PEN NEEDLE HUB WITH A PATIENT CONTACT SURFACE
20230077792 · 2023-03-16
Assignee
Inventors
- Sean Sullivan (Ridgewood, NJ, US)
- David Huang (Hayward, CA, US)
- Brendon Hill (Haworth, NJ, US)
- Sudarsan Srinivasan (Hawthorne, NJ, US)
- Christopher Rini (Raleigh, NC, US)
- Richard Klug (Roxboro, NC, US)
- Bruce Roberts (Hillsborough, NC, US)
- Didier Morel (Meylan, FR)
- Ronald Pettis (Cary, NC, US)
Cpc classification
A61M5/343
HUMAN NECESSITIES
A61M5/3202
HUMAN NECESSITIES
International classification
A61M5/32
HUMAN NECESSITIES
Abstract
A needle-bearing hub for a pen needle is provided with a distal patient-facing side having an enlarged surface for contact with the subject's skin. The enlarged surface is provided with a radius of curvature that increases the likelihood that the needle reaches full injection depth when an injection is performed at an inclined angle with respect to the surface of the skin and with to the desired depth less discomfort to the patient.
Claims
1.-26. (canceled)
27. A pen needle, comprising: a hub having a recess on a proximal side for receiving a medication pen body and a distal face forming a skin contact surface; and a cannula received in the hub and extending from the distal face, the cannula having a distal end for injection into a subject's skin and a proximal end for positioning in a medication compartment of the pen body, wherein the distal face comprises: an annular outer portion at a peripheral edge of the distal face; an annular inner portion surrounding the cannula; and a continuous convex surface extending between the annular outer portion and the annular inner portion.
28. The pen needle of claim 27, wherein the distal face has a width greater than 3.0 mm.
29. The pen needle of claim 27, wherein the distal face has a width in a range of 6.0 mm to 8.0 mm.
30. The pen needle of claim 27, wherein the convex surface has a radius of curvature in a range of 3.0 mm to 16.0 mm.
31. The pen needle of claim 27, wherein the convex surface has a radius of curvature in a range of 6.0 mm to 8.0 mm.
32. The pen needle of claim 27, wherein the annular outer portion and the annular inner portion are aligned in a continuous curve.
33. The pen needle of claim 32, wherein the continuous curve has a radius of curvature in a range of 3.0 mm to 16.0 mm.
34. The pen needle of claim 32, wherein the continuous curve has a radius of curvature in a range of 6.0 mm to 8.0 mm.
35. The pen needle of claim 32, wherein a radius of curvature of the continuous curve is concentric with a radius of curvature of the annular recess.
36. The pen needle of claim 27, wherein the annular outer portion and the annular inner portion project axially outward from the convex surface.
37. The pen needle of claim 27, wherein the annular outer portion comprises an axial surface that is inclined with respect to an axial dimension of the hub.
38. The pen needle of claim 27, wherein the annular inner portion is spaced axially outward from the annular outer portion.
39. The pen needle of claim 27, wherein the convex surface is an annular recess.
40. The pen needle of claim 27, wherein the annular inner portion comprises a substantially flat axial face.
41. A medication pen assembly, comprising: a medication pen comprising a pen body having a medication compartment and a distal end; and a pen needle, configured to be attached to the medication pen and comprising: a hub having a recess on a proximal side for receiving the pen body and a distal face forming a skin contact surface; and a cannula received in the hub and extending from the distal face, the cannula having a distal end for injection into a subject's skin and a proximal end for positioning in a medication compartment of the pen body, wherein the distal face comprises: an annular outer portion at a peripheral edge of the distal face; an annular inner portion surrounding the cannula; and a continuous convex surface extending between the annular outer portion and the annular inner portion.
42. A pen needle, comprising: a hub having a recess on a proximal side, for receiving and coupling to a pen body, and a distal face forming a skin contact surface; and a cannula received in the hub and extending from the distal face, the cannula having a distal end for injection into a subject's skin and a proximal end for positioning in a medication compartment of the pen body, wherein the distal face comprises: an annular outer portion at a peripheral edge of the distal face; an annular inner portion surrounding the cannula; and an annular recess forming a continuous convex surface and extending between the annular outer portion and the annular inner portion, wherein the annular outer portion and the annular inner portion project axially outward from the annular recess.
43. The pen needle of claim 42, wherein the annular inner portion is spaced axially outward from the annular outer portion.
44. The pen needle of claim 42, wherein: the distal face has a width in a range of 6.0 mm to 8.0 mm; and the annular recess has a radius of curvature in a range of 6.0 mm to 8.0 mm.
45. The pen needle of claim 42, wherein: wherein the annular outer portion and the annular inner portion are aligned in a continuous curve; and a radius of curvature of the annular recess is concentric with a radius of curvature of the continuous curve.
46. A pen needle, comprising: a hub having a recess on a proximal side for receiving a medication pen body and a distal face forming a skin contact surface; and a cannula received in the hub and extending from the distal face, the cannula having a distal end for injection into a subject's skin and a proximal end for positioning in a medication compartment of the pen body, wherein the distal face comprises: an annular outer portion at a peripheral edge of the distal face; an annular inner portion surrounding the cannula; and an annular recess forming a continuous convex surface and extending between the annular outer portion and the annular inner portion, wherein: the annular outer portion and the annular inner portion project axially outward from the annular recess; the annular inner portion is spaced axially outward from the annular outer portion; and the annular outer portion and the inner annular portion are aligned in a continuous curve.
47. The pen needle of claim 46, wherein: the annular recess has a radius of curvature in a range of 6.0 mm to 8.0 mm; the continuous curve has a radius of curvature in a range of 6.0 mm to 8.0 mm; and the distal face has a width in a range of 6.0 mm to 8.0 mm.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The following is a brief description of the drawing in which:
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DETAILED DESCRIPTION OF THE INVENTION
[0042] A “medication pen” is used herein to refer to a device having a medication compartment, typically containing multiple doses of medication, and a separate pen needle. The phrase “pen needle” refers to a needle-bearing assembly which can be attached to the medication pen body so that a proximal end of the pen needle assembly accesses a medication compartment and a distal end is adapted for insertion into an injection site to perform one or more injections. The terms “needle” and “cannula” are used herein interchangeably to refer to a thin tubular member having a sharpened or beveled end for insertion into an injection site on a subject. As used herein, the “distal” direction is in the direction toward the injection site, and the “proximal” direction is the opposite direction. “Axial” means along or parallel to the longitudinal axis of the needle and the “radial” direction is a direction perpendicular to the axial direction.
[0043] The position of the subcutaneous layer in a subject's tissue and the desired injection depth vary depending on the age of the patient, the part of the body where the injection is administered, etc. Therefore, an injection depth in absolute terms cannot be considered a critical aspect of the invention. However, as general guidance, the intradermal (ID) layer in adults has a thickness of around 2 to 3 mm, so that ID injection depth is in a range of about 0 to 3 mm, depth being measured from the outer surface of the skin. The subcutaneous (SC) region thickness can vary widely depending on the location of the injection site on the subject's body and the subject's body mass index (BMI). The average thickness of the SC space is in the range of about 7 mm to about 12 mm, so that SC injection depth is in a range of about 3 to 15 mm. The SC region may be further subdivided into the shallow subcutaneous (SSC) layer, having a thickness of about 1 mm, and an injection depth of about 2 to about 4 mm, the SC layer having a thickness of about 4 mm, at a depth of about 3 to 7 mm, and the deep subcutaneous (DSC) layer, having a thickness of about 4 mm, and a depth of about 7 to about 12 mm. If injections from a device occur in the upper region of the subcutaneous space (SSC), it is more likely that an ID injection will occur with that device. If injections from a device occur in the deeper regions of the subcutaneous space (DSC), it is more likely that an IM injection will occur with that device. Insulin is preferably delivered to the SC space. Injections to either the ID or intramuscular (IM) space may result in different uptake of insulin from what is prescribed.
[0044] The position of different regions and layers in the tissue of different subjects may be ascertained using ultrasound imaging. These techniques also may be used to determine the location of a medication depot after injection for an empirical determination whether a particular injection was “shallow,” (i.e., the depot is found at less than a predetermined optimal depth). These observations in turn may be used to verify that the number of shallow injections is reduced. If an injection is intended to be deposited in the SC region, a “shallow injection” is defined as an injection in which the depot is in the SSC or ID region.
[0045] The invention is directed to an injection device having a cannula with a predetermined length for penetrating the skin to a predetermined penetrating depth. The injection device has a skin contact surface for contacting and deforming the skin when the cannula penetrates the skin to assist in controlling the depth of penetration at various angles of injection with respect to the surface of the skin. The contact surface has a predetermined shape, width and height to control the depth of penetration into the skin to the desired layer of the skin. It has been found that the penetration force with a device having a small narrow skin contact surface of about 3 mm or less forms a deep indentation in the skin around the cannula when the device is pressed against the skin during use. The indentation formed in the outer surface of the skin often results in the cannula penetrating deeper into the skin to skin layers deeper than intended by the user. By way of example, a 4.0 mm cannula mounted in a post having a width of about 3 mm can result in the contact surface forming a concave depression in the surface of the skin so that the cannula can penetrate the deeper than 4 mm and penetrate the deeper layers of the skin that can cause pain or discomfort to the user. The deeper penetration can also cause the cannula to deliver the drug to layers of the skin that are less effective in delivering the drug to the patients.
[0046] The skin contact surface of the pen needle device surrounding the cannula has a width and height configured for providing greater control of the depth of penetration by the cannula. In one embodiment of the invention, the pen needle device is configured to obtain a cannula penetration of about 4 mm. The skin contact surface is further configured to control the shape, width and depth of deformation of the skin surface when the device is pressed against the skin during the penetration of the cannula. The width is determined as being the surface area that contacts the skin during the insertion of the cannula and during the injection or delivery of the drug using a normal insertion force. The height refers to the linear distance between the outer peripheral edge of the contact surface and the proximal end of the contact surface.
[0047] The skin contact surface of the device in one embodiment has a surface area for contacting the skin of about 5.0 mm.sup.2 to about 70.0 mm.sup.2 surrounding the cannula. In various embodiments, the skin contact has a surface area of about 15 mm.sup.2 to 60 mm.sup.2. In one embodiment, the contact surface can have a surface area of about 45-55 mm.sup.2. The skin contact surface in the embodiments shown has a substantially circular or substantially circular shape with the cannula located along the center axis of the circular skin contact surface. The cannula in this embodiment has a length of about 4.0 mm to about 6.0 mm to penetrate the skin to a depth and skin layer for delivering the drug, and particularly insulin, to the most efficient depth of the skin.
[0048] The skin contact surface has a convex shape forming a continuous and uniform curvature extending from the outer edge of the hub to the distal end or outermost portion of the contact surface of the hub and the cannula so that the skin contact surface has a substantially semispherical or dome shape that contacts the skin during penetration of the cannula and delivery of the drug. The convex surface of the skin contact area can have a width or diameter of greater than 3.0 mm and typically about 6.0 to 8.0 mm and a height of about 0.5 to about 1.5 mm measured from the outer peripheral edge of the contact surface to the outermost center portion of the contact surface surrounding the cannula and spaced axially from the peripheral edge. In one embodiment the convex skin contact surface has a height of about 1.0 mm and a diameter of about 7.0 mm. The convex surface can have a radius of curvature of 6.0 to 16.0 mm. In various embodiments of the invention, the convex surface has radius of curvature of 6.0 to 9.0 mm. In other embodiments, the convex surface can have a radius of curvature of 6.0 to 7.0 mm. In one embodiment, the convex contact surface has a radius of curvature equal to or greater than the diameter of the contact surface. The radius curvature can be about 1 to 1½ times the diameter of the contact surface.
[0049] The ratio of the diameter (D) to the height (H) of the contact surface influences the depth of penetration of the cannula on insertion into the skin. Generally, the larger the ratio provides more surface area that will contact the skin and greater control of the depth of penetration. A smaller ratio D:H provides a smaller surface area that can compress the skin on insertion and result in a deeper penetration of the cannula. In certain embodiments, the ratio of the diameter to the height of the surface area can range from about 2:1 to 10:1. In other embodiments the ratio can range from about 5:1 to 8:1.
[0050] In one embodiment of the invention, the skin contact surface of the injection device has a hemispherical shape with an annular recess in the contact surface surrounding the cannula. The recess in one embodiment has a depth that enables the skin to contact the bottom of the recess when the device is pressed against the skin during the insertion of the cannula into the skin. The depth and width or diameter of the recess can be configured to form part of the contact surface to control the deformation of the skin surface during penetration of the cannula to control the depth of penetration. The recess can have a depth of about 0.4 to 1.0 mm and typically about 0.5 mm. The recess can be defined by an outer ring at the outer peripheral edge of the hub and the cannula or by an outer ring at the peripheral edge and a post or inner ring around the cannula at the center of the contact surface. In other embodiments, the recess formed in the skin contact surface can have a volume of about 0.4 to 3.0 μl.
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[0052] The distal face of the hub 10 generally has a diameter between 3.0 mm and 10.0 mm. Preferably the diameter is greater than 4.0 mm, more preferably greater than 5.0 mm, and still more preferably, 6.5 mm or greater. It has been found that a relatively large surface area contacting the skin affords a more stable and comfortable injection with less compression of the skin, as compared to the prior device shown in 1D of
[0053] In addition to increased surface area, at least a portion of the distal face of the hub according to the invention is curved outwardly to form a convex surface. The curved portion has a radius of curvature in a range of 3.0 mm to 16.0 mm, and preferably 6 mm to 8 mm. In one embodiment, the curved portion has a radius of curvature of about 7 mm.
[0054] The entire distal face need not be curved. For example, an area adjacent the cannula having a diameter of 0.5 mm to 7 mm may be flat, i.e., perpendicular to the axis of the needle, and an area adjacent the flat area and including the peripheral edge of the distal face may have a convex curvature. The curvature at the edge of the distal face allows a needle approaching an injection site at an angle to be reoriented with respect to the injection site to penetrate more deeply, whereas the edge of a distal hub having insufficient curvature on an edge (such as shown in 1A and 1B) may prevent the needle from penetrating into the injection site when the edge of the distal face of the hub engages the skin proximate the injection site. This can cause a lateral force against the cannula that can cause the cannula to bend by the insertion force.
[0055]
[0056]
[0057] Referring to
[0058] In the embodiment of
[0059] The hub 18 of
[0060] The inner ring 34 typically has a central bore that extends through the hub for receiving and mounting the cannula. The open end of the bore has a width slightly greater than the width of the bore for receiving an adhesive to fix the cannula to the hub. The open end forms an adhesive well with a diameter of about 1.0 to 2.0 mm and typically about 1.74 mm. The adhesive is placed in the open end without projecting from the contact surface of the axial face.
[0061] As shown in
[0062] The cannula 20 in the embodiments shown has a length of about 4.0 to 5.0 mm, typically about 4.0 mm to penetrate the skin to the desired depth for the efficient delivery of the drug and particularly insulin. The contact surface of the hub has a width and height to control the deformation and dimension of the indentation in the skin thereby controlling the depth of penetration of the cannula. The shape and dimension of the contact surface distribute the applied pressure upon full engagement to the skin surface. The contour in combination with the pressure distribution provides improve comfort to the patient. The height and surface area of the hub and the perimeter surface area influence the degree of compression and relaxation of the tissue for a given application force.
[0063] The hub 18 in the embodiment of
[0064] The hub 18 has a centrally located passage 58 for supporting cannula 20 and a recessed open end 60 for receiving an adhesive 62 as shown in
[0065] In another embodiment of the invention shown in
[0066] Contact surface 68 in the embodiment of
[0067] Contact surface 68 in the embodiment shown has a substantially convex shape with a height and width to provide the desired control of the compression of the skin and the depth of penetration of cannula 20. The distal outer face 74 of contact surface 68 as shown has an incline with respect to the axial dimension of hub 18 converging toward the outermost portion of contact surface 68 at the cannula 20 and having a substantially frustoconical shape. The distal face 80 of inner ring 76 has a similar shape inclined surface with a frustoconical shape aligned with distal outer face 74. In one embodiment distal face 80 and distal outer face 76 at aligned to form a convex shape having a radius of curvature as shown in
[0068] Bottom surface of recess 82 as shown in
[0069] Referring to
[0070] The annular recess 82 can have a radial width of about 2.0 to about 3 mm. The recess can have a volume of about 6.0 to 34.0 μl depending on the width and depth of the recess. In one embodiment the recess can have a volume of about 25.0 to 36.0 μl. The annular recess can have a radial width greater than the radial width of the inner ring and/or the outer ring. In the embodiment shown in
[0071] The distal contact face of the hub can have various configurations for providing the desired control for the depth of penetration of the cannula. In each embodiment, the distal contact face has a width or diameter to provide a sufficient surface area and height defined by the curvature of the contact face to minimize the depressing of the skin that can cause the cannula to penetrate the skin deeper than intended.
[0072] In the embodiment of
[0073] The axial distal face 96 of the outer ring 93 and the outer distal face 95 of the inner ring 94 form the skin contact surface and define the width and height of the contact surface. The inner ring 94 extends in an axial direction a distance greater than the outer ring 93 to define the height of the contact surface. As in the previous embodiments, the contact surface can have a height of about 0.5 to about 1.50 mm and a width of about 6.0 to 7.0 mm.
[0074] The axial distal face 96 of the outer ring 93 and the axial distal face 95 of the inner ring 94 in the embodiment shown have a round, curved surface to define a radius of curvature of the contact surface in a manner similar to the embodiment of
[0075] In another embodiment shown in
[0076] The distal face 106 has an inclined distal surface 114 with a substantially dome or semispherical shape extending between the peripheral edge 116 and the base 118 of the inner ring 108. The inclined distal surface 114 has a radius of curvature of about 6.0 to about 9.0 mm to form a continuous arc and radius of curvature. The inner ring 108 has an annular distal face 120 that is inclined to complement the incline and curvature of the distal surface 114.
[0077] In one embodiment the distal face 120 of the ring 108 has a semispherical shape with a radius of curvature substantially the same as the radius of curvature of the distal surface 114 so that the surfaces are concentric. The height of the inner ring 108 is selected to complement the width of the distal face so that the skin contacts the inner ring 108 and at least a substantial portion of the surface of the inclined distal surface during penetration of the cannula to control the depth of depression of the skin and the depth of penetration of the cannula. The contact surface can have a surface area of 30.0 to 50.0 mm.sup.2. The inclined surface 114 can have a surface area of about 31.0 to 33.0 mm.sup.2. The distal face 120 of the inner ring 94 can have a surface area of about 1.0 to about 3.0 mm.sup.2 and a diameter of about 2.0 to about 2.5 mm.
[0078] In the embodiment of
[0079] The distal face 128 is formed by a continuous inclined surface 134 forming a substantially continuous dome or semispherical shape with a radius of curvature of about 6.0 to about 10.0 mm. The inclined surface 134 forms a continuous surface surrounding the cannula 136. In the embodiment of
[0080] The distal surface 142 of outer ring 130 as shown in
[0081] In a further embodiment shown in
[0082] The outer ring 160 is formed by a cylindrical outer surface extending from the side wall and a substantially parallel inner surface 170. The distal face 156 in the embodiment shown is formed at an incline to slope radially outward from the center of the hub. The inner ring 164 has in substantially cylindrical inner surface 172 parallel with the inner surface of the outer ring 160. An annular recess 174 is formed between the outer ring 160 and the inner ring 164. In the embodiment shown, the recess 174 has depth of about 0.4 to about 0.6 mm, a volume of about 7.0 μl and a width or radius of about 1.0 to 1.5 mm. As in the previous embodiments, the recess has a width and a depth to enable the skin to contact the bottom face of the recess forming a central portion of the distal face forming the contact surface. The contact surface has a width of about 6.0 to 8.0 mm. Another embodiment shown in
[0083]
[0084] The contact surface defined by the distal face 212 has substantially convex shaped forming a dome or semispherical shape depicted by line 214 in
[0085] The post 210 as shown in
[0086] The outer ring 216 and the inner ring 218 in the embodiment shown have a height extending from the bottom wall 222 of the recess 220 to define the depth of the recess. The outer ring and inner ring have the same axial length so that the recess 220 has a substantially uniform and continuous depth extending between the outer radial edge and the inner edge of the recess. The outer ring 216 has an axial annular surface 224 that is inclined with respect to the axial dimension of the hub to form the convex distal face 212. The incline of the axial face 224 conforms to the radius of curvature of the distal face 212.
[0087] The inner ring 218 in the embodiment shown also has an axial face 226 with a curvature corresponding substantially to the curvature of the axial face 224 of the outer ring. The axial face 224 and axial face 226 are aligned along the curvature of the distal face 212 indicated by line 214. In the embodiment shown, the axial face 224 and axial face 226 are substantially the same width with substantially the same radius of curvature. The bottom wall 222 of recess 220 has a radius of curvature that is substantially the same as the radius of curvature of the distal face 212 as indicated by line 228 so that the contour of the bottom wall 22 is substantially parallel or concentric to line 214. The curvature of the distal face 212 defines a height of about 0.5 to 2.0 mm as measured from the outer edge of the outer ring to the axial face of the inner ring. In one embodiment the distal face 212 can have a height of about 1.0 to 1.5 mm
[0088] The inner ring 218 defines a central opening 230 for receiving and mounting a cannula 232 as in the previous embodiments. The opening 230 can have a diameter of 0.5 to 3.0 mm for securing the cannula to the hub. In one embodiment, the distal face 212 forming the skin contact surface can have a diameter of about 6.0 to 8.0 mm. The radial dimension or width of the annular recess 220 can be equal to the combined radial width of the inner ring and the outer ring. In the embodiment shown, the annular recess has a radial width about twice the radial width of each of the inner and outer rings. The axial face 224 and axial face 226 each can have radial width of about 0.3 to 0.7 mm and the annular recess 220 can have a radial width of about 0.6 to 1.4 mm. The annular recess can have a depth of about 0.3 to about 0.7 mm and typically about 0.5 mm. The cannula can have an axial length of about 4 to 5 mm. The combination of the cannula length with the distal contact surface having a radial diameter and height as defined herein provide control of the depth of penetration of the cannula during insertion into the patient. The width and curvature of the distal face provide the controlled depression of the skin to reduce the incidence of that cannula penetrating the skin to a depth deeper than desired during the drug delivery.
[0089] In various embodiments, the inner ring can have a diameter of about 2.0-4.0 mm and generally about 2.5-3.5 mm with a surface area of about 3-5 mm.sup.2. The inner ring can have a height of about 1.0-1.5 mm as measured from the outer periphery of the contact surface. The ratio of the diameter (D) of the inner ring to the height of the inner ring can range from about 2:1 to about 4:1 and generally about 2.5:1 to 3:1. The larger ratio provides a greater surface area that provides increased comfort to the patient and greater control of the insertion depth.
[0090] The depth of the recess can vary depending on the desire depth of penetration by the cannula. The radial dimension of the annular recess is typically greater than the radial dimension of the inner and outer rings. In the embodiment shown the radial dimension of the annular recess is greater than the combined radial dimension of the inner and outer rings. Generally the greater the depth of the recess the small contact surface area of the distal face and more deformation of the skin surface enabling deeper penetration by the cannula. The curvature of the distal surface of the inner and outer rings forming the contact surface can also vary. In the embodiments illustrated, the distal surface of the inner and other rings are substantially the same. In other embodiments, the distal surface of the inner ring can have a radius of curvature that is greater or smaller than the radius of curvature of the outer ring. In further embodiments, the distal surfaces of the inner ring and/or the outer ring can be substantially flat and formed in a plane substantially perpendicular to the axis of the cannula.
[0091] The hub device is suitable for use in a method of reducing shallow injections and for injecting a drug to a patient. The method includes providing a pen body having a medication compartment and a distal end configured for receiving a pen needle. The pen needle includes a hub having base with a recess on a proximal side for receiving and coupling to the pen body. As distal face and an opening extends between the proximal side and the distal face. The distal face of the hub has a diameter greater than about 3.0 mm. At least a portion of the distal face has a convex surface with a radius of curvature of about 3.0 to 16.0 mm. It has been found that a hub having a width of about 6.0 to 8.0 mm and a radius of curvature of about 12.0 to 16.0 mm provides a desired depth of penetration. In various embodiments the radius of curvature of the distal face forming the skin contact surface can be about one to one and a half times the diameter of the distal surface 212 to form a small curvature and a height of about 0.5 mm. A cannula is received in the opening in the hub and has a beveled end for injecting into the subject's skin, and a proximal end for positioning in the medication compartment of the pen body. The cannula is inserted into the subject's skin where the convex surface contacts the skin to limit the depressing and deforming the surface of the skin to control the depth of penetration of the cannula.
[0092] The above description of the preferred embodiments is not to be deemed as limiting the invention, which is defined by the appended claims. The disclosure is intended to enable the artisan of ordinary skill to practice variants of the invention described without departing from the scope of the invention. Numerical limitations herein, in the specification and in the claims, are understood to be limited by the modifier “about,” such that minor departures yielding equivalent results is within the scope of the invention. Features or dependent claim limitations disclosed in connection with one embodiment or independent claim may be combined in another embodiment or with a different independent claim without departing from the scope of the invention.