US 20060264798 A1
A multilumen catheter that maximizes the blood flow into and out of the patient's vasculature while also providing for passive and/or active perfusion of tissue downstream of where the catheter resides in the vasculature. The inventive catheter comprises a proximal end, a first distal and a second distal end with first and second lumens extending from the proximal end to each of these distal ends to provide for blood circulation within one blood vessel or between two different blood vessels. The second lumen, and any additional lumens so desired, may be positioned coaxially with or radially around the first lumen. Redirecting means is provided at a distal end of at least one of said lumens for directing blood in a direction generally opposite of the direction of flow through said lumen.
1. A method of treating a patient, comprising:
providing an apparatus comprising:
a first elongate body having a first proximal end, a first distal end, and a first lumen extending therebetween; and
a second elongate body having a second proximal end, a second distal end, and a second lumen extending therebetween;
advancing the second elongate body percutaneously into a patient such that an outer surface thereof engages a femoral artery at an access point and the second distal end is between the access point and the aorta;
advancing the first elongate body in coaxial relationship with the second elongate body into the vasculature until the first distal end is at a location within the aorta of the patient;
configuring the second elongate body to permit blood to flow downstream of the access point to minimize ischemia.
2. The method of
This application is a divisional of U.S. application Ser. No. 10/078,283, filed Feb. 14, 2002, which is a continuation-in-part of U.S. application Ser. No. 09/876,281, filed Jun. 6, 2001, both of which are incorporated herein in their entireties by reference.
1. Field of the Invention
The present invention relates to a multilumen catheter and, in particular, to multilumen catheters designed to prevent ischemia in patients when the catheter is positioned within the body.
2. Description of the Related Art
It is often necessary to divert the flow of blood from a patient's blood vessel back to the same or a different blood vessel as part of treating a patient suffering from one or more of numerous health impairments, including cardiovascular disease, such as congestive heart failure. Although surgical cut-down procedures can achieve this, percutaneous insertion of catheters has made this procedure less invasive and therefore less traumatic to the patient. Still, insertion of a cannula into the circulatory system can cause complex, and sometimes adverse, reactions within the body.
Some of the percutaneous procedures involve removing blood from the body and subsequently returning it to the body. For example, dialysis treatment involves first removing blood from the patient's circulatory system, treating the blood outside of the body, and then returning the blood to the patient's circulatory system to perfuse the various tissues and organs. Depending on the volume of blood flow, cannulae with large carrying capacity may be necessary. By maximizing the cross-sectional area of the cannula, the volume of blood that may be removed and/or returned to the patient's vascular system via the cannula is maximized. One approach to maximize the cross-sectional area of the cannula involves using either two single lumen catheters or a multi-lumen catheter. In a recirculation application, one lumen would function to withdraw blood and one would function to return blood to the patient. One problem with using two single lumen catheters is that it subjects the patient to multiple percutaneous insertion procedures, which complicates the procedure and increases the potential for infection and other complications. Therefore, it would be desirable to have a catheter assembly which could be inserted into the patient through a single insertion site.
Multilumen catheters in various forms have been employed for this purpose. For example, multilumen catheters have been made with two, three or more lumens to serve various aspiration and infusion functions, including extracting and returning blood to vessels, taking blood samples for testing and providing medications to the patient's vascular system. Simple multilumen catheters have been made by providing two round catheters of equal or nearly equal length joined by a web, or thin strip. This approach is described in U.S. Pat. No. 5,776,111 to Tesio. Other multilumen catheter designs have a unitary body with at least one septum dividing the lumens which extend from a proximal to a distal end.
While multilumen catheters require only a single puncture of the epidermis, their performance is limited in at least two ways. For one, the outer perimeter of the multilumen catheter cannot exceed the inner diameter of the vessel into which it is inserted. Furthermore, the already limited cross-sectional area must be divided into at least two lumens, one for withdrawal and one for return. Thus the carrying capacity of each lumen is further reduced. To supply the same amount of blood, the velocity and pressure of the blood in the lumens must increase over what it would be in the vessel itself. This has the potential to cause damage to the vessel as blood comes jetting out of the return lumen. Also, it may put further stress upon blood cells, even causing hemolysis. Thus, multilumen catheters must be made as large as possible to carry enough blood at satisfactory conditions.
Where the size of a catheter approaches the interior size of a vessel, less and less blood can flow around the catheter. As a result, limited blood supply reaches tissues and organs located downstream of the catheter in the vascular system. With insufficient perfusion, the tissues downstream of the lumen insertion site suffer from ischemia and become oxygen deprived. Prolonged oxygen deprivation can lead to tissue damage, as is well known in the art. Therefore, it would be desirable to have a multilumen catheter that can maximize cross-sectional area of withdrawal and return lumens while at the same time providing for acceptable levels of blood perfusion of tissue downstream of the catheter insertion site in the vascular system. It would also be advantageous to have a multilumen catheter that can also remove blood from one peripheral vessel and return blood to a second peripheral vessel.
Overcoming many if not all of the limitations of the prior art, the present invention comprises a multilumen catheter for directing the flow of blood to and from a patient through a single cannulation site. The catheter comprises a proximal end, a first distal end and a second distal end. The first distal end extends farther from the proximal end than the second distal end. A first lumen extends between the first distal end and the proximal end and a second lumen extends between the second distal end and the proximal end. At least one aperture, but preferably a plurality of apertures may be formed in one of the first or second lumens positioned near the proximal end so that the aperture permits active maintenance or enhancement of perfusion of blood to the patient's vasculature downstream of where the aperture resides in the vasculature when the catheter is inserted into the patient for treatment.
In an alternative embodiment, the multilumen catheter further comprises a third lumen with distal and proximal ends configured to be positioned entirely within the patient's vascular system. This third lumen is configured to permit the passive flow of blood downstream of the catheter site to maintain or enhance perfusion.
In another embodiment, the multilumen catheter also comprises means for redirecting at least a portion of the blood flow exiting a lumen of the catheter in a direction generally opposite of the direction of flow of blood in the catheter. In one embodiment, the redirecting means is a redirecting tip positioned at the distal end of one of the lumens. In this embodiment, the redirecting tip is configured to redirect at least a portion of the blood flow exiting the lumen in a direction generally opposite of the direction of flow.
In one embodiment, a connector formed in the shape of a Y (“Y-connector”) is positioned at the proximal end of the multilumen catheter. One leg of the Y-connector is in fluid communication with the first lumen and the other leg of the Y-connector is in fluid communication with the second lumen.
Preferably, in an application of the present invention, an outflow conduit of a pumping system is fluidly engaged to one lumen of the multilumen catheter and an inflow conduit of the same system is fluidly engaged to the other lumen. The inflow and outflow conduits are fluidly coupled to a pump so that, when connected to the patient, the pump circulates blood from one distal end of the multilumen catheter to the other distal end, and also through at least one aperture in one of the first or second lumens positioned near the proximal end. In one application, the multilumen catheter of the present invention is incorporated into an extracardiac pumping system for supplementing blood circulation in a patient without any component thereof being connected to the patient's heart. Such a system is described in U.S. Pat. Nos. 6,200,260 and 6,299,575, which are incorporated herein by reference. The system includes, in addition to the multilumen catheter, a pump configured to pump blood through the patient at subcardiac rates, an inflow conduit fluidly coupled to the pump to divert blood to the pump from a first blood vessel, and an outflow conduit fluidly coupled to the pump to direct blood from the pump to a second blood vessel.
Another embodiment of the present invention is an extracardiac pumping system for supplementing blood circulation through a patient without any component thereof being connected to the patient's heart. The extracardiac system comprises a multilumen catheter that has at least two lumens therethrough. Each lumen has a distal end configured for insertion into the patient's vasculature and a proximal end. At least two of the lumens are in fluid communication with each other at their proximal end. The extracardiac pumping system also comprises a pump secured within one of the lumens and configured to pump blood through the patient at subcardiac volumetric rates. The pump has an average flow rate that, during normal operation thereof, is substantially below that of the patient's heart when healthy. The pump can be operated to pump blood from one location in the patient's vasculature to a different location in the vasculature while the proximal end of each lumen resides outside the patient's body.
The present invention also provides a method for treating a patient using one of the multilumen catheters of the present invention. The method comprises the step of inserting the multilumen catheter described above into the patient at a single cannulation site of a first blood vessel, locating the catheter such that a first lumen may be in fluid communication with a second blood vessel and a second lumen may be in fluid communication with the first blood vessel, withdrawing blood from one of said blood vessels through one of the first or said second lumens, and delivering blood through the other of said first or second lumens so that blood is delivered upstream and downstream of the cannulation site.
These and other features and advantages of the invention will now be described with reference to the drawings, which are intended to illustrate and not to limit the invention.
Turning now to the drawings provided herein, a more detailed description of the embodiments of the present invention is provided below.
With reference to
The first distal end 18 may be formed with one or more distal apertures 22, although such apertures may also be located in the second distal end 20. The distal apertures 22 may be positioned close together or spaced circumferentially around the distal end. The apertures 22 serve to decrease the pressure drop across the cannula tip, thereby minimizing damage to vessel walls from jetting effects. It may also be appropriate to practice methods for directing blood flow so as to minimize damage to vessel walls from jetting effects and from the recoil effect on the catheter of blood exiting a catheter. The present. invention may further comprise a tapered tip 24 at the first distal end 18, which facilitates insertion and threading of the catheter into the patient. The present invention may also further comprise a tapered tip 26 at the second distal end 20.
One preferred embodiment of the multilumen catheter further comprises a set of apertures 28 positioned on the catheter 10 near the proximal end 16. The apertures 28 are formed on at least one lumen of the catheter to provide for fluid communication between one of the lumens 12, or 14 of the multilumen catheter 10 and the blood vessel in which it resides. A radiopaque marker 30 may be positioned at the distal end 18 of the multilumen catheter 10. The multilumen catheter could further comprise markings 32 near the proximal end of the multilumen catheter which are a known distance from one or more of the distal ends. These markings 32, as well as the marker 30 can be used to accurately position the catheter when applied to the patient.
In another embodiment of the present multilumen catheter shown in
In one variation of the three lumen embodiment the third lumen 134 may be made of collapsible material. In the collapsed state, the third lumen 134 would conform to at least a portion of the outside surface of the multilumen catheter 110. Once applied to the patient, as described in more detail below, the lumen 134 would be expanded to the deployed state shown in
In an alternate embodiment of the multilumen catheter 210, shown in
Any of the multilumen catheters described herein may be made from various materials to improve their viability in long-term treatment applications. For example, it is preferred that the biocompatibility of the catheter be improved compared to uncoated catheters to prevent adverse reactions such as compliment activation and the like. To prevent such side effects, the interior lumens of the catheters can be coated with biocompatible materials. Also known in the art are anti-bacterial coatings. Such coatings may be very useful on the outer surface of the catheter. This is especially true at or about where the catheter enters the patient's skin. At such a location, the patient is vulnerable to introduction of bacteria into the body cavity. Anti-bacterial coatings can reduce the likelihood of infection and thus improve the viability of long-term treatments.
In one application, the multilumen catheter of the present invention may be integrated into a pumping system, such as the one described in more detail in U.S. Pat. No. 6,200,260. Referring to
In one example, the distal end 18 may be located in the aortic arch 48. The pump draws blood from the patient's vascular system in the area near the distal end 18 and into the lumen 12. This blood is further drawn into the lumen of the conduit 40 and into the pump 42. The pump 42 then expels the blood into the lumen of the outflow conduit 38. This lumen carries the blood into the lumen 14 of the multilumen catheter 10 and back into the patient's vascular system in the area near the distal end 20. As described in greater detail below regarding
Means for redirecting the flow of blood out of the catheter is provided. For example, in the embodiment of
In the embodiment of
The redirecting tip 434 further comprises a flow redirecting surface 446 that defines the proximal portion of the closed end 438 and the travel path of the redirected blood. In this embodiment, a crosssection of the flow redirecting surface 446 taken through the longitudinal axis of the lumen 426 reflects two parabolic curves meeting at the longitudinal axis. The three dimensional shape of the redirecting surface 446 of this embodiment is defined by rotating one of the parabolic curves about the longitudinal axis of the lumen 426 in which the surface 446 is positioned. This is one geometrical shape that could be used to form the redirecting surface 446 to gradually redirect the flow of the blood exiting the lumen 426. Other geometrical shapes could be used as well to define the redirecting surface.
The J-tip configuration, discussed above is another means for redirecting blood in a direction generally opposite of the direction of flow of blood through the lumen 426.
One application of the catheter 510 comprises connecting the second lumen 524 to a patient's blood vessel, preferably via an anastomosis connection after the first lumen 522, which is preferably of tubular configuration, is inserted through the same vessel. In this application, blood may be drawn through the second lumen 524 and redirected into the first lumen 522 using a circulating system such as that disclosed in U.S. Pat. No. 6,200,260. In another application, the first and second lumen may be inserted in the blood vessel in a manner that results in the second lumen 524 extending into the vessel. In this application, if desired, apertures 526 may be provided to permit a more diffuse discharge of blood into the vessel from second lumen 524.
With reference to
The multilumen catheter 704 of the system 700 comprises a first lumen 708 with a proximal end 710 and a distal end 712. The catheter 704 also comprises a second lumen 716 with a proximal end 718 and a distal end 720. In other embodiments, the catheter 704 can have additional lumens, as discussed above. The distal ends 712, 720 are configured for insertion into the patient's vasculature. The two lumens 708, 716 are in fluid communication with each other at their proximal ends 710, 718. First lumen 708 is longer than second lumen 716. In other variations, the lumens 708, 716 could be of the same length.
The pump 706 is secured within one of the lumens 708, 716 and is configured to pump blood through the patient at subcardiac volumetric rates the benefits of which are discussed in U.S. Pat. No. 6,200,260. The pump 706 has an average flow rate that, during normal operation thereof, is substantially below that of the patient's heart when healthy. The pump 706 may be operated to pump blood from one location in the patient's vasculature to a different location in the vasculature while the proximal end 710 of the first lumen 708 and the proximal end 718 of the second lumen 716 resides outside the patient's body. If desired, the entire system 700 may be implanted into a patient's blood vessel.
If desired, at least one aperture 724 is provided in one of the lumens, in this case lumen 708 and is positioned in the lumen distal from the proximal end 710 so that the aperture(s) 724 may reside within the patient's vasculature, close to the point of insertion. The aperture 724 can maintain or enhance perfusion of blood to the patient's vasculature downstream of where the aperture(s) 724 resides in the vasculature when inserted into the patient. As discussed above, one or more of the lumens of the catheter 704 can have a tapered tip 726. Also, at least one aperture may be positioned proximate a distal end of at least one of the lumens. In other embodiment, a third lumen could be provided that is configured similar to, and functions the same as, the third lumen 134 shown in
A variety of redirecting tip constructions can be employed in different embodiments of the catheter 704 of the extracardiac pumping system 700, as discussed above; for example redirecting tip 730. Also, the extracardiac pumping system 700 may be provided with a radiopaque marker 728. As discussed above, the marker 728 can be used to position the catheter 704 of the extracardiac pumping system 700 when applied to a patient.
The invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiment is to be considered in all respects only as illustrative and not restrictive and the scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.