METHOD AND DEVICE FOR SAFE PERCUTANEOUS PERICARDIAL DRAINAGE

Abstract

A safe, reliable, reproducible system and method for entry into the pericardial sac. The method and system described generally includes penetration of the subcutaneous tissue with a guide sheath or a relatively blunt stylet contained within a sheath. The stylet is removed from the sheath and a vacuum mechanism is installed. Once in contact with the pericardium, the sheath is engaged with the pericardial tissue, allowing the vacuum mechanism to draw the pericardium away from the heart to create a greater space between the heart and pericardium allowing needle insertion onto the pericardial cavity in a much safer and controlled manner.

Claims

1. A system for safe entry to a pericardial membrane, comprising: an outer sheath with at least one lumen therein; and a means of drawing suction within said lumen, said suction engaging said pericardial membrane when said outer sheath is in contact with said pericardial membrane.

2. The system of claim 1, wherein said suction engages said pericardial membrane allowing it to be pulled away from the heart.

3. The system of claim 1, wherein said suction draws a portion of said pericardial membrane into said lumen in said sheath.

4. The system of claim 3, wherein said suction engages said pericardial membrane allowing it to be pulled away from the heart.

5. The system of claim 1, further comprising a large bore needle inserted within said lumen of said sheath for penetrating said pericardial membrane.

6. The system of claim 5, further comprising a guide wire inserted within said large bore needle.

7. A method for safe entry through a pericardial membrane, comprising: inserting an outer sheath with at least one lumen therein through subcutaneous tissue to a position adjacent a pericardial membrane; and drawing suction within said lumen, said suction engaging said pericardial membrane when said outer sheath is in contact with said pericardial membrane; and

8. The method of claim 7, wherein said suction engages said pericardial membrane allowing it to be pulled away from the heart.

9. The method of claim 7, wherein said suction draws a portion of said pericardial membrane into said lumen in said sheath.

10. The method of claim 9, wherein said suction engages said pericardial membrane allowing it to be pulled away from the heart.

11. The method of claim 7, further comprising: penetrating said pericardial membrane using a large bore needle.

12. The method of claim 11, further comprising: Inserting a guide wire into said pericardial membrane through said large bore needle.

13. The method of claim 7 further comprising: pulling said pericardial membrane into said lumen in said sheath using said suction.

14. The method of claim 13, further comprising: penetrating said pericardial membrane using a large bore needle.

15. The method of claim 14, further comprising: Inserting a guide wire into said pericardial membrane through said large bore needle.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0016] In the drawings which illustrate the best mode presently contemplated for carrying out the present invention:

[0017] FIG. 1 is an illustration of a heart and the pericardium;

[0018] FIG. 2 illustrates the prior art method of gaining entry to the pericardium for drainage;

[0019] FIG. 3 is a diagrammatic view of an illustrative embodiment of a device in accordance with the teachings of the present invention;

[0020] FIG. 4 is a diagrammatic view of a method in accordance with the present disclosure

[0021] FIG. 5 is an expanded diagrammatic view of an illustrative embodiment of a device in accordance with the teachings of the present invention;

[0022] FIG. 6 is a diagrammatic view of an alternate illustrative embodiment of a device in accordance with the teachings of the present invention;

[0023] FIG. 7 is a diagrammatic view of an alternate method in accordance with the present disclosure;

[0024] FIG. 8 is a diagrammatic view of an additional alternate illustrative embodiment of a device in accordance with the teachings of the present invention;

[0025] FIG. 9 is a diagrammatic view of an additional alternate illustrative embodiment of a device in accordance with the teachings of the present invention;

[0026] FIG. 10 a diagrammatic view of a further additional alternate illustrative embodiment of a device in accordance with the teachings of the present invention; and

[0027] FIG. 11 is a diagrammatic view of an alternate method in accordance with the present disclosure;

DETAILED DESCRIPTION OF THE INVENTION

[0028] Now referring to the drawings, the method and system of the present invention provides a solution for the problems of the prior art by providing a safe, reliable, reproducible method for entry into the pericardial sac. In one embodiment, the system includes an outer large bore sheath or needle that provides a guide for a hooking mechanism that engages and grasps the pericardium. With the pericardium secure, it can be drawn away from the heart to create space for penetration through the pericardium for further procedures while reducing risk to the heart itself. In another embodiment the method and system described generally includes penetration of the subcutaneous tissue with a relatively blunt stylet contained within a sheath. The stylet is removed from the sheath and a hook mechanism is installed. Once in contact with the pericardium, the hook is engaged with the pericardial tissue, allowing the hook mechanism to draw the pericardium away from the heart to create a greater space between the heart and pericardium thereby allowing needle insertion into the pericardial cavity in a much safer and controlled manner.

[0029] Turning now to FIGS. 3 and 4 in a first exemplary embodiment, a system 10 is provided that generally includes a guide sheath 12 that can have a sharp tip 14 or a relatively blunt tip 16, a hook mechanism 18 includes an engagement member 20 on a proximal end thereof which allows for the pericardium to be engaged in a safe manner and includes a bore thereto guide a large bore needle 22 and optionally a guide wire 24. The hook mechanism preferably includes a hook end 26 that is disposed approximately 90 degrees to the direction that the guide sheath 12 and or the large-bore needle 22 is pointed.

[0030] The arrangement of the system 10 is configured such that the possibility for over-penetration through the pericardium by the needle 22 is avoided or significantly minimized by several mechanisms. First, the direction of initial penetration into the pericardium by the hook end 26 is now pointed “sideways” or approximately 90 degrees relative to the plane of entry into the pericardium. Second, the depth of initial penetration is significantly limited to a few millimeters.

[0031] Turning now to FIG. 4, the method of using the system 10 of the present disclosure is illustrated. The guide sheath 12 is inserted through the subcutaneous tissue until it is proximate the pericardium 28 as seen at illustration a of FIG. 4. The hook mechanism 18 is then extended from the sheath 12 to allow the hook end 26 of the engagement member 20 to reach the pericardium 28. With slight pressure, the hook end 26 of the engagement member 20 penetrates the pericardium 28 and with a rotation of the hook mechanism the engagement member captures the pericardium as seen at illustration c.

[0032] Once the pericardium 28 is securely grasped by the engagement member 20 on the hook mechanism 18, the pericardium 28 can be pulled back, away from the heart 30 to create a greater distance between the heart 30 and the location at the pericardium 28 that is the subsequent needle entry site. As shown at illustration d. Finally, at illustration d the needle 22 can be seen inserted through the pericardium 28 and into the pericardial cavity 32 as well as the insertion of a guide wire 24 for assistance with further procedures. In the manner the system 10 allows entry to the pericardial cavity 32 a much safer, more controlled manner.

[0033] In one embodiment, once hooked by the engagement member 20, the pericardium 28 can be grasped and pulled back into a blunt end guide sheath 12. This allows for additional safety in that the pericardial penetration by the large-bore needle 22 can be performed within the confines of the sheath 12. This ensures that the tip of the large-bore needle 22 never leaves the confines of the sheath 12 and therefore remains “safe” at all times. This can be combined with a large bore needle that has a “limiting” mechanism that eliminates the ability of the needle to penetrate beyond the end of the stylet.

[0034] Turning to FIG. 6, an alternate embodiment illustrates the system 110 wherein a blunt plastic or metal tip in the form of a stylet 116 is positioned at the end of the sheath 12. In this manner the blunt stylet 116 is used to deliver the system into contact with the pericardial surface in a manner that penetrates subcutaneous tissues but does not penetrate the pericardial sac itself as the pericardial sac is a much tougher tissue. This can be helpful, especially with imaging, in demonstrating that the system is properly positioned in direct contact with the pericardium.

[0035] Further, the hook mechanism 18 is shown to include two engagement members 120 extending from its tip and positioned at approximately a 90-degree angle relative to the direction of insertion with the two hook ends 126 being positioned such that rotation allows them to penetrate and grasp the pericardium.

[0036] As can be seen in FIG. 7 at illustration a, the blunt stylet 116 is used to deliver the system 110 into contact with the pericardial surface in a manner that penetrates subcutaneous tissues but does not penetrate the pericardial sac 28 itself. The blunt tipped stylet 116 is then removed through the existing sheath 12 as shown at illustration b and is exchanged for the hooking mechanism 18 as shown at illustration c. The hooking mechanism 18 is rotated such that the engagement member 120 penetrates grasps the pericardium 28 safely.

[0037] Once safely grasped, the pericardium 28 is pulled back away from the heart 30. The pericardium 28 may or may not be pulled partially into the sheath 12 as shown at illustration d, where the large bore needle 22 is introduced, either through the center lumen/cannula of the hooking mechanism 18 or in parallel but adjacent the hooking mechanism but within the sheath 12. Once the needle 22 has been safely introduced through the pericardium 28 as shown in illustration e, a guide wire 24 is placed in standard fashion to allow further procedures.

[0038] At this point in the procedure the guide wire 24 can be left positioned within the pericardium 28 while the remaining hardware is removed, and the procedure is completed in standard fashion. Alternatively, if necessary, tension can be maintained on the grasped pericardium to allow for greater space (distance from the heart) with which to work while the drain is placed.

[0039] In one embodiment the hooking mechanism may consist of one or several (usually symmetrical) barbs. Alternately there may be one or more helical, corkscrew shaped extensions of the barbs. Still further, the hooking mechanism may be one or more barbs extending from the end of end of the hooking mechanism. Still further the hooking mechanism may have a lumen therein to allow insertion of a large bore needle or may be solid wherein a large bore needle is inserted adjacent thereto within the sheath.

[0040] Turning to FIG. 8, an alternate embodiment illustrates the system 210 wherein a hooking mechanism 220 is positioned at the end of the sheath. The hooking mechanism is two opposed arms 230 with barbs thereon such that closing the arms 230 relative to one another grasp the pericardium 20. In this manner the grasping arms stabilize pericardial sac to allow delivery of the needle 22 and guide wire 24.

[0041] Further, the hook mechanism 18 is shown to include two engagement members 120 extending from its tip and positioned at approximately a 90-degree angle relative to the direction of insertion with the two hook ends 126 being positioned such that rotation allows them to penetrate and grasp the pericardium.

[0042] Turning to FIG. 9, an embodiment is shown that illustrates the system 310 including an outer sheath 312 with a needle 22 positioned therein. A stabilizer 314 may be employed to maintain the position of the needle 22 within the bore of the sheath 312. When the sheath 312 is positioned adjacent the pericardium a knob 316 can be rotated which engages with threading 318 on the needle 22 causing the needle to advance in a controlled fashion out of the sheath thereby penetrating the pericardium.

[0043] Alternately as shown at FIG. 10, an embodiment is shown that illustrates the system 410 including an outer sheath 412 with a needle 22 positioned therein. A grasping mechanism 420 is shown on the end of the sheath. The needle is in a fixed position relative to the sheath while the sheath is rotatable. The grasping mechanism 420 penetrates the pericardium 28 and then the sheath and grasping mechanism are rotated using knob 416 causing the pericardium 28 to be drawn down onto the needle.

[0044] In another embodiment, the grasping mechanism may be a corkscrew positioned 90 degrees relative to the to the previous embodiment described.

[0045] As can be seen in FIG. 11 at illustration a, the blunt stylet 116 is used to deliver the system 110 into contact with the pericardial surface in a manner that penetrates subcutaneous tissues but does not penetrate the pericardial sac 28 itself. The blunt tipped stylet 116 is then removed through the existing sheath 12 as shown at illustration b and the sheath 12 is extended into contact with the pericardial sac 28 as shown at illustration c. A vacuum is applied on the lumen of the sheath 12 such that the vacuum engages and grasps the pericardium 28 safely drawing it downwardly into the lumen of the sheath 12 as shown in illustration d. The suction draws the pericardium into a safe zone into the distal end 29 of the sheath 12. In this manner, the pericardium is “grasped” using only suction which is a non-penetrating mechanism. Without a penetrating mechanism that extends beyond the distal end 29 of the sheath 12, the heart cannot be injured. Suction, itself, will not be able to affect the heart, only the outside of the pericardium.

[0046] Once safely grasped, the pericardium 28 is pulled back away from the heart 30. The pericardium 28 may or may not be pulled partially into the sheath 12 as shown at illustration d, where the large bore needle 22 is introduced, through the center lumen/cannula of the sheath 12. Once the needle 22 has been safely introduced through the pericardium 28 as shown in illustration e, a guide wire 24 is placed in standard fashion to allow further procedures.

[0047] At this point in the procedure the guide wire 24 can be left positioned within the pericardium 28 while the remaining hardware is removed, and the procedure is completed in standard fashion. Alternatively, if necessary, tension can be maintained on the grasped pericardium to allow for greater space (distance from the heart) with which to work while the drain is placed.

[0048] It can therefore be seen that the present disclosure provides a unique solution to the problem of safe percutaneous entry into the pericardial sac. For these reasons, the present disclosure is believed to represent a significant advancement in the art, which has substantial commercial merit.

[0049] While there is shown and described herein certain specific structure embodying the invention, it will be manifest to those skilled in the art that various modifications and rearrangements of the parts may be made without departing from the spirit and scope of the underlying inventive concept and that the same is not limited to the particular forms herein shown and described except insofar as indicated by the scope of the appended claims.