel using laparoscopy or other minimally invasive procecLures to observe the blood vessel, as on a television monitor or using fiber-optical means. The suggested procedure is:
- locate the blood vessel 206;
- penetrate the body wall 220 with needle 22 and pusher member 70';
- puncture the waLI of the blood vessel 206;
- observe fLashback in the syringe or chamber 46;
- use the indica 28 to determine the directiDn of the guide-wire 52;
- introduce the guide-wire 52 into the blood vessel 206 through the side arm and grommet 6U of the "Y" chamber 27;
- draw back the instrument 20 so that the needLe 22 exits the blood vessel 206, leaving the g ude-wire 52 in place within the vessel lumen 206;
- use the pusher member 70' as "pusher" to slide the catheter 90 off the needle 22;
- slide the catheter 90 aLorlg the guide-wire 52 into the blood vessel lumen 206;
- remove the instrument 20, leaving the catheter 90 in place.
Note that in some situations, the ease, safety or speed of said procedure can be enhanced using a curved needle, depending on the site to be catheterized.

WO 95/12427 2 1 i 3 4 7 4 PCTIUS9~1112482 Figure 8 shows another embodiment of the instrument of Figure 4 or 5 wherein a catheter 90a has multiple limbs or prongs 91a, b and c having side holes 160. Prongs 91 provide the important benefit of allo~ing the practitioner to insert cllhst~nr~ simultaneously into different parts of tissue 5 or material. This feature is of particular importance in the treatment of solid tissues. Further, this embodiment of instrument 20 uniquely and advantageously permits ~ rimin ltr~ry or focused treatment of diseases, such as cancer.
Figure 9 shows an embodiment of the instrument of Figure 8 where the prongs 91 of catheter 90a have multiple side holes 160, and where prongs 91 are embedded in tumor 300. The side holes 160 allow the practitioner to insert substances (e.g., chemotherapeutic agents) into multiple sites within said tumor.
The features of the instruments of Figures 8 and 9 are of particular lS importance because:
- it is difficult for sl1hst~nr~ to diffuse through solid structures (e.g., tumors), and - the pressure within tumor cells is often cl1hst~nti~lly higher than the pressure in surrounding tissues, hence precluding or sllhst~nti~lly 20 rlimini~hing the efficient delivery of substances (e.g., chemotherapeutic agents) through the blood stream.
Improvements in the performance of the embodiments of instruments 20 of Figures 8 and 9 can be achieved by making tips 93 of the prongs 91 of rigid material, and making the tips 93 sharp to allow easier 25 penetration of solid tissues. Further improvements in the performance of the instruments shown in Figures 4, 8 and 9 can be made by including indicia 28a on said instruments to allow the practitioner to determine the depth to which the tissue has been penetrated.

WO 95/12427 G ~ 2 1 5 4 ~ 4 PCTNS9411Z482 ~
Figure 10e shows a part of an alternative embodiment of a protective sleeve 92 wherein protective sleeve 92 Pncr~mr~cpc or partially Pnromr~c~Pc a catheter 90. Protective sleeve r72 advantageously has three sections:
- a distal section 95a which is located closer to the catheterization site;
- a proximal section 95c which is located away from the r~rhPtPri7~tir)n site; and - a middle section 95b which is located between distal section 95a and proximal section 95c;
Middle section 95b may be adv~ul~t ou~y coiled and may preferably include one or more tabs 97 or other means for attaching the protective sleeve 92 to the skin 200. Middle section 95b can be made of a material having sufficient firmness to maintain a plr~ rl " ,il~P~i length or preformed shape. In a preferred embodiment, middle section 95b can also include a plurality of sllhcpction~ 95d, 95e and 95f, each of which is made of a differentmaterial(s) with varying degrees of firmness, rigidity or flexibility to provideimproved maneuverability and ease of fastening. Distal section 95a can also be connected as at 99 to any part of an adjustable length protective sleeve 92 as shown in Figures 10a, 10b, 10c and 10d.
Figure 10f shows another embodiment of protective sleeve 92 includes a connector mPrhlnicm 101, such as a self-sticking adhesive 103 along one edge 105 of a sheet 107. Other connector m~ rh~nicm~ such as snaps 111 may be used along corresponding edges 105 and 113. "Ziploc tracking" 109, such that a protective sleeve 92 may be formed ~ u~l~L~ L;ally situated around catheter 90 by the practitioner at any time during or after the r~thPtPri7~tirln procedure.
Embodiments of the invention with protective sleeves as described aboveprovide important advantages overprevious r~thPtPri7:~ticm devices and methods, including:

WO 95112427 2 1 7 5 4 7 ~ PCTIUS9 111Z48~
- removal of tension on catheter 90 at the site of insertion;
- secure immobilization of the catheter 90 and protective sleeve at all times;
- repositioning and immobilizing catheter 90 in a sterile environment while IllA;ll~ g the integrity of the catheter. This feature is especially important for catheters with small lumens or catheters which include thin conduit fibers which may be damaged by current crimping mt~-hanicmc used to immobilize the catheters within a protective sleeve.
Eigure 15 shows a catheter 90 within a body cavity 222. For illustrative purposes, catheter 90 is shown entering a blood vessel 206.
Catheter 90 is partially or fully on - ~ by protective sleeve 92 which may include proximal tabs 224 or other means for securing said protective sleeve to a part of the body wall 220 and distal tabs 226 or other means for securing the protective sleeve to tissue at or adjacent to the target tissue or material. Catheter 90 is attached to a sllk~ltan~ollc reservoir 228 (e.g., Medi-Port) located under skin 200. This embodiment of a catheterization instrument allows the practitioner to use a chamber 230 of the subcutaneous reservoir 228 to insert substances into, or withdraw material from, blood vessel 206 with ease, while ensuring that the catheter 90 is both firmly immobilized and also protected by protective sleeve 92 from damage by surrounding tissue or organs.
Figure 16 shows a catheter 90, one end of which includes a balloon 232. The catheter is in ~ ;on with blood vessel 206. The other end of catheter 90 is attached to a reservoir 234 (e.g., Medi-Port). Reservoir 234 may be sllh~ltan~-ollc and is advcu--d~,~uu~ly partitioned into two non-........... ,,il~l;,,~ chambers 236 and 238 by septum 240. The first chamber 236 rt~mmllnifatt~ with balloon 232 through a ~IP~i~n~t~l lumen 242 and is used to inflate or deflate the balloon 232. The second chamber 238 WO 95/12427 ~ ~l 2 1 7 5 4 7 4 PCT/US94/12482 commllnir~r~ with lumen 89 of catheter 90 and is used to insert sllhct~nr into, or withdraw material from, blood vessel 206. One of the preferred methods requires that, prior to inserting substances (e.g., chemotherapeutic agents) into the blood vessel 206 entering or leaving malignant tissue or tumors, the practitioner temporal-ily limits the blood flow to or from said malignant tissue or tumor by inflating or partially inflating balloon 232. The balloon 232 is then deflated after the substances have been inserted into said blood vessels. Another method requires the use of two catheters, each with a balloon and two separate reservoirs,~one catheter in the blood vessel through which blood enters the malignant tissue or tumor, and the other catheter in the blood vessel through which blood leaves the malignant tissue or tumor.
Referring to Figures 21 and 22, if the practitioner desires to treat a tumor 300 using hyperthermia or freezing of tissue, this is easily done using the invention. The needle 22 is used to penetrate tumor 300, and a wire 246 for hyperthermia or freezing of tissue is inserted through "Y" chamber 27.
This embodiment allows the practitioner to use minimally invasive procedures for discriminatory methods of treatment.
Figure 23 is a sectional view of a sheath 80, shown inserted through a first tissue, such as skin 200 and s~lhrllt~n~ous tissue 202. Sheath 80 can include tabs 82 or other means for grasping, maneuvering, or securing said sheath at the site of insertion. Advantageously and uniquely, sheath 80 does not commllnir~tr at all with the target tissue or material 206 at the r~thPtrri7~tinn site.
Figure 24 is a sectional view of an alternative embodiment of a sheath 80, including a side-port 248 which rommllnir~t~ ~rith a lumen 250.
Side-port 248 can be used to insert sllh~t~nr~ (e.g., antibiotics or other agents) or to withdraw tissues or materials via lumen 250.

WO 95/12427 2 1 7 ~ 4 ~ ~ rcT/usg~ll2482 Figure 25 is a sectional view of an embodiment of sheath 80 which includes a side-port 248 crlmmllnir~ting with lumen 250. Lumen 250 also rnmmllnir~tPc with a balloon 252 w hich is positioned under skin 200. The practitioner can inflate balloon 252 as necessary to further secure and immobilize sheath 80. Other devices such as flanges 254 can be used to perform the function of balloon 252.
Connecting devices, particularly those used to attach components in the medical field, can often easily disengage and result in serious, possibly lethal, cr,nC~-qll~nrPC This invention s.lhct~nti~lly corrects the problem.
Eigure 27 shows ronnPrtin~ ends 260 and 262 of r~thPtPri7ltion system components. Projections 264 extend from ronnPrrin~ end 262 and projections 266 extend from crlnnrrtin~ end 260. The projections 264 and 266 may be attached to each other using any means (e.g., a snap or twist mPrh~nicm) to ensure secure immobilization of said ronnPrring ends 260 and = 262.
Figure 28 is an embodiment of the connector system of a catheterization wherein crlnnPrrin~ end 260 has threads 270 and connecting end 262 has threads 272. A movable coupler member 274 is incorporated over connecting ends 260 and 262 so that the threads 270 and 272 engage said movable member which has threads 276 as shown srhPm ltir~lly in Figure 28.
This embodiment allows improved immobilization of rr~nnPcrin~ ends 260 and 262. Other means (e.g., sliding member) for securing of C,oll~ ,L;ll~; ends 260 and 262 might also be used instead of the threaded coupler 274 as shown.
Using prior methods of r~rhPtPri7~tion, when a dilator is inserted into a blood vessel and the guide-wire is in place, the practitioner observes limited "flashback" because the lumen of the dilator is almost totally occluded by the guide-wire. Consequently, there is a risk that the - practitioner can perforate the wall of the blood vessel while dilating the puncture site. This problem is c~hsr~nti ~lly eliminated using an embodiment WO 95/1~427 ;{~ A2 1 7 5 4 7 4 PCT/US9~11248~ ~

of the invention as shown in Figures 30 and 31 which show perspective views of an advantageous method according to the invention. The guide-wire is not shown for clarity. Figure 30 shows needle 22 in place in blood vessel 206. Dilator 70 is ~ ulllrclcllLially disposed around needle 22.
Chamber or syringe 46 is attached to needle 22 to allow continuous obser- ation of "flashback." Dilator 70 has a side-port 278 which comn1unicates with the lumen of the dilator 70. Side-port 278 is attached to another reversibly aspiratable chamber or syringe 46' to allow observation of "rlashback" when dilator 70 has been slid over needle 22 into blood vessel 0 206 as shown in Figure 31. As a result, the practitioner can safely dilate the puncture site while continuously ~.llril Ulillg that the tip of the dilator 70 is located within the lumen of the blood vessel 206. Dilator 70 can include tabs 72 or other means of m~cuvcl;llg~ grasping or securing dilator 70.
This invention allows r:~tllct~ri7~ti~n to be performed anywhere on or in the body (i.e., it is universaV; any type of catheterization can be accomplished (i.e, it is uniform); diagnosis and treatment can be performed at the same time using one procedure; all or selected components may be used depending on the purpose of ~thrt~ri7ltion, (i.e., the invention is comprehensive); fli~rimin~t-)ry treatment is allowed with minimal or no hospir~li7~ti-~n; risk to the patient is reduced; cost to the patient as well asto the health-care industry is reduced; the invention improves the quality of life for the patient and should increase his or her length of survival; and catheterization is achieved using the invention described herein and claimed below without the multiple problems discussed in the BACKGROUND OF
THE INVENTION. :
Whereas the present invention has been described with respect to specific embodiments thereof, it will be understood that various changes and mt)rlifi~ri~ln~ will be suggested to one skilled in the art and the invention is Wl~9~i/12427 21 7547~ PCIIIJS9~12482 intended to ~n~-,mr~Cc such changes and mr.l~ifi~:ltionc as fall within the scope of the appended claims.

Claims (157)

CLAIMS:
WHAT IS CLAIMED IS:

1. An instrument for inserting or removing substances or devices into or from a target tissue or material comprising.
(a) a needle having an elongated shaft with at least one lumen, including a distal portion for insertion into said target tissue or material and a proximal portion which remains outside said target tissue or material into which said distal portion is inserted;
(b) a position-sensitive feature formed at a predetermined location on the distal portion of said needle; and (c) indicia associated with said proximal portion of said needle at a fixed position relative to said location of said position-sensitive feature, which indicia is observable outside of said tissue or material into which said distal portion of said needle is to be inserted and by which indicia said predetermined location of said position-sensitive feature on said distal portion of said needle is indicated.

2. The instrument of claim 1 wherein:
(a) said position-sensitive feature formed at said predetermined location on said distal portion of said needle is a beveled needle end; and (b) said indicia is associated with said proximal portion of said needle in a fixed relationship to said angled direction of said bevel by which said direction of said bevel end may be observed from outside of said target tissue or material.

3. An instrument as in claim 1 further comprising:
(a) a first and a second lumen extending longitudinally inside of said elongated hollow needle shaft;
(b) wherein a relative position of said first lumen with respect to said second lumen is said position-sensitive feature of the distal portion of said needle; and (c) said indicia is associated with said proximal portion of said needle in a fixed position with respect to said relative position of said first and second lumens, and said indicia may be observed from outside of the tissue or material into which the instrument is inserted so that said relative position of said first and second lumens is indicated.

4. The instrument of claim 1 wherein:
(a) said position-sensitive feature comprises a bent portion of said distal portion of said elongated needle; and (b) said indicia is associated with said proximal portion of said needle in a fixed position relative to a direction of said bent distal portion, which indicia is observable from outside of said tissue or material into which said needle is inserted so that said bent direction is indicated.

5. The instrument of claim 1 wherein:
(a) said position-sensitive feature of said distal end of said needle comprises a depth of insertion of said needle into said target tissue or material; and (b) said indicia comprises graduation markings formed on said needle and extending along said proximal portion by which said depth of insertion of said needle is indicated by said graduation markings outside of said target tissue or material.

6. An instrument for inserting or for removing substances or devices into or from target tissue or material, comprising:
(a) a needle having an elongated hollow shaft sized to permit movement of substances longitudinally therethrough; and (b) a self-sealing device interposed within said hollow elongated shaft for restricting said movement of substances in at least one longitudinal direction through said hollow elongated shaft.

7. An instrument as in claim 6 wherein said self-sealing device interposed within said hollow elongated needle shaft comprises a one-way valve.

8. An instrument as in claim 6 wherein said self-sealing device comprises a self-sealing grommet through which a device may be inserted through said hollow needle shaft and said self-sealing grommet and by which said self-sealing grommet upon removal of said device restricts movement of substances in at least one longitudinal direction through said hollow needle shaft.

9. An instrument as in claim 6 in which said hollow elongated needle shaft further comprises a plurality of lumens extending longitudinally along said hollow elongated shaft and said self-sealing device interposed within said hollow elongated needle shaft comprises one or more self-sealing devices interposed in one or more of said plurality of lumens.

10. An instrument as in claim 9 in which said plurality of lumens comprise:
(a) a first lumen sized for close tolerance fit with a guide-wire and a second lumen sized for passage of substances therethrough; and (b) said self-sealing device is interposed in at least one of said lumens.

11. An instrument for facilitating catheterization as in claim 1 wherein a self-sealing device is interposed within an elongated lumen in said needle for restricting movement of substances in at least one longitudinal direction through said lumen.

12. An instrument for dilation of tissue or material comprising:
(a) an elongated hollow shaft having a first diameter at a distal portion thereof and a second larger diameter at a proximal portion thereof with an expanding surface extending along said shaft progressively expanding from said first diameter at said distal portion to said second larger diameter at said proximal portion thereof; and (b) at least one side-port communicating through said expanding surface with said hollow shaft.

13. An instrument for dilation of claim 12 further comprising a plurality of orifices through said surface and into said hollow shaft.

14. An instrument for dilation as in claim 12 further comprising a plurality of lumens with said at least one side-port communicating with at least one of said lumens through said surface.

15. An instrument for dilation as in claim 12 wherein said hollow shaft is composed of a material which is sufficiently hard at ambient air temperature and humidity for dilation of said tissue or material and which material changes, after a period of time of exposure to body temperature and moisture content of said tissue or material, to a second relatively softer hardness sufficiently soft to permit flexure of said instrument for dilation.

16. An instrument for dilation of tissue or material comprising:
(a) an elongated hollow shaft having a first diameter at a distal portion thereof and a second larger diameter at a proximal portion thereof with an expanding surface extending along said shaft expanding from said first diameter at said distal portion to said second larger diameter at said proximal portion thereof; and (b) at least one side-port communicating through said expanding surface with said hollow shaft.

17. An instrument for dilation as in Claim 16, further comprising at least one orifice formed in said distal portion of said hollow shaft.

18. An instrument for dilation as in Claim 17, further comprising a plurality of side-ports and plurality of orifices with a plurality of lumens extending along said hollow shaft between said side-ports and said orifices.

19. An instrument for dilation of tissue or material comprising:
(a) an elongated hollow shaft having a first diameter at a distal portion thereof and a second larger diameter at a proximal portion thereof with an expanding surface extending along said shaft progressively expanding from said first diameter at said distal portion to said second larger diameter at said proximal portion thereof; and (b) at least one orifice formed in said distal portion of said shaft surface of said instrument for fluid communication between said target tissue or material and said hollow shaft.

20. An instrument for dilation as in claim 19 further comprising a plurality of lumens with said at least one orifice accessing at least one of said plurality of lumens.

21. An instrument as in claim 19 wherein said at least one orifice comprises a plurality of orifices.

22. An instrument for dilation as in claim 19 wherein said shaft is composed of a material sufficiently hard at ambient air temperature and humidity for rigidly dilating said tissue or material and which material changes over a period of time, upon exposure to normal body temperature and moisture content of said tissue or material, to a second hardness softer than said first hardness, which second hardness is sufficiently soft to permit flexure of said instrument within said tissue or material.

23. An instrument for dilation of tissue or material comprising:
(a) an elongated hollow shaft having a first diameter at a distal portion thereof and a second larger diameter at a proximal portion thereof with an expanding surface extending along said shaft progressively expanding from said first diameter at said distal portion to said second larger diameter at said proximal portion thereof; and (b) a plurality of lumens extending along said hollow shaft.

24. An instrument as in claim 23 wherein said instrument is composed of a material which is sufficiently hard at ambient air temperature and humidity for dilation of said tissue or material and which material of said instrument changes, after a period of time after exposure to body temperature and moisture content of said tissue or material, to a second relatively softer hardness sufficiently soft to permit flexure of said instrument for dilation.

25. An instrument for dilation of tissue or material comprising:
(a) an elongated hollow shaft having a first exterior diameter at a distal portion thereof and a second larger diameter at a proximal portion thereof; and (b) said shaft composed of a material having a first hardness when exposed to ambient air temperature and relative humidity sufficient for expanding said tissue or material and having a second hardness relatively softer than said first hardness when exposed to body temperature and moisture content of said tissue or material, which second harness is sufficiently soft to permit flexure within said tissue or material.

26. A dilator comprising a hollow shaft having a distal portion with a first exterior diameter and a proximal portion with a second exterior diameter and an exterior surface therebetween and a self-sealing means interposed within said hollow portion of said dilator restricting movement of substances in at least one longitudinal direction between said distal portionand said proximal portion.

27. A dilator as in claim 26 wherein said self-sealing means comprises a one-way valve interposed within said hollow shaft.

28. A dilator as in claim 26 wherein said self-sealing means comprises a self-sealing grommet by which devices may be sealingly inserted through said grommet and by which removal of said devices from said grommet causes said grommet to close therearound thereby restricting movement of substances.

29. An instrument for dilation of tissue or material comprising a first end portion having circumferentially disposed surface portions defining a first diameter at a distal portion thereof and said plurality of circumferentially disposed surface portions defining a second diameter at a proximal portion thereof, with progressively expanding surface portions extending longitudinally between said surface portions with said first diameter and said surface portions with said second diameter.

30. An instrument for dilation of tissue or material in a procedure for facilitating catheterization comprising a dilator circumferentially disposedaround a needle shaft wherein said dilator includes a wall having a lumen circumferentially disposed around said needle such that said wall can be filled with air or fluid for controlling the diameter of said dilator.

31. An instrument for dilation of tissue or material circum-ferentially disposed around a needle wherein said dilator includes a wall having a lumen extending longitudinally adjacent said needle such that said wall can be filled with air or fluid for controlling the radial distance from said needle to said wall longitudinally therealong.

32. The instrument of claim 12, 16, 18, 23, 25, 26 or 29 further comprising a lumen circumferentially disposed around said dilator such that said lumen can be filled with air or fluid for controlling the diameter of said external surface of said dilator.

33. The instrument of claim 12, 16, 18, 23, 25, 26 or 29 further comprising an elongated lumen disposed around a portion of said external surface such that said lumen can be filled with air or fluid for controlling theexpansion of said surface portion of said dilator therealong.

34. The instrument for dilation of said claim 12, 16, 18, 23, 25, 26, 29, 30 or 31 further comprising at least one projection from said external surface at said proximal portion thereof for grasping, maneuvering or securing said instrument to any other surface.

35. The instrument for dilation of said claim 12, 16, 18, 23, 25, 26, 29, 30 or 31 wherein said instrument for dilation is circumferentially disposed around an elongated shaft of a needle used for puncturing said target tissue or material prior to dilation thereof.

36. An instrument for use in a catheterization procedure in which said catheter or catheterization device is inserted through one tissue or material and into a target tissue or material to be catheterized, said instrument comprising a sheath at least partially encompassing said catheter or catheterization device, said sheath having a portion thereof extending partially into said one tissue or material, and having a length such that it does not contact said target tissue or material.

37. The sheath of claim 36 further comprising a plurality of lumens extending along the length thereof.

38. The sheath of claim 36 further comprising at least one side-port communicating through said sheath with a space formed between said sheath and said catheter or catheterization device which is at least partially encompassed by said sheath.

39. The instrument of claim 38 wherein said at least one side-port is in fluid communication with means for insertion of substances or devices or removal of tissue or material into or from a point in said one tissue or material adjacent to said target tissue or material.

40. The sheath of claim 36 further comprising at least one side-port communicating through said sheath with said tissue adjacent said sheath and said catheter or catheterization device which is at least partially encompassed by said sheath.

41. The sheath of claim 36 further comprising means in fluid communication with said interior of said sheath for insertion of substances or devices into or withdrawal of tissue or material therethrough from a point in said one tissue or material.

42. The instrument of claim 36 wherein said sheath has a projection extending from a portion thereof for grasping, maneuvering, or securing said sheath.

43. The sheath of claim 36 further incorporating a balloon inflatable against said one tissue or material into which said sheath is partially inserted wherein said balloon is used for securing said sheath in place.

44. The instrument of claim 36 further comprising a flange for securing said sheath in place when said sheath is partially inserted within saidone tissue or material.

45. The sheath of claim 36 further comprising connection means by which said sheath may be attached to a protective sleeve at least partially encompassing said catheter or other catheterization device.

46. The sheath of claim 36 further comprising connection means by which said sheath may be attached to another sheath, which other sheath is in contact with said target tissue or material.

47. A "Y" chamber for insertion or withdrawal of substances, devices, tissue, or material, comprising a first chamber having an opening in communication with said substances, devices, tissue or material, and which said first chamber communicates with additional chambers, each having a separate entry opening and each in communication with said first chamber and at least one of said chambers having more than one lumen therealong.

48. The "Y" chamber of claim 47 wherein one of said more than one lumen communicates between said first chamber and only one of said additional chambers.

49. The "Y" chamber of claim 47 wherein said opening of said first chamber is adapted for communication with said tissue or material through a needle.

50. The "Y" chamber of claim 47 wherein said first chamber includes a number of lumens which is more than one and a needle with a corresponding number of lumens attachable so that said corresponding lumens in said first chamber and in said needle are aligned.

51. The "Y" chamber as in claim 47 further comprising at least one self-sealing device interposed in at least one of said chambers for restricting movement of substances therethrough.

52. The "Y" chamber of claim 51 wherein said self-sealing device comprises a one-way valve restricting movement of substances in at least one longitudinal direction.

53. A "Y" chamber as in claim 51 wherein said self-sealing device comprises a self-sealing grommet formed of a resilient material such that a device may be inserted therethrough and such that said grommet automatically closes upon removal of said device.

54. A "Y" chamber as in claim 47 wherein said additional chambers which are connected to said first chamber comprise a plurality of chambers, each connected in fluid communication with said first chamber.

55. A shock sheath for use in a catheterization procedure at a catheterization site for access to tissue or material which is the target of catheterization, which shock sheath comprises one lumen, and at least two side-ports thereinto, which said one lumen is extendable through a first tissue to said target tissue or material, and through which said one lumen, catheters, devices or substances may be inserted into or withdrawn from said target tissue or material through said one lumen.

56. An instrument for use in a catheterization procedure for access to tissue or material which is the target of catheterization comprising a shock sheath having two side-ports extending into at least one lumen of said shock sheath wherein said at least one lumen extends at least partially into said target tissue or material and said side-ports may be used for insertion substances or devices or withdrawal of tissue or material.

57. An instrument for use in a catheterization procedure for access to tissue or material which is the target of said catheterization comprising a shock sheath having at least one side-port extending into at least one of the lumens of said shock sheath wherein said shock sheath has at least two lumens, at least one of which lumens extends at least partially into said targettissue or material.

58. An instrument for use in a catheterization procedure for access to tissue or material which is the target of said catheterization as in claim 54wherein said at least two lumens communicate with each other.

59. An instrument for use in a catheterization procedure for access to tissue or material which is the target of said catheterization as in claim 54wherein said at least two lumens do not communicate with each other.

60. An instrument for use in a catheterization procedure comprising a shock sheath having two or more side-ports communicating with two or more lumens of said shock sheath wherein said two or more lumens of said shock sheath extend at least partially into target tissue or material.

61. The instrument of claim 60 wherein said two or more lumens do not communicate with each other.

62. The instrument of claim 60 wherein said two or more lumens communicate with each other.

63. The instrument of claim 56, 57 or 60 wherein said lumens of said shock sheath may be designated for the insertion of substances or devices into or removal of tissue or material from said target tissue or material.

64. The instrument of claim 55, 56, 57 or 60 wherein said shock sheath further comprises means for the securing of said shock sheath to a protective sleeve.

65. The instrument of claim 55, 56, 57 or 60 wherein said shock sheath further comprises means for the securing of said shock sheath to another sheath which does not contact said target tissue or material.

66. The instrument of claim 55, 56, 57 or 60 wherein said shock sheath further comprises means for grasping, maneuvering or securing said shock sheath.

67. The instrument of claim 55, 56, 57 or 60 wherein said shock sheath further comprises multiple orifices located along said at least one lumen of said shock sheath.

68. The instrument of claim 55, 56, 57 or 60 wherein at least one lumen of said shock sheath is circumferentially disposed around another lumen.

69. The instrument of claim 55, 56, 57 or 60 comprising a first and a second lumen longitudinally disposed with respect to each other.

70. The instrument of claim 55, 56, 57 or 60 wherein at least one lumen of said shock sheath incorporates a self-sealing mechanism.

71. The instrument of claim 55, 56, 57 or 60 wherein at least one lumen of said shock sheath incorporates a self-sealing mechanism comprising a self-sealing grommet.

72. The instrument of claim 55, 56, 57 or 60 wherein at least one lumen of said shock sheath incorporates a self-sealing mechanism comprising a one-way valve.

73. An instrument, for use in a catheterization procedure, to protectively encompass a catheter or other catheterization device, while said catheter or catheterization device is being inserted or is in use, comprising a protective sleeve having a fixed length and composed of a sufficiently firm material to maintain said fixed length while permitting partial bending.

74. An instrument for use in a catheterization procedure to protectively encompass a catheter or other catheterization device, while said catheter or catheterization device is being inserted or is in use, comprising a protective sleeve having a fixed shape and composed of a sufficiently firm material to maintain said fixed shape while permitting partial bending.

75. An instrument for at least partially encompassing a catheter or catheterization device comprising a protective sleeve having a portion thereof with a fixed length composed of a sufficiently rigid material to maintain said fixed length and having another portion composed of a flexible material to permit flexibly changeable lengths and shapes thereof.

76. An instrument as in claim 73, 74 or 75 further comprising:
(a) a sheet of material elongated in a predetermined direction with a first edge substantially parallel to said elongated direction and a second edge substantially parallel to said first edge;
(b) a connector means positioned along said first edge for connection to said second edge, so that said protective sleeve may be formed by said sheet of material and secured at least partially encompassing said catheter or catheterization device even after said catheter or catheterization device has been inserted into tissue or material.

77. A protective sleeve for at least partially encompassing an elongated catheter or other elongated device for use in catheterization procedures comprising:
(a) a sheet of material elongated in a predetermined direction with a first edge substantially parallel to said elongated direction and a second edge substantially parallel to said first edge;
(b) a connector means positioned along said first edge for connection to said second edge, so that said protective sleeve may be formed by said sheet of material and secured at least partially encompassing said elongated catheter or catheterization device even after said catheter or catheterization device has been inserted into tissue or material.

78. The protective sleeve as in claim 77 wherein said connector means positioned along said first edge comprises a self-sticking adhesive securable to said second edge.

79. A protective sleeve as in claim 77 further comprising a latching mechanism aligned along said second edge for engagement with said connector means positioned along said first edge.

80. A protective sleeve as in claim 79 wherein:
(a) said connector means along said first edge comprises a rib having a projecting portion; and (b) wherein said latching mechanism attached along said second edge comprises a channel, such that said rib portion may be manually squeezed into said channel portion with sufficient holding force to maintain said first edge connected to said second edge.

81. A protective sleeve as in claim 79 wherein said connector means positioned along said first edge comprises a series of snaps and said latching mechanism positioned along said second edge comprises a series of snap-engaging clips correspondingly located for snap attachment between said first and second edges.

82. A protective sleeve at least partially encompassing a catheter or catheterization device and comprising a non-compressibly attached portion therealong for immobilizing said protective sleeve with respect to said catheterization device without collapsing said protective sleeve on said catheter or said catheterization device, such that the integrity or function of said catheter or catheterization device is not comprised.

83. A flexible protective sleeve for at least partially encompassing an elongated catheter or catheterization device, comprising:
(a) a first substantially rigid projection at one predetermined position along an elongated length of said flexible protective sleeve;
(b) a second substantially rigid projection at a second position along the elongated length of said flexible protective sleeve; and (c) an adjustable length bridge connecting between said first projection and said second projection to permit adjustment of the length thereof in order to maintain a desired adjusted length between said first and second projection so that said flexible sleeve does not collapse in a longitudinal direction.

84. A flexible protective sleeve for at least partially encompassing an elongated catheter or catheterization device, comprising:
(a) a first substantially rigid projection at one predetermined position along an elongated length of said flexible protective sleeve;
(b) a second substantially rigid projection at a second position along the elongated length of said flexible protective sleeve; and (c) said projections constructed so that they may be secured at an adjustably fixed distance therebetween in order to maintain a desired adjusted length so that said flexible sleeve does not collapse in a longitudinaldirection.

85. The protective sleeve as in claim 83 or 84 wherein:
(a) said first substantially rigid projection is at a distal portion thereof, which distal portion is attached to a component of a catheterization system; and (h) said second substantially rigid projection is at a proximal portion thereof, which proximal portion is incompressibly attached to said catheter or catheterization device, such that the integrity or function of said catheter or catheterization device is not compromised.

86. A protective sleeve as in claim 73, 74, 75, 77, 82, 83 or 84 further comprising a sheath and means for attaching said sheath to said protective sleeve.

87. A protective sleeve as in claim 73, 74, 75, 77, 82, 83 or 84 further comprising a shock sheath and means for attaching said shock sheath to said protective sleeve.

88. A protective sleeve as in claim 73, 74, 75, 77, 82, 83 or 84 further comprising at least one projection extending from said protective sleeve for grasping, maneuvering or securing said protective sleeve.

89. A protective sleeve as in claim 73, 74, 75, 77, 82, 83 or 84 wherein said protective sleeve comprises a first flexible portion and a second substantially rigid portion attached thereto, such that said rigid portion may be secured at a distance from said catheterization site without collapsing said protective sleeve as with tape or sutures thereover.

90. An instrument for catheterization comprising:

(a) an elongated needle for puncturing a target tissue or material to be catheterized; and (b) a catheter having an open distal tip, a hollow lumen portion and a side hole spaced in a proximal direction from said distal tip, which distal tip opening, hollow shaft portion and side hole are sized for receiving said needle therethrough.

91. An instrument for catheterization as in claim 90 further comprising, a self-sealing device interposed in said side hole through which said needle may be removably inserted and by which removal of said needle causes sealing of said self-sealing device, thereby closing said side hole of said catheter.

92. An instrument as in claim 90 further comprising a pusher member, movably guided along said needle, having a proximal portion and having a contact at a distal portion for pushing said catheter from said needle into said tissue or material to be catheterized.

93 . The instrument of claim 90 incorporating a guide-wire wherein said guide-wire may pass through said needle so that said catheter circumferentially disposed around said needle may be inserted over said guide-wire into said target tissue or material.

94. The instrument of claim 90 further comprising a pusher member circumferentially disposed around said needle to slide or maneuver said catheter circumferentially disposed around said needle into said target tissue or material.

95. The instrument of claim 90 further comprising a slidable tubing at least partially encompassing said needle by which said catheter may be pushed along said needle, thereby disengaging said needle from said tip opening, said hollow shaft portion and said side hole allowing said catheter to be left in place in the target tissue or material.

96. The instrument of claim 92 or 94 wherein said distal end of said pusher member is slanted so as to allow sufficient engagement with said circumferentially disposed catheter so that said catheter may be easily slid off.

97. The instrument of claim 90 wherein an at least partially transparent chamber is attached to said needle allowing the insertion of substances or devices or withdrawal of tissue or material from said catheterization site.

98. The instrument of claim 93 wherein a "Y" chamber is attached to said needle so that said guide-wire may be inserted through said "Y"
chamber and through said needle, thus facilitating catheterization of said target tissue or material using said catheter circumferentially disposed around said needle.

99. The instrument of claim 98 wherein an at least partially transparent chamber is attached to the "Y" chamber so that substances or devices may be inserted into and tissue or material may be withdrawn from said catheterization site through said needle which is in communication with said "Y" chamber, said needle having said catheter circumferentially disposed therearound.

100. The instrument of claim 90 further comprising an at least partially transparent chamber communicating with said needle for observing "flashback" from said catheterization site.

101. The instrument of claim 90 further comprising a sheath.

102. The instrument of claim 90 further comprising a protective sleeve.

103. The instrument of claim 90 wherein said catheter comprises a plurality of separate lumens.

104. The instrument of claim 90 or 103 wherein at least one lumen of said catheter is rigid allowing insertion into tissue or material.

105. A system for catheterization procedures of the type including members each having corresponding ends for connecting of one of said members to another, the improvement comprising connecting ends having threads and a threaded movable member incorporated over said threaded connecting ends for threadably engaging said two connecting ends so that said one and other members of said system are secured to each other.

106. An instrument for catheterization comprising a plurality of components coaxially connectable, one with another, end to end with male to female couplings, further comprising mechanical connector means secured to one of said components and removably connectable to another of said components, thereby immobilizing said one and another component coupled to each other.

107. The catheterization instrument as in claim 106 wherein said connector means comprises right-hand threads formed on one of said components, left-hand threads formed on another of said components and a movable threaded coupler having left-hand and right-hand threads on opposite ends for threadably connecting said one and another components.

108. The catheterization instrument as in claim 106 wherein said connector means comprises a hook attached to one end of said component and a projection attached to another component, which hook is engageable over said projection thereby preventing disengagement.

109. The catheterization instrument as in claim 106 wherein said one connector means comprises wings formed on corresponding ends of another component which wings have mating snap portions affixed thereto to be snapped together for immobilizing said connection.

110. The catheterization instrument as in claim 106 wherein said connector means comprises a member having an inside diameter corresponding to the outside diameter of said components for slip fit engagement therebetween to frictionally immobilize said connection.

111. The catheterization instrument as in claim 106 wherein said connector means comprises flexible projections attached to each component which projections are deformably twistable together.

66 117. A catheter including a balloon which may be connected to a reservoir wherein said reservoir has a division so that there are at least two non-communicating chambers, one or more of said chambers communicating with one or more lumens of said catheter to allow insertion of substances or devices or withdrawal of tissue or material and at least one other chamber communicating selectively with said balloon allowing said balloon to be inflated or deflated.

113. The instrument of claim 112 wherein said non-communicating chambers are located in separate reservoirs.

114. The instrument of claim 112 or 113 wherein said catheter has at least two lumens.

115. The method comprising the steps of:
(a) inserting a catheter including a balloon into a conduit which enters or leaves target tissue or material;
(b) inflating said balloon with fluid from a first chamber, which chamber communicates selectively only with said balloon to selectively limit flow to or from said target tissue or material;
(c) inserting substances through said catheter by infusing substances through a second chamber, which second chamber communicates with a lumen of said catheter; and (d) deflating said balloon by withdrawing fluid from said balloon through said first chamber thereby restoring flow to or from said target tissue or material.

116. An instrument for facilitating catheterization comprising:
(a) a needle for puncturing a tissue or material to be catheterized; and (b) a dilator having an exterior diameter increasing from a distal portion to a proximal portion and circumferentially disposed around said needle for expanding said punctured tissue or material so that catheterization is facilitated.

117. An instrument for facilitating catheterization as in claim 116 wherein said needle further comprising an exterior having a substantially uniform diameter.

118. A instrument for facilitating catheterization comprising:
(a) a needle; and (b) a dilator having an exterior diameter increasing from a distal portion to a proximal portion circumferentially disposed around said needle for expanding said punctured tissue or material so that catheterization is facilitated.

119. The instrument of claim 118 wherein said needle further comprises an exterior surface which is tapered from a distal portion to a proximal portion.

120. An instrument for facilitating catheterization as in claim 116, 117, 118 or 119 further comprising:
(a) a distal portion and a proximal portion of said needle and at least one lumen extending through said needle between said distal and proximal portions; and (b) at least one "Y" chamber attached to said proximal portion of said needle in fluid communication with one of said at least one lumen and for insertion or removal of substances or devices therethrough.

121. An instrument for facilitating catheterization as in claim 120 further comprising:
(a) a catheter or catheterization device having a diameter sized for insertion into said target tissue or material expanded by said dilator;
and (b) a protective sleeve at least partially encompassing said catheter or catheterization device.

122. An instrument for facilitating catheterization as in claim 116, 117, 118 or 119 further comprising:
(a) a catheter or catheterization device sized for insertion into tissue or material expanded by said dilator; and (b) a protective sleeve at least partially encompassing said catheter or catheterization device exterior to said tissue or material.

123. An instrument for facilitating catheterization as in claim 116, 117, 118 or 119 further comprising a guide-wire insertable through said needle into said tissue or material by which guide-wire insertion of a catheter or catheterization device into said tissue or material is facilitated.

124. A device as in claim 116, 117, 118 or 119 further comprising an at least reversibly aspiratable chamber connected to said needle to allow detection of tissue or material or insertion of substances.

125. An instrument for catheterization comprising:
(a) a needle for puncturing a target tissue or material to be catheterized;
(h) a "Y" chamber attached to said needle for insertion or removal of substances or devices to or from said target tissue or material to be catheterized and through said needle and said "Y" chamber;
(c) a catheter or catheterization device at least partially insertable into said punctured target tissue or material; and (d) a protective sleeve at least partially encompassing said device used for catheterization.

126. The catheterization instrument of claim 125 further comprising a guide-wire for insertion through said "Y" chamber and said needle into said target tissue or material for facilitating insertion of said catheter or catheterization device into said target tissue or material.

127. The instrument as in claim 125 further comprising a reversibly aspiratable chamber in fluid communication with said needle to allow detection of tissue or material or insertion of substances.

28. A kit for use in a catheterization procedure comprising:
(a) a needle with a substantially uniform diameter for puncturing a tissue or material which is the target of catheterization; and (b) a dilator having an exterior diameter increasingly sized for engagement over said needle circumferentially disposed around said needle for expanding said punctured tissue or material which is the target of catheterization.

129. A kit for use in a catheterization procedure comprising:
(a) a needle with a tapered shaft having a distal end smaller than a proximal end for puncturing a tissue or material which is the target of catheterization; and (b) a dilator having an exterior diameter increasingly sized for engagement over said needle circumferentially disposed around said needle for expanding said punctured tissue or material which is the target of catheterization.

130. A kit for use in a catheterization procedure as in claim 128 or 129 further comprising at least one "Y" chamber attachable to a proximal portion of said needle for insertion or removal of substances or devices therethrough.

131. A kit for use in a catheterization procedure as in claim 130 further comprising:
(a) a catheter or catheterization device having a diameter sized for insertion into said punctured and expanded tissue or material which is the target of catheterization; and (b) a protective sleeve at least partially encompassing said catheter or catheterization device.

132. A kit for use in a catheterization procedure as in claim 128 or 129 further comprising:
(a) a catheter or catheterization device sized for insertion into said punctured tissue or material expanded by said dilator; and (b) a protective sleeve at least partially encompassing said catheter or catheterization device along a portion thereof which is exterior to said tissue or material which is the target of catheterization.

133. A kit for use in a catheterization procedure as in claim 128 or 129 further comprising a guide-wire insertable through said needle into said tissue or material and by which insertion of a device used for catheterization into said tissue or material is facilitated.

134. A kit as in claim 128 or 129 further comprising a reversibly aspiratable chamber in fluid communication with said needle to allow detection of tissue or material or insertion of substances.

135. A kit for catheterization of a target tissue or material comprising:
(a) a needle for insertion into a tissue or material which is the target of catheterization;
(b) a "Y" chamber attached to said needle for insertion or removal of substances or devices from said tissue or material which is the target of the catheterization through said needle and said "Y" chamber;
(c) a catheter or catheterization device at least partially insertable into said target tissue or material into which said needle has been inserted; and (d) a protective sleeve at least partially encompassing said catheter or catheterization device.

136. A kit for catheterization as in claim 135 further comprising a guide-wire for insertion through said "Y" chamber and said needle into said target tissue or material for facilitating insertion of said catheter or catheterization device into said target tissue or material.

137. A kit as in claim 135 further comprising a reversibly aspiratable chamber in fluid communication with said needle to allow detection of tissue or material or insertion of substances.

138. A kit for catheterization of a target tissue or material comprising:
(a) a hollow tubing for use in inserting or withdrawing substances or devices from the target tissue or material to be catheterized;
(b) a "Y" chamber attachable to said hollow tubing through which substances or devices may be inserted or tissue or material withdrawn through said hollow tubing which is in communication with said target tissue or material;
(c) a protective sleeve for at least partially encompassing a catheter or catheterization device at a point thereon which is exterior to said tissue or material which is the target of catheterization.

139. A kit for use in catheterization as in claim 138 further comprising a guide-wire insertable through said "Y" chamber and insertable through said hollow tubing and into said target tissue or material to facilitatecatheterization.

140. A kit as in claim 138 further comprising a reversibly aspiratable chamber attachable in fluid communication with said hollow tubing to allow detection of tissue or material or insertion of substances.

141. A method for catheterization of a tissue or material which is the target of catheterization comprising the steps of:
(a) circumferentially disposing a dilator around a needle;
(b) inserting said needle into said target tissue or material;
(c) sliding said dilator along said needle into said tissue or material to be catheterized for expanding said tissue or material so that catheterization is facilitated; and (d) using a "Y" chamber for insertion of substances or devices or removal of tissue or material through said needle.

142. A method as in claim 141 further comprising the steps of:
(a) inserting a catheter or catheterization device into the target tissue or material to be catheterized; and (b) at least partially encompassing said catheter or catheterization device with a protective sleeve exterior to said tissue or material.

143. A method as in claim 142 further comprising the step of inserting a guide-wire through said needle and dilator and into said tissue or material which is the target of catheterization thereby facilitating insertion of said catheter or catheterization device.

144. A method as in claim 143 further comprising a reversibly aspiratable chamber in fluid communication with said needle to allow detection of tissue or material or insertion of substances.

145. A method for catheterization of a target tissue or material comprising the steps of:
(a) puncturing said target tissue or material for catheterization with a hollow needle;
(b) inserting a catheter or catheterization device through a "Y" chamber which is attached to said hollow needle and thence into said punctured tissue or material which is the target of catheterization; and (c) partially encompassing said catheter or catheterization device with a protective sleeve exterior to said tissue or material which is thetarget of catheterization.

146. A method as in claim 145 further comprising the steps of:
(a) circumferentially disposing a dilator around said hollow needle; and (b) sliding said circumferentially disposed dilator along said hollow needle and thereby expanding said punctured target tissue or material.

147. A method as in claim 145 further comprising a reversibly aspiratable chamber in fluid communication with said needle to allow detection of tissue or material or insertion of substances.

148. A method of catheterization comprising the steps of:
(a) inserting a guide-wire through a "Y" chamber and then into said target tissue or material;
(b) inserting a catheter or other catheterization device along said guide-wire into said target tissue or material; and (c) at least partially encompassing said catheter or catheterization device with a protective sleeve.

149. A device for catheterization of a target tissue or material comprising a dilator including at least one side-port for infusion or withdrawal of substances or devices into or from said target tissue or material through said dilator and said side-port.

150. A device for catheterization as in claim 149 further comprising a reversibly aspiratable chamber connected to said dilator to allow detection of tissue or material or insertion of substances.

151. A device as in claim 116, 117, 118, 119 or 125 wherein:
(a) said needle further comprises a position-sensitive feature on a distal portion thereof; and (b) indicia associated with a proximal portion of said needle in a fixed spatial relationship with respect to said position-sensitive feature such that said indicia can be observed when said needle is inserted into said target tissue or material so that the position of said position-sensitive feature is indicated.

152. A kit as in claim 128, 129 or 135 wherein:
(a) said needle further includes a position-sensitive feature at a distal portion thereof; and (b) further comprising an indicia associated with a proximal portion of said needle in a fixed relative position with respect to said position-sensitive feature so that observation of said indicia outside of said target tissue or material indicates the position of said position-sensitive feature.

153. A kit as in claim 138 wherein:
(a) said hollow tubing further comprises a position-sensitive feature at a distal portion thereof; and (b) further comprising an indicia associated with a proximal portion of said hollow tubing in a fixed relative position with respect to said position-sensitive feature so that observation of said indicia outside of said target tissue or material indicates the position of said position-sensitive feature.

154. An instrument for facilitating catheterization as in claims 116, 117, 118, 119 or 125 wherein a self-sealing device is interposed with an elongated lumen in said needle for restricting movement of substances in at least one longitudinal direction through said lumen of said needle.

155. A kit for use in a catheterization procedure as in claims 128, 129 or 135 wherein:
(a) said needle further comprises at least one lumen extending longitudinally therethrough; and (b) further comprising a self-sealing device interposable within said elongated lumen for restricting movement of substances in at least one longitudinal direction through said lumen of said needle.

156. An instrument for facilitating catheterizations in claim 149 further comprising a self-sealing device interposed within an elongated lumen formed in said dilator, said self-sealing device for restricting movement of substances in at least one longitudinal direction therethrough.

157. A kit for catheterization as in claim 138 further comprising a self-sealing device interposed within said hollow tubing for restricting movement of substances in at least one longitudinal direction therethrough.