COMPRESSION DEVICE FOR CLOSING TISSUE OPENINGS AND METHODS OF USING THEREOF
20220142646 · 2022-05-12
Inventors
Cpc classification
A61B2017/12004
HUMAN NECESSITIES
A61B2017/086
HUMAN NECESSITIES
A61F2013/0028
HUMAN NECESSITIES
International classification
Abstract
A compression device for compressing an area of tissue surrounding a tissue opening to close the tissue opening. The device includes a compression support frame having an outer peripheral edge forming an arc whose central angle is less than 180° and greater than 45°. The device also includes a compression support and a tension member. The compression support is mounted on the compression support frame, and the tension member is selectively slidable in relation to the compression support.
Claims
1. A device for closing a tissue opening, the device comprising: a compression support frame having an outer peripheral edge forming an arc whose central angle is less than 180° and greater than 45°; a compression support mounted to the compression support frame; and a tension member selectively slidable in relation to the compression support.
2. The device for closing of claim 1, wherein the central angle is less than about 180° and greater than about 60°.
3. The device for closing the tissue opening of claim 1, wherein the central angle is less than about 150° and greater than about 90°.
4. The device for closing of claim 1, wherein the compression support is rotatably mounted to the compression support frame.
5. The device for closing of claim 1, wherein the compression support frame comprises a body having an adhesive configured to be adhered on a tissue contact side of the body.
6. The device for closing of claim 1, wherein the compression support comprises an opening to accommodate the tension member.
7. The device for closing of claim 1, wherein the compression support comprises an opening to accommodate the tension member and a pawl to releasably engage complementary structures on the tension member.
8. The device for closing of claim 7, wherein the complementary structures comprise teeth formed in the tension member.
9. A device for closing a tissue opening, the device comprising: a compression support frame having an outer peripheral edge forming an arc whose central angle is less than 180° and greater than 45°; a plurality of compression supports mounted to the compression support frame; and a plurality of tension members, each tension member being selectively slidable in relation to at least two compression supports of the plurality of supports.
10. The device for closing of claim 9, wherein the central angle is less than about 180° and greater than about 60°.
11. The device for closing the tissue opening of claim 9, wherein the central angle is less than about 150° and greater than about 90°.
12. The device for closing of claim 9, wherein the compression support is rotatably mounted to the compression support frame.
13. The device for closing of claim 9, wherein the compression support frame comprises a body having an adhesive configured to adhere on a tissue contact side of the body.
14. The device for closing of claim 9, wherein each of the plurality of compression supports comprises an opening to accommodate the tension member and a pawl to releasably engage complementary structures on the tension member.
15. The device for closing of claim 14, where the complementary structures comprise teeth formed in the tension member.
16. A method for compressing an area of tissue of a patient for closing a tissue opening, comprising: attaching an adhesive side of a first compression support frame on a first area of tissue of a patient surrounding a vascular access site to gather epidermal tissue of the first area; attaching an adhesive side of a second compression support frame on a second area of the patient surrounding the vascular access site to gather epidermal tissue of the second area; attaching a first tension member to the first compression support frame and the second compression support frame; tightening a portion of the first tension member between the first compression support frame and the second compression support frame to push the gathered epidermal tissue toward the tissue opening; keeping the first tension member tightened for a predetermined period of time to cause the tissue opening to close; releasing the first tension member after keeping the tension member tightened for a predetermined period; and removing the first compression support frame and the second compression support frame from the respective first area and second area of tissue.
17. The method of claim 16, wherein a pressure applied to the first area and second area of tissue surrounding the vascular access site is controlled at a range between 2 lbf (8.9 Newtons) to 12 lbf (53.4 Newtons).
18. The method of claim 16, wherein the first area or the second area is upstream or downstream from the vascular access site based on a direction of blood flow.
19. The method of claim 18, the method further comprising: attaching a second tension member to both the first compression support frame and the second compression support frame; and tightening a portion of the second tension member between the first compression support frame and the second compression support frame to push the gathered epidermal tissue toward the tissue opening.
20. The method of claim 19, wherein the first tension member and the second tension member intersect each other.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] In order to describe the manner in which the above-recited and other advantages and features of the invention can be obtained, a more particular description of the invention briefly described above will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. Understanding that these drawings depict only typical embodiments of the invention and are not therefore to be considered to be limiting of its scope, the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
[0015]
[0016]
[0017]
[0018]
[0019]
[0020]
[0021]
[0022]
[0023]
[0024]
[0025]
DETAILED DESCRIPTION
[0026] One or more specific embodiments of the present disclosure will be described below. In an effort to provide a concise description of these embodiments, some features of an actual embodiment may be described in the specification. It should be appreciated that in the development of any such actual embodiment, as in any engineering or design project, numerous embodiment-specific decisions will be made to achieve the developers' specific goals, such as compliance with system-related and business-related constraints, which may vary from one embodiment to another. It should further be appreciated that such a development effort might be complex and time consuming, but would nevertheless be a routine undertaking of design, fabrication, and manufacture for those of ordinary skill having the benefit of this disclosure.
[0027] One or more embodiments of the present disclosure may generally relate to devices and methods for closing a tissue opening and/or providing hemostasis. The compression devices and method may be used to compress tissue near the vascular access site for closing the tissue opening caused by the vascular access. As used here, like reference numerals will be used for like structures and the discussions or disclosure of one feature is also applicable to other like features and structures.
[0028] While the present disclosure will describe a particular implementation of the compression devices and methods, it should be understood that the compression devices and method described herein may be applicable to uses, including and not limited to compressing tissue areas for other purposes and/or closing tissue openings caused by other means. Additionally, elements described in relation to any embodiment depicted and/or described herein may be combinable with elements described in relation to any other embodiment depicted and/or described herein.
I. Introduction
A. Vascular Access
[0029] Vascular access is one of the most basic yet critical components of patient care both in hospitals and in ambulatory patient settings. Safe and reliable vascular access is an important issue in daily practice. Access is most commonly achieved via the Seldinger technique.
[0030] The most common form of vascular access is a peripheral venous cannula which is generally inserted into veins of the hands, forearms, and occasionally feet. A catheter is introduced to the vascular system at a convenient access location and guided through the vascular system to a target location using established techniques. In some situations, vascular access is obtained by inserting catheters into the large central vessels of the body, such as the internal jugular, subclavian, or femoral vessels. This type of vascular access may be done with central venous catheters (CVCs), and is required in certain situations where peripheral access is inadequate. Such situations include, but are not limited to, the need for long-term vascular access, administering of medications that can damage smaller veins (e.g., chemotherapy), measuring central venous pressure, or obtaining certain blood tests (e.g., central venous oxygen saturation). Midline access is a type of peripheral vascular access inserted into peripheral veins that extends farther than standard peripheral catheters but does not yet reach the large central veins of the thorax. They are used when intermediate-term access is needed or when administering medications that are highly irritating to smaller veins.
II. Device for Closing a Tissue Opening
[0031]
[0032] The first and second tension members 332a, 332b have a released state and a locked state. When the first and second tension members 332a, 332b are in the released state, the first and second tension members 332a and 332b are selectively movable through the compression supports 322a, 322b, 322c, and 322d. When the first and the second tension members are in the locked state, at least a portion of the first and second tension members 332a, 332b engage the compression supports 322a, 322b, 322c, and 322d to selectively lock the tension member 332a, 332b relative to the corresponding compression supports 322a, 322b, 322c, or 322d. As such, the first and second compression support frames 310a, 310b are pushed towards the tissue opening 342 to close the tissue opening 338. The locking mechanism of engaging the portion of the tension member 332a or 332b with the compression supports 322a, 322b, 322c, or 322d will be further described later with respect to
[0033] In some embodiments, each of the first and second tension members 332a, 332b includes one or more complementary structures 339a, 339b, 339c, 339d. The one or more complementary structures 339a, 339b, 339c, and 339d are configured to engage the compression supports 322a, 322b, 322c, and 322d to selectively lock the position of the first and second tension members 332a, 332b in relation to the compression supports 322a, 322b, 322c, and 322d. The locking mechanism of engaging the complementary structure 339a, 339b, 339c, and 339d with the compression supports 322a, 322b, 322c, or 322d will be further described later with respect to
[0034]
[0035] The compression support frame 310a has an outer peripheral edge 316a forming an arc. The arc 316a is a part of a circle that has a center 315a. The central angle α of the arc 316a is less than 180° and greater than 45°. The compression support frame 310a also has an inner peripheral edge 317a. As illustrated in
[0036] The compression support frame 310a has a top side 312a and a bottom side 314a. The bottom side 314a is a side that is in contact with an area of tissue of a patient. Thus, the bottom side 314a is also referred to as the “tissue contact side.” To attach the compression support frame 310 to the epidermal tissue 341, at least a portion of the bottom side 314a of the mounting frame 310a includes a layer of adhesive 350a configured to gather epidermal tissue 341 in the contact area. Thus, the bottom side 314a is also referred to as the “adhesive layer.” The top side 312a is a surface that faces away from the area of tissue when the compression device is applied on the area of tissue.
[0037] The compression support frame 310a may be substantially planar, though in some configurations, the top side 312a and the bottom side 314a may have one or more convex portions or concave portions. The Y axis is parallel to a line I-I connecting the center 315a of the circle that the outer peripheral arc 316a is a part and a center point 313a of the outer peripheral arc 316a. Hereinafter, the direction of the Y axis is also referred to as the width direction. The X axis is parallel to a line II-II that runs through a center 311a of the line I-I and orthogonal to the line I-I. Hereinafter, the direction of the X axis is also referred to as the length direction. A direction of a Z axis is a direction that is orthogonal to the X-Y plane, pointing from the bottom side 314a toward the top side 312a Hereinafter, the direction of the Z axis is also called a thickness direction.
[0038] The compression device 300 also includes one or more compression support(s) 322a, 322b mounted to the compression support frame 310a. The one or more compression supports 322a, 322b can be fixedly or movably mounted to the compression support frame 310a. For instance, in some configurations, the one or more compression support(s) 322a, 322b are rotatably mounted to the compression support frame 310a, such that the compression support 322a, 322b is configured to rotate based on a tension force applied by the tension member 332a, 332b.
[0039]
[0040] As illustrated in
[0041] In some configurations, the opening 324 of the compression support 322a, 322b is sufficiently large to accommodate a portion of a ratchet mechanism 400 that selectively receives and engages with the tension member 332. For instance, as illustrated in
[0042] Ratchet wheels 404, with cams 406, cooperate with a pawl 408 mounted in an actuator handle 410 and a pawl 412 mounted to the compression support 322a, 322b. With both pawls 408, 412 biased towards the ratchet wheels 404 (as illustrated by the dotted arrows), rotation of the actuator handle 410 in one direction rotates the mandrel 402 through engagement between the pawl 412 and the cams 406, while such engagement also prevents reverse rotation of the mandrel 402. Reverse rotation of the mandrel 402 can be achieved by disengaging the pawls 408, 412 from the ratchet wheels 404 through overcoming the biasing force, as illustrated in
[0043]
[0044] In some configurations, the elongate member of the tension member 332 or at least a portion thereof is made from stretch fabric or material. In particular, the elongate member of the tension members may be made from one or more of the following: polymeric materials, metallic materials (such as, but not limited to, corrosion-resistant steels), a combination of polymeric and metallic materials, nylon, polycarbonate, fluoropolymer, glass, and/or carbon fiber reinforcement. In some configurations, the elongate member of the tension members may be made via wire cable inserted molding. In some configurations, the tension member 332 further includes a tension control mechanism, such that the tension force applied onto the tension member 332 cannot exceed a predetermined threshold, and when the tension member 332 is tightened to cause the tension to reach the predetermined threshold, the tension control mechanism prevents the tension member 332 from being further tightened. For example, in some embodiments, the tension force may be controlled by the shape of the ratcheting wheel 404 and the shape of the pawls of
[0045]
[0046] The one or more compression support(s) 322, 324 may be mounted at various positions and/or orientations of the top side or edges of the compression support(s) 322. Referring back to
[0047]
[0048] As previously described, the bottom side 314 of the compression support frame 310 includes adhesive 350 that is configured to be attached to an area surrounding a vascular access site to gather the epidermal tissue. When the tension member(s) 322a, 322b is tightened between the two compression supports (e.g., 322a, 322d), the adhesive 350 is configured to push or pull the gathered epidermal tissue toward the tissue opening 342 to close the tissue opening 342, while keeping the patient as comfortable as possible. To achieve this goal, the bottom side 314 of the compression support frame 310 having the adhesive 350 may be formed in a particular shape. In some configurations, at least a portion of the bottom side 314 is planar, such that the compression support frame 310 can be easily attached to the skin of the patient and gather a large area of flat epidermal.
[0049] In some configurations, the bottom side 314 is a convex-shaped surface that applies an even force to the epidermal tissue around the vascular access site evenly. The curved surface also prevents the edge of the compression support frame 310 from scratching or cutting the epidermal tissue when the epidermal tissue is compressed.
[0050]
[0051]
[0052] Similar to the bottom side 314, the top side 312 of the compression support frame 310 may also be formed in different shapes, e.g., flat or with various convex or concave portions.
[0053]
[0054] Generally, the compression support frame may be made from one or more of the following: polymeric materials (such as, but not limited to acetal, polycarbonate, PETG, HDPE, polypropylene), or a combination of polymer and metallic materials. Such materials may be glass or carbon fiber reinforced. In some configurations, the compression support(s) may be made from the same material of the compression support frame, and the compression support frame and the compression support(s) may be integrated as a single piece. In some configurations, the compression support(s) may be made from different materials of the compression support frame and attached to the compression support frame during manufacturing or at the time of use. Generally, the adhesive layer may be made from organic or inorganic materials. In some configurations, the adhesive is rubber, acrylic, and/or silicon-based. In some configurations, the adhesive layer is about 1 mm to 2.5 mm thick. In some configurations, in addition to adhesive, the compression frame may have microneedles to facilitate stability on the epidermis.
[0055] Generally, the length of the compression support frame is wider than a diameter of the procedural sheath for closure. For example, for an access site of up to 26-French catheter, the length of the compression support frame is between a range of about 40 mm to about 50 mm, the width of the compression support frame is between a range of about 20 mm to about 30 mm, the diameter of the circle, of which the outer peripheral arc is a portion, is between a range of about 30 mm to about 40 mm, and the diameter of the circle, of which the inner peripheral arc is a portion, is between a range of about 12 mm to about 20 mm.
III. Method of Using the Compression Device
[0056] The compression device described herein may be used to compress a vascular access site for closing the tissue opening caused by the vascular access. First, one or more compression support frame(s) is attached to an area of tissue surrounding the vascular access site prior to the vascular access. Referring to
[0057] The compression support frame 310a has two compression support 322a and 322b, and the compression support frame 310b has two compression support 322c and 322d. A first tension member 332a is inserted through the compression support 332a of the compression device 310a, and the compression support 332d of the compression device 310b. A second tension member 332b is inserted through the compression support 332c of the compression device 310b, and the compression support 332b of the compression device 310a. As such, the first tension member 332a and the second tension member 332b are positioned diagonally to allow the tension force applied onto the compression support frames 310a, 310b, which, in turn, passes on to the epidermal tissue via the adhesive 350a, 350b, to be evenly distributed along the arcs of the compression support frames 310a, 310b.
[0058] After the vascular access, each of the tension members 332a and 332b is tightened to apply a tension force onto the compression support frames 310a, 310b across directions pointing to the tissue opening 342, which are indicated by the arrows 232a, 232b, 232c, and 232d. As such, the tension force applied onto each of the compression support frames 310a and 310b is distributed substantially evenly to close the tissue opening and also keep the patient comfortable. The tension members 332a and 332b may be kept in the tightened state for a predetermined period that is between a range of about 15 minutes to about 600 minutes, before releasing them, depending on the vessel access site, the size of the access, the user of antiplatelet therapy, and/or the patient's condition and needs. Generally, for a small access site, the application period of the compression device could be in the range of about 60 minutes to as high as about 380 minutes.
[0059]
[0060] Thereafter, a tension member is attached to both the first compression support frame and the second compression support frame (act 1130). After the vascular access procedure is completed, a portion of the tension member between the first compression support frame and the second compression support frame is tightened to cause the first and second compression support frames to push or pull the gathered epidermal tissue toward the access site (act 1140). Since the tension member is attached to both the first compression support frame and the second compression support frame, the tension force generated by the tension member is substantially evenly applied onto both the first compression support frame and the second compression support frame towards the access site to provide better closure result and comfort to the patient. The tension member is kept as tightened for a predetermined period of time (e.g., 15-45 minutes) to cause the tissue opening to close (act 1150). Finally, the tension member is released, and the first and second compression support frames are released from the tissue of the patient (act 1160).
[0061] The articles “a,” “an,” and “the” are intended to mean that there are one or more of the elements in the preceding descriptions. The terms “comprising,” “including,” and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements. Additionally, it should be understood that references to “one embodiment” or “an embodiment” of the present disclosure are not intended to be interpreted as excluding the existence of additional embodiments that also incorporate the recited features. Numbers, percentages, ratios, or other values stated herein are intended to include that value, and also other values that are “about” or “approximately” the stated value, as would be appreciated by one of ordinary skill in the art encompassed by embodiments of the present disclosure. A stated value should therefore be interpreted broadly enough to encompass values that are at least close enough to the stated value to perform a desired function or achieve a desired result. The stated values include at least the variation to be expected in a suitable manufacturing or production process, and may include values that are within 5%, within 1%, within 0.1%, or within 0.01% of a stated value.
[0062] A person having ordinary skill in the art should realize in view of the present disclosure that equivalent constructions do not depart from the spirit and scope of the present disclosure, and that various changes, substitutions, and alterations may be made to embodiments disclosed herein without departing from the spirit and scope of the present disclosure. Equivalent constructions, including functional “means-plus-function” clauses are intended to cover the structures described herein as performing the recited function, including both structural equivalents that operate in the same manner, and equivalent structures that provide the same function. It is the express intention of the applicant not to invoke means-plus-function or other functional claiming for any claim except for those in which the words ‘means for’ appear together with an associated function. Each addition, deletion, and modification to the embodiments that falls within the meaning and scope of the claims is to be embraced by the claims.
[0063] The terms “approximately,” “about,” and “substantially” as used herein represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms “approximately,” “about,” and “substantially” may refer to an amount that is within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of a stated amount. Further, it should be understood that any directions or reference frames in the preceding description are merely relative directions or movements. For example, any references to “up” and “down” or “above” or “below” are merely descriptive of the relative position or movement of the related elements.
[0064] Following are some further example embodiments of the invention. These are presented only by way of example and are not intended to limit the scope of the invention in any way. Further, any example embodiment can be combined with one or more of the example embodiments.
[0065] Embodiment 1. A device for closing a tissue opening. The device includes a compression support frame having an outer peripheral edge forming an arc whose central angle is less than 180° and greater than 45°. The device also includes a compression support mounted to the compression support frame and a tension member selectively slidable in relation to the compression support.
[0066] Embodiment 2. The device of embodiment 1, wherein the central angle is less than about 180° and greater than about 60°.
[0067] Embodiment 3. The device of any of embodiments 1-2, wherein the central angle is less than about 150° and greater than about 90°.
[0068] Embodiment 4. The device of any of embodiments 1-3, wherein the compression support is rotatably mounted to the compression support frame.
[0069] Embodiment 5. The device of any of embodiments 1-4, wherein the compression support frame comprises a body having an adhesive configured to be adhered on a tissue contact side of the body.
[0070] Embodiment 6. The device of any of embodiments 1-5, wherein the compress support comprises an opening to accommodate the tension member.
[0071] Embodiment 7. The device of any of embodiments 1-6, wherein the compression support comprises an opening to accommodate the tension member and a pawl to releasably engage complementary structures on the tension member.
[0072] Embodiment 8. The device of any of embodiments 1-7, wherein the complementary structures comprise teeth formed in the tension member.
[0073] Embodiment 9. A device for closing a tissue opening. The device includes a compression support frame having an outer peripheral edge forming an arc whose central angle is less than 180° and greater than 45°. The device also includes a plurality of compression supports mounted to the compression support frame and a plurality of tension members, each of which is selectively slidable in relation to at least two compression supports of the plurality of supports.
[0074] Embodiment 10. The device of embodiment 9, wherein the central angle is less than about 180° and greater than about 60°.
[0075] Embodiment 11. The device of any of embodiments 9-10, wherein the central angle is less than about 150° and greater than about 190°.
[0076] Embodiment 12. The device of any of embodiments 9-11, wherein the compression support is rotatably mounted to the compression support frame.
[0077] Embodiment 13. The device of any of embodiments 9-12, wherein the compression support frame comprises a body having an adhesive configured to adhere on a tissue contact side of the body.
[0078] Embodiment 14. The device of any of embodiments 9-13, wherein each of the plurality of compression supports includes an opening to accommodate the tension member and a pawl to releasably engage complementary structures on the tension member.
[0079] Embodiment 15. The device of any of embodiments 9-14, the complementary structures include teeth formed in the tension member.
[0080] Embodiment 16. A method for compressing an area of tissue of a patient for closing a tissue opening. The method includes attaching an adhesive side of a first area of tissue of a patient surrounding a vascular access site to gather epidermal tissue of the first area, and attaching an adhesive side of a second compression support frame on a second area of the patient surrounding the vascular access site to gather epidermal tissue of the second area. Next, a first tension member is attached to the first compression support frame and the second compression support frame. A portion of the first tension member between the first compression support frame and the second compression support frame is tightened to push the gathered epidermal tissue toward the tissue opening, and the first tension member is kept tightened for a predetermined period of time to cause the issue opening to close. Finally, the first compression support frame and the second compression support frame are removed from the respective first area and second area of tissue.
[0081] Embodiment 17. The method of embodiment 16, the pressure applied to the first area and second area of tissue surrounding the vascular access site is controlled at a range between 2 lbf (8.9 Newtons) to 12 lbf (53.4 Newtons).
[0082] Embodiment 18. The method of any of embodiments 16-17, wherein the first area or the second area is upstream or downstream from the vascular access site based on a direction of the blood flow.
[0083] Embodiment 19. The method of any of embodiments 16-18, further includes attaching a second tension member to both the first compression support frame and the second compression support frame, and tightening a portion of the second tension member between the first compression support frame and the second compression support frame to push the gathered epidermal tissue toward the tissue opening.
[0084] Embodiment 20. The method of any of embodiment 19, wherein the first tension member and the second tension member intersect each other.
[0085] The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.