CA2197682A1

CA2197682A1 - Method and apparatus for location of a catheter tip

Info

Publication number: CA2197682A1
Application number: CA002197682A
Authority: CA
Inventors: Jerald Glantz
Original assignee: Individual
Current assignee: Smiths Medical ASD Inc
Priority date: 1994-09-06
Filing date: 1995-08-24
Publication date: 1996-03-14
Also published as: US5749835A; US6112111A; WO1996007352A1; EP0779790A1; AU3371595A

Abstract

The present invention relates to a method and apparatus used to place a catheter (100) having a distal end (106) and a proximal end (102, 104) where the proximal end cannot be trimmed within a patient. The method and apparatus utilize a device operative in locating the tip of a catheter, which includes a detector assembly (200) having a detector (220) and a locator (240). The detector (220) of the detector assembly (200) is locked into position remote from the distal end (106) of the catheter (100) prior to inserting the catheter in the patient. The distal end of the catheter (100) is trimmed, as to define a trimmed distal end, the detector (220) is then unlocked and placed proximate the trimmed end. In the preferred embodiment the detector (220) is locked into place proximate the trimmed distal end and the catheter (100) is placed within the patient.

Description

~ W096/0735~2 1 9 7 6 8 2 PCT~S95/10746 METHOD AND APPARATUS
FOR ~OCATIO~ OF A CATHETER TIP

Field of the Invention 5The present invention relates to methods and apparatus for locating the tip of a catheter positioned in biological tissue.
Backqround The treatment of certain diseases often re¢uires infusion of drugs or medicants into the body.
When infusing such medicants, a caregiver will often make a venipuncture with a cannula to access a vein, and thread a catheter through the vein to a desired location. The catheter ; n~l lld~.c a distal end, a proximal end and one or more lu.mens therebetween. The distal end of the catheter may be placed at a variety of locations including the superior vena cava. The proximal end of the catheter is then coupled to a portal within the body or passes exterior of the body.
Generally, portals are sealed reservoirs accessible through a septum. The portal is connected to the proximal end of the catheter and subcutaneously implanted within the patient. Catheters which pass external of the body include: PICC (Peripherally Inserted Central Catheter) catheters, which access the superior vena cava through the cephalic vein in the arm;
and chest catheters (often referred to as Hickman catheters) which pass through a tunnel bored into the chest then into the cephalic vein.
The prior art provides for methods and devices to locate the distal end of the catheter within the body as the catheter is inserted into the vein. For example, commonly assigned U.S. Patent No. 4,905,698 to Strohl et :1 al describes a method and apparatus for catheter location determination. The method and apparatus of Strohl utilizes a source which generates an alternating magnetic field, and a detector positioned proximate the distal end of the catheter. The detector generates a voltage in response to the proximity of the field W096/073s2 2 1 q 1 6 8 2 PCT~S951107~6 generated by the source. The phase of the voltage in the detector shifts as the source passes over it. By referencing anatomical landmarks at the time the phase shift occurs, the caregiver can ~t~rm;.n~ the exact location of the detector, and thus the location of the tip of the cathete~.
The method and apparatus of S~rohl are advantageous because the tip of the catheter can be located without use of fluoroscopy. Fluoroscopy involves usi~g x-rays to locate the distal end of the catheter After the catheter i6 implanted, medicants are delivered therethrough to the desired location Medicants are introduced either directly into the catheter, as-in the case of a PICC catheter or chest catheter, or=through bolus injection or continuous infusion into the portal. Each techni~ue for delivering medicants has associated advantages which a caregiver evaluates in ~t~rm;n;ng how medicants will be delivered to a patient.
In the prior art, catheters are sold in predetermined length6. Often, the length of the catheter purchased does no~ meet the exact needs of the patient. In the case of catheters used in conjunction with portals, the caregiver positions the distal end of the catheter within the patient, for example at the superior vena cava, and trims the proximal end so that the catheter is the proper length. This is especially necessary when the length of the catheter is greater than the distance between the superior vena cava and the location of the portal. The distal end will be located, and the proximal end will be trimmed prior to connection with the portal.
If the device of Strohl has been used to locate the distal end of the catheter, in connection with placement of a portal, the caregiver will remove the device of Strohl prior to trimming the proximal end ~ W096/07352 21 97 ~8 2 PCT~595ll0746 of the catheter. The device of Strohl is removed by disconnecting a coupling positioned on an associated junction box The caregiver then trims the proximal end of the catheter, fits the portal to the proximal end of the catheter and places the portal within the patient.
Chest type and PICC catheters are also sold in predetermined lengths which do not often meet the needs of the patient. To place a chest or PICC catheter the caregiver would lay the catheter over the patient to determine the proper length and trim the distal end.
The catheter would then be placed using fluoroscopy.
In the prior art, use of devices of the type described in Strohl U.S. Patent No. 4,905,698 are not used with either chest or PICC type catheters. Use of these devices in the prior art are limited to use with portals. In particular, the device of Strohl is secured within the lumen of the catheter so that the detector o~
Strohl is positioned at the distal end of the catheter When the distal end of the catheter has been located the proximal end is trimmed. soth PICC and chest catheters include permanent fittings on their proximal ends which cannot be trimmed. The device and method taught by Strohl cannot be used with catheters which include fittings at the proximal end, such as PICC catheters or -chest catheters, because the proximal end of the catheter cannot be trimmed Therefore, a need has arisen to provide an apparatus and method which permits the safe and convenient use of the devicç of Strohl or other related devices with PICC and chest catheters.
SummarY of thç Invention The present invention provides a method for det~r~;n;ng the location of a tip of a catheter located in biological tissue. The catheter includes a dlstal end, a proximal end, and a lumen positioned therebetween. The method includes providing a source ~ -:
which develops an external alternating magnetic field, W096107352 21 976~2 PCT~3951107~6 ~

to locate a detectort which is operable in generating a voltage when the source is proximate the detector. ~he detector is locked remote from the distal end of the lumen of the catheter.
The method further includes the steps of trimming the distal end of the catheter. The detector is then unlocked from within the lumen of the catheter and positioned proximate the trimmed dissal end of the catheter ~he catheter is then positioned within the biological t ssue and the source is placed proximate the detector toslocate the trimmed distal end of the catheter. : ~
~ he present invention also provides a catheter for use with a catheter tip location device. ~he catheter includes a proximal end, a distal end, and a lumen positioned therebetween, while the catheter tip location device includes a source pro~i~ing an alternating magnetic current and a detector positioned within the lumen of the catheter. ~he catheter tip location devlce is operable in detecting the position of the detecto~positioned within the lumen of the catheter. A lock i~ positioned at the proximal end o~
the catheter, the lock being selectively movable among a variety of locked positions, the lock operable in selectively locking the detector re~ote from the distal end in any position chosen by the caregiver or manufacturer.

Brief Description of the Drawinqs Figure 1 is a front view of a dual lumen chest catheter.
Figure 2 is a cross-sectional view of the chest cathetçr taken along the line 2-2.
Figure 3 is a front view of the catheter shown in Figure 1~=showing its distal end being trimmed.

W096107352 ~ 1 9 7 6 82 PCTIUS95110746 Figure 4 is a front view of a patient with the chest catheter of Figure 3 in place prior to removal of a detector.
Figure 5 is a front view of a patient with the ~
chest catheter of Figure 3 in place, with a device : ~_ operative in locating the tip of the catheter in use.
Figure 5A is a front view of a patient with the chest catheter o~ Figure l, with the catheter in operation.
Figure 6 is a front view of a PIC~ catheter having its distal end trimmed.
Figure 6A is a front view of a patient with the PICC catheter of Figure 6 in place, prior to removal of the detector.
Figure 7 is a cross sectional view of a detector assembly operative in locating the tip of a catheter.

Detailed Descri~tion of the Preferred ~mborl;r t.':
The present invention is directed toward a method and apparatus for placing a chest catheter or PICC catheter within a patient. The catheter includes a distal end, a proximal end, and at least one lumen positioned therebetween. The proximal end of the catheter includes a lock fittil~Lg. The method involves the steps of providing a catheter having a lumen and a detector locked within the lumen of the catheter where the detector is positioned remote from the distal end of -the catheter. The detector is operable in generating a voltage when a source is proximate the detector. ~ ~-The catheter is placed external to the body as to determine the proper length of the catheter. The distal end of the catheter is trimmed to the proper - ~ -length, and then the detector is nnl~ k~rl from within the lumen of the catheter. The detector is then repositioned proximate to the trlmmed distal end of the catheter and locked in place using the lock ~itting.

W096/07352 PCT~S95/10746 21~7682 ~

After the detector is repositioned, the catheter is positioned within the biological tissue~and the source is placed proximate the detector to locate the trimmed distal end of the catheter.
Referring now to the Figures in which like elements are numbered alike, the present invention is shown. The catheter shown in Figure 1 is a dual lumen chest catheter, while the catheter shown in Figure 6 is a PICC catheter. A significant difference i~ structure between the chest catheter of Figure 1 and the PICC
catheter of Figure 6 is dimension and the number of lumens each m~ay contain. For example, the greater diameter of the chest catheter shown in Figure 1 permits the multiple lumens disclosed in Figure 2. However, the method and apparatus of the present invention is not precluded fro~m use in multi-lumen PICCs.
With initial reference to Figure 1, there is shown a catheter loo having a first proximal end 102, a second proximal end 104 and a distal end 106. ~atheter loo ~f the f~rst preferred em~odiment includes three portions, which are connected by a Y shaped member 108.
Generally these portions are a lower portion 11~ and two pigtail porti~ns 112, lls.
Lower portion llO of catheter lO0, as shown in Figure 2, includes a ~irst lumen 116 and a sec~nd lumen 118 separated by a septum 119. First lumen 116 connects distal end lo~ to a first pigtail and first proximal end 102 and seco~d lumen 116 connects distal end 106 to second pigtail and second proximal end lOs. In one preferred embodiment, first lumen 116 has a larger lumen than that of second lumen llo.
Positioned on lower portion llO between Y
member 10~ and distal end 106 is a cuff 120.
Preferably, cuff 120 is constructed from Dacrbn, a 3~ registered tra~m~rk of E. I. Dupont De ~emours.
(Dacron is a~polyester fiber typically made from polyethylene~terephthalate.) Cuff 120 functions to W096/073~2 2 1 9 7 6 82 PCT~S9~ll0746 anchor catheter lD0 within the biological tissue after :~
placement. Specifically, and with reference to Figure 4, there is shown a chest catheter, which when implanted within a patient passes through a tunnel 250 bored within the chest of the patient. Catheter 100 is anchored by the biological tissue surrounding cuff 120 in tunnel Z50 which grows into cuff 12Q. Cuff 120 then assists in preventing infection within the patient.
Referring to Figures 1 and 3, a pair of fittings 132 and 134 are attached to first and second proximal ends 102, 104 of catheter 100, respectively.
Fittings 132 and 134 facilitate connection of catheter 100 to other medical devices, such as an infusion pump (not shown), which operates to deliver medicants through ~ 15 catheter lOD to the superior vena cava, for example.
In the first preferred embodiment of the present invention, a locking fitting 140 is attached to first proximal end 102 of catheter 100 at fitting 132. ~~
~ocking fitting 140 is preferably a locking hemostasis type valve which includes an aperture which decreases in .
size in response to twisting the valve. Uemostasis type valves ordinarily are used to prevent blood flow out of -the patient through the catheter Specifically, locking fitting 140 operates to lock a detector assembly 200, of 25 an apparatus for locating the tip of the catheter, into --place. The apparatus for locating the tip of the catheter is of the type described in commonly assigned U.S. Patent No. 4,905,698 the disclosure of which is ful~y incorporated herein by reference.
Referring to Figures 5 and 7, detector assembly 200 generally includes a detector 220 which has a magnetic core 210 wrapped by a wire 212. Wire 212 includes a first end and a second end both of which are : :
connected to an electronic controller 230. Magnetic core 210 including wire 212 which is wrapped therearound :h is generally referred to as detector 220. The detector assembly 200, as described in U.S. Patent 4,905,698, is . . . ~

W096/07352 PCT~S951107~6 2i q76~2 ~~

located in hollow jacket 225, while the detector is located at the tip of the hollow jacket.
In the preferred embodiment o~ the present inventlon detector assembly 200 is locked within ~irst lumen 116 of ~ower portion lIQ of catheter 100 proximate cuff 120 Detector assembly 200 is locked into position by locking ~itting 140. In the ~ir~t preferred embodiment, aetector assembly 200 passes through locking fitting 140, which operates to capture hollow jacket 225 :-of detector assembly 200.
As shown in Figure 3 fittings 130 and 132 are positioned on the proximal ends 102 and~10s of catheter 100. Becaus-e fittings 130 and 132 are positioned on proximal ends 102 and lQ4 of catheter 100, a caregiver cannot first:place catheter 100 and then trim the excess catheter le~gth off of the proximal end as taught by the priQr art. In the present invention, the caregiver first lays catheter 100 on the patient to determine the approximate length of catheter 100 nece~sary for the specific patient. The proper length is determined by the caregiver through reference to anatomical landmarks on the patient.
The caregiver then trims distal end 106 of catheter 100, as to define a trimmed distal end 107, as shown in Figure 3 so that it i8 the proper length. Once catheter 100 is trimmed to the proper length, the caregiver car~ loosen locking fitting 140 and reposition detector 220 of detector assembly 200 at trimmed distal end 107 of catheter 100.
The catheter can then be placed into the biological tissue using the techni~ues of commonly assigned U.5~ Patent No. 4,905,698, which has been previously incorporated by reference. The method and apparatus described in U.S. Patent ~o. 4,905,698 involves the use of detector 220, a source, shown as 235 in Figure 5, and a locator 240 Source~;.235 generates an alternating magnetic field which is placed proximate ~ W096/07352 21 9 7 6 8 2 PCT~S95110746 detector 220 by a locator 240. Detector 220 generates a S --voltage in response to the magnetic field when locator 240 is proximate detector 220. As stated above, detector is positioned proximate trim~ed distal end 107 of catheter 100. The phase of the voltage generated by detector 220 shifts as locator 240 passes over it. By referencing anatomical landmarks at the time the phase ~ -shift occurs, the caregiver can determine the location of detector 220, and thus the location of trimmed distal end 107 of catheter 100_ Once the trimmed distal end 107 of catheter 100 is placed, and located, locking fitting 140 is loosened and detector assembly 110 is removed. Detector assembly is removed by pulling it through lumen 116 of catheter 100.
As shown in Figure 5A, fittings 130 and 132 may each then be connected to a mating fitting 133 from a pump (not shown) or another catheter (not shown). In this fashion medicants may be delivered through the catheter to the patient.
It is to be understood that the above described method and constructlon is intended for use : -with any catheter, regardless of how many pigtail ends, which has a fitting or other structure on its proximal end and therefore prohibits the trimming of its proximal end after pl~pm~n~ Further, it is to be understood that the above-described method includes alternate methods of catheter tip location which include insertion or removal of a detector --With reference to Figures 6 and 6A, an example of a second type of catheter which in~ln~q a fitting at its proximal end is shown. Specifically, the catheter shown in Figure 6 is a PICC catheter 300 PICC catheter 300 accesses the cephalic vein proximate the arm of the patient and travels therethrough to the superior vena cava, where medicants may be delivered. As above, PICC : 1 catheter 300 ;n~ q a detector assembly 200 placed . . . _ _ . .. ... ... .. . .. . . _ _ _ _ _ W096/07352 PCTNS95110746 ~b 21 976~2 '' within its lumen, not separately shown, with detector 220 of detect:or assembly 200 positioned distal from the distal end of PICC catheter 300.
Generally, and with reference to ~igure 6, PICC catheter 300 does not include pigtails as the diameter of the lumen of PICC catheter 300 is too small.
PICC catheter 300 includes a distal end 304 having a fitting 330 and a proxim-al end ~0~. To place PICC
catheter 30~ using the method of the present invention, a caregiver-places PICC catheter 300 over the pasient to estimate the approximate length of PICC catheter 300, in a fashion similar to that described above. As shown in Figure 6, the caregivër then trims distal end 304 as to define a trimmed distal end 305 of PICC catheter 300.
On-ce the distal end of PICC catheter 300 has been trimmed, a locking fitting 341, preferably a locking hemostasis type valve, may be loosed and detector 220 of detector assembly 2Q0 may be placed proximate trimmed distal end 305 of PICC catheter 300.
PICC catheter 30Q may then be placed using the method taught in U.S. patent 4,905,698 to Strohl, previously incorporated by reference.
The present invention includes significant advantages over the prior art. These advantages include minimization of steps necessary in positioning a catheter. Minimization of the steps reduces the opportunity or error to occur. Errors which may occur in the placement of the catheter include cutting the detector assembly and nnne~ss~ry placement of catheters which have an improper length.
Additionally, PICC type catheters which travel a relatively great distance within the body can now be tracked using the non-intrusive method taught by United States Patent 4,905,698 to Strohl. This is a significant advantage in view of the various body pathway "intersections" which a PICC type catheter must pass, on its way to the superior vena cava, in which the ~ W096/07352 PCT~SgS/10746 21 q7682 catheter can deviate from its intended path during placement. If such deviation goes unchecked it can result in delivering much needed medicants to the wrong - -~
location. ~ -While the foregoing detailed description of the present invention describes the invention of the preferred em'oodiments, it will be appreciated that it is the intent of the invention to include all modifications and equlvalent designs. Accordingly, the scope of the present invention is intended to ~e limited only ~y the claims which are appended hereto. :=

Claims

What is claimed is:

1. A method sizing a catheter having a proximal end and a distal end and lumen therebetween, the catheter further including a source; and a detector locked within the lumen of the catheter remote from the distal end of the catheter, the detector operable in generating a voltage when the source is proximate the detector, the method comprising the steps of:
a) trimming the distal end of the catheter as to define a trimmed distal end;
b) unlocking the detector from within the lumen of the catheter; and c) positioning the detector proximate the trimmed distal end of the catheter.

2. A method as in claim 1 wherein said source is operative in generating an external alternating magnetic field.

3. A method as in claim 1 further comprising the step of locking the detector proximate the trimmed distal end of the catheter after positioning the detector proximate the distal end of the catheter.

4. A method as in claim 3 further comprising the steps of unlocking the detector and removing the detector.

5. A method as in claim 4, wherein the catheter includes a fitting at a proximal end, the method further comprising the step of connecting a mating fitting to the fitting.

6. A method as in claim 1, further comprising:
a) positioning the trimmed distal end of the catheter within biological tissue; and b) placing the source proximate the detector to locate the trimmed distal end of the catheter.

7. A catheter detection system, comprising:
a) a catheter including a proximal end, a distal end, and a lumen positioned therebetween;
b) a catheter tip location device including a source providing an alternating magnetic current and a detector positioned within the lumen of the catheter; the catheter tip location device operable in detecting the position of the detector positioned within the lumen of the catheter; and c) a lock positioned at the proximal end of the catheter, the lock being selectively movable between a locked position and an unlocked position, the lock selectively locking the detector remote from the distal end.

8. A catheter detection system as in claim 7 wherein the proximal end of the catheter includes a fitting.

9. A catheter detection system as in claim 7 wherein the lock comprises a locking hemostasis valve.

10. A catheter detection system as in claim 7 wherein the catheter includes a single distal end and multiple proximal ends, and multiple lumens therebetween, each of the multiple proximal ends including a fitting.

11. A catheter detection system as in claim 7 wherein the catheter is a chest-type catheter.

12. A catheter detection system as in claim 7 wherein the catheter is a peripherally inserted central catheter.

13. A catheter comprising:
a) a catheter body including a proximal end, a distal end, and a lumen positioned therebetween;

b) a catheter detector positioned within the lumen of the catheter remote from the distal end of the catheter; and c) a lock positioned at the proximal end of the catheter, the lock being selectively movable between a locked position and an unlocked position, the lock operable in selectively locking the detector remote from the distal end, the lock locking the detector at the remote location.