A catheter system includes a proximal base having a distal diagonal end surface and a distal tip connected to the proximal base and movable relative to the proximal base, wherein the distal tip has a proximal diagonal end surface. The distal diagonal end surface and the proximal diagonal end surface contact opposing sides of a tissue portion to create the fistula. A peripheral edge defines the proximal distal end surface. A proximal point is disposed on the peripheral edge. The proximal point comprises a shortened angle and a fully radiused edge relative to a remaining portion of the peripheral edge and a relief recess is disposed on a distal end of the proximal base, both for the purpose of minimizing tissue snagging.

Disclosed embodiments include apparatuses, systems, and methods for providing a sheath tip with an angled distal face to conform the sheath to a surface of tissue toward which the sheath is being extended to potentially help reduce or avoid tissue damage upon extending a sheath to convey an elongated instrument for sampling or treatment. In an illustrative embodiment, an apparatus includes a sheath tip positionable at an end of a sheath configured to convey an elongated medical instrument to a location adjacent a detection range of a detecting device. The sheath tip includes a distal member that extends a finite distance beyond the end of the sheath. The distal member is detectable by the detecting device when the end of the sheath is within the finite distance of the detection range of the detecting device.

A catheter system for creating an arteriovenous (AV) fistula includes a proximal base having a distal end surface. A distal tip is connected to the proximal base and is movable relative to the proximal base. The distal tip has a proximal end surface. The distal end surface and the proximal end surface are adapted to contact opposing sides of a tissue portion to create the fistula. A peripheral edge defines the distal end surface of the proximal base. A stop is formed in the peripheral edge and is configured to limit movement of the distal tip in a proximal direction.

An integrated catheter assembly includes a housing member, an outer lumen member extending from the housing member, and a needle member slidably or movably coupled to the housing member, wherein the needle member can be extended beyond a first port of the outer lumen member in a first position and concealed in the outer lumen member in a second position. The outer lumen member has a side port between its first and second ports such that when the needle is extended in the first position and inserted into an arteriovenous fistula, blood from the arteriovenous fistula flashes into the needle member, is diverted through a relief port of the needle member out the side port of the outer lumen member for delivery to a dialysis machine. The assembly further includes an inner lumen member that is disposable through the housing member to extend out from the same the outer lumen member to provide dialyzed blood from the machine. The assembly therefore receives and delivers blood through a single injection site.

A chest tube insertion device includes a semi-rigid curvilinear sheath body having a distal end and a proximal end, a lumen defined axially through the sheath body from the distal end to the proximal end, the lumen including a distal end opening at the distal end and a proximal end opening at the proximal end, and a tapered pneumostatic tube clamp at the distal end of the sheath body, the tube clamp including one or more clamp tabs angled radially inward toward the distal end opening. The chest tube insertion device is supported during insertion into the chest cavity by a stylet. The chest tube insertion device is also removable from a chest tube when a free end of the chest tube is positioned in the chest cavity of a patient.

In one aspect, a playback device includes a command-keyword engine having a local natural language unit (NLU). The playback device detects, via the command-keyword engine, a first command keyword in voice input of sound detected by one or more microphones of the playback device. The playback device determines whether the sound input data includes a keyword from a first predetermined library of keywords via a local natural language unit (NLU). The playback device transmits the input sound data to a second playback device over a local area network, the second playback device employing a second local NLU with a second predetermined library of keywords. The playback device receives a response from the second playback device and performs an action based on an intent determined by at least one of the first NLU or the second NLU according to the keywords in the voice input.

A medical instrument may include a tube, a sheath provided around and coaxial with the tube, and an inflatable balloon at a distal end of the sheath. The balloon may receive a fluid from a lumen of the sheath, and may have a central opening along a longitudinal axis thereof, and into which the tube extends, a proximal portion, a middle portion adjacent to and distal of the proximal portion, and a distal portion adjacent to and proximal of the middle portion. When the balloon is inflated with the fluid, a maximum diameter of the middle portion may be less than a maximum diameter of the proximal portion, and less than a maximum diameter of the distal portion. The medical instrument may also include an extraction member provided at a distal end of the tube, distal to the balloon, and movable axially relative to the balloon.

In some examples, a catheter may include an elongate body and a push assembly. The elongate body may include an inner liner defining an entry port into a lumen, and an outer jacket. The push assembly may an elongate member extending from a proximal portion to a distal portion, where a cross-section of the distal portion is D-shaped and tapers in a distal direction. Distal to a proximal end of the elongate body, a first portion of the elongate member may be positioned between a portion of the inner liner and a portion of the outer jacket, and proximal to the proximal end of the elongate body, a second portion of the elongate member may be positioned outside of the outer jacket and the inner liner.

Expandable sheaths and introducers are disclosed herein. In some examples, the expandable introducer includes an elongated body member, an inflatable balloon disposed between a proximal and distal end of the elongated body member, and an inflation lumen in fluid communication with the inflatable balloon. A portion of the balloon is sized and configured to pass through a distal opening of an expandable introducer sheath when in the deflated condition, and to dilate the distal end of the introducer sheath as the balloon expands from the deflated configuration to the inflated configuration. Methods of making and using the devices disclosed herein are also disclosed.

A surgical needle comprising: (a) a sensor; (b) a distal tip with the sensor being located at the distal tip; (c) a needle advancing mechanism that is adjustable to change an insertion depth; and (d) a control unit in communication with the needle advancing mechanism; wherein the sensor provides a signal to the control unit regarding a thickness of a feature of interest and the control unit controls the insertion depth based upon the signal from the sensor so that the insertion depth into the feature of interest is varied or the control unit prevents the needle advancing mechanism from activating.