US20130317368A1 - System for Mitigating the Effects of Tissue Blood Volume Changes to Aid in Diagnosing Infiltration or Extravasation in Animalia Tissue - Google Patents

Abstract

A system including a sensor and a device coupled to the sensor. The sensor is configured to detect in Animalia tissue (i) a first electromagnetic radiation extinction dominated by absorption of a first wavelength and (ii) a second electromagnetic radiation extinction dominated by scattering of a second wavelength. The device is configured to aid in diagnosing at least one of infiltration and extravasation in the Animalia tissue based on the first and second electromagnetic radiation extinctions detected by the sensor.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• This application is a continuation-in-part of U.S. application Ser. No. 13/794,776, filed 11 Mar. 2013, which claims the priority of U.S. Provisional Application No. 61/609,865, filed 12 Mar. 2012. This application is also a continuation-in-part of U.S. application Ser. No. 13/792,193, filed 11 Mar. 2013, which claims the priority of U.S. Provisional Application No. 61/640,542, filed 30 Apr. 2012, and also claims the priority of U.S. Provisional Application No. 61/609,865, filed 12 Mar. 2012. This application is also a continuation-in-part of U.S. application Ser. Nos. 13/792,074 and 13/792,079, filed 10 Mar. 2013, both of which claim the priority of U.S. Provisional Application No. 61/706,726, filed 27 Sep. 2012, and also claim the priority of U.S. Provisional Application No. 61/609,865, filed 12 Mar. 2012. This application is also a continuation-in-part of U.S. application Ser. No. 13/792,051, filed 9 Mar. 2013, and of U.S. application Ser. No. 13/792,068, filed 10 Mar. 2013, both of which claim the priority of U.S. Provisional Application No. 61/755,273, filed 22 Jan. 2013, and also claim the priority of U.S. Provisional Application No. 61/609,865, filed 12 Mar. 2012. This application also claims the priority of U.S. Provisional Application No. 61/809,651, filed 8 Apr. 2013. Each of the aforementioned Applications and Provisional Applications are hereby incorporated by reference in their entirety.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
• Not Applicable
BACKGROUND OF THE INVENTION
• FIGS. 33A and 33B show a typical arrangement for intravascular infusion. As the terminology is used herein, “intravascular” preferably refers to being situated in, occurring in, or being administered by entry into a blood vessel, thus “intravascular infusion” preferably refers to introducing a fluid or infusate into a subcutaneous blood vessel V. Intravascular infusion accordingly encompasses both intravenous infusion (administering a fluid into a vein) and intra-arterial infusion (administering a fluid into an artery).
• Acannula20 typically is used for administering fluid via the blood vessel V. Typically,cannula20 is inserted through skin S at a cannulation site N and punctures the blood vessel V, for example, the cephalic vein, basilica vein, median cubital vein, or any suitable vein for an intravenous infusion. Similarly, any suitable artery may be used for an intra-arterial infusion.
• Cannula20 typically is in fluid communication with afluid source22. Typically,cannula20 includes anextracorporeal connector20a, ahub20b, and atranscutaneous sleeve20c. An extension tube may couple theextracorporeal connector20aand thehub20b, as shown inFIG. 33A, or thehub20bmay incorporate theextracorporeal connector20a.Fluid source22 typically includes one or more sterile containers that hold the fluid(s) to be administered. Examples of typical sterile containers include plastic bags, glass bottles or plastic bottles.
• An administration set30 typically provides a sterile conduit for fluid to flow fromfluid source22 tocannula20. Typically, administration set30 includestubing32, adrip chamber34, aflow control device36, and acannula connector38.Tubing32 typically is made of polypropylene, nylon, or another flexible, strong and inert material.Drip chamber34 typically permits the fluid to flow one drop at a time for reducing air bubbles in the flow. Tubing32 anddrip chamber34 typically are transparent or translucent to provide a visual indication of the flow. Typically,flow control device36 controls fluid flow intubing32 and is positioned upstream fromdrip chamber34. Roller clamps and Dial-A-Flo®, manufactured by Hospira, Inc. (Lake Forest, Ill., US), are examples of typical flow control devices. Typically,cannula connector38 andextracorporeal connector20aprovide a leak-proof coupling through which the fluid may flow. Luer-Lok™, manufactured by Becton, Dickinson and Company (Franklin Lakes, N.J., US), is an example of a typical leak-proof coupling.
• Administration set30 may also include at least one of aclamp40, aninjection port42, afilter44, or other devices. Typically, clamp40pinches tubing32 to cut-off fluid flow.Injection port42 typically provides an access port for administering medicine or another fluid viacannula20.Filter44 typically purifies and/or treats the fluid flowing through administration set30. For example,filter44 may strain contaminants from the fluid.
• Aninfusion pump50 may be coupled with administration set30 for controlling the quantity or the rate of fluid flow tocannula20. The Alaris® System manufactured by CareFusion Corporation (San Diego, Calif., US), BodyGuard® Infusion Pumps manufactured by CMA America, L.L.C. (Golden, Colo., US), and Flo-Gard® Volumetric Infusion Pumps manufactured by Baxter International Inc. (Deerfield, Ill., US) are examples of typical infusion pumps.
• Intravenous infusion or therapy typically uses a fluid (e.g., infusate, whole blood, or blood product) to correct an electrolyte imbalance, to deliver a medication, or to elevate a fluid level. Typical infusates predominately consist of sterile water with electrolytes (e.g., sodium, potassium, or chloride), calories (e.g., dextrose or total parenteral nutrition), or medications (e.g., anti-infectives, anticonvulsants, antihyperuricemic agents, cardiovascular agents, central nervous system agents, chemotherapy drugs, coagulation modifiers, gastrointestinal agents, or respiratory agents). Examples of medications that are typically administered during intravenous therapy include acyclovir, allopurinol, amikacin, aminophylline, amiodarone, amphotericin B, ampicillin, carboplatin, cefazolin, cefotaxime, cefuroxime, ciprofloxacin, cisplatin, clindamycin, cyclophosphamide, diazepam, docetaxel, dopamine, doxorubicin, doxycycline, erythromycin, etoposide, fentanyl, fluorouracil, furosemide, ganciclovir, gemcitabine, gentamicin, heparin, imipenem, irinotecan, lorazepam, magnesium sulfate, meropenem, methotrexate, methylprednisolone, midazolam, morphine, nafcillin, ondansetron, paclitaxel, pentamidine, phenobarbital, phenytoin, piperacillin, promethazine, sodium bicarbonate, ticarcillin, tobramycin, topotecan, vancomycin, vinblastine and vincristine. Transfusions and other processes for donating and receiving whole blood or blood products (e.g., albumin and immunoglobulin) also typically use intravenous infusion.
• Unintended infusing typically occurs when fluid fromcannula20 escapes from its intended vein/artery. Typically, unintended infusing causes an abnormal amount of the fluid to diffuse or accumulate in perivascular tissue P and may occur, for example, when (i)cannula20 causes a vein/artery to rupture; (ii)cannula20 improperly punctures the vein/artery; (iii)cannula20 backs out of the vein/artery; (iv)cannula20 is improperly sized; (v)infusion pump50 administers fluid at an excessive flow rate; or (vi) the infusate increases permeability of the vein/artery. As the terminology is used herein, “tissue” preferably refers to an association of cells, intercellular material and/or interstitial compartments, and “perivascular tissue” preferably refers to cells, intercellular material, interstitial fluid and/or interstitial compartments that are in the general vicinity of a blood vessel and may become unintentionally infused with fluid fromcannula20. Unintended infusing of a non-vesicant fluid is typically referred to as “infiltration,” whereas unintended infusing of a vesicant fluid is typically referred to as “extravasation.”
• The symptoms of infiltration or extravasation typically include edema, pain or numbness in the vicinity of the cannulation site N; blanching, discoloration, inflammation or coolness of the skin S in the vicinity of the cannulation site N; breakdown, tautness or stretching of the skin S; or drainage from the cannulation site N. The consequences of infiltration or extravasation typically include skin reactions (e.g., blisters), nerve compression, compartment syndrome, or necrosis. Typical treatments for infiltration or extravasation include (i) applying warm or cold compresses; (ii) elevating the affected limb; (iii) administering hyaluronidase, phentolamine, sodium thiosulfate or dexrazoxane; (iv) fasciotomy; or (v) amputation.
BRIEF SUMMARY OF THE INVENTION
• Embodiments according to the present invention include a system to aid in diagnosing at least one of infiltration and extravasation in Animalia tissue. The system includes a sensor, a dressing configured to couple the sensor to an epidermis of the Animalia tissue, a device, and a cable that couples the sensor and the device. The sensor includes a housing having a surface configured to confront the epidermis and first and second waveguides partially disposed in the housing. The first waveguide is configured to transmit first and second signals that enter the Animalia tissue through the epidermis. The first signal has a peak wavelength between approximately 800 nanometers and approximately 1,050 nanometers, and the second signal has a peak wavelength between approximately 570 nanometers and approximately 620 nanometers. The second waveguide is configured to transmit third and fourth signals that exit the Animalia tissue through the epidermis. The third signal includes a portion of the first signal that is at least one of reflected, scattered and redirected from the Animalia tissue, and the fourth signal includes a portion of the second signal that is at least one of reflected, scattered and redirected from the Animalia tissue. The device is configured to evaluate the third and fourth signals, and includes an optics bench, a processor coupled to the optics bench, and an indicator coupled to the processor. The optics bench includes a first light emitting diode, a second light emitting diode and a photodiode. The first light emitting diode is configured to emit the first signal transmitted by the first waveguide, the second light emitting diode is configured to emit the second signal transmitted by the first waveguide, and the photodiode is configured to detect the third and fourth signals transmitted by the second waveguide. The processor is configured to (i) compute normalized values of the third and fourth signals, (ii) compare the normalized value of the third signal with a threshold value, and (iii) compare the normalized values of the third and fourth signals. The indicator is configured to output a notice when (i) the normalized value of the third signal is less than the threshold value and (ii) the normalized value of the fourth signal is greater than the normalized value of the third signal. The cable includes portions of the first and second waveguides.
• Other embodiments according to the present invention include a system to aid in diagnosing at least one of infiltration and extravasation in Animalia tissue. The system includes a sensor, a dressing configured to couple the sensor to an epidermis of the Animalia tissue, a device, and a cable that couples the sensor and the device. The sensor includes a housing having a surface configured to confront the epidermis and first and second waveguides partially disposed in the housing. The first waveguide is configured to transmit first and second signals that enter the Animalia tissue through the epidermis. The first signal has a peak wavelength between approximately 800 nanometers and approximately 1,050 nanometers, and the second signal has a peak wavelength between approximately 570 nanometers and approximately 620 nanometers. The second waveguide is configured to transmit third and fourth signals that exit the Animalia tissue through the epidermis. The third signal includes a portion of the first signal that is at least one of reflected, scattered and redirected from the Animalia tissue, and the fourth signal includes a portion of the second signal that is at least one of reflected, scattered and redirected from the Animalia tissue. The device is configured to evaluate the third and fourth signals, and includes an optics bench, a processor coupled to the optics bench, and an indicator coupled to the processor. The optics bench includes a first light emitting diode, a second light emitting diode and a photodiode. The first light emitting diode is configured to emit the first signal transmitted by the first waveguide, the second light emitting diode is configured to emit the second signal transmitted by the first waveguide, and the photodiode is configured to detect the third and fourth signals transmitted by the second waveguide. The processor is configured to (i) activate and deactivate the first and second light emitting diodes during each of a plurality of cycles, (ii) sample the third and fourth signals during each of the plurality of cycles, (iii) compute normalized values of individual third and fourth signal samples for each of the plurality of cycles, (iv) fit an equation to ordered pairs of the normalized values for each cycle in a first collection of the plurality of cycles, and (v) compare the equation to ordered pairs of the normalized values for each cycle in a second collection of the plurality of cycles. The indicator is configured to output a notice when (i) the ordered pairs of the second collection number more than a first threshold value, (ii) the ordered pairs of the second collection are perpendicularly spaced a displacement from the equation, (iii) the displacement corresponds to a change in the normalized values of the third signal samples that is greater than a second threshold value, and (iv) the displacement corresponds to a change in the normalized values of the fourth signal samples that is less than the change in the normalized values of the third signal samples. The cable includes portions of the first and second waveguides.
• Other embodiments according to the present invention include a system to aid in diagnosing at least one of infiltration and extravasation in Animalia tissue. The system includes a sensor, a dressing configured to couple the sensor to an epidermis of the Animalia tissue, a device, and a cable that couples the sensor and the device. The sensor includes a housing having a surface configured to confront the epidermis and first and second waveguides partially disposed in the housing. The first waveguide is configured to transmit first and second signals that enter the Animalia tissue through the epidermis. The first signal has a peak wavelength between approximately 800 nanometers and approximately 1,050 nanometers, and the second signal has a peak wavelength between approximately 570 nanometers and approximately 620 nanometers. The second waveguide is configured to transmit third and fourth signals that exit the Animalia tissue through the epidermis. The third signal includes a portion of the first signal that is at least one of reflected, scattered and redirected from the Animalia tissue, and the fourth signal includes a portion of the second signal that is at least one of reflected, scattered and redirected from the Animalia tissue. The device is configured to evaluate the third and fourth signals, and includes an optics bench, a processor coupled to the optics bench, and an indicator coupled to the processor. The optics bench includes a first light emitting diode, a second light emitting diode and a photodiode. The first light emitting diode is configured to emit the first signal transmitted by the first waveguide, the second light emitting diode is configured to emit the second signal transmitted by the first waveguide, and the photodiode is configured to detect the third and fourth signals transmitted by the second waveguide. The processor is configured to (i) compute normalized values of the third and fourth signals, (ii) compute a predicted signal based on the normalized values of the fourth signal, and (iii) compare the predicted signal and the normalized values of the third signal. The indicator is configured to output a notice when (i) the predicted signal is less than a first threshold value and (ii) the predicted signal and the normalized values of the third signal diverge less than a second threshold value. The cable includes portions of the first and second waveguides.
• Other embodiments according to the present invention include a system to aid in diagnosing at least one of infiltration and extravasation in Animalia tissue. The system includes a sensor configured to emit first and second signals entering the Animalia tissue and to detect third and fourth signals exiting the Animalia tissue, and a device coupled to the sensor and configured to output a notice based on the third and fourth signals. The first signal has a peak wavelength between approximately 800 nanometers and approximately 1,050 nanometers, and the second signal has a peak wavelength between approximately 560 nanometers and approximately 660 nanometers. The third signal includes a portion of the first signal that is at least one of reflected, scattered and redirected from the Animalia tissue, and the fourth signal includes a portion of the second signal that is at least one of reflected, scattered and redirected from the Animalia tissue. The third signal is configured to detect infusate accumulation over time in the Animalia tissue, and the fourth signal is configured to detect tissue blood volume changes in the Animalia tissue.
• Other embodiments according to the present invention include a system including a sensor and a device coupled to the sensor. The sensor is configured to detect infusate accumulation in Animalia tissue and to detect tissue blood volume change in the Animalia tissue. The device is configured to aid in diagnosing at least one of infiltration and extravasation in the Animalia tissue based on evaluating infusate accumulation detected by the sensor and on evaluating tissue blood volume change detected by the sensor.
• Other embodiments according to the present invention include a system including a sensor and a device coupled to the sensor. The sensor is configured to detect in Animalia tissue (i) a first electromagnetic radiation extinction that is dominated by absorption of a first wavelength and (ii) a second electromagnetic radiation extinction that is dominated by scattering of a second wavelength. The device is configured to aid in diagnosing at least one of infiltration and extravasation in the Animalia tissue based on evaluating the first and second electromagnetic radiation extinctions detected by the sensor.
• Other embodiments according to the present invention include a method to aid in diagnosing at least one of infiltration and extravasation in the Animalia tissue. The method includes detecting infusate accumulation in the Animalia tissue, detecting tissue blood volume change in the Animalia tissue, evaluating whether infusate is accumulating in the Animalia tissue, and evaluating whether tissue blood volume is changing in the Animalia tissue.
• Other embodiments according to the present invention include a method to aid in diagnosing at least one of infiltration and extravasation in the Animalia tissue. The method includes (i) detecting extinction of a first electromagnetic radiation signal in the Animalia tissue, the extinction is dominated by scattering of the first electromagnetic radiation signal, (ii) detecting extinction of a second electromagnetic radiation signal in the Animalia tissue, the extinction is dominated by absorption of the second electromagnetic radiation signal; and (iii) evaluating the extinctions of the first and second electromagnetic radiation signals in the Animalia tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
• The accompanying drawings, which are incorporated herein and constitute part of this specification, illustrate exemplary embodiments of the invention, and, together with the general description given above and the detailed description given below, serve to explain the features, principles, and methods of the invention.
• FIG. 1 illustrates a system according to the present disclosure for aiding in diagnosing at least one of infiltration and extravasation in Animalia tissue.
• FIG. 2A is a plan view illustrating an embodiment of an epidermal appliance according to the present disclosure. Portions of a fitting and a frame are shown in dashed line.
• FIG. 2B is a bottom view of the appliance shown inFIG. 2A.
• FIG. 2C is a cross-section view taken along line IIC-IIC inFIG. 2A.
• FIG. 3A is a partial cross-section view illustrating a second arrangement of the appliance shown inFIG. 2A releasing an electromagnetic radiation sensor.
• FIG. 3B is a partial cross-section view illustrating a first arrangement of the appliance shown inFIG. 2A retaining an electromagnetic radiation sensor.
• FIG. 4 is a partially exploded perspective view illustrating a dressing assembly including an embodiment of an appliance according to the present disclosure, an electromagnetic radiation sensor, a cannula, and a barrier film.
• FIG. 5 is an exploded view of the dressing assembly shown inFIG. 4.
• FIG. 6A is a cross-section view illustrating a first arrangement of the appliance shown inFIG. 4 retaining an electromagnetic radiation sensor.
• FIG. 6B is a cross-section view illustrating a second arrangement of the appliance shown inFIG. 4 releasing an electromagnetic radiation sensor.
• FIG. 7 is a partially exploded perspective view illustrating a dressing assembly including an embodiment of an appliance according to the present disclosure, an electromagnetic radiation sensor, a cannula, and a barrier film.
• FIG. 8 is an exploded view of the dressing assembly shown inFIG. 7.
• FIG. 9 is a schematic view illustrating an embodiment according to the present disclosure of a dressing assembly including an appliance integrated with a barrier film. A cannula is also shown in broken line.
• FIG. 10 is an exploded schematic partial cross-section view taken along line X-X inFIG. 9. An electromagnetic radiation sensor and a portion of a sensor cable are also shown. Certain features of Animalia tissue are also shown.
• FIGS. 11A-11D illustrate a fitting of the dressing assembly shown inFIG. 9.FIG. 11A is a plan view,FIG. 11B is a cross-section view taken along line XIB-XIB inFIG. 11A, FIG.11C is an enlarged view illustrating detail XIC inFIG. 11B, andFIG. 11D is an enlarged view illustrating detail XID inFIG. 11B.
• FIG. 12 is a schematic view illustrating an embodiment according to the present disclosure of a dressing assembly including an appliance integrated with a barrier film. An electromagnetic radiation sensor, a portion of a sensor cable, a cannula and a portion of an administration set are also shown.
• FIGS. 13A-13D are schematic views illustrating details of the dressing shown inFIG. 12.FIG. 13A is a cross-section view taken along line XIIIA-XIIIA inFIG. 12 with the electromagnetic radiation sensor shown in dash-dot line,FIG. 13B is a detail view showing features of the electromagnetic radiation sensor inFIG. 13A,FIG. 13C is a cross-section view taken along line XIIIC-XIIIC inFIG. 12, andFIG. 13D is a cross-section view taken along line XIIID-XIIID inFIG. 12.
• FIGS. 14A and 14B are schematic views illustrating an embodiment according to the present disclosure of a set of alternate dressing assemblies. Each assembly includes an appliance integrated with a barrier film. A cannula and a portion of an administration set are also shown.
• FIGS. 15A-15D illustrate an embodiment according to the present disclosure of a dressing assembly including an appliance integrated with a barrier film.FIG. 15A is a plan view showing the dressing assembly including a frame,FIG. 15B is a plan view showing the barrier film ofFIG. 15A with a framework,FIG. 15C is a plan view of the frame inFIG. 15A including a lead management system, andFIG. 15D is a plan view showing an implementation of the dressing assembly including the frame and the lead management system. An electromagnetic radiation sensor, a portion of a sensor cable, a cannula and a portion of an administration set are also shown inFIG. 15D.
• FIGS. 16A-16D illustrate embodiments according to the present disclosure of dressing assemblies including an appliance integrated with a barrier film.FIG. 16A is a plan view illustrating a dressing assembly including the appliance integrally molded with a frame,FIG. 16B is a cross-section view taken along line XVIB-XVIB inFIG. 16A,FIG. 16C is a plan view illustrating a dressing assembly including the appliance over-molded with a frame, andFIG. 16D is a cross-section view taken along line XVID-XVID inFIG. 16C.
• FIG. 17 is a schematic view illustrating an electromagnetic radiation sensor according to the present disclosure. The electromagnetic radiation sensor is shown contiguously engaging Animalia skin.
• FIGS. 18A-18C are schematic cross-section views explaining how an anatomical change over time in perivascular tissue impacts the electromagnetic radiation sensor shown inFIG. 17.
• FIGS. 18D-18F are schematic cross-section views explaining how a tissue volume blood change impacts the electromagnetic radiation sensor shown inFIG. 17.
• FIG. 19 is a schematic plan view illustrating a superficies geometry of the electromagnetic radiation sensor shown inFIG. 17.
• FIGS. 20A-20C are schematic cross-section views explaining the impact of different nominal spacing distances between emission and detection waveguides of the electromagnetic radiation sensor shown inFIG. 17.
• FIG. 21 is a graph illustrating a relationship between spacing, depth and wavelength for the electromagnetic radiation sensor shown inFIG. 17.
• FIG. 22 is a schematic cross-section view illustrating an angular relationship between waveguides of the electromagnetic radiation sensor shown inFIG. 17.
• FIG. 23A is a schematic cross-section view illustrating another angular relationship between waveguides of an electromagnetic radiation sensor according to the present disclosure.
• FIG. 23B illustrates a technique for representing the interplay between emitted and collected electromagnetic radiation of the waveguides shown inFIG. 23A.
• FIG. 24 is a schematic cross-section view illustrating an electromagnetic radiation sensor according to the present disclosure. The electromagnetic radiation sensor is shown contiguously engaging Animalia skin.
• FIG. 25 is a schematic cross-section view explaining separation between the Animalia skin and the electromagnetic energy sensor shown inFIG. 24.
• FIGS. 26A and 26B are schematic cross-section views illustrating alternative details of area XXVI shown inFIG. 25.
• FIG. 27 is a schematic cross-section view illustrating an electromagnetic radiation sensor according to the present disclosure. The electromagnetic radiation sensor is shown separated from Animalia skin.
• FIGS. 28A-28C are perspective views illustrating a patient monitoring device according to the present disclosure.
• FIG. 29 is a schematic diagram illustrating one embodiment of an operating device of the patient monitoring device shown inFIGS. 28A-28C.
• FIGS. 30A and 30B are time lines schematically illustrating embodiments of strategies for controlling the optics bench shown inFIG. 29.
• FIGS. 31A and 31B are plots schematically illustrating a relationship between the electromagnetic radiation collected by the electromagnetic radiation sensor shown inFIG. 17. The plots illustrate the normalized optical signals of the infrared radiation versus the visible light when an infiltration/extravasation examination is contraindicated (FIG. 31A) and indicated (FIG. 31B).
• FIGS. 32A and 32B are graphs schematically illustrating normalized signals of the infrared radiation and visible light collected over time by the electromagnetic radiation sensor shown inFIG. 17. A predicted signal based on the normalized signals illustrates when an infiltration/extravasation examination is contraindicated (FIG. 32A) and indicated (FIG. 32B).
• FIG. 33A is a schematic view illustrating a typical set-up for infusion administration.
• FIG. 33B is a schematic view illustrating a subcutaneous detail of the set-up shown inFIG. 33A.
• FIGS. 34A-34C are schematic views illustrating level, dependency and elevation relative to a patient's heart of the cannulation site shown inFIG. 33A.
• FIG. 35A is a graph of extinction coefficients for deoxyhemoglobin, oxyhemoglobin and water at electromagnetic radiation wavelengths between 400 nanometers and 1000 nanometers.
• FIG. 35B is a schematic view illustrating materials in the propagation path of typical pulse oximetry systems. The relative proportions of the materials are not to scale.
• In the figures, the thickness and configuration of components may be exaggerated for clarity. The same reference numerals in different figures represent the same component.
DETAILED DESCRIPTION OF THE INVENTION
• The following description and drawings are illustrative and are not to be construed as limiting. Numerous specific details are described to provide a thorough understanding of the disclosure. However, in certain instances, well-known or conventional details are not described in order to avoid obscuring the description.
• Reference in this specification to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment according to the disclosure. The appearances of the phrases “one embodiment” or “other embodiments” in various places in the specification are not necessarily all referring to the same embodiment, nor are separate or alternative embodiments mutually exclusive of other embodiments. Moreover, various features are described that may be exhibited by some embodiments and not by others. Similarly, various features are described that may be included in some embodiments but not other embodiments.
• The terms used in this specification generally have their ordinary meanings in the art, within the context of the disclosure, and in the specific context where each term is used. Certain terms in this specification may be used to provide additional guidance regarding the description of the disclosure. It will be appreciated that a feature may be described more than one-way.
• Alternative language and synonyms may be used for any one or more of the terms discussed herein. No special significance is to be placed upon whether or not a term is elaborated or discussed herein. Synonyms for certain terms are provided. A recital of one or more synonyms does not exclude the use of other synonyms. The use of examples anywhere in this specification including examples of any terms discussed herein is illustrative only, and is not intended to further limit the scope and meaning of the disclosure or of any exemplified term.
System Overview
• FIG. 1 shows asystem100 to preferably aid in diagnosing at least one of infiltration and extravasation in Animalia tissue. Preferably,system100 includes adressing1000, anelectromagnetic radiation sensor3000, asensor cable5000, and apatient monitoring device6000.
Dressing
• Dressing1000 preferably includes an epidermal appliance couplingelectromagnetic radiation sensor3000 with the skin S. Preferably, dressing1000 locateselectromagnetic radiation sensor3000 to overlie a target area of the skin S. As the terminology is used herein, “target area” preferably refers to a portion of a patient's skin that is generally proximal to where an infusate is being administered and frequently proximal to the cannulation site N. Preferably, the target area overlies the perivascular tissue P. According to one embodiment, dressing1000 preferably uses adhesion to coupleelectromagnetic radiation sensor3000 with respect to an epidermis E of the skin S. According to other embodiments, any suitable coupling may be used that preferably minimizes relative movement betweenelectromagnetic radiation sensor3000 and the skin S. Preferably, dressing1000 and the skin S have generally similar viscoelastic characteristics such that both respond in a generally similar manner to stress and strain.
• Dressing1000 preferably includes different arrangements that permitelectromagnetic radiation sensor3000 to be coupled, decoupled and recoupled, e.g., facilitating multiple independent uses with one or a plurality ofdressings1000. As the terminology is used herein, “arrangement” preferably refers to a relative configuration, formation, layout or disposition of dressing1000 andelectromagnetic radiation sensor3000. Preferably, dressing1000 includes a first arrangement that retainselectromagnetic radiation sensor3000 relative to the skin S for monitoring infiltration or extravasation during an infusion withcannula20. A second arrangement of dressing1000 preferably releaseselectromagnetic radiation sensor3000 from the first arrangement. Accordingly,electromagnetic radiation sensor3000 may be decoupled from asingular dressing1000 in the second arrangement, e.g., during patient testing or relocation, and subsequently recoupled in the first arrangement of thesingular dressing1000 such that a relationship betweenelectromagnetic radiation sensor3000 and the skin S is generally repeatable.Electromagnetic radiation sensor3000 may also be coupled to afirst dressing1000 in the first arrangement, decoupled from thefirst dressing1000 in the second arrangement, and subsequently coupled to asecond dressing1000 in the first arrangement.
• A first embodiment of dressing1000 is shown inFIGS. 2A-3B. Anappliance1100 includes (i) a fitting1110 for receivingelectromagnetic radiation sensor3000, which senses if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c; (ii) aframe1120 for distributing to the skin S forces acting onappliance1100; and (iii) abody1130 for covering fitting1110 andframe1120 with a soft haptic surface.Appliance1100 preferably coupleselectromagnetic radiation sensor3000 with the skin S proximate the cannulation site N. According to one embodiment,appliance1100 positionselectromagnetic radiation sensor3000 relative to skin S within approximately 10 centimeters of the cannulation site N and preferably in a range of approximately one centimeter to approximately five centimeters away from the cannulation site N. According to other embodiments,appliance1100 positionselectromagnetic radiation sensor3000 relative to skin S so as to generally overlie an infusate outlet oftranscutaneous sleeve20c.
• Electromagnetic radiation sensor3000 may be coupled to the skin S separately from typical contamination barriers. An example of acontamination barrier1260 is shown inFIG. 4. Typical contamination barriers may (i) protect the cannulation site N; and (ii) allow the epidermis E to be observed around the cannulation site N. Preferably,appliance1100 and a contamination barrier are coupled to the epidermis E separately, e.g., at different times or in different steps of a multiple step process. According to one embodiment, a contamination barrier that overlies the cannulation site N may also overlie portions of thecannula20 and/orappliance1100. According to other embodiments, a contamination barrier may overlie the cannulation site N and be spaced fromappliance1100.
• Fitting1110 preferably provides two arrangements with respect toelectromagnetic radiation sensor3000. Referring toFIG. 3A, a first arrangement of fitting1110 preferably retainselectromagnetic radiation sensor3000 relative toappliance1100 for monitoring infiltration or extravasation during an infusion withcannula20. Referring toFIG. 3B, a second arrangement of fitting1110 preferably releaseselectromagnetic radiation sensor3000 from the first arrangement. Accordingly,electromagnetic radiation sensor3000 may be decoupled fromappliance1100 in the second arrangement of fitting1110, e.g., during patient testing or relocation, and subsequently recoupled in the first arrangement of fitting1110 such that a positional relationship betweenelectromagnetic radiation sensor3000, the skin S and the perivascular tissue P is generally repeatable.
• Relative movement betweenelectromagnetic radiation sensor3000 andappliance1100 preferably is limited between the first and second arrangements. Preferably, fitting1110 includes achute1112 that extends along an axis A between afirst end1114 and asecond end1116. According to one embodiment,chute1112 preferably is centered about axis A, which preferably is obliquely oriented relative to theepidermis E. Chute1112 andelectromagnetic radiation sensor3000 preferably are cooperatively sized and shaped so that (i)electromagnetic radiation sensor3000 can be inserted infirst end1114 in only one relative orientation; and (ii) relative movement between the first and second arrangements is constrained to substantially only translation along axis A. As the terminology is used herein, “translation” refers to movement without rotation or angular displacement.Electromagnetic radiation sensor3000 preferably does not rub the epidermis E during translation along axis A. Accordingly, forces that may tend to distort the skin S preferably are prevented or at least minimized while movingelectromagnetic radiation sensor3000 between the first and second arrangements of fitting1110. It is believed that reducing distortion of the skin S reduces distortion of subcutaneous tissue including the perivascular tissue P and the blood vessel V, and therefore also reduces the likelihood of displacingcannula20 while movingelectromagnetic radiation sensor3000 between the first and second arrangements of fitting1110.
• Appliance1100 preferably includes alatch1118 for retainingelectromagnetic radiation sensor3000 in the first arrangement of fitting1110. Preferably,latch1118 is resiliently biased into engagement with a cooperating feature onelectromagnetic radiation sensor3000 in the first arrangement. According to one embodiment,latch1118 preferably includes acantilever1118athat has a recess oraperture1118bfor cooperatively receiving aprojection3106 ofelectromagnetic radiation sensor3000 in the first arrangement. In the second arrangement,latch1118 may be manipulated to alter the nominal form ofcantilever1118afor releasingprojection3106 from recess oraperture1118aso thatelectromagnetic radiation sensor3000 may be withdrawn fromchute1112 thoughfirst end1114. Preferably,latch1118 provides a positive indication, e.g., a tactile or audible notification, thatelectromagnetic radiation sensor3000 is in at least one of the first and second arrangements. According to other embodiments,latch1118 may include snaps, a cap, or another suitable device that, in the first arrangement, retainselectromagnetic radiation sensor3000 in fitting1110 and, in the second arrangement, releaseselectromagnetic radiation sensor3000 from fitting1110, e.g., allowingelectromagnetic radiation sensor3000 to separate fromappliance1100.
• Fitting1110 preferably permits multiple uses ofelectromagnetic radiation sensor3000. The first and second arrangements of fitting1110 preferably permitelectromagnetic radiation sensor3000 to be decoupled and recoupled withappliance1100, or decoupled from a first patient'sappliance1100 and coupled to a second patient'sappliance1100. Thus, fitting1110 preferably permits reusing electromagnetic radiation sensor11000 with a plurality ofappliances1100 that are individually coupled to patients' epidermises.
• Appliance1100 also preferably maintainselectromagnetic radiation sensor3000 in a substantially consistent location relative to the perivascular tissue P. Preferably,chute1112 constrains movement ofelectromagnetic radiation sensor3000 such that asuperficies3300 ofelectromagnetic radiation sensor3000 is disposed proximatesecond end1116 of fitting1110 in the first arrangement.Electromagnetic radiation sensor3000 preferably emitselectromagnetic radiation3002 fromsuperficies3300 and collectselectromagnetic radiation3006 that impinges on superficies. According to one embodiment,electromagnetic radiation sensor3000 projects fromappliance1100 such thatsuperficies3300 preferably is disposed beyondsecond end1116 toward the epidermis E for substantially eliminating or at least minimizing a gap betweensuperficies3300 and the epidermis E. Thus,appliance1100 in the first arrangement of fitting1110 preferably maintains a substantially consistent relative position betweensuperficies3300 and the skin S for sensing over time if fluid fromcannula20 is infusing the perivascular tissue P.
• Appliance1100 preferably resists forces that tend to change the position ofelectromagnetic radiation sensor3000 relative to the perivascular tissue P. Pulling or snaggingsensor cable5000 is one example of the forces thatframe1120 distributes over a larger area of the skin S than the areas overlaid bysuperficies3300 or by fitting1110.Frame1120 therefore preferably enhances maintaining a substantially consistent relative position betweensuperficies3300 and the skin S for sensing over time if fluid fromcannula20 is infusing the perivascular tissue P.
• Appliance1100 preferably includes a relatively rigid skeleton and a relatively supple covering. Preferably, the skeleton includes fitting1110 for interacting withelectromagnetic radiation sensor3000 andframe1120 for distributing to the skin S forces acting on fitting1110.Frame1120 preferably includes ahoop1122 coupled with fitting1110 by at least one arm (four arms1124a-1124dare indicated inFIG. 2A). According to one embodiment,hoop1122 preferably includes an uninterrupted annulus disposed about fitting1110. According to other embodiments,hoop1122 preferably includes a plurality of segments disposed about fitting1110.
• The composition and dimensions of the skeleton preferably are selected so that forces acting onappliance1100 are distributed to the skin S. According to one embodiment, fitting1110 andframe1120 preferably are formed as a single independent component, e.g., integrally molded with a substantially homogeneous chemical compound. According to another embodiment, fitting1110 andframe1120 may be composed of more than one compound and/or may include an assembly of a plurality of pieces.Appliance1100 may be subjected to a variety of forces, for example, due to pulling or snaggingsensor cable5000, and preferably the dimensions ofhoop1122 and arms1124a-1124dare selected for reacting to these forces. According to one embodiment, the dimensions offrame1120 preferably includearm1124abeing relatively more robust thanarms1124b-1124d,arms1124cand1124dbeing relatively the least robust, andarm1124bbeing relatively less robust thanarm1124aand relatively more robust thanarms1124cand1124d. Thus, according to this embodiment,appliance1100 reacts to forces, e.g., an approximately eight-pound force pullingsensor cable5000 away from the skin S, that may tend to moveelectromagnetic radiation sensor3000 by (i) distributing a compression force to a first area of the skin Sproximate arm1124a; and (ii) distributing a tension force to a second area of the skin Sproximate arm1124b. The first and second areas preferably are larger than a third area of the skin S that thesuperficies3300 and/or fitting1110 overlie. Similarly,arms1124cand1124dpreferably distribute compression and tension forces to fourth and fifth areas of the epidermis in response to, e.g., torsion forces acting onsensor cable5000.Appliance1100 therefore preferably resists changes to the relative position betweensuperficies3300 and the skin S by distributing over relatively large areas of the skin S the forces that may tend to moveelectromagnetic radiation sensor3000 in the first arrangement of fitting1110.
• The relatively supple covering ofappliance1100 preferably includes abody1130 that presents a soft haptic exterior surface overlying the skeleton. Preferably,body1130 has a relatively lower hardness as compared to fitting1110 andframe1120. According to one embodiment,body1130 preferably consists of a first homogeneous chemical compound, fitting1110 andframe1120 preferably consist of a second homogeneous chemical compound, and the first homogeneous chemical compound has a lower hardness than the second homogeneous chemical compound. The first homogeneous chemical compound preferably includes silicone or another material having a relatively low durometer, e.g., approximatelyShore A 10 to approximately Shore A 60, and the second homogeneous chemical compound preferably includes polyurethane or another material having a relatively higher durometer, e.g., approximatelyShore D 30 to approximately Shore D 70. Accordingly, the skeleton including fitting1110 andframe1120 preferably provides a structure for distributing forces applied toappliance1100, andbody1130 provides a soft haptic exterior surface that imparts to appliance1100 a desirable tactile feel, which may be characterized as soft rather than hard to the touch.Body1130 includes aface1132 preferably confronting the epidermis E.
• A process formanufacturing appliance1100 preferably includes covering the skeleton with the soft haptic exterior surface. According to one embodiment,appliance1100 is molded in a multiple step process. Preferably, one step includesmolding fitting1110 andframe1120 in a mold, another step includes adjusting the mold, and yet another step includesmolding body1130 over fitting1110 andframe1120 in the adjusted mold. An apparatus formolding fitting1110,frame1120 andbody1130 preferably includes a common mold portion, a first mold portion cooperating with the common mold portion for molding fitting1110 andframe1120, and a second mold portion cooperating with the common mold portion forover-molding body1130. Preferably, the common and first mold portions receive a first shot of material to mold fitting1110 andframe1120, the mold is adjusted by decoupling the first mold portion from the common mold portion and coupling the second mold portion with the common mold portion, and the common and second mold portions receive a second shot of material to moldbody1130. Fitting1110 andframe1120 preferably remain in the common mold portion while decoupling the first mold portion and coupling the second mold portion. Accordingly,appliance1100 is preferably molded in a two-shot process with a skeleton including fitting1110 andframe1120 being subsequently covered with a soft haptic exteriorsurface including body1130. According to another embodiment, the skeleton may consist solely of fitting1110, which may exclusively be molded in the first shot of a two-shot process.
• Appliance1100 may be wholly biocompatible and/or include a biocompatible layer for contacting the epidermis E. As the terminology is used herein, “biocompatible” preferably refers to compliance with Standard 10993 promulgated by the International Organization for Standardization (ISO 10993) and/or Class VI promulgated by The United States Pharmacopeial Convention (USP Class VI). Other regulatory entities, e.g., National Institute of Standards and Technology, may also promulgate standards that may additionally or alternatively be applicable regarding biocompatibility.
• Referring particularly toFIGS. 2C and 3A, afoundation1150 preferably (1) couplesappliance1100 and the epidermis E; and (2) separates the rest ofappliance1100 from the epidermis E. Preferably,foundation1150 includes apanel1152 that is coupled to face1132 confronting the epidermis E. According to one embodiment,panel1152 preferably is adhered to face1132.Panel1152 preferably includes polyurethane and occludessecond end1116 for providing a barrier between the epidermis E andsuperficies3300 in the second arrangement. Preferably,panel1152 is biocompatible according to ISO 10993 and/or USP Class VI.
• Foundation1150 preferably includes anadhesive coating1154 for adheringappliance1100 to the epidermis E. Adhesive1154 preferably includes a silicone adhesive, an acrylic adhesive or another medical grade adhesive that is biocompatible according to ISO 10993 and/or USP Class VI. According to one embodiment, adhesive1154 may be applied to all or a portion ofpanel1152 on the surface that confronts the epidermis E. According to other embodiments,panel1152 may be omitted and adhesive1154 may directly adherebody1130 and/or fitting1110 to the epidermis E.
• Adhesive1154 preferably may be adjusted to vary the bond strength betweenappliance1100 and the epidermis E. Preferably, stronger or more adhesive1154 may be used forcoupling appliance1100 to relatively robust skin, e.g., adult skin, and weaker or less adhesive1154 may be used forcoupling appliance1100 to relatively delicate skin, e.g., pediatric skin.
• Preferably,appliance1100 permits viewing the epidermis E with visible light and generally rejects interference by ambient sources with emitted and collectedelectromagnetic radiation3002 and3006. As the terminology is used herein, “visible light” refers to energy in the visible portion of the electromagnetic spectrum, for example, wavelengths between approximately 380 nanometers and approximately 760 nanometers. These wavelengths generally correspond to a frequency range of approximately 400 terahertz to approximately 790 terahertz. Preferably,body1130 is transparent or translucent to visible light for viewing the epidermis E that underlies at least a portion ofappliance1100. According to one embodiment, fitting1110 andframe1120 preferably are also transparent or translucent to visible light. According to other embodiments, fitting1110 and/orframe1120 may be generally opaque to visible light. According to still other embodiments,body1130 may be generally opaque to visible light or fitting1110 and/orframe1120 may be may be transparent or translucent to visible light. Preferably, fitting1110,frame1120 andbody1130, but notfoundation1150, absorb or block electromagnetic radiation with wavelengths that approximately correspond to emitted and collectedelectromagnetic radiation3002 and3006, e.g., radiation in the near-infrared portion of the electromagnetic spectrum. Accordingly,appliance1100 preferably permits visible light viewing of the epidermis E and minimizes ambient source interference with emitted and collectedelectromagnetic radiation3002 and3006.
• Appliance1100 preferably is advantageous at least because (i) the location ofelectromagnetic radiation sensor3000 is not linked byappliance1100 to cannula20 or to an IV dressing for the cannulation site N; (ii)appliance1100 is useable with typical dressings for the IV cannulation site N; and (iii) minimal stress and strain is transferred byappliance1100 to the skin S when changing between the first and second arrangements of fitting1110. As the terminology is used herein, “link” or “linking” preferably refers to at least approximately fixing the relative locations of at least two objects.
• A second embodiment of dressing1000 is shown inFIGS. 4-6B. Anappliance1200 preferably includes (i) a fitting1210 for receivingelectromagnetic radiation sensor3000, which senses if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c; (ii) aframe1220 for distributing to the skin S forces acting onappliance1200; and (iii) abody1230 for covering fitting1210 andframe1220 with a soft haptic surface. As compared to appliance1100 (FIGS. 2A-3B), the location ofcannula20 is linked byappliance1200 toelectromagnetic radiation sensor3000. According to one embodiment,appliance1200 preferably positionselectromagnetic radiation sensor3000 relative to the skin S within approximately five centimeters of the cannulation site N and preferably in a range of approximately one centimeter to approximately three centimeters away from the cannulation site N. According to other embodiments,appliance1200 positionselectromagnetic radiation sensor3000 relative to skin S so as to generally overlie an infusate outlet oftranscutaneous sleeve20c.
• Appliances1100 and1200 preferably include some features and advantages that are comparable. As the terminology is used herein, “comparable” refers to similar, if not identical, compositions, constructions, properties, functions or purposes, and preferably combinations thereof. Preferably, features ofappliances1100 and1200 that are comparable include (i)fittings1110 and1210; (ii)chutes1112 and1212; (iii) latches1118 and1218; (iv)hoops1122 and1222; and (v)arms1124 and1224.
• Appliance1200 preferably includes one ormore wings1240 that are in addition to at least some of the features and advantages ofappliance1100. Preferably,individual wings1240 perform several functions including (i) linkingelectromagnetic radiation sensor3000 with respect tocannula20; (ii) separatingcannula20 from the epidermis E; (iii) providing resistance to forces that tend to change the relative position ofappliance1200 with respect to the perivascular tissue P; and/or (iv) stabilizing the positions ofcannula20 andelectromagnetic radiation sensor3000 relative to the skin S. Eachwing1240 preferably is coupled with fitting1210,frame1220 orbody1230 and includes afirst surface1242 for contiguously engagingcannula20 and asecond surface1244 for confronting the epidermis E. According to one embodiment,individual wings1240 include portions offrame1220 andbody1230.
• Appliance1200 preferably includes plural locating options for linkingelectromagnetic radiation sensor3000 with respect tocannula20. According to one embodiment,individual wings1240 preferably extend in two generally opposite lateral directions with respect to axis A offitting1210. Accordingly, a footprint ofappliance1200 on the epidermis E preferably is approximately T-shaped or approximately Y-shaped andcannula20 may be located on either one of thewings1240 on opposite sides ofelectromagnetic radiation sensor3000. According to other embodiments, asingle wing1240 preferably extends in one lateral direction with respect to axis A offitting1210. Accordingly, a footprint ofappliance1200 on the epidermis E preferably is approximately L-shaped withcannula20 being located onwing1240 extending to one side ofelectromagnetic radiation sensor3000. Preferably,individual appliances1200 withsingle wings1240 that extend on different sides ofelectromagnetic radiation sensor3000 may be included in a kit. Accordingly, one or another ofappliances1200 in the kit preferably is selected to provide the most suitable locating option for linkingelectromagnetic radiation sensor3000 with respect tocannula20. The most suitable locating option preferably is selected based on one or more factors including: (i) the location on the patient of the cannulation site N; (ii) the orientation ofcannula20 relative to the cannulation site N; (iii) minimizing movement ofcannula20 orelectromagnetic radiation sensor3000 due to pulling or snaggingtubing32 orsensor cable5000; and (iv) comfort of the patient. Preferably, asingle wing1240 may makeappliance1200 more compact andplural wings1240 on asingle appliance1200 may provide additional options for locatingelectromagnetic radiation sensor3000 relative tocannula20. Further,appliance1200 may include perforations or shear line indicators for separating, e.g., tearing-off or cutting, at least onewing1240 from the rest ofappliance1200. Accordingly, the size ofappliance1200 may be compacted and/orappliance1200 may be made wingless in the manner ofappliance1100. Thus, an advantage of each of the aforementioned embodiments is increasing the options for how an anatomical sensor may be located on a patient relative to the cannulation site N.
• Appliance1200 preferably separatescannula20 from the epidermis E. According to one embodiment,wing1240 includes athickness1246 betweenfirst surface1242 andsecond surface1244. Preferably,thickness1246 provides a spacer that prevents or at least minimizes contiguous engagement between the epidermis E andhub20bofcannula20.Wing1240 therefore preferably eliminates or at least substantially reduces epidermal inflammation or breakdown, e.g., chafing or blistering, caused bycannula20. Accordingly,wing1240 eliminates or at least minimizeshub20bas a source of epidermal inflammation or breakdown that may be observed when a healthcare giver evaluates the cannulation site N.
• Wing(s)1240 preferably supplement the ability ofappliance1200 to resist forces that tend to change the positions ofelectromagnetic radiation sensor3000 andcannula20 relative to the skin S and the perivascular tissue P. Preferably, a skeleton ofappliance1200 includes fitting1210,frame1220, and at least onewing rib1248. Fitting1210 preferably interacts withelectromagnetic radiation sensor3000 in a manner comparable to fitting1110 discussed above. Preferably,frame1220 includes ahoop1222 coupled with fitting1210 by at least onearm1224. Thus,frame1220 may be comparable toframe1120 at least insofar as preferably contributing to distributing to the skin S the forces that act on fitting1210.Appliance1200 preferably resists changes to the relative position betweensuperficies3300 and the epidermis E by distributing over relatively large areas of the skin S the forces that may tend to moveelectromagnetic radiation sensor3000 in the first arrangement of fitting1210.Individual wing ribs1248 preferably enlarge the area of the skin S over whichframe1220 distributes forces acting on fitting1210. According to one embodiment,individual wing ribs1248 preferably include a cantilever having a base coupled withframe1220 and a tip disposed in acorresponding wing1240. According to other embodiments, more than onewing rib1248 may be disposed in acorresponding wing1240,individual wing ribs1248 may include a bifurcated cantilever, and/or individual cantilevers may include one or more branches. The skeleton ofappliance1200 therefore preferably enhances maintaining a substantially consistent relative position betweenelectromagnetic radiation sensor3000 and the perivascular tissue P for sensing over time if fluid fromcannula20 is infusing the perivascular tissue P.
• Appliance1200 preferably is sufficiently flexible to conform to the approximate contours of the skin S. For example,frame1220 may include one or more lines of weakness disposed onhoop1222, arm(s)1224 and/or wing rib(s)1248. As the terminology is used herein, “lines of weakness” preferably refers to living hinges or other suitable features for increasing flexibility at a particular location of the skeleton ofappliance1200.
• Body1230 preferably presents a soft haptic exterior surface ofwings1240. In a manner comparable tobody1130 discussed above,body1230 is relatively supple, e.g., has a relatively lower hardness, and may be molded over fitting1210,frame1220 and wing rib(s)1248. According to one embodiment,body1230 preferably includesfirst surface1242, at least a portion ofsecond surface1244, and a large portion ofthickness1246. The remaining portions ofsecond surface1244 andthickness1246 preferably are occupied by wing rib(s)1248. Accordingly, anindividual wing1240 preferably is primarily composed of the relatively supple material ofbody1230 with wing rib(s)1248 included for force distribution and/or structural reinforcement. According to other embodiments, one or more ofhoop1222,arms1224 andwing ribs1248 preferably are omitted from the skeleton ofappliance1200. Thus,individual wings1240 preferably include portions ofbody1230 with minimal or no reinforcement by the skeleton ofappliance1200. According to other embodiments, wing rib(s)1248 preferably are excluded from anindividual wing1240.
• Appliance1200 includes afoundation1250 that preferably (1) separates the rest ofappliance1200 from the epidermis E; and (2) couplesappliance1200 and the epidermis E. Preferably,foundation1250 includes apanel1252 that is coupled to a face ofappliance1200 confronting the skin S. According to one embodiment,panel1252 preferably is adhered tosecond surface1244 and separates at least one of fitting1210,frame1220 andbody1230 from the epidermis E. According to other embodiments,panel1252 occludeschute1212 for providing a barrier between the epidermis E andsuperficies3300 in the second arrangement. Preferably,panel1252 includes polyurethane or another sheet material that is biocompatible according to ISO 10993 and/or USP Class VI.
• Foundation1250 includes an adhesive1254 preferably forbonding appliance1200 to the epidermis E. Preferably, adhesive1154 includes a silicone adhesive, an acrylic adhesive or another medical grade adhesive that is biocompatible according to ISO 10993 and/or USP Class VI. According to one embodiment, the shape and size of adhesive1254 preferably is congruent withpanel1252. According to other embodiments, adhesive1254 preferably is omitted in awindow1254athrough which emitted and collectedelectromagnetic radiation3002 and3006 propagate. Preferably,foundation1250 includes a release liner (not shown) that is removed tobond appliance1200 to the epidermis E.
• Akit including appliance1200 preferably also includes at least oneindependent contamination barrier1260 for overlying the epidermis E and at least a portion ofcannula20 while allowing visual inspection of the cannulation site N.FIG. 4 shows an exploded view withcontamination barrier1260 displaced fromappliance1200. Referring additionally toFIG. 5,contamination barrier1260 preferably is biocompatible according to ISO 10993 and/or USP Class VI and may include apolyurethane membrane1262 with a coating of medicalgrade acrylic adhesive1264. Examples of typical contamination barriers include Tegaderm™, manufactured by 3M (St. Paul, Minn., USA), REACTIC™, manufactured by Smith & Nephew (London, UK), and other transparent or translucent polymer films that are substantially impervious to solids, liquids, microorganisms and/or viruses. Preferably,contamination barrier1260 is supplied in the kit separate fromappliance1200 and is independently coupled to the skin S at different times or in different steps.
• Appliance1200 andcontamination barrier1260 preferably include form factors that cooperate with one another. According to one embodiment,body1230 preferably includes a form factor such as aflange1232 that covershoop1222 and arm(s)1224. Preferably,flange1232 includes atop surface1232ato which adhesive1264 may adheremembrane1262 whenappliance1200 andcontamination barrier1260 are used in combination. According to one embodiment, a set ofindividual contamination barriers1260 preferably accompanies eachappliance1200. Each of thecontamination barriers1260 in the set preferably includes anotch1266 or another form factor having a peripheral edge that is sized and/or shaped to correspond with at least a portion offlange1232 and/orwing1240 on one or the other side of axis A. Accordingly, one or another ofcontamination barriers1260 in the set preferably is selected to apply to the skin S on the side of axis A that cannula20 is located. According to other embodiments,contamination barrier1260 has a symmetrical shape that preferably is turned or otherwise reoriented to cooperatively engageappliance1200 on either side of axis A that cannula20 is located.
• A method of usingappliance1200 to monitor if fluid is infusing perivascular tissue aroundcannula20 preferably includes (i)coupling appliance1200 to theskin5; (ii) couplingelectromagnetic radiation sensor3000 in the first arrangement of fitting1210; and (iii)coupling cannula20 with onewing1240. Preferably,appliance1200 is coupled with the skin S by adhesive1254 or by another suitable epidermal fastener.Adhesive1254 preferably is exposed to the skin S by removing a release liner (not shown).Electromagnetic radiation sensor3000 preferably is translated along axis A to the first arrangement of fitting1210 and securely latched. Preferably, onewing1240 underlayscannula20 and an adhesive strip1270 (seeFIG. 5) securescannula20 towing1240. According to one embodiment,cannula20 is inserted in the blood vessel V and then onewing1240 is positioned undercannula20 before adheringappliance1200 to the epidermisE. Adhesive strip1270 subsequently overlies and couples cannula20 with respect towing1240 before couplingelectromagnetic radiation sensor3000 in the first arrangement of fitting1210. According to other embodiments,electromagnetic radiation sensor3000 is coupled in the first arrangement of fitting1210 before positioning onewing1240 undercannula20 and adheringappliance1200 to the epidermisE. Adhesive strip1270 subsequently overlies and couples cannula20 with respect towing1240. Each of the aforementioned embodiments may also include adheringcontamination barrier1260 withtop surface1232aofflange1232, as well as with the epidermis E. Preferably,electromagnetic radiation sensor3000 may be moved between the first and second arrangements of fitting1210 withoutdecoupling appliance1200 from the epidermis E, withoutdecoupling cannula20 oradhesive strip1270 fromwing1240, and withoutdecoupling contamination barrier1260 from the epidermis E.
• Appliance1200 preferably is advantageous at least because (i)appliance1200 may be physically associated with a dressing for the IV cannulation site N; (ii)appliance1200 linkselectromagnetic radiation sensor3000 andcannula20; (iii)appliance1200 includes a plurality of locating options for linkingelectromagnetic radiation sensor3000 with respect tocannula20; (iv)appliance1200 maintains a substantially consistent relative position betweenelectromagnetic radiation sensor3000 and the perivascular tissue P for sensing over time if fluid fromcannula20 is infusing the perivascular tissue P; and (v)appliance1200 eliminates or at least reduces epidermal inflammation or breakdown caused bycannula20.
• Appliance1200 preferably also is advantageous insofar as preventing or minimizing forces that tend to distort the skin S while moving between the first and second arrangements of fitting1210. It is believed that reducing distortion of the skin S reduces distortion of subcutaneous tissue including the perivascular tissue P and the blood vessel V, and therefore also reduces the likelihood of displacingcannula20 while moving between the first and second arrangements of fitting1210.
• A third embodiment of dressing1000 is shown inFIGS. 7 and 8. Anappliance1300 preferably includes (i) a fitting1310 for receivingelectromagnetic radiation sensor3000, which senses if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c; (ii) aframe1320 for distributing forces acting onappliance1300 to the skin S; and (iii) abody1330 for covering fitting1310 andframe1320 with a soft haptic surface. As compared toappliances1100 and1200 (FIGS. 2A-6B), a first arrangement of fitting1310 preferably is an alternate to the first arrangements offittings1110 and1210; however, the second arrangements offittings1110,1210 and1310 preferably are similar insofar as releasingelectromagnetic radiation sensor3000 from the respective first arrangements. Preferably, other features and advantages ofappliances1100,1200 and1300 are comparable including (i) frames1120,1220 and1320; (ii)wings1240 and1340; (iii)wing ribs1248 and1348; (iv)bodies1130,1230 and1330; (v)foundations1150,1250 and1350; (vi)contamination barriers1260 and1360; and (vii)adhesive strips1270 and1370. According to one embodiment,appliance1300 preferably positionselectromagnetic radiation sensor3000 relative to the skin S within approximately five centimeters of the cannulation site N and preferably in a range of approximately one centimeter to approximately three centimeters away from the cannulation site N. According to other embodiments,appliance1300 positionselectromagnetic radiation sensor3000 relative to skin S so as to generally overlie an infusate outlet oftranscutaneous sleeve20c.
• The first arrangement of fitting1310 preferably includes sets of pegs for constraining relative movement betweenelectromagnetic radiation sensor3000 andappliance1300. As the terminology is used herein, “peg” preferably refers to a projecting piece or portion of a surface that is used as a support or boundary. According to one embodiment, fitting1310 includes a first set ofpegs1312 disposedproximate superficies3300 and a second set ofpegs1314 disposedproximate sensor cable5000. Preferably, a cage ofappliance1300 includes first and second sets ofpegs1312 and1314. The cage preferably defines a pocket for receivingelectromagnetic radiation sensor3000 and constrains relative movement betweenelectromagnetic radiation sensor3000 andappliance1300 in the first arrangement of fitting1310. Preferably, first set ofpegs1312—two pegs are shown in FIG.8—preferably includes a form factor that generally conforms to the contours ofelectromagnetic radiation sensor3000 to define a first portion of the cage.Individual pegs1312 preferably include a cantilever extending between a base1312aand atip1312b. Preferably, base(s)1312aare coupled toframe1320 and tip(s)1312bat least slightly overlieelectromagnetic radiation sensor3000 to constrain movement away from the skin S in the first arrangement of fitting1310. According to one embodiment,individual pegs1312 preferably are bifurcated at base1312aand converge attip1312b.
• Second set ofpegs1314—two pegs are shown in FIG.8—preferably are disposed on opposite sides ofelectromagnetic radiation sensor3000 to define a second portion of the cage.Individual pegs1314 preferably include cantilevers extending between a base1314aand atip1314b. Preferably,bases1314aare coupled toframe1320 and a portion ofelectromagnetic radiation sensor3000proximate sensor cable5000 is received betweentips1314bto constrain relative angular movement and/or provide strain relief forelectromagnetic radiation sensor3000 in the first arrangement of fitting1310.
• Other embodiments ofappliance1300 may have sets including different numbers, locations and shapes ofpegs1312 and pegs1314. For example, the first set may include more or less than twopegs1312; the second set may include more than asingle peg1314 located on each side ofelectromagnetic radiation sensor3000; and/ortip1314bof at least onepeg1314 may include a bump or other projection for retainingelectromagnetic radiation sensor3000 in the first arrangement of fitting1310.
• Body1330 preferably presents a soft haptic exterior surface overlying the relatively rigid fitting1310 andframe1320 ofappliance1300. In a manner comparable tobodies1130 and1230 discussed above,body1330 is relatively supple, e.g., has a relatively lower hardness, and may be molded over fitting1310,frame1320 and wing rib(s)1348.
• Appliance1300 preferably includes a link betweenelectromagnetic radiation sensor3000 andcannula20. Preferably,appliance1300 includes at least onewing1340 coupled with at least one of fitting1310,frame1320, andbody1330.Individual wings1340 preferably are comparable toindividual wings1240 ofappliance1200 at least insofar as (i) locatingelectromagnetic radiation sensor3000 with respect tocannula20; (ii) separatingcannula20 from the epidermis E; and/or (iii) providing resistance to forces that tend to change the position ofelectromagnetic radiation sensor3000 relative to the perivascular tissue P.
• Individual wings1340 ofappliance1300 preferablyseparate cannula20 from the epidermis E, and preferably supplement the ability ofappliance1300 to resist forces that tend to change the position ofelectromagnetic radiation sensor3000 relative to the perivascular tissue P. Preferably,wing1340 includes a thickness that eliminates or at least reduces epidermal inflammation or breakdown caused bycannula20. Preferably, a skeleton ofappliance1300 includes fitting1310,frame1320, and at least onewing rib1348 to distribute to the skin S the forces that act on fitting1310. Further,appliance1300 preferably resists changes to the relative position betweensuperficies3300 and the perivascular tissue P by distributing over relatively large areas of the skin S the forces that may tend to moveelectromagnetic radiation sensor3000 in the first arrangement of fitting1310. Accordingly,appliance1300 is comparable at least in this regard toappliances1100 and1200.Individual wing ribs1348 preferably enhance the capability ofindividual wings1340 to distribute to the skin S forces that act on fitting1310. The skeleton ofappliance1300 therefore preferably facilitates maintaining a substantially consistent relative position betweenelectromagnetic radiation sensor3000 and the perivascular tissue P for sensing over time if fluid fromcannula20 is infusing the perivascular tissue P.
• Appliance1300 preferably is comparable toappliance1200 insofar as including plural locating options for linkingelectromagnetic radiation sensor3000 with respect tocannula20. Factors for selecting the most suitable locating option are discussed above with regard toappliance1200.Appliance1300 also therefore includes the advantage of having more than one choice for how an anatomical sensor may be located on a patient relative to the cannulation site N.
• A process for implementingappliance1300 to sense if fluid is infusing perivascular tissue aroundtranscutaneous sleeve20cpreferably includes (i)coupling appliance1300 to the skin S; (ii) couplingelectromagnetic radiation sensor3000 in the first arrangement of fitting1310; and (iii)coupling cannula20 with onewing1340. A process for couplingelectromagnetic radiation sensor3000 withappliance1300 preferably includes (i) orientingelectromagnetic radiation sensor3000 obliquely with respect toframe1320; (ii) slippingelectromagnetic radiation sensor3000 under tip(s)1312a; and (iii) pivotingelectromagnetic radiation sensor3000 between peg(s)1314. Accordingly, the cage including first and second sets ofpegs1312 and1314 preferably constrains relative movement betweenelectromagnetic radiation sensor3000 andappliance1300. Preferably, the second arrangement of fitting1310 includes reversing the above process for couplingelectromagnetic radiation sensor3000 withappliance1300. Decouplingelectromagnetic radiation sensor3000 in the second arrangement of fitting1310 accordingly permits multiple uses ofelectromagnetic radiation sensor3000 in the same or adifferent appliance1300.
• A fourth embodiment of dressing1000 is shown inFIGS. 9-11D. Anappliance1400 preferably includes (i) apane1410 overlying the cannulation site N; and (ii) a fitting1430 for receivingelectromagnetic radiation sensor3000, which senses if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c.Appliance1400 preferably includes an integrated contamination barrier that is substantially impervious to solids, liquids, microorganisms and/or viruses. Preferably, the contamination barrier may be semi-permeable to allow air or vapor to pass, thus permitting the epidermis E to breathe.
• Pane1410 preferably permits viewing the cannulation site N. Preferably,pane1410 is transparent or translucent to light in the visible portion of the electromagnetic spectrum, for example, light having wavelengths between approximately 380 nanometers and approximately 760 nanometers. These wavelengths generally correspond to a frequency range of approximately 400 terahertz to approximately 790 terahertz.Pane1410 preferably includes polyurethane film or another suitable material and/or construction to also provide a contamination barrier that may be transparent or translucent.
• An adhesive1412 preferably bondspane1410 to the skin S around the cannulation site N. Preferably, adhesive1412 includes a silicone adhesive, an acrylic adhesive or another medical grade adhesive that is biocompatible according to ISO 10993 and/or USP Class VI.Adhesive1412 may be applied topane1410 on the entire surface that confronts the epidermis E, or adhesive1412 may be omitted from one or more portions of the surface. Also, the strength of the bond betweenpane1410 and the epidermis E may vary according to different embodiments ofappliance1400. For example, stronger or more adhesive1412 may be used forcoupling appliance1400 to relatively robust skin, e.g., adult skin, and weaker or less adhesive1412 may be used forcoupling appliance1400 to relatively delicate skin, e.g., pediatric skin.
• Pane1410 may also include adiagnostic tool1414 to assist in visually analyzing symptoms of infiltration or extravasation. For example,diagnostic tool1414 may include a set of concentric arcs, a geometric shape, a set of parallel lines, a color gradient, or another suitable reticle for evaluating conditions at the epidermis E that may be symptomatic of infiltration or extravasation. According to one embodiment, the appearance of a set of concentric arcs or a geometric shape may become distorted when the epidermis E, and thuspane1410, is distended due to edema. According to another embodiment, changes in the coloration of the epidermis E may be evaluated by periodic comparison with a color gradient included onpane1410.
• Appliance1400 is preferably located or oriented with respect to at least one ofcannula20, the cannulation site N, or an anatomical feature. According to one embodiment,appliance1400 may include anotch1416aor another suitable guide that is sized or shaped for cooperating with at least a portion ofcannula20. According to another embodiment,pane1410 may includecrosshairs1416bor another suitable guide for locatingappliance1400 relative to the cannulation site N. According to another embodiment, indicia, symbols and/or other markings preferably provide a guide for relatively positioningappliance1400 with resect to an anatomical feature. For example,guide1416cincludes an arrow and a symbol that suggests a position forappliance1400 relative to the heart.
• Appliance1400 preferably includes aframe1420 coupled topane1410.Frame1420 preferably has greater resistance to deformation than doespane1410. Accordingly,frame1420 may maintain the general shape ofpane1410 whileappliance1400 is laid over the cannulation site N. According to one embodiment,frame1420 entirely cincturespane1410. According to other embodiments,frame1420 may (i) partiallycincture pane1410; (ii) extend from a peripheral portion ofpane1410 toward an interior portion ofpane1410; (iii) extend from the interior portion toward the peripheral portion; (iv) be spaced from the peripheral portion; or (v) include some combination of (i)-(iv).Frame1420 preferably includes polyvinyl chloride, polyethylene, polypropylene, or another suitable material that is relatively rigid with respect topane1410. According to one embodiment,frame1420 may includepolyethylene tape1420abeing relatively associated with or disposed on a pad ofpolyvinyl chloride foam1420b.
• Frame1420 is preferably transparent or translucent to visible light for viewing the epidermis E in the vicinity of the cannulation site N. Preferably,frame1420 absorbs or blocks the transmission of radiation having the same wavelength(s) as emitted and collectedelectromagnetic radiation3002 and3006, e.g., near-infrared radiation. Thus, according to one embodiment, the epidermis E that underliesframe1420 may be optically visible and shielded from ambient near-infrared radiation.
• Frame1420 is preferably coupled topane1410 by an adhesive1422 or another suitable coupling. According to one embodiment, adhesive1422 preferably provides a coupling betweenpane1410 andframe1420 that is relatively stronger than the bond betweenpane1410 and the epidermis E. Accordingly,pane1410 remains attached toframe1420 when separating dressing1400 from the epidermis E. Adhesive1422 according to another embodiment ofappliance1400 preferably provides a coupling betweenpane1410 andframe1420 that is relatively weaker than the bond betweenpane1410 and the epidermis E. Accordingly,frame1420 may be released frompane1410 afterappliance1400 is laid over the cannulation site N.
• Fitting1430 preferably coupleselectromagnetic radiation sensor3000 withappliance1400. There are preferably two arrangements of fitting1430 with respect toelectromagnetic radiation sensor3000. A first arrangement of fitting1430 preferably retainselectromagnetic radiation sensor3000 relative toappliance1400 for monitoring infiltration or extravasation during an infusion withcannula20. Accordingly, the first arrangement of fitting1430 with respect toelectromagnetic radiation sensor3000 preferably senses over time if fluid fromcannula20 is infusing the perivascular tissue P. A second arrangement of fitting1430 preferably releaseselectromagnetic radiation sensor3000 from the first arrangement. The first arrangement preferably includes one or more projections3106 (seeFIG. 10) onelectromagnetic radiation sensor3000 being snapped under correspondinglatches1432a(seeFIGS. 11B and 11C) offitting1430. Accordingly, the second arrangement preferably includes snapping theprojections3106 overlatches1432ato releaseelectromagnetic radiation sensor3000 from the first arrangement. Other embodiments may use a cap, a resilient element, or another suitable device that, in the first arrangement, retainselectromagnetic radiation sensor3000 in fitting1430 and preferably biases superficies3300 toward the epidermis E and, in the second arrangement, releaseselectromagnetic radiation sensor3000 from fitting1430, e.g., allowingelectromagnetic radiation sensor3000 to separate from fitting1430. Accordingly, the first and second arrangements permitelectromagnetic radiation sensor3000 to have multiple uses with a plurality ofappliances1400 that are individually applied to patients' epidermises.
• Fitting1430 may be indirectly or directly coupled topane1410. According to one embodiment of dressing1400,frame1420 preferably couples fitting1430 topane1410. According to another embodiment of dressing1400, fitting1430 andpane1410 are preferably directly coupled. Fitting1430 is preferably fixed toappliance1400 using an adhesive1430a(seeFIG. 10) or another suitable coupling that is relatively stronger than the bond betweenpane1410 and the epidermis E. Moreover, adhesive1430apreferably couples fitting1430 to frame1420 and provides a coupling that is at least as strong as the coupling betweenframe1420 andpane1410.
• Details according to one embodiment of fitting1430 are shown inFIGS. 11A-11D. Preferably, fitting1430 includes awall1432 that defines apocket1434 for receivingelectromagnetic radiation sensor3000. In the first arrangement of fitting1430,wall1432 may (i) entirely surroundelectromagnetic radiation sensor3000; (ii) include a plurality of individual segments or posts intermittently disposed aroundelectromagnetic radiation sensor3000; or (iii) have any suitable configuration for locatingelectromagnetic radiation sensor3000 with respect to dressing1400.Wall1432 preferably includes one ormore latches1432a(three are shown inFIG. 11B) that cooperate with projection(s)3106 for retainingelectromagnetic radiation sensor3000 inpocket1434 in the first arrangement of fitting1430. Preferably, fitting1430 maintainselectromagnetic radiation sensor3000 in a desired orientation with respect to dressing1400. According to one embodiment,wall1432 includes arecess1432bthat, in the first arrangement, cooperatively receives an anti-rotation projection3008 (seeFIG. 10) onelectromagnetic radiation sensor3000. According to other embodiments, fitting1430 andelectromagnetic radiation sensor3000 may include any suitable mating features for eliminating or at least minimizing rotation ofelectromagnetic radiation sensor3000 inpocket1434.
• Fitting1430 andappliance1400 are preferably coupled via an interface that permitsappliance1400 to approximately conform to epidermis E. Preferably, a rim orflange1436 projects fromwall1434 and provides a surface for adhesive1430aat the interface between fitting1430 andappliance1400. According to one embodiment,flange1436 may include a plurality ofsegments1436a(four are shown inFIG. 11A) separated byindividual gaps1436b(three are shown inFIG. 11A). One or more lines ofweakness1438 may be disposed onflange1436 to increase flexibility of the interface between fitting1430 andappliance1400. Accordingly, fitting1430 may approximately conform to the contours of epidermis E to thereby facilitate, in the first arrangement, maintainingelectromagnetic radiation sensor3000 relative to the skin S.
• Appliance1400 preferably integrates in a single unit an occlusive barrier and a retainer for an anatomical sensor. According to one embodiment, the anatomical sensor may includeelectromagnetic radiation sensor3000 or another sensor for sensing over time a change of body structure, e.g., infiltration and extravasation. Preferably, the occlusive barrier includespane1410 for protecting the cannulation site N and the retainer includes fitting1430 for positioningelectromagnetic radiation sensor3000 to sense if fluid is infusing the perivasculartissue P. Fitting1430 preferably permitselectromagnetic radiation sensor3000 to be decoupled and recoupled withappliance1400, or decoupled from afirst appliance1400 and coupled to asecond appliance1400.Appliance1400 preferably also includesframe1420 for distributing forces over a larger area of the skin S. For example, forces due to pulling or snaggingsensor cable5000 may be distributed bypane1410,frame1420 and fitting1430 over an area of the skin S that is larger than that overlaid bysuperficies3300.Appliance1400 therefore preferably enhances an approximately consistent positional relationship betweenelectromagnetic radiation sensor3000 and the perivascular tissue P when sensing infiltration or extravasation.Appliance1400 is advantageous at least because applying an occlusive dressing for an intravascular infusion concurrently establishes an approximately consistent location for an infiltration/extravasation sensor.
• A fifth embodiment of dressing1000 is shown inFIGS. 12-13D. Anappliance1500 preferably includes (i) a contamination barrier overlying the cannulation site N; and (ii) a plurality of location options for couplingelectromagnetic radiation sensor3000 to sense if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c. The contamination barrier preferably is substantially impervious to solids, liquids, microorganisms and/or viruses. Preferably,appliance1500 may be semi-permeable to allow air or vapor to pass, thus permitting the epidermis E to breathe.
• The contamination barrier ofappliance1500 preferably includes apane1510 for viewing the cannulation site N. Preferably,pane1510 is transparent or translucent to light in the visible portion of the electromagnetic spectrum.Pane1510 preferably includes a polyurethane film or another suitable material and/or construction for providing a contamination barrier that may be transparent or translucent.
• An adhesive1512 preferably bondspane1510 to the epidermis E (not indicated inFIG. 12) around the cannulation site N. Preferably, adhesive1512 includes an acrylic adhesive that is suitable for contact with the epidermis E or another medical grade adhesive that is biocompatible according ISO 10993 and/or USP Class VI.Adhesive1512 may be applied topane1510 on the entire surface that confronts the epidermis E, or adhesive1512 may be omitted from one or more portions of the surface. Also, the strength of the bond betweenpane1510 and the epidermis E may vary according to different embodiments ofappliance1500. For example, stronger or more adhesive1512 may be used forcoupling appliance1500 to relatively robust skin, e.g., adult skin, and weaker or less adhesive1512 may be used forcoupling appliance1500 to relatively delicate skin, e.g., pediatric skin.
• Pane1510 may also include adiagnostic tool1514 to assist in visually analyzing symptoms of infiltration or extravasation. For example,diagnostic tool1514 may include a set of concentric arcs, a geometric shape, a set of parallel lines, a color gradient, or another suitable reticle for evaluating conditions at the epidermis E that may be symptomatic of infiltration or extravasation. According to one embodiment, the appearance of a set of parallel lines may become distorted when the epidermis E, and thuspane1510, is distended due to edema. According to another embodiment, changes in the coloration of the epidermis E may be evaluated by periodic comparison with a color gradient included onpane1510.
• Pane1510 may include one or more guides for positioning or orientingappliance1500 on the skin S. According to one embodiment,guide1516 preferably includes a notch or some other feature ofappliance1500 that may be sized or shaped to receive a portion ofcannula20, e.g.,hub20b.
• Appliance1500 preferably includes aframe1520 coupled topane1510. According to one embodiment ofappliance1500, a coupling betweenpane1510 andframe1520 is preferably relatively stronger than the bond betweenpane1510 and the epidermis E. Accordingly,pane1510 remains attached toframe1520 when separatingappliance1500 from the epidermis E.
• Frame1520 preferably has greater resistance to deformation than doespane1510. Accordingly,frame1520 may maintain the shape ofpane1510 whileappliance1500 is laid over the cannulation site N. According to one embodiment,frame1520 entirely cincturespane1510. According to other embodiments,frame1520 may (i) partiallycincture pane1510; (ii) extend from a peripheral portion ofpane1510 toward an interior portion ofpane1510; (iii) extend from the interior portion toward the peripheral portion; (iv) be spaced from the peripheral portion; or (v) include some combination of (i)-(iv).Frame1520 preferably includes polyvinyl chloride, polyethylene, polypropylene, or another suitable material that is relatively rigid with respect topane1510. For example,frame1520 may include a pad of polyvinyl chloride foam.Frame1520 may be opaque, but is preferably transparent or translucent to visible light for viewing the epidermis E in the vicinity of the cannulation site N. Preferably,frame1520 absorbs or blocks the transmission of electromagnetic radiation having the same wavelength(s) emitted and/or collected viasuperficies3300, e.g., near-infrared radiation. Thus, according to one embodiment, the epidermis E that underliesframe1520 may be optically visible and shielded from ambient near-infrared radiation.
• Appliance1500 preferably includes a plurality of fittings to provide alternate location options for coupling withelectromagnetic radiation sensor3000 toappliance1500. Preferably, first fitting1530aand second fitting1530bare disposed at locations on opposite sides ofguide1516. Accordingly, the first arrangements of first andsecond fittings1530aand1530bpreferably include location options for retainingelectromagnetic radiation sensor3000 on either side ofguide1516 for monitoring infiltration or extravasation during an infusion withcannula20. Second arrangements of first fitting1530aand second fitting1530bpreferably releaseelectromagnetic radiation sensor3000 from the first arrangements for the respective fittings.
• Appliance1500 preferably includes multiple fittings to permit multiple options for locatingelectromagnetic radiation sensor3000 relative to the cannulation site N. Preferably,electromagnetic radiation sensor3000 may be disposed in one of first andsecond fittings1530aand1530bwith the other of first andsecond fittings1530aand1530bmay be used for controllingtubing32 and/orsensor cable5000. Permutations of the arrangements of first andsecond fittings1530aand1530bwith respect toelectromagnetic radiation sensor3000 may be characterized as “conditions” ofappliance1500. For example, a first condition ofappliance1500 may be characterized by the second arrangements of first andsecond fittings1530aand1530b. Accordingly,electromagnetic radiation sensor3000 is not coupled toappliance1500 in the first condition.Electromagnetic radiation sensor3000 may be moved from the first condition to a second condition ofappliance1500 so as to be in the first arrangement of the first fitting1530aand in the second arrangement of second fitting1530b. Accordingly,electromagnetic radiation sensor3000 would be retained in first fitting1530aon the left-hand side ofguide1516 as viewed inFIG. 12.Electromagnetic radiation sensor3000 may also be moved from the first condition to a third condition ofappliance1500 so as to be in the first arrangement of thesecond fitting1530band in the second arrangement of first fitting1530a. Accordingly,electromagnetic radiation sensor3000 would be retained in second fitting1530bon the right-hand side ofguide1516 as viewed inFIG. 12.Appliance1500 may also be changed between the second and third conditions, e.g., movingelectromagnetic radiation sensor3000 to the other side ofguide1516, and may also be changed from either of the second or third conditions to the first condition, e.g., decouplingelectromagnetic radiation sensor3000. Accordingly,electromagnetic radiation sensor3000 preferably has multiple uses with a plurality ofindividual dressings1500 and on whichever side ofguide1516 is advantageous for a particular patient or a particular cannulation site N. Factors for evaluating which of first andsecond fittings1530aand1530bmay be advantageous to use for retainingelectromagnetic radiation sensor3000 preferably include reducing the likelihood of pulling or snaggingsensor cable5000, properly placingelectromagnetic radiation sensor3000 relative to the cannulation site N, and patient comfort.
• Referring additionally toFIG. 13A, individual fittings preferably are each capable of retainingelectromagnetic radiation sensor3000. Preferably, individual fittings, e.g., first fitting1530aor second fitting1530b, each include apocket1532 that is defined by awall1534.Pocket1532 preferably receives electromagnetic radiation sensor3000 (shown in dash-dot line inFIG. 13A) in the first arrangement. Preferably,pane1510 extends acrosspocket1532 and is interposed betweensuperficies3300 and the epidermis E in the first arrangement, as shown in, e.g.,FIG. 13A. According to one embodiment,wall1534 preferably includes a plurality of individual segments disposed partially aroundpocket1532. Preferably, at least onetab1536 projects fromwall1534 and overlies a portion ofelectromagnetic radiation sensor3000 in the first arrangement. Elastic deformation ofwall1534 ortab1536 preferably permitselectromagnetic radiation sensor3000 to snap-in to pocket1532 in the first arrangement and to snap-out frompocket1532 in the second arrangement. According to one embodiment,tab1536 preferably includes a raised portion orbump1538 for biasingsuperficies3300 toward the epidermis E by contiguously engagingelectromagnetic radiation sensor3000 in the first arrangement. According to other embodiments, individual fittings may include a latch, a cap, a resilient element, or another suitable device that, in a first arrangement, retainselectromagnetic radiation sensor3000 inpocket1532 and preferably biases superficies3300 toward the epidermis E, and in a second arrangement, releaseselectromagnetic radiation sensor3000 to move out ofpocket1532.
• Referring additionally toFIG. 13B,electromagnetic radiation sensor3000 and individual fittings in the first arrangement preferably are coupled in a preferred manner. Preferably, a portion ofelectromagnetic radiation sensor3000 has a first feature that cooperates with a second feature ofpocket1532. According to one embodiment,electromagnetic radiation sensor3000 includes a front-sidecylindrical portion3142 having a first cross-section shape andpocket1532 has a second cross-section shape that matingly receives front-sidecylindrical portion3142. Preferably, the first and second cross-sectional shapes are approximately congruent circles or other suitable mating shapes. Portions ofelectromagnetic radiation sensor3000 other than front-side cylindrical portion3162 preferably do not fit inpocket1532. According to one embodiment,electromagnetic radiation sensor3000 preferably includes a backsidecylindrical portion3144 having a third cross-section shape, e.g., a tear drop shape, that does not matingly cooperate with the second cross-section shape ofpocket1532. Accordingly,electromagnetic radiation sensor3000 preferably can matingly engage individual fittings in only one manner.
• Referring additionally toFIG. 13C, strain relief devices preferably redirect forces fromsensor cable5000 toappliance1500. Preferably, individual fittings, e.g., first fitting1530aor second fitting1530b, each include a set of strain relief devices that contiguously engagesensor cable5000 in the first arrangement. According to one embodiment, each set of strain relief devices preferably includes afirst fixture1540aand asecond fixture1540b.Individual fixtures1540aor1540bpreferably each include a pair of posts separated by a gap that is smaller than the diameter ofsensor cable5000. Accordingly,sensor cable5000 may be retained by an interference fit between a pair of posts that preferably limit lateral and/or longitudinal movement ofsensor cable5000 relative to frame1520.
• Preferably, first andsecond fixtures1540aand1540bare disposed on opposite sides ofguide1516. In the first arrangement,first fixture1540apreferably retainssensor cable5000 proximate a first one of the first andsecond fittings1530aand1530b, andsecond fixture1540bpreferably retainssensor cable5000 andtubing32 proximate a second one of the first andsecond fittings1530aand1530b.First fixture1540aof second fitting1530bis shown on the right-hand side ofguide1516 as viewed inFIG. 12 andsecond fixture1540bof second fitting1530bis shown on the left-hand side ofguide1516 as viewed inFIG. 12. According to one embodiment,first fixture1540apreferably cooperates withsensor cable5000 to eliminate or at least minimize rotation ofelectromagnetic radiation sensor3000 inpocket1532, andsecond fixture1540bpreferably establishes afirst bight5000aand asecond bight32aforsensor cable5000 andtubing32, respectively.
• Appliance1500 includes substantially identical features at different location options to increase compatibility of a single dressing for individual patients' cases. Preferably, multiple fittings and fixtures permit selecting the best available option for positioningelectromagnetic radiation sensor3000 relative to the cannulation site N and for controllingsensor cable5000 and/ortubing32. Selecting either first fitting1530aor second fitting1530bpreferably reduces the likelihood of pulling or snaggingsensor cable5000 and/ortubing32, positionselectromagnetic radiation sensor3000 proximate to the cannulation site N, and increases patient comfort.
• Aclip1542 preferably couplestubing32 andsensor cable5000. Preferably, clip242 may be fixed tosensor cable5000 at a selected distance fromelectromagnetic radiation sensor3000. The distance is preferably selected to cooperate withsecond fixture1540bfor consistently establishing an approximate size and radius offirst bight5000a. According to one embodiment,clip1542 abuts againstsecond fixture1540b. Clip1540 preferably includes a first portioncincturing sensor cable5000 and a second portion having an opening for receiving and retaining, e.g., by interference fit,tubing32. Thus,first fixture1540a,second fixture1540b, andclip1542 preferably redirect toappliance1500 rather than toelectromagnetic radiation sensor3000 orcannula20 any forces due to pulling or snaggingsensor cable5000 and/ortube32. Accordingly, in the first arrangement,electromagnetic radiation sensor3000 may be retained in an approximately consistent positional relationship with respect to the perivascular tissue P aroundcannula20 when sensing infiltration or extravasation.
• Referring additionally toFIG. 13D,frame1520 preferably is sufficiently flexible to conform to the approximate contours of epidermis E. Preferably,frame1520 includes one or more lines ofweakness1544 disposed aboutframe1520 at various positions including, for example, in the general vicinity of corners forpane1510 and parallel to the longitudinal axis ofcannula20. According to one embodiment, individual lines ofweakness1544 preferably include living hinges or other suitable features for increasing the flexibility offrame1520.
• Appliance1500 preferably is a single unit that includes plural location options for retaining an anatomical sensor. According to one embodiment, the anatomical sensor may includeelectromagnetic radiation sensor3000 or another sensor for sensing over time a change of body structure, e.g., infiltration and extravasation. Preferably, individual fittings, e.g., first fitting1530aor second fitting1530b, provide alternate location options for couplingelectromagnetic radiation sensor3000 toappliance1500. The location option that is most suitable is preferably selected based on one or more factors including: (i) location of the cannulation site N; (ii) orientation ofcannula20; (iii) avoiding movement ofcannula20 orelectromagnetic radiation sensor3000 due to pulling or snaggingtubing32 orsensor cable5000; and (iv) comfort of the patient.Appliance1500 is advantageous at least because the most suitable of plural location options for couplingelectromagnetic radiation sensor3000 is preferably selected.
• A sixth embodiment of dressing1000 is shown inFIGS. 14A and 14B. An appliance set preferably includes (i) a contamination barrier overlying the cannulation site N; and (ii)different appliances1600a(FIG. 14A) and 1600b(FIG. 14B) for locating electromagnetic radiation sensor3000 (not shown inFIG. 14A or14B) to sense if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c. As compared toappliance1500, which includes a plurality of individual fittings at alternate location options onframe1520,appliances1600aand1600bseparately provide different locations for a fitting1630 relative to aguide1614. Accordingly, one or the other ofappliances1600aand1600b, rather than one or the other of first and second fitting1530aand1530bonappliance1500, may be selected for couplingelectromagnetic radiation sensor3000 at the most suitable location option.
• Appliances1600aand1600bpreferably each include apane1610, aframe1620 and fitting1630 that are functionally similar to, respectively,pane1510,frame1520 and first or second fitting1530aand1530b. Accordingly,appliances1600aand1600bpreferably each provide a contamination barrier that is substantially impervious to solids, liquids, microorganisms and/or viruses, but which may be semi-permeable to allow air or vapor to pass, thus permitting the skin Sunderlying pane1610 to breathe.Pane1610 is preferably transparent or translucent to visible light for viewing the cannulationsite N. Frame1620 preferably maintains the shape ofpane1610 whileappliance1600aorappliance1600bis laid over the cannulation site N. And a first arrangement of fitting1630 preferably retainselectromagnetic radiation sensor3000 relative toappliance1600aorappliance1600bfor monitoring an intravascular infusion bycannula20, and a second arrangement of fitting1630 preferably releaseselectromagnetic radiation sensor3000 from the first arrangement.
• Frame1620 preferably has greater resistance to deformation than doespane1610. Accordingly,frame1620 may maintain the shape ofpane1610 whileappliance1600aorappliance1600bis laid over the cannulation site N. According to one embodiment,frame1620 entirely cincturespane1610. According to other embodiments,frame1620 may (i) partiallycincture pane1610; (ii) extend from a peripheral portion ofpane1610 toward an interior portion ofpane1610; (iii) extend from the interior portion toward the peripheral portion; (iv) be spaced from the peripheral portion; or (v) include a combination of (i)-(iv).Frame1620 preferably includes polyvinyl chloride, polyethylene, polypropylene, or another suitable material that is relatively rigid with respect topane1610. For example,frame1620 may include a pad of polyvinyl chloride foam.Frame1620 may be opaque, but is preferably transparent or translucent to visible light for viewing the epidermis E in the vicinity of the cannulation site N. Preferably,frame1620 absorbs or blocks the transmission of radiation having the same wavelength(s) as emitted and collectedelectromagnetic radiation3002 and3006, e.g., near-infrared radiation. Thus, according to one embodiment, the epidermis E that underliesframe1620 may be optically visible and shielded from ambient near-infrared radiation.
• Appliance1600aandappliance1600bpreferably are independent units that separately include different locations for retaining an anatomical sensor. Preferably,appliance1600aincludes fitting1630 at a first location relative to guide1614, e.g., on the right-hand side ofguide1614, andappliance1600bincludes fitting1630 at a second location relative to guide1614, e.g., on the left-hand side ofguide1614. Accordingly, the most suitable one ofappliance1600aorappliance1600bpreferably is selected based on one or more factors including: (i) location of the cannulation site N; (ii) orientation ofcannula20; (iii) avoiding movement ofcannula20 orelectromagnetic radiation sensor3000 due to pulling or snaggingtubing32 orsensor cable5000; and (iv) comfort of the patient.Independent appliances1600aand1600bare advantageous at least because a choice is available for how an anatomical sensor, e.g.,electromagnetic radiation sensor3000, is located relative tocannula20.
• A seventh embodiment of dressing1000 is shown inFIGS. 15A-15D. Anappliance1700 preferably includes (i) aframe1720 that relatively positionselectromagnetic radiation sensor3000 andcannula20; and (ii) a contamination barrier that overlies the cannulation site N andframe1720. The contamination barrier preferably is substantially impervious to solids, liquids, microorganisms and/or viruses, and may be semi-permeable to allow air or vapor to pass for permitting the skin S to breathe. The contamination barrier preferably includes apane1710 that is transparent or translucent to light in the visible portion of the electromagnetic spectrum for viewing the cannulationsite N. Pane1710 preferably includes a polyurethane film or another suitable material and/or construction for providing a contamination barrier that may be transparent or translucent.
• An adhesive1712 preferably bondspane1710 to the epidermis E (not indicated inFIGS. 15A-15D). Preferably, adhesive1712 includes an acrylic adhesive that is suitable for contact with the epidermis E or another medical grade adhesive that is biocompatible according ISO 10993 and/or USP Class VI.Adhesive1712 may be applied to the contamination barrier on the entire surface that confronts the epidermis E, or adhesive1712 may be omitted from one or more portions of the surface. For example, adhesive1712 may be omitted from afirst area1712aonpane1710 in the vicinity of the cannulation site N or from asecond area1712bonpane1710 preferably to facilitate pullingpane1710 from the epidermis E. Preferably, the first orsecond areas1712aand1712bmay be identified, e.g., with printing onpane1710. Also, the strength of the bond betweenpane1710 and the epidermis E may vary according to different embodiments of dressing1700. For example, stronger or more adhesive1712 may be used for coupling dressing1700 to relatively robust skin, e.g., adult skin, and weaker or less adhesive1712 may be used for coupling dressing1700 to relatively delicate skin, e.g., pediatric skin. Preferably, a removable release liner (not shown) preserves adhesive1712 until the contamination barrier is ready to be laid over the cannulation site N andframe1720.
• Referring particularly toFIG. 15B, aframework1714 preferably supportspane1710 while being laid over the cannulation site N. Preferably,framework1714 includes paper or another suitable material that has greater resistance to deformation than doespane1710 but is flexible enough to conform to the contours of the skin S. Accordingly,framework1714 preferably maintains the approximate shape of the outer peripheral edge ofpane1710 and of anyapertures1710a(two are shown inFIGS. 15A,15B and15D) while the contamination barrier is being laid over the cannulation site N andframe1720. According to one embodiment of dressing1700, a coupling betweenpane1710 andframework1714 is preferably relatively weaker than the bond betweenpane1710 and the epidermis E. Accordingly,framework1714 may be released afterpane1710 bonds to the epidermis E. Preferably, atab1714afacilitates pullingframework1714 frompane1710.
• Frame1720 preferably has greater resistance to deformation than doespane1710. Preferably,frame1720 preferably includes polyvinyl chloride, polyethylene, polypropylene, or another suitable material that is relatively rigid with respect topane1710. For example,frame1720 may include a pad of polyvinyl chloride foam.Frame1720 preferably distributes forces, e.g., due to pulling or snaggingsensor cable5000, over an area of the skin S that is larger than that overlaid by superficies3300 (not shown inFIGS. 15A-15D).
• Frame1720 preferably linkscannula20 andelectromagnetic radiation sensor3000. Preferably,frame1720 includes (i) amount1722 for cooperatively engagingcannula20; and (ii) at least one fitting—a first fitting1730aand asecond fitting1730bare shown inFIGS. 15A,15C and15D—for coupling withelectromagnetic radiation sensor3000. Accordingly,frame1720 preferably includes a link for establishing and maintaining a positional relationship betweencannula20 andelectromagnetic radiation sensor3000. According to one embodiment,mount1722 preferably includes a base1722aand one or moreresilient projections1722bextending from base1722a. Preferably, base1722aincludes an interface forcoupling mount1722 withframe1720, e.g., via an adhesive, and projection(s)1722bresiliently capture a portion ofcannula20. Therefore,mount1722 preferably establishes and maintains a positional relationship betweencannula20 andframe1720. Preferably, individual fittings, e.g., first fitting1730aor second fitting1730b, may be comparable tofittings1110,1210,1310,1430 or1530a/1530bdiscussed above and therefore each may retainelectromagnetic radiation sensor3000. Therefore, each individual fitting preferably establishes and maintains a positional relationship betweenelectromagnetic radiation sensor3000 andframe1720. Thus, according to one embodiment,frame1720,mount1722, and first fitting1730aor second fitting1730bpreferably linkcannula20 andelectromagnetic radiation sensor3000 by establishing and maintaining their relative positional relationship.
• Referring particularly toFIG. 15C,frame1720 preferably prevents contiguous engagement betweenelectromagnetic radiation sensor3000 and the epidermis E. Preferably, abarrier layer1720aextends across the pocket of individual fittings, e.g., first fitting1730aand second fitting1730b, and is interposed betweensuperficies3300 and the epidermis E in the first arrangements ofindividual fittings1730aor1730b.Barrier layer1720amay be the same material aspane1710 or another material that is substantially impervious to solids, liquids, microorganisms and/or viruses, and substantially transparent to emitted and collectedelectromagnetic radiation3002 and3006.
• Strain relief devices preferably redirect forces fromelectromagnetic radiation sensor3000 to dressing1700. Preferably, individual fittings, e.g., first fitting1730aor second fitting1730b, each include a set of strain relief devices that contiguously engagesensor cable5000 in the first arrangement. According to one embodiment, each set of strain relief devices preferably includes afirst fixture1740aand asecond fixture1740b.Individual fixtures1740aor1740bpreferably each include a plurality of posts separated by a gap that is smaller than the diameter ofsensor cable5000 and/or the diameter oftubing32. Accordingly,sensor cable5000 and/ortubing32 may be retained by a resilient interference fit between a pair of posts that preferably limit lateral and/or longitudinal movement ofsensor cable5000 ortubing32 relative to frame1720.
• Preferably, first andsecond fixtures1740aand1740bare disposed on opposite sides ofmount1722. Each ofFIGS. 15A,15C and15D indicate only one of two pairs of fixtures that are shown. In the first arrangement,first fixture1740apreferably retainssensor cable5000 proximate a first one of the first andsecond fittings1730aand1730b, andsecond fixture1740bpreferably retainssensor cable5000 andtubing32 proximate a second one of the first andsecond fittings1730aand1730b.First fixture1740aof first fitting1730ais shown on the left-hand side ofmount1722 as viewed inFIG. 15D andsecond fixture1740bof first fitting1730ais shown on the right-hand side ofmount1722 as viewed inFIG. 15D. According to one embodiment,first fixture1740apreferably cooperates withsensor cable5000 to eliminate or at least minimize rotation ofelectromagnetic radiation sensor3000 with respect to first fitting1730a, andsecond fixture1740bpreferably establishesfirst bight5000aandsecond bight32aforsensor cable5000 andtubing32, respectively.
• A method of implementing dressing1700 will now be discussed with reference toFIG. 15D.Cannula20 is inserted at cannulation site N in a typical manner. Preferably,frame1720 is bonded to the epidermis E (not indicated) with projection(s)1722bofmount1722 engaging a portion ofcannula20.Pane1710 andframework1714 preferably are overlaid onframe1720 withapertures1710acincturing first fitting1730a, second fitting1730b, and first andsecond fixtures1740aand1740b. Preferably, adhesive1712bonds pane1710 to the epidermis E, andframework1714 is separated frompane1710.Adhesive1712 preferably also adherespane1710 over the portion ofcannula20 that is engaged bymount1722 so thatcannula20 is coupled toframe1720.Tubing32 is coupled withcannula20 in a typical manner and preferably also engagessecond fixture1740bto formsecond bight32a. Preferably,electromagnetic radiation sensor3000 is coupled to an individual fitting, e.g., the fitting on the left-hand side ofmount1722 as viewed inFIG. 15D, withsensor cable5000 engagingfirst fixture1740a.Sensor cable5000 preferably also engagessecond fixture1740bto formfirst bight5000a.Electromagnetic radiation sensor3000 is thereby coupled toframe1720. Preferably, alead management system1750 limits the forces that may be transmitted to dressing1700 as a result of pulling or snaggingtubing32 orsensor cable5000.Lead management system1750 preferably bonds to the epidermis E, e.g., with an adhesive, and includes apatch1750aand aboard1750b. According to one embodiment,patch1750apreferably is shaped and sized to overlay first andsecond bights5000aand32a, andboard1750bpreferably includes at least onefixture1750cthat is similar tosecond fixture1740bin construction and function. Preferably,board1750bis spaced from first andsecond bights5000aand32aalong the lengths oftubing32 andsensor cable5000. According to one embodiment,frame1720,patch1750aandboard1750bpreferably share a similar construction and may be manufactured concurrently as a unit, which may then be separated when implementingdressing1700.
• Removing dressing1700 preferably occurs after releasingelectromagnetic radiation sensor3000 from one of the first andsecond fittings1730aand1730b. Preferably,pane1710 is peeled off beginning withsecond area1712bwhilewings1720b(two are indicated onFIG. 15A) are held toseparate pane1710 fromframe1720.Cannula20 preferably is disengaged frommount1722 and extracted from the cannulation site N, andframe1720 is peeled off the epidermis E. A barrier film such as Cavilon™, manufactured by 3M (St. Paul, Minn., USA), or another topical agent may be used when implementing dressing1700 for protecting the epidermis E from adhesive trauma due to peeling offpane1710 and/orframe1720.
• Dressing1700 is advantageous at least because there is a link betweencannula20 andelectromagnetic radiation sensor3000 when sensing if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c. Preferably,frame1720,mount1722, and individual fittings, e.g., first fitting1730aor second fitting1730b, establish and maintain a relative positional relationship that linkscannula20 andelectromagnetic radiation sensor3000.Dressing1700 is also advantageous because a contamination barrier is implemented in a typical manner, e.g., overlying the cannulation site N, and concurrently cooperates with the link betweencannula20 andelectromagnetic radiation sensor3000.
• An eighth embodiment of dressing1000 is shown inFIGS. 16A-16D.Appliances1800aand1800bpreferably include (i) a contamination barrier that overlies the cannulation site N (not shown inFIGS. 16A-16D); (ii) a molded frame that locates electromagnetic radiation sensor3000 (not shown inFIGS. 16A-16D) to sense if fluid is infusing the perivascular tissue P aroundtranscutaneous sleeve20c; and (iii) a plurality of options for relatively locatingelectromagnetic radiation sensor3000 and cannula20 (not shown inFIGS. 16A-16D). According to one embodiment,pane1810 includes a contamination barrier that preferably is substantially impervious to solids, liquids, microorganisms and/or viruses, and may be semi-permeable to allow air or vapor to pass for permitting the skin S to breathe. Preferably,appliance1800a(FIGS. 16A and 16B) includes afirst frame1820athat is integrally molded with a first fitting1830a, andappliance1800b(FIGS. 16C and 16D) includes asecond frame1820bover-molding asecond fitting1830b.
• Employing molding to manufactureappliances1800aand1800bpreferably reduces the number of independent components included inappliances1800aand1800bas compared to, for example,appliances1400,1500,1600a/1600band1700. Preferably, the phrase “independent component” as it is used herein refers to a single part that (a) has a substantially uniform composition; and (b) is coupled with other parts in an assemblage.Appliance1800apreferably reduces the number of independent components by at least two as compared to, for example,appliances1400,1500,1600a/1600band1700 because (i)first frame1820aand first fitting1830amay be formed as a single independent component, e.g., integrally molded with a homogeneous chemical compound, before assemblingappliance1800a; and (ii) an adhesive for couplingfirst frame1820awith first fitting1830amay be eliminated.Appliance1800bpreferably reduces the number of independent components by at least one as compared to, for example,appliances1400,1500,1600a/1600band1700 because an adhesive for couplingfirst frame1820awith first fitting1830ais eliminated. Preferably, further reductions are possible in the number of independent components included inappliances1800aand1800bas compared toappliances1500 or1700. For example, as compared toappliances1500 and1700, a further reduction of at least one additional independent component may be possible because first orsecond frames1820aor1820band strain relief device(s) forsensor cable5000 may be formed as a single independent component, e.g., integrally molded with a homogeneous chemical compound, before assemblingappliance1800aor1800b. And as compared toappliance1700, a yet further reduction of at least two additional independent components may be possible because (i) first orsecond frames1820aor1820band a mount forcannula20 may be formed as a single independent component, e.g., integrally molded with a homogeneous chemical compound, before assembling the dressing; and (ii) an adhesive for coupling the mount with first orsecond frames1820aor1820bmay be eliminated. Thus, employing molding may reduce the number of independent components that preferably are included inappliances1800aand1800b.
• Appliance1800a(orappliance1800b) preferably includes apane1810,frame1820a(orframe1820b), and fitting1830a(or fitting1830b) that function similar to, for example,pane1610,frame1620 and fitting1630, respectively. Accordingly,pane1810 preferably is transparent or translucent to visible light for viewing the cannulation site N;frame1820a(orframe1820b) preferably maintains the shape ofpane1810 whileappliance1800a(orappliance1800b) is laid over the cannulation site N; and a first arrangement of fitting1830a(or fitting1830b) preferably retainselectromagnetic radiation sensor3000 relative toappliance1800a(orappliance1800b) for monitoring an intravascular infusion bycannula20 and a second arrangement of fitting1830a(or fitting1830b) preferably releaseselectromagnetic radiation sensor3000 from the first arrangement.
• Pane1810 preferably uses an adhesive1812 to bond with the epidermis E in the vicinity of the cannulation site N. Preferably,pane1810 includes a polyurethane film or another suitable material for providing a contamination barrier that may be transparent or translucent.Adhesive1812 preferably couplespane1810 to the epidermis E. Preferably, adhesive1812 includes an acrylic adhesive that is suitable for contact with the epidermis E or another medical grade adhesive that is biocompatible according ISO 10993 and/or USP Class VI.Adhesive1812 may be applied topane1810 on the entire surface that confronts the epidermis E, or adhesive1812 may be omitted from one or more portions of the surface. Also, the strength of the bond betweenpane1810 and the epidermis E may vary according to different embodiments of the dressing. For example, stronger or more adhesive1812 may be used forcoupling appliance1800aorappliance1800bto relatively robust skin and weaker or less adhesive1812 may be used forcoupling appliance1800aorappliance1800bto relatively delicate skin.
• Appliances1800aand1800beach preferably include a plurality of options for positioning or orienting the appliances on the skin S. Preferably,appliance1800aincludes afirst guide1814aat a first location relative to fitting1830a, e.g., on the right-hand side of fitting1830aas viewed inFIG. 16A, and asecond guide1814bat a second location relative to fitting1830a, e.g., on the left-hand side of fitting1830aas viewed inFIG. 16A. Similarly,appliance1800bincludesfirst guide1814alocated on the right-hand side of fitting1830bas viewed inFIG. 16C, andsecond guide1814blocated on the left-hand side of fitting1830bas viewed inFIG. 16C. The most suitable one offirst guide1814aorsecond guide1814bpreferably is selected based on one or more factors including: (i) location of the cannulation site N; (ii) orientation ofcannula20; (iii) avoiding movement ofcannula20 orelectromagnetic radiation sensor3000 due to pulling or snaggingtubing32 orsensor cable5000; and (iv) comfort of the patient. According to one embodiment,individual guides1814aand1814bpreferably include a notch or some other feature ofappliance1800aor1800bthat may be sized or shaped to receive a portion ofcannula20. According to another embodiment,individual guides1814aand1814bpreferably include a mount (not shown) for cooperatively engagingcannula20. Alternate first andsecond guides1814aand1814bare advantageous at least because a choice is available for howelectromagnetic radiation sensor3000 is located relative tocannula20.
• First andsecond frames1820aand1820bpreferably have greater resistance to deformation than doespane1810. Accordingly, individual frames, e.g.,first frame1820aorsecond frame1820b, may maintain the shape ofpane1810 whileappliance1800aorappliance1800bis laid over the cannulation site N. First andsecond frames1820aand1820bpreferably are formed as single independent components, e.g., integrally molded with a homogenous chemical compound, rather than being built-up as a laminate. Preferably, individual frames, e.g.,first frame1820aorsecond frame1820b, include polydimethylsiloxanes or another suitable material for molding the frames. Advantageously,appliances1800aand800bpreferably resist absorbing fluids as compared to typical woven or fabric dressings.
• First andsecond fittings1830aand1830bpreferably are capable of retainingelectromagnetic radiation sensor3000. Preferably, individual fittings, e.g., first fitting1830aor second fitting1830b, each include apocket1832, awall1834, and atab1836.Pocket1832 preferably receives electromagnetic radiation sensor3000 (not shown inFIGS. 16A-16D) in the first arrangement. Preferably,pane1810 extends acrosspocket1832 and is interposed betweensuperficies3300 and the epidermis E in the first arrangement of the individual fittings. According to one embodiment,wall1834 preferably includes a plurality of individual segments disposed partially aroundpocket1832. Preferably, at least onetab1836 projects fromwall1834 and overlies a portion ofelectromagnetic radiation sensor3000 in the first arrangement. Elastic deformation ofwall1834 ortab1836 preferably permitselectromagnetic radiation sensor3000 to snap-in to pocket1832 in the first arrangement and to snap-out frompocket1832 in the second arrangement. According to one embodiment,tab1836 preferably biases superficies3300 toward the skin S by contiguously engagingelectromagnetic radiation sensor3000 in the first arrangement. According to other embodiments, individual fittings may include a latch, a cap, a resilient element, or another suitable device which, in the first arrangement, retainselectromagnetic radiation sensor3000 inpocket1832 and preferably biases superficies3300 toward the epidermis E, and in the second arrangement, releaseselectromagnetic radiation sensor3000 from the first arrangement so as to permit movement out ofpocket1832.
• Appliances1800aand1800bpreferably maintain an approximately consistent positional relationship betweenelectromagnetic radiation sensor3000 and the perivascular tissue P. According to an embodiment ofappliance1800a,frame1820apreferably distributes forces acting onelectromagnetic radiation sensor3000 due to, e.g., pulling or snaggingsensor cable5000, over an area of the skin S that is larger than that overlaid bysuperficies3300. Preferably, one or more arms1838 (four are shown inFIG. 16C) are coupled withwall1834 according to an embodiment ofappliance1800b. Arm(s)1838 preferably extend away frompocket1832, e.g., beyond an area of the skin S that is overlaid bysuperficies3300 in the first arrangement of fitting1830b. Accordingly, forces acting onelectromagnetic radiation sensor3000 due to, e.g., pulling or snaggingsensor cable5000, may be distributed by arm(s)1838 andframe1820bover an area of the skin S that is larger than that overlaid bysuperficies3300.Appliances1800aand1800btherefore preferably enhance an approximately consistent positional relationship betweenelectromagnetic radiation sensor3000 and the perivascular tissue P when sensing infiltration or extravasation.
• Strain relief devices preferably redirect forces fromsensor cable5000 toappliance1800aorappliance1800b. Preferably,first frame1820aor second fitting1830binclude at least one strain relief device that contiguously engagessensor cable5000 in the first arrangement.First frame1820aand a strain relief device1840 (FIGS. 16A and 16B) preferably are formed as a single independent component, e.g., integrally molded with a homogeneous chemical compound, before assemblingappliance1800a. Second fitting1830band first andsecond fixtures1840aand1840b(FIGS. 16C and 16D) preferably are formed as a single independent component, e.g., integrally molded with a homogeneous chemical compound, before assemblingappliance1800b. According to an embodiment ofappliance1800b, portions of first andsecond fixtures1840aand1840bpreferably are exposed with respect to frame1820b. Preferably,strain relief device1840,first fixture1840a, andsecond fixture1840beach include a plurality of posts separated by a gap that is smaller than the diameter ofsensor cable5000. Accordingly,sensor cable5000 may be retained by a resilient interference fit between a pair of posts that preferably limit lateral and/or longitudinal movement ofsensor cable5000 relative to frame1820aorframe1820b.
• Molding during manufacturing ofappliance1800aand1800bpreferably includes at least one of (i) integrally molding a single independent component that fulfills more than one role in an assemblage; or (ii) over-molding a first independent component with another independent component in an assemblage. Preferably,first frame1820ais integrally molded withwall1834 andtab1836 as an independent component included inappliance1800a. Roles including maintaining the shape ofpane1810 and retaining/releasingelectromagnetic radiation sensor3000 are therefore fulfilled by a single independent component inappliance1800a. According to an embodiment ofappliance1800a,strain relief device1840 preferably also is integrally molded withfirst frame1820aas an independent component included inappliance1800a. Accordingly, the additional role of limiting relative movement ofsensor cable5000 is also fulfilled by a single independent component inappliance1800a. According to an embodiment ofappliance1800b, preferably an initial shot in a multi-shot mold forms a first independent component and a subsequent shot in the multi-shot mold assemblesappliance1800b, including the independent component formed with the initial shot. Preferably,second frame1820bover-molds second fitting1830binappliance1800b. For example,wall1834 andtab1836 preferably are integrally molded with second fitting1830bas an independent component before being over-molded withsecond frame1820b. According to embodiments ofappliance1800b,first fixture1840aand/orsecond fixture1840bpreferably also are integrally molded with second fitting1830bas an independent component before being over-molded withsecond frame1820b. Employing molding inmanufacturing appliances1800aand1800bis advantageous at least because fewer independent components are preferably assembled as compared to, for example,appliances1400,1500,1600a/1600band1700.
Sensor
• FIG. 17 shows an embodiment according to the present disclosure of theelectromagnetic radiation sensor3000 that preferably includes an anatomic sensor. As the terminology is used herein, “anatomic” preferably refers to the structure of an Animalia body and an “anatomic sensor” preferably is concerned with sensing a change over time of the structure of the Animalia body. By comparison, a physiological sensor is concerned with sensing the functions or activities of an Animalia body, e.g., pulse or blood chemistry, at a point in time.
• The electromagnetic radiation signals emitted byelectromagnetic radiation sensor3000 preferably are not harmful to an Animalia body. According to one embodiment,electromagnetic radiation sensor3000 preferably emits electromagnetic radiation signals at wavelengths in the visible light or infrared radiation portions of the electromagnetic spectrum. Preferably,electromagnetic radiation sensor3000 emits wavelengths in a range between approximately 380 nanometers and approximately 1 millimeter. These wavelengths generally correspond to a frequency range of approximately 790 terahertz to approximately 300 gigahertz. According to other embodiments,electromagnetic radiation sensor3000 may emit electromagnetic radiation signals in shorter wavelength portions of the electromagnetic spectrum, e.g., ultraviolet light, X-rays or gamma rays, preferably when radiation power and/or signal duration are such that tissue harm is minimized.
• Electromagnetic radiation sensor3000 preferably aids in diagnosing infiltration or extravasation. Preferably, firstelectromagnetic radiation3002 is emitted viasuperficies3300 ofelectromagnetic radiation sensor3000 and firstelectromagnetic radiation3006 is collected viasuperficies3300. First emittedelectromagnetic radiation3002 preferably includes (i) cutaneouselectromagnetic radiation3002athat minimally penetrates theskin5; and (ii) transcutaneouselectromagnetic radiation3002bthat passes through the target area of the skin S into the perivascular tissue P. The perivascular tissue P in the vicinity of blood vessel V preferably includes the cells or compartments that may become unintentionally infused, e.g., infiltrated or extravasated by fluid exiting fromcannula20. First collectedelectromagnetic radiation3006 preferably includes (i) anoise component3006adue at least in part to cutaneouselectromagnetic radiation3002a; and (ii) asignal component3006bthat is a portion of transcutaneouselectromagnetic radiation3002bthat is at least one of specularly reflected, diffusely reflected (e.g., due to elastic or inelastic scattering), fluoresced (e.g., due to endogenous or exogenous factors), or otherwise redirected from the perivascular tissue P before passing through the skin S.
• The wavelength of first emittedelectromagnetic radiation3002 preferably is longer than approximately 750 nanometers. The frequency of first emittedelectromagnetic radiation3002 therefore is no more than approximately 400 terahertz. According to one embodiment, first emittedelectromagnetic radiation3002 preferably is in the near-infrared radiation portion of the electromagnetic spectrum. As the terminology is used herein, “near-infrared” preferably refers to electromagnetic radiation having wavelengths between approximately 750 nanometers and approximately 2,100 nanometers. These wavelengths generally correspond to a frequency range of approximately 400 terahertz to approximately 145 terahertz. A desirable range in the near-infrared portion of the electromagnetic spectrum preferably includes wavelengths between approximately 800 nanometers and approximately 1,050 nanometers. These wavelengths generally correspond to a frequency range of approximately 375 terahertz to approximately 285 terahertz.
• First emitted and collectedelectromagnetic radiation3002 and3006 preferably share one or more wavelengths. According to one embodiment, first emitted and collectedelectromagnetic radiation3002 and3006 preferably share a single peak wavelength, e.g., approximately 940 nanometers (approximately 320 terahertz). As the terminology is used herein, “peak wavelength” preferably refers to an interval of wavelengths including a spectral line of peak power. The interval preferably includes wavelengths having at least half of the peak power. Preferably, the wavelength interval is +/−approximately 20 nanometers with respect to the spectral line. According to other embodiments, first emitted and collectedelectromagnetic radiation3002 and3006 preferably share a plurality of peak wavelengths, e.g., approximately 940 nanometers and approximately 1,050 nanometers. According to other embodiments, a first one of first emitted and collectedelectromagnetic radiation3002 and3006 preferably spans a first range of wavelengths, e.g., from approximately 700 nanometers to approximately 1000 nanometers. This wavelength range generally corresponds to a frequency range from approximately 430 terahertz to approximately 300 terahertz. A second one of first emitted and collectedelectromagnetic radiation3002 and3006 preferably shares with the first range a single peak wavelength, a plurality of peak wavelengths, or a second range of wavelengths. Preferably,patient monitoring device6000 performs an electromagnetic radiation power analysis at the wavelength(s) shared by first emitted and collectedelectromagnetic radiation3002 and3006 for indicating an anatomical change over time in the perivascular tissue P.
• The inventors discovered a problem regarding accurately alerting a healthcare giver to perform an infiltration/extravasation examination. The examination that healthcare givers perform typically includes palpating the skin S in the vicinity of the target area, observing the skin S in the vicinity of the target area, and/or comparing limbs that include and do not include the target area of the skin S. Typically, the object of the examination is to identify, for example, (i) edema, pain or numbness in the vicinity of the cannulation site N; (ii) blanching, discoloration, inflammation or coolness of the skin S in the vicinity of the cannulation site N; (iii) breakdown, tautness or stretching of the skin S; or (iv) drainage from the cannulation site N. False alerts to perform an infiltration/extravasation examination may distract healthcare givers or reduce confidence in the alerting system. The inventors further discovered, inter alia, the problem is first collectedelectromagnetic radiation3006 may not accurately alert healthcare givers to perform an infiltration/extravasation examination.
• An Animalia body typically includes macrovascular and microvascular systems for circulating blood between the heart and tissues. Typically, the macrovascular system includes the relatively large (approximately 1.0-10.0 millimeter diameter) arteries and veins that deliver and return blood with respect to the heart, and the microvascular system includes the relatively small blood vessels that are embedded within the tissues. The microvascular system typically includes arterioles (approximately 0.1 millimeter diameter), capillaries (approximately 0.01 millimeter diameter), and venules (approximately 0.1 millimeter diameter). Preferably, the arterioles carry blood from arteries to capillaries and the venules carry blood from capillaries to veins.
• Tissue blood perfusion is a physiological function that typically is regulated by the microvascular system. As the terminology is used herein, “blood perfusion” preferably refers to a delivery process that includes (i) transporting nutrients, e.g., oxygen, to capillaries; (ii) exchanging the nutrients and waste, e.g., carbon dioxide, through the capillaries between blood and interstitial fluid; and (iii) transporting the waste from the capillaries. Typically, tissue blood perfusion is evaluated based on blood flow per unit volume of tissue, e.g., (milliliters/minute)_blood/or blood flow per unit mass of tissue, e.g., (milliliters/minute)_blood/gram_tissue. Body temperature and blood pressure are additional examples of physiological functions that typically are at least partially regulated by the microvascular system.
• The microvascular system typically includes pre-capillary and post-capillary regulators for tissue blood perfusion. Typically, pre-capillary regulation includes modulating blood flow entering the capillaries and venules by contracting and relaxing pre-capillary sphincters and smooth muscles on the walls of the arterioles. Post-capillary regulation typically includes microscopic venous valves that restrict blood flow from post-capillary venules back into capillaries.
• A posture change of an Animalia body typically elicits a vascular response including the microvascular system regulating tissue blood perfusion. As the terminology is used herein, “posture change” preferably refers to the result of actions or activities that modify the elevation of the cannulation site N relative to a patient's heart. Typically, posture changes include raising or lowering a limb.FIG. 34A schematically illustrates a first posture with preferably nominal tissue blood perfusion because the cannulation site N is relatively level with respect to the heart.FIG. 34B schematically illustrates a second posture with the cannulation site N relatively dependent with respect to the heart. Typically, the tissue blood perfusion in the second posture increases relative to the nominal tissue blood perfusion in the first posture because the microscopic venous valves preferably are at least partially inverted such that flow from post-capillary venules back into capillaries is less restricted. Accordingly, there preferably is an increased volume of blood in the microvascular system in the second posture as compared with the first posture.FIG. 34C schematically illustrates a third posture with the cannulation site N relatively elevated with respect to the heart. Typically, the tissue blood perfusion in the third posture decreases relative to the nominal tissue blood perfusion in the first posture because the pre-capillary sphincters and smooth muscles on the walls of the arterioles are less effective modulating blood flow against gravity. Accordingly, there preferably is a decreased volume of blood in the microvascular system in the third posture as compared with the first posture
• The inventors discovered a source of the problem regarding accurately alerting a healthcare giver to perform an infiltration/extravasation examination is changing tissue blood volume affects the propagation of first emitted and collectedelectromagnetic radiation3002 and3006. As the terminology is used herein, “tissue blood volume” preferably refers to a volume of blood along a monitoring path ofsensor3000, and “monitoring path” preferably refers to a volume of tissue in which first emitted and collectedelectromagnetic radiation3002 and3006 propagate. Thus, tissue blood volume preferably is a measure of blood concentration in tissue. The inventors further discovered, inter alia, tissue blood volume is affected by patient posture changes. Typically, lowering the cannulation site N, e.g., changing posture from the first posture (FIG. 34A) to the second posture (FIG. 34B), increases the tissue blood volume and raising the cannulation site N, e.g., changing posture from the first posture (FIG. 34A) to the third posture (FIG. 34C), decreases the tissue blood volume. The inventors further discovered, inter alia, tissue blood volume changes along the monitoring path ofsensor3000 affect the propagation of first emitted and collectedelectromagnetic radiation3002 and3006 such that first collectedelectromagnetic radiation3006 responds to tissue blood volume changes as well as to infiltration/extravasation events. Thus, the inventors discovered, inter alia, that tissue blood volume changes due to patient posture changes might falsely alert healthcare givers to perform an infiltration/extravasation examination.
• Electromagnetic radiation sensor3000 preferably mitigates false alerts caused by tissue blood volume changes. Preferably, a second wavelength is used to determine the accuracy of an alert to perform an infiltration/extravasation examination by distinguishing between tissue blood volume changes and infiltration/extravasation events. According to one embodiment, a secondelectromagnetic radiation3012 is emitted viasuperficies3300 ofelectromagnetic radiation sensor3000 and a secondelectromagnetic radiation3016 is collected viasuperficies3300. Second collectedelectromagnetic radiation3016 preferably is a portion of second emittedelectromagnetic radiation3012 that is at least one of specularly reflected, diffusely reflected (e.g., due to elastic or inelastic scattering), fluoresced (e.g., due to endogenous or exogenous factors), or otherwise redirected from subcutaneous tissue.
• The wavelength of second emitted and collectedelectromagnetic radiation3012 and3016 preferably is shorter than approximately 750 nanometers. The frequency therefore is at least approximately 400 terahertz. Preferably, second emitted and collectedelectromagnetic radiation3012 and3016 preferably are in the visible light portion of the electromagnetic spectrum. According to one embodiment, second emitted and collectedelectromagnetic radiation3012 and3016 preferably are in the yellow to red visible light portions of the electromagnetic spectrum. As the terminology is used herein, “yellow to red” preferably refers to electromagnetic radiation having wavelengths between approximately 570 nanometers and approximately 750 nanometers. These wavelengths generally correspond to a frequency range of approximately 525 terahertz to approximately 400 terahertz. A desirable range for second emitted and collectedelectromagnetic radiation3012 and3016 preferably includes wavelengths between approximately 570 nanometers and approximately 620 nanometers. These wavelengths generally correspond to a frequency range of approximately 525 terahertz to approximately 485 terahertz. According to other embodiments, second emitted and collectedelectromagnetic radiation3012 and3016 preferably are approximately at an isosbestic wavelength to minimize the effect of blood oxygenation on measuring tissue blood volume. As the terminology is used herein, “isosbestic wavelength” preferably refers to a wavelength at which oxyhemoglobin and deoxyhemoglobin have generally the same molar absorptivity. Conversely, absorptivity at non-isosbestic wavelengths typically is different for oxyhemoglobin and deoxyhemoglobin. For example, oxyhemoglobin typically is more absorptive than deoxyhemoglobin at non-isosbestic wavelengths of infrared light; and deoxyhemoglobin typically is more absorptive than oxyhemoglobin at non-isosbestic wavelengths of red visible light. Tissue blood volume preferably includes a summation of oxyhemoglobin and deoxyhemoglobin components. Preferably, second emitted and collectedelectromagnetic radiation3012 and3016 are at an approximately isosbestic wavelength for measuring the oxyhemoglobin and deoxyhemoglobin components of tissue blood volume with a single wavelength. According to other embodiments, second emitted and collectedelectromagnetic radiation3012 and3016 include two wavelengths: one for particularly measuring the oxyhemoglobin component of tissue blood volume and another for particularly measuring the deoxyhemoglobin component of tissue blood volume.
• There are eight isosbestic wavelengths between approximately 400 nanometers and approximately 1,000 nanometers. Isosbestic wavelengths typically are indicated by intersections of the extinction curves for oxyhemoglobin (HbO₂) and deoxyhemoglobin (Hb). Referring toFIG. 35A, known isosbestic points of deoxyhemoglobin and oxyhemoglobin are shown at approximately 421 nanometers (approximately 712 terahertz), approximately 449 nanometers (approximately 668 terahertz), approximately 506 nanometers (approximately 592 terahertz), approximately 522 nanometers (approximately 574 terahertz), approximately 548 nanometers (approximately 547 terahertz), approximately 569 nanometers (approximately 527 terahertz), approximately 586 nanometers (approximately 512 terahertz), and approximately 808 nanometers (approximately 371 terahertz). According to one embodiment, a generally isosbestic wavelength for second emittedelectromagnetic radiation3012 preferably is approximately 586 nanometers.
• According to one embodiment, second emitted and collectedelectromagnetic radiation3012 and3016 preferably are at an approximately isosbestic wavelength in contradistinction to typical pulse oximeters. Typically, pulse oximetry propagates non-isosbestic wavelengths of visible light and near-infrared radiation through biological materials including tissue, oxyhemoglobin and deoxyhemoglobin. The Beer-Lambert law relates absorption of the visible light and near-infrared radiation with (i) the absorption coefficient of a material; and (ii) the propagation path length through that material.FIG. 35B schematically illustrates the materials in the propagation path of typical pulse oximetry systems. Typically, absorption includes a fixed component DC, which generally includes absorption by tissue, venous blood (deoxyhemoglobin) and non-pulsatile arterial blood (non-pulsatile oxyhemoglobin), and a fluctuating component AC, which generally includes absorption by pulsatile arterial blood (pulsatile oxyhemoglobin). The fluctuating component AC as compared to the fixed component DC typically is relatively small (e.g., approximately 2% of absorption) and therefore relatively difficult to accurately measure.
• Pulse oximetry typically uses two non-isosbestic wavelengths for calculating blood oxygen saturation. The principle of pulse oximetry is based on different absorption characteristics of oxyhemoglobin and deoxyhemoglobin at wavelengths typically in the visible light and near-infrared radiation portions of the electromagnetic radiation spectrum. Typically, the visible light is at approximately 660 nanometers (approximately 455 terahertz) and the near-infrared radiation is at approximately 940 nanometers (approximately 320 terahertz). Pulse oximeters typically compute a normalized absorption ratio of the visible light to the near-infrared radiation according to the following equation:
• $\frac{\mathrm{visible}}{\mathrm{infrared}}=\frac{AC_{\mathrm{visible}}}{DC_{\mathrm{visible}}}/\frac{AC_{\mathrm{infrared}}}{DC_{\mathrm{infrared}}}$
• and then plug the normalized absorption ratio into an algorithm or lookup table for determining blood oxygen saturation. Typically, increasing the differences between the absorption characteristics magnifies the fluctuating component AC as compared to the fixed component DC, thereby expanding the range of the normalized absorption ratio and improving accuracy in determining blood oxygen saturation. Increasing the difference between absorption coefficients of oxyhemoglobin and deoxyhemoglobin at non-isosbestic wavelengths therefore is a fundamental of accurate pulse oximetry. Moreover, measuring absorption at two wavelengths and using both measurements in a computation are required in pulse oximetry before a result, e.g., blood oxygen saturation or pulse rate, can be determined. Pulse oximetry typically cannot determine the result by measuring absorption at only one wavelength. By comparison, the second wavelength ofelectromagnetic radiation sensor3000 preferably is at an approximately isosbestic wavelength because of the generally similar absorption coefficients of oxyhemoglobin and deoxyhemoglobin. According to one embodiment, the two wavelengths ofelectromagnetic radiation sensor3000 independently provide (i) alerts to perform an infiltration/extravasation examination; and (ii) indications of a tissue blood volume change.System100 therefore preferably uses the first and second wavelengths ofelectromagnetic radiation sensor3000 to, respectively, analyze anatomical changes over time in the perivascular tissue P and verify the cause of the anatomical change.
• Electromagnetic radiation sensor3000 preferably also detects tissue blood volume changes in addition to those due to patient posture changes. The inventors further discovered, inter alia,electromagnetic radiation sensor3000 detects tissue blood volume changes caused by (i) the application of certain devices; or (ii) the introduction of certain medicines. For example,electromagnetic radiation sensor3000 preferably detects the application of sphygmomanometers, tourniquets, dressings or other devices that affect circulation and therefore affect blood perfusion in capillary beds of limbs including the cannulation site N. Other sources of tissue blood volume changes thatelectromagnetic radiation sensor3000 preferably detects include the introduction of markers (e.g., methylene blue), anticoagulants, or medicines to control anemia or other blood conditions. Preferably, healthcare givers take into account such additional sources of tissue blood volume changers when deciding to perform an infiltration/extravasation examination.
• Referring again toFIG. 17,electromagnetic radiation sensor3000 preferably includes waveguides to transmit first and second emitted and collectedelectromagnetic radiation3002,3006,3012 and3016. As the terminology is used herein, “waveguide” preferably refers to a duct, pipe, fiber or other device that generally confines and directs the propagation of electromagnetic radiation along a path. Preferably, anemission waveguide3210 includes anemitter face3214 for emitting first and second emittedelectromagnetic radiation3002 and3012, and adetection waveguide3220 includes adetector face3224 for collecting first and second collectedelectromagnetic radiation3006 and3016. According to one embodiment,emission waveguide3210 preferably includes a set of emissionoptical fibers3212 anddetection waveguide3220 preferably includes a set of detectionoptical fibers3222. Individual emission and detectionoptical fibers3212 and3222 preferably each have an end face. Preferably, an aggregation of end faces of emissionoptical fibers3212forms emitter face3214 and an aggregation of end faces of detectionoptical fibers3222forms detector face3224.
• FIGS. 18A-18C schematically illustrate how an evolving infiltration/extravasation event preferably affects the electromagnetic radiation signals ofelectromagnetic radiation sensor3000.FIGS. 18A-18C include individual schematic illustrations of the monitoring paths for (i) first emitted and collectedelectromagnetic radiation3002 and3006; and (ii) second emitted and collectedelectromagnetic radiation3012 and3016. According to one embodiment, the monitoring paths preferably overlap; however, they are separately shown on the left and right sides of each figure for the sake of clearly illustrating each monitoring path. Therefore, the left and right sides of individualFIGS. 18A-18C include duplicate showings of the materials (e.g., the skin S, the blood vessel V, the perivascular tissue P, and the infusate F) along the monitoring paths ofelectromagnetic radiation3002,3012,3006 and3016.
• FIGS. 18A-18C show examples of three stages of infiltration/extravasation.FIG. 18A shows the skin S prior to an infiltration/extravasation event. Preferably, the skin S includes the cutaneous tissue C (e.g., dermis and/or the epidermis E including the stratum corneum) overlying subcutaneous tissue (e.g., the hypodermis H). The blood vessel V for intravenous therapy typically is disposed in the hypodermis H.FIG. 18B shows an infusate F beginning to accumulate in the perivascular tissue P. Accumulation of the infusate F typically begins in the hypodermis H, but may also begin in the cutaneous tissue C or at an interface of the hypodermis H with the cutaneous tissue C.FIG. 18C shows the accumulation of the infusate F expanding in the perivascular tissue P. Typically, the expanded accumulation extends further in the hypodermis H but may also extend into the cutaneous tissue C. According to one embodiment, infiltration/extravasation generally originates and/or expands in proximity to the blood vessel V as illustrated inFIGS. 18A-18C. According to other embodiments, infiltration/extravasation may originate and/or occur some distance from the blood vessel V, e.g., if pulling on the cannula C or administration set30 causes the cannula outlet to become displaced from the blood vessel V.
• The left sides ofFIGS. 18A-18C schematically illustrate an optical power Φ₆of first collectedelectromagnetic radiation3006 relative to an optical power Φ₂of first emittedelectromagnetic radiation3002. Preferably, first emittedelectromagnetic radiation3002 enters the skin S, at least some electromagnetic radiation propagates through the Animalia tissue, and first collectedelectromagnetic radiation3006 exits the skin S. First emittedelectromagnetic radiation3002 is schematically illustrated with an arrow directed toward the skin S and first collectedelectromagnetic radiation3006 is schematically illustrated with an arrow directed away from the skin S. Preferably, the relative sizes of the arrows correspond to the optical power Φ₂and the optical power Φ₆. The monitoring path of first emitted and collectedelectromagnetic radiation3002 and3006 is schematically illustrated with a crescent shape that preferably includes the predominant electromagnetic radiation paths through the skin S from first emittedelectromagnetic radiation3002 to first collectedelectromagnetic radiation3006. Stippling in the crescent shape schematically illustrates a distribution of optical power in the skin S with relatively weaker optical power generally indicated with less dense stippling and relatively stronger optical power generally indicated with denser stippling.
• First collectedelectromagnetic radiation3006 preferably is impacted by the infusate F accumulating in the perivascular tissue P. Prior to an infiltration/extravasation event (FIG. 18A), the optical power Φ₆preferably is a fraction of the optical power Φ₂due to extinction along the monitoring path. As the terminology is used herein, “extinction” preferably refers to attenuation of electromagnetic radiation due to (i) absorption; (ii) scattering; or (iii) a combination of absorption and scattering. According to one embodiment, the optical power Φ₆relative the optical power Φ₂decreases in response to the infusate F accumulating in the perivascular tissue P (FIGS. 18B and 18C).
• The optical power Φ₆preferably decreases due to scattering of near-infrared electromagnetic radiation by the infusate F. Typically, the compositions of most infusates are dominated by water, which has different absorption and scattering coefficients as compared to the perivascular tissue P. At wavelengths between approximately 500 nanometers (approximately 600 terahertz) and approximately 1,300 nanometers (approximately 230 terahertz), extinction coefficients of water typically are dominated by scattering coefficients rather than absorption coefficients. Scattering therefore dominates extinction of near-infrared radiation propagating through water at wavelengths between approximately 800 nanometers and approximately 1,300 nanometers. Thus, the optical power Φ₆preferably decreases relative to the optical power Φ₂because of extinction primarily due to scattering when the infusate F accumulates in the perivascular tissue P. Decreased optical power is schematically illustrated inFIGS. 18A-18C by the changing relative sizes of the arrows corresponding to first emitted and collectedelectromagnetic radiation3002 and3006.
• The right sides ofFIGS. 18A-18C schematically illustrate an optical power Φ₁₆of second collectedelectromagnetic radiation3016 relative to an optical power Φ₁₂of second emittedelectromagnetic radiation3012. Preferably, second emittedelectromagnetic radiation3012 enters the skin S, at least some electromagnetic radiation propagates through the Animalia tissue, and second collectedelectromagnetic radiation3016 exits the skin S. Second emittedelectromagnetic radiation3012 is schematically illustrated with an arrow directed toward the skin S and second collectedelectromagnetic radiation3016 is schematically illustrated with an arrow directed away from the skin S. Preferably, the relative sizes of the arrows correspond to the optical power Φ₁₂relative to the optical power Φ₁₆. The monitoring path of second emitted and collectedelectromagnetic radiation3012 and3016 is schematically illustrated with a crescent shape that preferably includes the predominant electromagnetic radiation paths through the skin S from second emittedelectromagnetic radiation3012 to second collectedelectromagnetic radiation3016. Stippling in the crescent shape schematically illustrates a distribution of optical power in the skin S with relatively weaker optical power generally indicated with less dense stippling and relatively stronger optical power generally indicated with denser stippling.
• The infusate F accumulating in the perivascular tissue P preferably also impacts second collectedelectromagnetic radiation3016. Prior to an infiltration/extravasation event (FIG. 18A), the optical power Φ₁₆preferably is a fraction of the optical power Φ₁₂due to extinction along the monitoring path. According to one embodiment, the optical power Φ₁₆preferably decreases relative to the optical power Φ₁₂in response to the infusate F accumulating in the perivascular tissue P (FIGS. 18B and 18C).
• Scattering of visible light by the infusate F preferably decreases the optical power Φ₁₆. According to one embodiment, second collectedelectromagnetic radiation3016 preferably is in the yellow to red visible light portions of the electromagnetic spectrum. As the terminology is used herein, “yellow to red” preferably refers to electromagnetic radiation having wavelengths between approximately 570 nanometers and approximately 750 nanometers. These wavelengths generally correspond to a frequency range of approximately 525 terahertz to approximately 400 terahertz. A desirable range for second collectedelectromagnetic radiation3016 preferably includes wavelengths between approximately 570 nanometers and approximately 620 nanometers. These wavelengths generally correspond to a frequency range of approximately 525 terahertz to approximately 485 terahertz. Accumulation of the infusate F causes the optical power Φ₁₆to decrease due to extinction. As discussed above, extinction coefficients at wavelengths between approximately 570 nanometers and approximately 750 nanometers typically are dominated by scattering coefficients rather than absorption coefficients. Thus, the optical power Φ₁₆preferably decreases relative to the optical power Φ₁₂because of extinction primarily due to scattering when the infusate F accumulates in the perivascular tissue P. Decreased optical power is schematically illustrated inFIGS. 18A-18C by the changing relative sizes of the arrows corresponding to second emitted and collectedelectromagnetic radiation3012 and3016.
• Certain differences and similarities between first and second collectedelectromagnetic radiation3006 and3016 preferably are apparent in the three stages of infiltration/extravasation shown inFIGS. 18A-18C. Preferably, first emitted and collectedelectromagnetic radiation3002 and3006 generally penetrate deeper into the skin S than second emitted and collectedelectromagnetic radiation3012 and3016. According to one embodiment, the predominant electromagnetic radiation paths from first emittedelectromagnetic radiation3002 to first collectedelectromagnetic radiation3006 preferably extend along a longer path length though the hypodermis H; whereas, the predominant electromagnetic radiation paths through the skin S from second emittedelectromagnetic radiation3012 to second collectedelectromagnetic radiation3016 preferably extend a shorter path length though the cutaneous tissue C. Accordingly, the percentage of extinction solely due to the skin S (FIG. 18A) preferably is greater between first emitted and collectedelectromagnetic radiation3002 and3006 than between second emitted and collectedelectromagnetic radiation3012 and3016 because of the relative path lengths. As an infiltration/extravasation event begins (FIG. 18B) and expands (FIG. 18C), the percentage of electromagnetic power extinction due to the infusate F preferably is proportionally greater for near-infrared radiation than visible light. In particular, an extinction rate of first collectedelectromagnetic radiation3006 relative to first emittedelectromagnetic radiation3002 preferably is greater than an extinction rate of second collectedelectromagnetic radiation3016 relative to second emittedelectromagnetic radiation3012. According to one embodiment, comparing the stage prior to an infiltration/extravasation event (FIG. 18A) and the stage with expanded accumulation of the infusate F (FIG. 18C), preferably there is up to 40% or more decrease in the optical power Φ₆and up to 30% or more decrease in the optical power Φ₁₆.
• FIGS. 18D-18F schematically illustrate how changing the tissue blood volume preferably affects the electromagnetic radiation signals ofelectromagnetic radiation sensor3000.FIGS. 18D-18F include individual schematic illustrations of the monitoring paths for (i) first emitted and collectedelectromagnetic radiation3002 and3006; and (ii) second emitted and collectedelectromagnetic radiation3012 and3016. According to one embodiment, the monitoring paths preferably overlap; however, they are separately shown on the left and right sides of each figure for the sake of clearly illustrating each monitoring path. The left and right sides of individualFIGS. 18D-18F include duplicate showings of the materials (e.g., the skin S including the cutaneous tissue C overlying the hypodermis H) along the monitoring paths ofelectromagnetic radiation3002,3012,3006 and3016.
• FIGS. 18D-18F show examples of three states of the tissue blood volume.FIG. 18D schematically illustrates a certain blood volume TBV₁of the skin S.FIG. 18E schematically illustrates a decreased tissue blood volume TBV₂relative to the tissue blood volume TBV₁.FIG. 18F schematically illustrates an increased tissue blood volume TBV₃relative to the tissue blood volume TBV₁.
• The left sides ofFIGS. 18D-18F schematically illustrate the optical power Φ₆relative to the optical power Φ₂. Preferably, first emittedelectromagnetic radiation3002 enters the skin S, at least some electromagnetic radiation propagates through the Animalia tissue, and first collectedelectromagnetic radiation3006 exits the skin S. First emittedelectromagnetic radiation3002 is schematically illustrated with an arrow directed toward the skin S and first collectedelectromagnetic radiation3006 is schematically illustrated with an arrow directed away from the skin S. Preferably, the relative sizes of the arrows correspond to the optical power Φ₂relative to the optical power Φ₆. The monitoring path of first emitted and collectedelectromagnetic radiation3002 and3006 is schematically illustrated with a crescent shape that preferably includes the predominant electromagnetic radiation paths through the skin S from first emittedelectromagnetic radiation3002 to first collectedelectromagnetic radiation3006. Stippling in the crescent shape schematically illustrates a distribution of optical power in the skin S with relatively weaker optical power generally indicated with less dense stippling and relatively stronger optical power generally indicated with denser stippling.
• First collectedelectromagnetic radiation3006 preferably is impacted by changes in the tissue blood volume along the monitoring path. At the tissue blood volume TBV₁(FIG. 18D), the optical power Φ₆preferably is a fraction of the optical power Φ₂because hemoglobin along the monitoring path causes electromagnetic radiation extinction. According to one embodiment, the optical power Φ₆relative to first emittedelectromagnetic radiation3002 preferably increases when the tissue blood volume TBV₁changes to the decreased tissue blood volume TBV₂(FIG. 18E), and the optical power Φ₆relative to first emittedelectromagnetic radiation3002 preferably decreases when the tissue blood volume TBV₁changes to the increased tissue blood volume TBV₃(FIG. 18F).
• The optical power Φ₆preferably responds to absorption of near-infrared electromagnetic radiation by hemoglobin. Typically, hemoglobin has different absorption and scattering coefficients as compared to the perivascular tissue P. As discussed above, absorption by hemoglobin depends on blood oxygenation; however, extinction coefficients of both deoxyhemoglobin and oxyhemoglobin are dominated by absorption coefficients rather than scattering coefficients. Absorption therefore dominates extinction of near-infrared radiation propagating through deoxyhemoglobin and oxyhemoglobin. Thus, the optical power Φ₆increases relative to the optical power Φ₂as extinction preferably due to absorption decreases when there is the decreased tissue blood volume TBV₂(FIG. 18E), and the optical power Φ₆decreases relative to the optical power Φ₂as extinction preferably due to absorption increases when there is the increased tissue blood volume TBV₃(FIG. 18F). These optical power changes are schematically illustrated by the changing relative sizes of the arrows corresponding to first emitted and collectedelectromagnetic radiation3002 and3006.
• The right sides ofFIGS. 18D-18F schematically illustrate the optical power Φ₁₆relative to the optical power Φ₁₂. Preferably, second emittedelectromagnetic radiation3012 enters the skin S, at least some electromagnetic radiation propagates through the Animalia tissue, and second collectedelectromagnetic radiation3016 exits the skin S. Second emittedelectromagnetic radiation3012 is schematically illustrated with an arrow directed toward the skin S and second collectedelectromagnetic radiation3016 is schematically illustrated with an arrow directed away from the skin S. Preferably, the relative sizes of the arrows correspond to the optical power Φ₁₂and the optical power Φ₁₆. The monitoring path of second emitted and collectedelectromagnetic radiation3012 and3016 is schematically illustrated with a crescent shape that preferably includes the predominant electromagnetic radiation paths through the skin S from second emittedelectromagnetic radiation3012 to second collectedelectromagnetic radiation3016. Stippling in the crescent shape schematically illustrates a distribution of optical power in the skin S with relatively weaker optical power generally indicated with less dense stippling and relatively stronger optical power generally indicated with denser stippling.
• Changing tissue blood volume along the monitoring path preferably also impacts second collectedelectromagnetic radiation3016. At the tissue blood volume TBV₁(FIG. 18D), the optical power Φ₁₆preferably is a fraction of the optical power Φ₁₂because hemoglobin along the monitoring path causes extinction. According to one embodiment, the optical power Φ₁₆preferably increases relative to the optical power Φ₁₂when the tissue blood volume TBV₁changes to the decreased tissue blood volume TBV₂(FIG. 18E), and the optical power Φ₁₆preferably decreases relative to the optical power Φ₁₂when the tissue blood volume TBV₁changes to the increased tissue blood volume TBV₃(FIG. 18F).
• Absorption of visible light by oxyhemoglobin and deoxyhemoglobin preferably changes the optical power Φ₁₆. According to one embodiment, a desirable range of wavelengths for second collectedelectromagnetic radiation3016 preferably is between approximately 570 nanometers (approximately 525 terahertz) and approximately 750 nanometers (approximately 400 terahertz). As discussed above, extinction coefficients of both deoxyhemoglobin and oxyhemoglobin are dominated by absorption coefficients rather than scattering coefficients. Absorption therefore dominates extinction of visible light propagating through deoxyhemoglobin and oxyhemoglobin. Thus, the optical power Φ₁₆increases relative to the optical power Φ₁₂as extinction preferably due to absorption decreases when there is the decreased tissue blood volume TBV₂(FIG. 18E), and the optical power Φ₁₆decreases relative to the optical power Φ₁₂as extinction preferably due to absorption increases when there is the increased tissue blood volume TBV₃(FIG. 18F). These optical power changes are schematically illustrated by the changing relative sizes of the arrows corresponding to first emitted and collectedelectromagnetic radiation3012 and3016.
• Certain differences and similarities between first and second collectedelectromagnetic radiation3006 and3016 preferably are apparent in the three states of the tissue blood volume shown inFIGS. 18D-18F. The distributions of blood in the skin S for the tissue blood volume TBV₁, the decreased tissue blood volume TBV₂and the increased tissue blood volume TBV₃are illustrated as being generally uniform for the sake of explaining the impact of changing tissue blood volume; however, the distribution of blood in the skin S may not be uniform. The percentage decrease of extinction preferably is greater for visible light than near-infrared radiation when there is the decreased tissue blood volume TBV₂. The percentage increase of extinction preferably is greater for visible light than near-infrared radiation when there is the increased tissue blood volume TBV₃. Thus, the extinction of second collectedelectromagnetic radiation3016 relative to second emittedelectromagnetic radiation3012 preferably is more responsive to changing tissue blood volume than is the extinction of first collectedelectromagnetic radiation3006 relative to first emittedelectromagnetic radiation3002. According to one embodiment, comparing the tissue blood volume TBV₁(FIG. 18D) with the increased tissue blood volume TBV₃(FIG. 18F), preferably there is up to 20% or more decrease in the optical power Φ₆and up to 50% or more decrease in the optical power Φ₁₆.
• The inventors also discovered a different problem regarding accurately alerting healthcare givers to perform an infiltration/extravasation examination. In particular, healthcare givers may not be accurately alerted because of a relatively low signal-to-noise ratio of collectedelectromagnetic radiation3006. Thus, the inventors discovered, inter alia, thatnoise component3006ain collectedelectromagnetic radiation3006 frequently obscuressignal component3006bthat alerts healthcare givers to perform an infiltration/extravasation examination.
• The inventors also discovered a source of the problem is emittedelectromagnetic radiation3002 being reflected, scattered, or otherwise redirected from various tissues/depths below the stratum corneum of the skin S. Referring again toFIG. 17, the inventors discovered thatnoise component3006aof collectedelectromagnetic radiation3006 includes cutaneouselectromagnetic radiation3002athat is reflected, scattered, or otherwise redirected from relatively shallow tissue, e.g., the cutaneous tissue C, and thatsignal component3006bof collectedelectromagnetic radiation3006 includes transcutaneouselectromagnetic radiation3002bthat is reflected, scattered, or otherwise redirected from the relatively deep tissue, e.g., the hypodermis H. The inventors further discovered, inter alia, thatsignal component3006bfrom relatively deep tissue provides more accurate indications for healthcare givers to perform an infiltration/extravasation examination and thatnoise component3006afrom relatively shallow tissue frequently obscuressignal component3006b.
• The inventors further discovered that sensor configuration preferably is related to the signal-to-noise ratio of a skin-coupled sensor. In particular, the inventors discovered that the relative configuration of emission anddetection waveguides3210 and3220 preferably impact the signal-to-noise ratio of collectedelectromagnetic radiation3006. Thus, the inventors discovered, inter alia, that the geometry, topography and/or angles of emission anddetection waveguides3210 and3220 preferably impact the sensitivity ofelectromagnetic radiation sensor3000 to signalcomponent3006brelative tonoise component3006a.
• Electromagnetic radiation sensor3000 preferably includessuperficies3300 that overlies and confronts the skin S. Preferably,superficies3300 includes ahousing surface3120,emitter face3214, anddetector face3224.Superficies3300 preferably may also include façades of a filler3150 (seeFIGS. 22 and 23A) that occludes apertures inhousing surface3120 around emission and detection end faces3214 and3224. Preferably,superficies3300 is a three-dimensional surface contour that is generally smooth. As the terminology is used herein, “smooth” preferably refers to being substantially continuous and free of abrupt changes.
• FIG. 19 shows an example ofsuperficies3300 having a suitable geometry for observing anatomical changes over time in the perivascular tissue P. In particular, the geometry ofsuperficies3300 preferably includes the relative spacing and shapes of emission and detector faces3214 and3224. According to one embodiment, a cluster of emission optical fiber end faces preferably has ageometric centroid3216 and an arcuate arrangement of detection optical fiber end faces preferably extends along acurve3226. As the terminology is used herein, “cluster” preferably refers to a plurality of generally circular optical fiber end faces that are arranged such that at least one end face is approximately tangent with respect to at least three other end faces. Preferably,curve3226 is spaced fromgeometric centroid3212 by a nominal spacingdistance D. Curve3226 may be approximated by a series of line segments that correspond to individual chords of generally circular detection optical fiber end faces. Accordingly, each detection optical fiber end face preferably is tangent to at most two other end faces. The arcuate arrangement of detection optical fiber end faces includes borders with radii of curvature that preferably originate atgeometric centroid3216, e.g., similar tocurve3226. Preferably, aconcave border3226ahas a radius of curvature that is less than the nominal spacing distance D by an increment ΔD, and aconvex border3226bhas a radius of curvature that is greater than the nominal spacing distance D by an increment ΔD. According to one embodiment, increment ΔD is approximately equal to the radius of individual detection optical fiber end faces. According to other embodiments,detector face3224 preferably includes individual sets of detection optical fiber end faces arranged in generally concentric curves disposed in a band between concave andconvex borders3226aand3226b. As the terminology is used herein, “band” preferably refers to a strip or stripe that is differentiable from an adjacent area or material.
• FIGS. 20A-20C illustrate how different nominal spacing distances between emission anddetection waveguides3210 and3220 preferably impact collectedelectromagnetic radiation3006. Preferably, emittedelectromagnetic radiation3002 enters the skin S fromemission waveguide3210, electromagnetic radiation propagates through the Animalia tissue, and collectedelectromagnetic radiation3006 exits the Animalia tissue towarddetection waveguide3220. Emittedelectromagnetic radiation3002 is schematically illustrated with an arrow directed toward the skin S and collectedelectromagnetic radiation3006 is schematically illustrated with an arrow directed away from the skin S. Preferably, the relative sizes of the arrows correspond to the optical power Φ₂and the optical power Φ₆. The propagation is schematically illustrated with crescent shapes that preferably include the predominant electromagnetic radiation paths through the skin S from emittedelectromagnetic radiation3002 to collectedelectromagnetic radiation3006. Stippling in the crescent shape schematically illustrates a distribution of optical power in the skin S with relatively weaker optical power generally indicated with less dense stippling and relatively stronger optical power generally indicated with denser stippling. Referring toFIG. 20A, a first nominal spacing distance D1 preferably separates emittedelectromagnetic radiation3002 and collectedelectromagnetic radiation3006. At the first nominal spacing distance D1, the paths of electromagnetic radiation through the skin S generally are relatively short and predominantly extend through the cutaneous tissue C. Referring toFIG. 20B, a second nominal spacing distance D2 preferably separates emittedelectromagnetic radiation3002 and collectedelectromagnetic radiation3006. At the second nominal spacing distance D2, the paths of electromagnetic radiation preferably penetrate deeper into the skin S and extend in both the cutaneous tissue C and the hypodermis H. Referring toFIG. 20C, a third nominal spacing distance D3 preferably separates emittedelectromagnetic radiation3002 and collectedelectromagnetic radiation3006. At the third nominal spacing distance D3, the paths of electromagnetic radiation through the skin S generally are relatively long and predominantly extend through the hypodermis H.
• The inventors discovered, inter alia, that varying the spacing distance between emission anddetection waveguides3210 and3220 preferably changes a balance between the optical power Φ₆and the signal-to-noise ratio of collectedelectromagnetic radiation3006. The optical power Φ₆preferably is greater than the optical power Φ₂for narrower nominal spacing distance D1 as compared to broader nominal spacing distance D3. On the other hand, the signal-to-noise ratio of collectedelectromagnetic radiation3006 preferably is higher for broader nominal spacing distance D3 as compared to narrower nominal spacing distance D1. Preferably, there is an intermediate nominal spacing distance D2 that improves the signal-to-noise ratio as compared to narrower nominal spacing distance D1 and, as compared to broader nominal spacing distance D3, improves the optical power Φ₆relative to the optical power Φ₂.
• The inventors designed and analyzed a skin phantom preferably to identify an optimum range for the intermediate nominal spacing distance D2. Preferably, the skin phantom characterizes several layers of Animalia skin including at least the epidermis (including the stratum corneum), dermis, and hypodermis. Table A shows the thicknesses, refractive indices, scattering coefficients, and absorption coefficients for each layer according to one embodiment of the skin phantom. Analyzing the skin phantom preferably includes tracing the propagation of up to 200,000,000 or more rays through the skin phantom to predict changes in the optical power Φ₆. Examples of suitable ray-tracing computer software include ASAP® from Breault Research Organization, Inc. (Tucson, Ariz., US) and an open source implementation of a Monte Carlo Multi-Layer (MCML) simulator from the Biophotonics Group at the Division of Atomic Physics (Lund University, Lund, SE). The MCML simulator preferably uses CUDA™ from NVDIA Corporation (Santa Clara, Calif., US) or another parallel computing platform and programming model. Preferably, a series of 1-millimeter thick sections simulate infiltrated perivascular tissue at depths up to 10 millimeters below the stratum corneum. The infiltrated perivascular tissue sections preferably are simulated with an infusate that approximates water, e.g., having a refractive index of approximately 1.33. Based on computer analysis of the skin phantom, the inventors discovered, inter alia, a relationship exists between (1) the spacing distance between emission anddetection waveguides3210 and3220; (2) an expected depth below the stratum corneum for the perivascular tissue P at which anatomical changes over time preferably are readily observed; and (3) the wavelength of the electromagnetic radiation.
• FIG. 21 shows a graphical representation of the spacing/depth/wavelength relationship based on a computer analysis of the skin phantom. In particular,FIG. 21 shows a plot of spacing distances with the greatest signal drop at various perivascular tissue depths for certain wavelengths of electromagnetic radiation. The terminology “spacing distance with the greatest signal drop” preferably refers to the spacing distance between emission anddetection waveguides3210 and3220 that experiences the greatest drop in the optical power Φ₆. The terminology “perivascular tissue depth” preferably refers to the depth below the stratum corneum of the perivascular tissue P at which anatomical changes over time are readily observed. According to the embodiment illustrated inFIG. 21, emission anddetection waveguides3210 and3220 that preferably are separated between approximately 3 millimeters and approximately 5 millimeters are expected to readily observe anatomical changes at depths between approximately 2.5 millimeters and approximately 3 millimeters below the stratum corneum for wavelengths between approximately 650 nanometers and approximately 950 nanometers (between approximately 460 terahertz and approximately 315 terahertz). Preferably, the spacing distance range between emission anddetection waveguides3210 and3220 is between approximately 3.7 millimeters and approximately 4.4 millimeters to observe an anatomical change over time in the perivascular tissue P at an expected depth of approximately 2.75 millimeters when the electromagnetic radiation wavelength is between approximately 650 nanometers and approximately 950 nanometers. The spacing distance between emission anddetection waveguides3210 and3220 preferably is approximately 4.5 millimeters to observe an anatomical change over time in the perivascular tissue P at an expected depth of approximately 2.8 millimeters when the electromagnetic radiation wavelength is approximately 950 nanometers. Preferably, the spacing distance between emission anddetection waveguides3210 and3220 is approximately 4 millimeters to observe an anatomical change over time in the perivascular tissue P at an expected depth of approximately 2.6 millimeters when the electromagnetic radiation wavelength is between approximately 850 nanometers (approximately 350 terahertz) and approximately 950 nanometers.
• Electromagnetic radiation sensor3000 preferably aids in observing anatomical changes that also occur at unexpected depths below the stratum corneum of the skin S. Preferably, the expected depth at which an anatomical change is expected to occur is related to, for example, the thickness of the cutaneous tissue C and the location of blood vessels V in the hypodermis H. Relatively thicker cutaneous tissue C and/or a blood vessel V located relatively deeper in the hypodermis H preferably increase the expected perivascular tissue depth for readily observing an anatomical change. Conversely, relatively thinner cutaneous tissue C and/or a relatively shallow blood vessel V, e.g., located close to the interface between the cutaneous tissue C and the hypodermis H, preferably decrease the expected perivascular tissue depth for readily observing an anatomical change. There may be a time delay observing anatomical changes that begin at unexpected distances fromelectromagnetic radiation sensor3000. The delay may last until the anatomical change extends within the observational limits ofelectromagnetic radiation sensor3000. For example, if anatomical changes over time begin at unexpected depths below the stratum corneum, observing the anatomical change may be delayed until the anatomical change extends to the expected depths below the stratum corneum.
• The shapes of emission and detector faces3214 and3224 preferably are related to the spacing distance range between emission anddetection waveguides3210 and3220. Preferably, each individual point ofemitter face3214 is disposed a minimum distance from each individual point ofdetector face3224, and each individual point ofemitter face3214 is disposed a maximum distance from each individual point ofdetector face3224. The minimum and maximum distances preferably correspond to the extremes of the range for the intermediate spacing distance D2. Preferably, the minimum distance is between approximately 2 millimeters and approximately 3.5 millimeters, and the maximum distance preferably is between approximately 4.5 millimeters and approximately 10 millimeters. According to one embodiment, each individual point ofemitter face3214 is disposed a minimum distance not less than 3 millimeters from each individual point ofdetector face3224, and each individual point ofemitter face3214 is disposed a maximum distance not more than 5 millimeters from each individual point ofdetector face3224. Preferably, the minimum distance is approximately 3.5 millimeters and the maximum distance is approximately 4.5 millimeters. According to other embodiments, each individual point ofemitter face3214 is spaced from each individual point ofdetector face3224 such that emittedelectromagnetic radiation3002 transitions to collectedelectromagnetic radiation3006 at a depth of penetration into the Animalia tissue preferably between approximately 1 millimeter and approximately 6 millimeters below the stratum corneum of the skin S. Preferably, the transition between transcutaneouselectromagnetic radiation3002bandsignal component3006balong individual electromagnetic radiation paths occur at the point of deepest penetration into the Animalia tissue. Emitted and collectedelectromagnetic radiation3002 and3006 preferably transition in the hypodermis H and may also transition in the dermis of relatively thick cutaneous tissue C. Preferably, transcutaneouselectromagnetic radiation3002bandsignal component3006btransition approximately 2.5 millimeters to approximately 3 millimeters below the stratum corneum of the skin S.
• The inventors also discovered, inter alia, that angles of intersection betweensuperficies3300 and emission anddetection waveguides3210 and3220 preferably impact emitted and collectedelectromagnetic radiation3002 and3006.FIG. 22 shows a first embodiment of the angles of intersection, andFIGS. 23A and 23B show a second embodiment of the angles of intersection. Regardless of the embodiment,emission waveguide3210 transmits electromagnetic radiation generally along afirst path3210atoemitter face3214, anddetection waveguide3220 transmits electromagnetic radiation generally along asecond path3220afromdetector face3224.Superficies3300 preferably includeshousing surface3120 and emitter and detector faces3214 and3224. Preferably,first path3210aintersects withsuperficies3300 at a first angle α₁andsecond path3220aintersects withsuperficies3300 at a second angle α₂. In the case of concave orconvex superficies3300, orsuperficies3300 that include projections or recesses, first and second angles α₁and α₂preferably are measured with respect to the tangent tosuperficies3300. Emittedelectromagnetic radiation3002 preferably includes at least a part of the electromagnetic radiation that is transmitted alongfirst path3210a, and the electromagnetic radiation transmitted alongsecond path3220apreferably includes at least a part of collectedelectromagnetic radiation3006. Preferably, emittedelectromagnetic radiation3002 exitsemitter face3214 within anemission cone3004, and collectedelectromagnetic radiation3006 entersdetector face3224 within anacceptance cone3008. Emission andacceptance cones3004 and3008 preferably include ranges of angles over which electromagnetic radiation is, respectively, emitted byemission waveguide3210 and accepted bydetection waveguide3220. Typically, each range has a maximum half-angle θ_maxthat is related to a numerical aperture NA of the corresponding waveguide as follows: NA=η sin θ_max, where η is the refractive index of the material that the electromagnetic radiation is entering (e.g., from emission waveguide3210) or exiting (e.g., to detection waveguide3220). The numerical aperture NA of emission or detectionoptical fibers3212 or3222 typically is calculated based on the refractive indices of the optical fiber core (η_core) and optical fiber cladding (η_clad) as follows: NA=√{square root over (η_core²−η_clad²)}. Thus, the ability of a waveguide to emit or accept rays from various angles generally is related to material properties of the waveguide. Ranges of suitable numerical apertures NA for emission or detection waveguides110 or120 may vary considerably, e.g., between approximately 0.20 and approximately 0.60. According to one embodiment, individual emission or detectionoptical fibers3212 or3222 preferably have a numerical apertures NA of approximately 0.55. The maximum half-angle θ_maxof a cone typically is a measure of an angle between the cone's central axis and conical surface. Accordingly, the maximum half-angle θ_maxofemission waveguide3210 preferably is a measure of the angle formed between acentral axis3004aand the conical surface ofemission cone3004, and the maximum half-angle θ_maxofdetection waveguide3220 preferably is a measure of the angle formed between acentral axis3008aand the conical surface ofacceptance cone3008. The direction ofcentral axis3004apreferably is at a first angle β₁with respect tosuperficies3300 and the direction ofcentral axis3008apreferably is at a second angle β₂with respect tosuperficies3300. Therefore, first angle β₁preferably indicates the direction ofemission cone3004 and thus also describes the angle of intersection between emittedelectromagnetic radiation3002 andsuperficies3300, and second angle β₂preferably indicates the direction ofacceptance cone3008 and thus also describes the angle of intersection between collectedelectromagnetic radiation3006 andsuperficies3300. In the case of concave orconvex superficies3300, orsuperficies3300 that include projections or recesses, first and second angles β₁and β₂preferably are measured with respect to the tangent tosuperficies3300.
• FIG. 22 shows a generally perpendicular relationship betweensuperficies3300 and emission anddetection waveguides3210 and3220. The inventors discovered, inter alia, if first and second angles α₁and α₂preferably are approximately 90 degrees with respect tosuperficies3300 then (1) first and second angles β₁and β₂preferably also tend to be approximately 90 degrees with respect tosuperficies3300; (2) emittedelectromagnetic radiation3002 preferably is minimally attenuated at the interface between the skin S andemitter face3214; and (3) collectedelectromagnetic radiation3006 preferably has an improved signal-to-noise ratio. An advantage of havingemission waveguide3210 disposed at an approximately 90 degree angle with respect tosuperficies3300 preferably is maximizing the electromagnetic energy that is transferred from along thefirst path3210ato emittedelectromagnetic radiation3002 at the interface betweenelectromagnetic radiation sensor3000 and the skin S. Preferably, this transfer of electromagnetic energy may be improved when internal reflection inwaveguide3210 due toemitter face3214 is minimized. Orientingemitter face3214 approximately perpendicular tofirst path3210a, e.g., cleaving and/or polishing emission optical fiber(s)3212 at approximately 90 degrees with respect tofirst path3210a, preferably minimizes internal reflection inwaveguide3210. Specifically, less of the electromagnetic radiation transmitted alongfirst path3210ais reflected atemitter face3214 and more of the electromagnetic radiation transmitted alongfirst path3210aexits emitter face3214 as emittedelectromagnetic radiation3002. Another advantage of havingemission waveguide3210 disposed at an approximately 90 degree angle with respect tosuperficies3300 preferably is increasing the depth below the stratum corneum that emittedelectromagnetic radiation3002 propagates into the skin S because first angle β₁also tends to be approximately 90 degrees when first angle α₁is approximately 90 degrees. Preferably, as discussed above with respect toFIGS. 18A-18C and20A-20C, the predominant electromagnetic radiation paths through the skin S are crescent-shaped and the increased propagation depth of emittedelectromagnetic radiation3002 may improve the signal-to-noise ratio of collectedelectromagnetic radiation3006. Thus, according to the first embodiment shown inFIG. 22, emission anddetection waveguides3210 and3220 preferably are disposed in ahousing3100 ofelectromagnetic radiation sensor3000 such that first andsecond paths3210aand3220aare approximately perpendicular tosuperficies3300 for increasing the optical power Φ₂and for improving the signal-to-noise ratio of collectedelectromagnetic radiation3006.
• FIGS. 23A and 23B show an oblique angular relationship betweensuperficies3300 and emission anddetection waveguides3210 and3220. Preferably, at least one of first and second angles α₁and α₂are oblique with respect tosuperficies3300. First and second angles α₁and α₂preferably are both oblique and inclined in generally similar directions with respect tosuperficies3300. According to one embodiment, the difference between the first and second angles α₁and α₂preferably is between approximately 15 degrees and approximately 45 degrees. Preferably, the first angle α₁is approximately 30 degrees less than the second angle α₂. According to other embodiments, first angle α₁ranges between approximately 50 degrees and approximately 70 degrees, and second angle α₂ranges between approximately 75 degrees and approximately 95 degrees. Preferably, first angle α₁is approximately 60 degrees and second angle α₂ranges between approximately 80 degrees and approximately 90 degrees. A consequence of first angle α₁being oblique with respect tosuperficies3300 is that a portion of the electromagnetic radiation transmitted alongfirst path3210amay be reflected atemitter face3214 in adirection3210brather than exitingemitter face3214 as emittedelectromagnetic radiation3002. Another consequence is that refraction may occur at the interface betweenelectromagnetic radiation sensor3000 and the skin S because the emission anddetection waveguides3210 and3220 typically have different refractive indices with respect to the skin S. Accordingly, first angles α₁and β₁would likely be unequal and second angles α₂and β₂would also likely be unequal.
• FIG. 23B illustrates a technique for geometrically interpreting the interplay between emittedelectromagnetic radiation3002 and collectedelectromagnetic radiation3006 when emission anddetection waveguides3210 and3220 are obliquely disposed with respect tosuperficies3300. Preferably,emission cone3004 represents the range of angles over which emittedelectromagnetic radiation3002 exitsemitter face3214, andacceptance cone3008 represents the range of angles over which collectedelectromagnetic radiation3006 entersdetector face3224. Projecting emission andacceptance cones3004 and3008 to a common depth below the stratum corneum of the skin S preferably maps out first andsecond patterns3004band3008b, respectively, which are shown with different hatching inFIG. 23B. Preferably, the projections of emission andacceptance cones3004 and3008 include a locus of common points where first andsecond patterns3004band3008boverlap, which accordingly is illustrated with cross-hatching inFIG. 23B. In principle, the locus of common points shared by the projections of emission andacceptance cones3004 and3008 includes tissue that preferably is a focus ofelectromagnetic radiation sensor3000 for monitoring anatomical changes over time. Accordingly, an advantage of havingemission waveguide3210 and/ordetection waveguide3220 disposed at an oblique angle with respect tosuperficies3300 preferably is focusingelectromagnetic radiation sensor3000 at a particular range of depths below the stratum corneum of the skin S and/or steeringelectromagnetic radiation sensor3000 in a particular relative direction. In practice, electromagnetic radiation propagating through the skin S is reflected, scattered and otherwise redirected such that there is a low probability of generally straight-line propagation that is depicted by the projections of emission anddetection cones3004 and3008. Accordingly,FIG. 23B preferably is a geometric interpretation of the potential for electromagnetic radiation to propagate to a particular range of depths or in a particular relative direction.
• Thus, the angles of intersection betweensuperficies3300 and emission anddetection waveguides3210 and3220 preferably impact emitted and collectedelectromagnetic radiation3002 and3006 ofelectromagnetic radiation sensor3000. Preferably, suitable angles of intersection that (i) improve the optical power Φ₂; (ii) improve the signal-to-noise ratio of collectedelectromagnetic radiation3006; and/or (iii) focuselectromagnetic radiation sensor3000 at particular depths/directions include, e.g., approximately perpendicular angles and oblique angles.
• The discoveries made by the inventors include, inter alia, configurations of an electromagnetic radiation sensor that preferably increase the optical power of emitted electromagnetic radiation and/or improve the signal-to-noise ratio of collected electromagnetic radiation. Examples of suitable configurations include certain superficies geometries, certain superficies topographies (e.g.,superficies3300 including projections or recesses), and certain angular orientations of emission and detection waveguides. Preferably, suitable configurations include combinations of superficies geometries, superficies topographies, and/or angular orientations of the waveguides. According to one embodiment, an electromagnetic radiation sensor has a configuration that includes approximately 4 millimeters between waveguides, a convex superficies, and waveguides that intersect the superficies at approximately 90 degrees.
• An electromagnetic radiation sensor according to the present disclosure preferably may be used, for example, (1) as an aid in detecting at least one of infiltration and extravasation; (2) to monitor anatomical changes in perivascular tissue; or (3) to emit and collect transcutaneous electromagnetic signals. The discoveries made by the inventors include, inter alia, that sensor configuration including geometry (e.g., shape and spacing), topography, and angles of transcutaneous electromagnetic signal emission and detection affect the accurate indications anatomical changes in perivascular tissue, including infiltration/extravasation events. For example, the discoveries made by the inventors include that the configuration of an electromagnetic radiation sensor is related to the accuracy of the sensor for aiding in diagnosing at least one of infiltration and extravasation in Animalia tissue.
• Sensors according to the present disclosure preferably are manufactured by certain methods that may vary. Preferably, operations included in the manufacturing method may be performed in certain sequences that also may vary. According to one embodiment, a sensor manufacturing method preferably includes molding first andsecond housing portions3102 and3104 (seeFIG. 17), which define aninterior volume3110. Preferably,superficies3300 is molded withfirst housing portion3102. At least one emissionoptical fiber3212 and at least one detectionoptical fiber3222 preferably extend throughinterior volume3110. Preferably, portions of emission and detectionoptical fibers3212 and3222 are disposed ininterior volume3110. First andsecond housing portions3102 and3104 preferably are coupled together. Preferably,filler3150, e.g., epoxy, is injected via a fill hole (not shown) inhousing3100 to occludeinternal volume3110 and cincture the portions of emission and detectionoptical fibers3212 and3222 ininternal volume3110. Portions of emission and detectionoptical fibers3212 and3222 disposedoutside housing3100 preferably are cleaved generally proximate tosuperficies3300. Preferably, end faces of emission and detectionoptical fibers3212 and3222 are polished substantially smooth withhousing surface3120. According to one embodiment, each individual point on end faces of emissionoptical fibers3212 preferably is disposed a distance not less than 3 millimeters and not more than 5 millimeters from each individual point on end faces detectionoptical fibers3222. According to other embodiments,first housing portion3102 preferably is supported withhousing surface3120 disposed orthogonal with respect to gravity, and portions of emission and detectionoptical fibers3212 and3222 insideinterior volume3110 are fixed with respect tofirst housing portion3102. The first and second angles of intersection α₁and α₂betweensuperficies3300 and emission and detectionoptical fibers3212 and3222 therefore preferably are approximately 90 degrees. According to other embodiments, at least one of emission and detectionoptical fibers3212 and3222 is fixed relative tofirst housing portion3102 at an oblique angle of intersection with respect tosuperficies3300. According to other embodiments, occludinginternal volume3110 preferably includes heating at least one ofhousing3100, emissionoptical fiber3212, and detectionoptical fiber3222. Preferably, heating facilitates flowingfiller3150 ininterior volume3110.
• Electromagnetic energy sensor3000 preferably is positioned in close proximity to the skin S. As the terminology is used herein, “close proximity” ofelectromagnetic energy sensor3000 with respect to the skin S preferably refers to a relative arrangement that minimizes gaps betweensuperficies3300 and the epidermis E of the skin S. According to one embodiment,electromagnetic energy sensor3000 contiguously engages the skin S as shown inFIG. 24.
• The inventors discovered a problem regarding accurately identifying the occurrence of infiltration or extravasation because of a relatively low signal-to-noise ratio of collectedelectromagnetic radiation3006. In particular, the inventors discovered a problem regarding a relatively large amount of noise in collectedelectromagnetic radiation3006 that obscures signals indicative of infiltration/extravasation events. Another discovery by the inventors is that the amount of noise in collectedelectromagnetic radiation3006 tends to correspond with the degree of patient activity. In particular, the inventors discovered that collectedelectromagnetic radiation3006 tends to have a relatively lower signal-to-noise ratio among patients that are more active, e.g., restless, fidgety, etc., and that collectedelectromagnetic radiation3006 tends to have a relatively higher signal-to-noise ratio among patients that were less active, e.g., calm, sleeping, etc.
• The inventors also discovered that a source of the problem is an imperfect cavity that may unavoidably and/or intermittently occur betweensuperficies3300 and the skin S. As the terminology is used herein, “imperfect cavity” preferably refers to a generally confined space that at least partially reflects electromagnetic radiation. In particular, the inventors discovered that the source of the problem is portions of emittedelectromagnetic radiation3002 and/or collectedelectromagnetic radiation3006 being reflected in the imperfect cavity betweensuperficies3300 and the skin S.
• FIG. 25 illustrates the source of the problem discovered by the inventors. Specifically,FIG. 25 shows a cavity G disposed betweenelectromagnetic energy sensor3000 and the skin S. The size, shape, proportions, etc. of the cavity G are generally overemphasized inFIG. 25 to facilitate describing the source of the problem discovered by the inventors. Referring also toFIG. 17, transcutaneouselectromagnetic radiation3002bpreferably passes through the cavity G and passes through the target area of the skin S toward the perivascular tissue P. Cutaneouselectromagnetic radiation3002agenerally is reflected in the cavity G between the cutaneous tissue C andsuperficies3300. Preferably,signal component3006bincludes at least some of transcutaneouselectromagnetic radiation3002bthat is at least one of reflected, scattered or otherwise redirected from the perivascular tissue P before passing through the skin S, passing through the cavity G, and enteringdetection waveguide3220 viadetector face3224.Noise component3006agenerally includes at least some of cutaneouselectromagnetic radiation3002athat is reflected in the cavity G before enteringdetection waveguide3220 viadetector face3224.
• Preferably,signal component3006bprovides an indication that an infiltration/extravasation event is occurring whereasnoise component3006atends to obscure an indication that an infiltration/extravasation event is occurring. Thus, the inventors discovered, inter alia, that a cavity betweensuperficies3300 and the skin S affects the signal-to-noise ratio of collectedelectromagnetic radiation3006.
• FIGS. 26A and 26B illustrate that the cavity G preferably includes one or an aggregation of individual gaps.FIG. 26A shows individual gaps betweensuperficies3300 and the skin S that, taken in the aggregate, preferably make up the cavity G. Preferably, the individual gaps may range in size between approximately microscopic gaps G1 (three are indicated inFIG. 26A) and approximately macroscopic gaps G2 (two are indicated inFIG. 26A). It is believed that approximately microscopic gaps G1 may be due at least in part to epidermal contours of the skin S and/or hair on the skin S, and approximately macroscopic gaps G2 may be due at least in part to relative movement betweensuperficies3300 and the skin S. Patient activity is an example of an occurrence that may cause the relative movement that results in approximately macroscopic gaps G2 betweensuperficies3300 and the skin S.
• FIG. 26B showselectromagnetic energy sensor3000 preferably isolated from the skin S by a foundation3130. Preferably, foundation3130 contiguously engagessuperficies3300 and contiguously engages the skin S. Accordingly, the cavity G between foundation3130 and the skin S preferably includes an aggregation of (1) approximately microscopic gaps G1 (two are indicated inFIG. 26B); and (2) approximately macroscopic gaps G2 (two are indicated inFIG. 26B). Foundation3130 preferably is coupled with respect toelectromagnetic energy sensor3000 and includes a panel3132 and/or adhesive3134. Preferably, panel3132 includes a layer disposed betweenelectromagnetic energy sensor3000 and the skin S. Panel3132 preferably includes Tegaderm™, manufactured by 3M (St. Paul, Minn., USA), REACTIC™, manufactured by Smith & Nephew (London, UK), or another polymer film, e.g., polyurethane film, that is substantially impervious to solids, liquids, microorganisms and/or viruses. Preferably, panel3132 is biocompatible, breathable, and/or transparent or translucent with respect to visible light. Panel3132 preferably is generally transparent with respect to emitted and collectedelectromagnetic radiation3002 and3006. Preferably, adhesive3134 bonds at least one of panel3132 andelectromagnetic energy sensor3000 to the skin S. Adhesive3134 preferably includes an acrylic adhesive, a synthetic rubber adhesive, or another biocompatible, medical grade adhesive. Preferably, adhesive3134 minimally affects emitted and collectedelectromagnetic radiation3002 and3006. According to one embodiment, as shown inFIG. 26B, adhesive3134 preferably is omitted where emitted and collectedelectromagnetic radiation3002 and3006 penetrate foundation3130, e.g., underlying emitter and detector faces3214 and3224.
• FIG. 27 shows ahousing3100 according to the present disclosure including anelectromagnetic radiation absorber3160. Preferably, emission anddetection waveguides3210 and3220 extend throughinterior volume3110 that is generally defined by aninterior wall3112 ofhousing3100.Housing3100 preferably includes a biocompatible material, e.g., polycarbonate, polypropylene, polyethylene, acrylonitrile butadiene styrene, or another polymer material. Preferably,filler3150, e.g., epoxy or another potting material, fillsinterior volume3110 around emission anddetection waveguides3210 and3220. According to one embodiment,filler3150 preferably cinctures emission and detectionoptical fibers3212 and3222 disposed ininterior volume3110. Preferably,housing3100 includessurface3120 that confronts the skin S and cinctures emitter and detector faces3214 and3224. Accordingly, superficies3300 ofelectromagnetic energy sensor3000 preferably includesemitter face3214,detector face3224 andsurface3120.
• Absorber3160 preferably absorbs electromagnetic radiation that impinges onsurface3120. As the terminology is used herein, “absorb” or “absorption” preferably refer to transforming electromagnetic radiation propagating in a material to another form of energy, such as heat. Preferably,absorber3160 absorbs wavelengths of electromagnetic radiation that generally correspond to the wavelengths of emitted and collectedelectromagnetic radiation3002 and3006. According to one embodiment,absorber3160 preferably absorbs electromagnetic radiation in the near-infrared portion of the electromagnetic spectrum.Absorber3160 may additionally or alternatively absorb wavelengths in other parts of the electromagnetic radiation spectrum, e.g., visible light, short-wavelength infrared, mid-wavelength infrared, long-wavelength infrared, or far infrared. According to one embodiment,absorber3160 absorbs at least 50% and preferably 90% or more of the electromagnetic radiation that impinges onsurface3120.
• Absorber3160 preferably includes a variety of form factors for inclusion withhousing3100. Preferably,absorber3160 includes at least one of a film, a powder, a pigment, a dye, or ink. Film or ink preferably are applied onsurface3120, and powder, pigment or dye preferably are incorporated, e.g., dispersed, in the composition ofhousing3100.FIG. 27 showsabsorber3160 preferably is included infirst housing portion3102; however,absorber3160 or another electromagnetic radiation absorbing material may also be included insecond housing portion3104 and/orfiller3150. Examples ofabsorbers3160 that are suitable for absorbing near-infrared electromagnetic radiation preferably include at least one of antimony-tin oxide, carbon black, copper phosphate, copper pyrophosphate, illite, indium-tin oxide, kaolin, lanthanum hexaboride, montmorillonite, nickel dithiolene dye, palladium dithiolene dye, platinum dithiolene dye, tungsten oxide, and tungsten trioxide.
• Absorber3160 preferably improves the signal-to-noise ratio of receivedelectromagnetic radiation3006 by reducingnoise component3006a. Preferably, electromagnetic energy that impinges onsurface3120 is absorbed rather than being reflected in the cavity G and therefore does not propagate further, e.g., towarddetector face3224. According to one embodiment,absorber3160 preferably substantially attenuates cutaneouselectromagnetic radiation3002aandnoise component3006aas compared toelectromagnetic energy sensor3000 shown inFIG. 25.
• Electromagnetic energy sensor3000 preferably may be used, for example, (1) as an aid in detecting at least one of infiltration and extravasation; (2) to identify an anatomical change in perivascular tissue; or (3) to analyze a transcutaneous electromagnetic signal. Emittedelectromagnetic radiation3002 preferably propagates fromemitter face3214 through foundation3130 and/or cavity G, if either of these is disposed in the path of emittedelectromagnetic radiation3002, toward the target area of the skin S. According to one embodiment, emittedelectromagnetic radiation3002 divides into cutaneouselectromagnetic radiation3002aand transcutaneouselectromagnetic radiation3002bin the cavity G.
• Cutaneouselectromagnetic radiation3002amay be initially reflected in cavity G, but preferably is generally absorbed byabsorber3160. According to one embodiment,absorber3160 absorbs at least 50% and preferably 90% or more of cutaneouselectromagnetic radiation3002athat impinges onsurface3120. Accordingly,noise component3006adue to cutaneouselectromagnetic radiation3002apreferably is substantially eliminated or at least reduced byabsorber3160.
• Transcutaneouselectromagnetic radiation3002bpreferably propagates through the skin S toward the perivascular tissue P. Preferably, at least a portion oftranscutaneous portion3002bis at least one of reflected, scattered or otherwise redirected from the perivascular tissue P toward the target area of the skin S assignal component3006b. After propagating through the target area of the skin S,signal component3006bpreferably further propagates through the cavity G and foundation3130, if either of these is disposed in the path ofsignal component3006b, towarddetector face3224. Preferably,detector face3224 collectssignal component3006banddetection waveguide3220 transmits collectedelectromagnetic radiation3006 topatient monitoring device6000. Preferably,patient monitoring device6000 analyzes collectedelectromagnetic radiation3006 to, for example, identify anatomical changes in perivascular tissue and/or aid in detecting an infiltration/extravasation event.
• Absorber3160 preferably also absorbs other noise in addition to that resulting fromcutaneous portion3002a. For example,absorber3160 preferably also absorbs a portion ofsignal component3006bthat impinges onsurface3120 rather than being collected bydetector face3224.
• Thus,absorber3160 preferably improves the signal-to-noise ratio of collectedelectromagnetic radiation3006 by absorbingnoise component3006a. Preferably, reducingnoise component3006ain collectedelectromagnetic radiation3006 makes it easier forpatient monitoring device6000 to analyzesignal3006bin collectedelectromagnetic radiation3006.
• Changes in the size and/or volume of cavity G preferably may also be used to monitor patient activity and/or verify inspections by caregivers. Preferably, information regarding the occurrence of patient posture change may be detected byelectromagnetic energy sensor3000. Accordingly, this information may aid a caregiver in evaluating if a patient is obsessed with or distracted bycannula20 and therefore at greater risk of disrupting the patient's infusion therapy. Similarly,electromagnetic energy sensor3000 preferably may be used to detect caregiver examinations of the target area of the skin and/or the cannulation site N. Preferably, a caregiver periodically examines the patient during infusion therapy for indications of infiltration/extravasation events. These examinations preferably include touching and/or palpating the target area of the patient's skin. These actions by the caregiver tend to cause relative movement betweenelectromagnetic energy sensor3000 and the skin S. Accordingly, a record of collectedelectromagnetic radiation3006 preferably includes the occurrences over time of caregiver inspections.
Sensor Cable
• Electromagnetic radiation sensor3000 may be coupled topatient monitoring device6000 viasensor cable5000. According to some embodiments,electromagnetic radiation sensor3000 andpatient monitoring device6000 may be coupled wirelessly rather than viasensor cable5000, orelectromagnetic radiation sensor3000 may incorporate certain features ofpatient monitoring device6000.
• FIGS. 28A-28C illustrate an embodiment ofsensor cable5000 according to the present disclosure.Sensor cable5000 preferably provides transmission paths for first and second light signals betweenpatient monitoring device6000 andelectromagnetic radiation sensor3000. According to one embodiment, sets of emission and detectionoptical fibers3212 and3222 preferably extend insensor cable5000 along a longitudinal axis L between first andsecond ends5002 and5004. Preferably,first end5002 is proximate topatient monitoring device6000 andsecond end5004 is proximate toelectromagnetic radiation sensor3000. Asheath5010 preferably cinctures sets of emission and detectionoptical fibers3212 and3222 along the longitudinal axis L between first andsecond ends5002 and5004. Preferably,sheath5010 includes afirst end5012 coupled to aplug5020 and includes asecond end5014 coupled toelectromagnetic radiation sensor3000.Plug5020 preferably facilitates consistent optical coupling and recoupling withpatient monitoring device6000.
• Sensor cable5000 preferably provides a conduit for emission and detectionoptical fibers3212 and3222. According to one embodiment, each set includes several hundred optical fibers and preferably includes approximately 600 individual borosilicate optical fibers having an approximately 50 micron diameter, a numerical aperture NA of approximately 0.55, and a low hydroxyl group content, e.g., less than 50 parts per million and preferably less than 20 parts per million. One example of a suitable optical fiber material is Glass 8250 manufacture by Schott North America, Inc. (Elmsford, N.Y., US). According to other embodiments, each set may include different numbers of optical fibers possibly with different diameters, higher or lower numerical apertures, and different hydroxyl group contents. According to other embodiments, the optical fiber material may include different types of glass or plastic. The material ofsheath5010 preferably includes a medical grade thermoplastic polyurethane, e.g., Tecoflex®, manufactured by The Lubrizol Corporation (Wickliffe, Ohio, US). According to one embodiment,sheath5010 preferably is extruded around the sets of emission and detectionoptical fibers3212 and3222. According to other embodiments, one set of emission or detectionoptical fibers3212 or3222 may be cinctured in a jacket (not shown) disposed insheath5010. According to other embodiments,sheath5010 may include an element to avoid crushing emission and detectionoptical fibers3212 and/or to limit the minimum bend radius ofsensor cable5000.
Patient Monitoring Device
• Patient monitoring device6000 preferably is suitable for controlling pulses of first and second emittedelectromagnetic radiation3002 and3012, and for analyzing corresponding pulses of optical power Φ₆and Φ₁₆corresponding to first and second collectedelectromagnetic radiation3006 and3016. Preferably, the optical power Φ₆changes over time in response to (i) fluid infusing the perivascular tissue P; and (ii) changing tissue blood volume along the monitoring path of first emitted and collectedelectromagnetic radiation3002 and3006. Changes over time in the optical power Φ₁₆preferably distinguish between fluid infusing the perivascular tissue P or changing tissue blood volume. Accordingly, second emitted and collectedelectromagnetic radiation3012 and3016 preferably (i) verify that an infiltration/extravasation examination is indicated based on an anatomic change due to fluid infusing the perivascular tissue P; and (ii) eliminate or at least substantially mitigate false alerts to perform an infiltration/extravasation examination based on changing tissue blood volume.
• FIGS. 28A-28C illustrate the exterior ofpatient monitoring device6000 according to one embodiment of the present disclosure.Patient monitoring device6000 preferably includes ashell6010 supported on a pole by aclamp6012. Preferably,shell6010 includes an exterior surface and defines an interior space. According to one embodiment,clamp6012 preferably is disposed on the exterior ofshell6010 and includes a fixedjaw6014 and a movingjaw6016. Anactuator6018, e.g., a knob and threaded rod, preferably displaces movingjaw6016 relative to fixedjaw6014 for gripping and releasingclamp6012 with respect to the pole. Preferably, abail6020 is coupled to shell6010 for capturingsensor cable5000, e.g., when dressing1000 is in the second arrangement. According to the embodiment shown inFIGS. 28A-28C,bail6020 includes a hook coupled toshell6010 at a plurality of junctures. According to other embodiments,bail6020 may be coupled toshell6010 at a single juncture or a basket or net slung fromshell6010 may be used to capture at least a portion ofsensor cable5000.
• Patient monitoring device6000 preferably includes a number of features disposed on the exterior ofshell6010. Preferably,patient monitoring device6000 includes apower button6030, anindicator set6040, adisplay6050, a set ofsoft keys6060, amute button6070, acheck button6080 and atest port6090. According to the embodiment shown inFIG. 28A, these features preferably are disposed on the front ofshell6010.Pressing power button6030 preferably toggles ON and OFFpatient monitoring device6000.
• Patient monitoring device6000 preferably provides status reports of varying detail. Preferably, indicator set6040 provides a basic status report anddisplay6050 provides a more detailed status report. According to one embodiment, indicator set6040 includes a set of multi-color light emitting diodes6042a-6042eproviding a visible indication of at least one of three states ofpatient monitoring device6000. A first state ofpatient monitoring device6000 preferably includes all of multi-color light emitting diodes6042a-6042eilluminating a first color, e.g., green. Preferably, the first state is characterized by actively monitoring for indications of infiltration or extravasation without identifying a cause for alerting a healthcare giver to evaluate the patient. A second state ofpatient monitoring device6000 preferably includes all of multi-color light emitting diodes6042a-6042eilluminating a second color, e.g., yellow. Preferably, the second state is characterized by identifying a cause for alerting the healthcare giver to evaluate the operation ofsystem100 with respect to the patient. For example, the second state may be indicated if the operation ofsystem100 is being disrupted because the patient is pulling onsensor cable5000. A third state ofpatient monitoring device6000 preferably includes all of multi-color light emitting diodes6042a-6042eilluminating a third color, e.g., red. Preferably, the third state is characterized bypatient monitoring device6000 alerting the healthcare giver to perform an infiltration/extravasation examination. According to other embodiments, the number as well as color(s) of multi-color light emitting diodes6042a-6042ethat are illuminated may provide information regarding, for example, duration or intensity of an event that is cause for alerting a healthcare giver.
• Display6050 preferably provides detailed information regarding the use, status, and alarms ofpatient monitoring device6000. Preferably,display6050 includes color, alphanumeric characters, graphs, icons and images to convey set-up and operating instructions, system maintenance and malfunction notices, system configuration statements, healthcare giver alerts, historical records, etc. According to one embodiment,display6050 preferably displaysindividual labels6052 describing a function assigned to a correspondingsoft key6060. According to other embodiments,display6050 preferably facilitates quantifying with precision when an identifiable event occurred, its duration, its magnitude, whether an alert was issued, and the corresponding type of alert.
• Mute button6070 andcheck button6080 preferably are hard keys having regularly assigned functions. Preferably,mute button6070 temporarily silences an audible alarm. According to one embodiment, a healthcare giver preferably silences the audible alarm while performing an infiltration/extravasation examination. Preferably, the function ofmute button6070 is temporary because disabling rather than silencing the audible alarm may be detrimental to the future effectiveness ofpatient monitoring device6000. Checkbutton6080 preferably includes one or more regularly assigned functions, e.g., registering periodic examinations of the cannulation site N. According to one embodiment,check button6080 is preferably pressed each time a healthcare giver performs an examination of the cannulation site N. Preferably, the examination is registered in a historical record maintained bypatient monitoring device6000. According to other embodiments, the historical record may be reviewed ondisplay6050 and/or the historical record may be transferred offpatient monitoring device6000 to a recordkeeping system that maintains a generally comprehensive chronicle of the patient's treatment(s).
• Patient monitoring device6000 preferably includes a test arrangement for verifying the operation and calibration ofsystem100. According topatient monitoring device6000 shown inFIG. 28C, the test arrangement includes preferably insertingelectromagnetic radiation sensor3000 intest port6090, e.g., prior toelectromagnetic radiation sensor3000 being coupled with dressing1000 in the first arrangement. Preferably, collectedelectromagnetic radiation3006 in the test arrangement includes a portion of emittedelectromagnetic radiation3002 that is redirected by an optically standard material disposed intest port6090. According to one embodiment, the optically standard material preferably includes Spectralon®, manufactured by Labsphere, Inc. (North Sutton, N.H., US), or another material having high diffuse reflectance. Preferably, collectedelectromagnetic radiation3006 is collected bydetector face3224 and the corresponding light signal is transmitted viadetection waveguide3220 and plug5020 topatient monitoring device6000. The light signal is preferably compared with accepted calibration values. A satisfactory comparison preferably results in an affirmative indication by at least one of indicator set6040 anddisplay6050; whereas,display6050 may present instructions for additional diagnostic routines and/or guidance for recalibrating or repairingsystem100 if the result is an unsatisfactory comparison.
• The test arrangement shown inFIG. 28C is preferably a generally passive system for verifying the operation and calibration ofsystem100. According to other embodiments ofpatient monitoring device6000, an active testing system preferably includes a light detector to measure the optical power Φ₂and a light source to mimic collectedelectromagnetic radiation3006.
• FIG. 29 shows a schematic block diagram of anoperating device6100 according to one embodiment ofpatient monitoring device6000. Preferably,operating device6100 includes acontroller6110, at least oneoptics bench6120, anotification section6150, and an input/output section6160.Controller6110 preferably is disposed in the interior space ofshell6010 and includes aprocessor6112,non-volatile memory6114, andvolatile memory6116. According to one embodiment,processor6112 preferably includes a Peripheral Interface Controller (PIC) microcontroller. An example of asuitable processor6112 is model number PI32MX695F512L-801/PT manufactured by Microchip Technology Inc. (Chandler, Ariz., US).Non-volatile memory6114 preferably includes flash memory or a memory card that is coupled withprocessor6112 via a bi-directional communication link. Examples of suitable bi-directional communication links include a serial peripheral interface (SPI) bus, an inter-integrated circuit (I²C) bus, or other serial or parallel communication systems. Preferably,non-volatile memory6114 extends the non-volatile memory available onprocessor6112. According to one embodiment,non-volatile memory6114 includes a Secure Digital (SD) memory card.Volatile memory6116 preferably includes, for example, random-access memory (RAM) that is coupled withprocessor6112 via a bi-directional communication link. Preferably,volatile memory6116 extends the volatile memory available onprocessor6112. Preferably,controller6110 performs a number of functions including, inter alia, (1) directing the storage of raw data that is collected viasensor3000; (2) processing the raw data according to an algorithm running onprocessor6112; (3) directing the storage of processed data; (4) issuing commands tonotification section6150; and (5) responding to inputs from input/output section6160. According to one embodiment, a timestamp is preferably stored with individual units of raw data, processed data and/or log events. Preferably,controller6110 maintains a log of events related topatient monitoring device6000. According to other embodiments,operating device6100 includes an electrical power supply, e.g., a battery, and/or manages electrical power supplied from a source that preferably is external topatient monitoring device6000. Preferably, an external source of alternating current is transformed and regulated to supply direct current to operatingdevice6100.
• Optics bench6120 preferably is disposed in the interior space ofshell6010 and includes a first electro-optical signal transducer, a second electro-optical signal transducer, and a third electro-optical signal transducer. Preferably, first and second electro-optical signal transducers transform corresponding first and second digital electric signals fromcontroller6110 to first and second emittedelectromagnetic radiation3002 and3012. According to one embodiment, the first electro-optical signal transducer preferably includes a first digital-to-analog converter6122aand a firstlight emitting diode6124ato transform the first digital electric signal to first emittedelectromagnetic radiation3002 at a first peak wavelength λ1, and the second electro-optical signal transducer preferably includes a second digital-to-analog converter6122band a secondlight emitting diode6124bto transform the second digital electric signal to second emittedelectromagnetic radiation3012 at a second peak wavelength λ2. According to other embodiments,optics bench6120 preferably includes additional electro-optical signal transducers to transform additional digital electric signals fromcontroller6110 to emitted electromagnetic radiation at additional discrete peak wavelengths. The third electro-optical signal transducer ofoptics bench6120 preferably includes aphotodiode6126, anoperational amplifier6128 and an analog-to-digital converter6130 to transform first and second collectedelectromagnetic radiation3006 and3016 to a third digital electric signal. Preferably, the third digital electric signal includes the raw data at each of the first and second peak wavelengths λ1 and λ2 that is collected byphotodiode6126. According to one embodiment, analog-to-digital converter6130 preferably transforms the first collectedelectromagnetic radiation3006 to a first sequence of values and transforms the second collectedelectromagnetic radiation3016 to a second sequence of values. Preferably, the first and second sequences of values are sent tocontroller6110 via a bi-directional communication link.
• Optics bench6120 preferably includes a printed circuit board (not shown) that supports first and second digital-to-analog converters6122aand6122b,operational amplifier6128, analog-to-digital converter6130, and atransceiver6125 that provides a common enclosure for firstlight emitting diode6124a, secondlight emitting diode6124b, andphotodiode6126. Preferably, plug5020 cooperatively mates withtransceiver6125 to provide consistent optical coupling betweensensor cable5000 andoptics bench6120. A bi-directional communication link preferably provides communication betweenoptics bench6120 andcontroller6110.Operating device6100 shown inFIG. 29 shows asingle optics bench6120 coupled withcontroller6110; however, a plurality ofoptics benches6120 may be coupled withcontroller6110 when, for example, it is preferable to use a singlepatient monitoring device6000 with a plurality ofelectromagnetic radiation sensors3000.
• Preferably, the first wavelength λ1 is sensitive to the infusate F and the second wavelength λ2 is sensitive to blood. According to one embodiment, the first wavelength λ1 is in the near-infrared portion of the electromagnetic spectrum, and the second wavelength λ2 is in the yellow to red visible light portions of the electromagnetic spectrum. According to other embodiments, the second wavelength λ2 preferably approximates an isosbestic wavelength of oxyhemoglobin and deoxyhemoglobin. Preferably, the second wavelength λ2 is approximately at an isosbestic wavelength not greater than 586 nanometers (approximately 512 terahertz) because the next longer isosbestic wavelength at approximately 808 nanometers (approximately 371 terahertz) is sensitive to the infusate F.
• FIGS. 30A and 30B are time lines illustrating embodiments of strategies for controlling the electro-optical signal transducers ofoptics bench6120 withcontroller6110. According to the embodiment illustrated inFIG. 30A, the first and second electro-optical signal transducers are preferably driven at approximately 60 Hertz by the corresponding first and second digital electric signals fromcontroller6110. As the terminology is used herein, “drive” preferably refers to a command for cyclically activating and deactivating a device. First and secondlight emitting diodes6124aand6124btherefore are individually activated once per cycle, e.g., twelve times every 0.2 seconds. Preferably, firstlight emitting diode6124ais activated during an initial period of each cycle, then there is a middle period Ro during each cycle when first and secondlight emitting diodes6124aand6124bare inactive, and secondlight emitting diode6124bis activated during a subsequent period of each cycle. The third digital signal from the third electro-optical signal transducer preferably is sampled three times during each cycle. Preferably, sampling durations are approximately 50% to approximately 75% of the initial, middle, or subsequent periods to isolate corresponding individual samples of (i) the optical power Φ₆; (ii) a optical power Φ₀that correlates to ambient electromagnetic radiation affecting electromagnetic radiation sensor3000 (e.g., measured during the middle period Ro); and (iii) the optical power Φ₁₆. Accordingly, the third digital signal preferably includes a first set of values including the samples of the optical power Φ₆from each cycle, a second set of values including the samples of the optical power Φ₁₆from each cycle, and a third set of values including the samples of the optical power Φ₀from each cycle.
• Second electro-optical signal transducer preferably is driven at a rate that overcomes a perception of flashing by second emitted and collectedelectromagnetic radiation3012 and3016. Preferably, the first electro-optical signal transducer can be driven at a slow rate, e.g., as low as 0.3 Hertz or lower, relative to the second electro-optical signal transducer when first emitted and collectedelectromagnetic radiation3002 and3006 include infrared radiation, which typically is imperceptible to human eyes. According to the embodiment illustrated inFIG. 30B,controller6110 drives the first electro-optical signal transducer at approximately 5 Hertz while driving the second electro-optical signal transducer at a rate such that second emitted and collectedelectromagnetic radiation3012 and3016 preferably are perceived by human eyes as glowing rather than flashing. Preferably, the second electro-optical signal transducer is driven at a minimum of approximately 24 Hertz and preferably at approximately 60 Hertz. Accordingly, the embodiment illustrated inFIG. 30B shows firstlight emitting diode6124ais activated once per cycle, e.g., one time every 0.2 seconds, and secondlight emitting diode6124bis activated 12 times per cycle, e.g., 12 times every 0.2 seconds. According to other embodiments,controller6110 preferably drives the second electro-optical signal transducer at approximately 120 Hertz or more. Similar to the embodiment shown inFIG. 30A, each cycle preferably includes a period of inactivity between activating first and secondlight emitting diodes6124aand6124b. Preferably, secondlight emitting diode6124bis activated before firstlight emitting diode6124aaccording to the embodiment illustrated inFIG. 30B. The third digital signal from the third electro-optical signal transducer preferably is sampled three times during each cycle bycontroller6110 for obtaining individual samples of the optical power Φ₆, the optical power Φ₀, and the optical power Φ₁₆. The amount of data that is processed bycontroller6110 and stored innon-volatile memory6114 preferably is reduced according to the embodiment illustrated inFIG. 30B principally because individual cycles take longer when the first electro-optical signal transducer is driven at approximately 5 Hertz or less. Other embodiments of control strategies preferably include an adaptable sampling rate for varying the sampling rates and cycle times, e.g., between those of the embodiments illustrated inFIGS. 30A and 30B.
• First and second collectedelectromagnetic radiation3006 and3016 preferably are corrected to eliminate or substantially reduce the extraneous contributions of ambient electromagnetic radiation. Preferably,controller6110 computes corrected values of the optical power Φ₆and the optical power Φ₁₆based on the corresponding value of optical power Φ₀in each cycle. According to one embodiment,controller6110 subtracts the value of optical power Φ₀from the values of the optical power Φ₆and the optical power Φ₁₆in each cycle. The accuracy of the corrected values of the optical power Φ₆and the optical power Φ₁₆preferably increases when there are short intervals, e.g., up to approximately 1 second and preferably approximately 10 milliseconds to approximately 100 milliseconds, between (i) sampling the optical power Φ₆and the optical power Φ₀; and (ii) sampling the optical power Φ₁₆and the optical power Φ₀.
• The corrected values of the optical power Φ₆and the optical power Φ₁₆preferably are normalized according to one embodiment ofpatient monitoring device6000 before determining if an infiltration/extravasation examination is indicated or contraindicated. As the terminology is used herein, “normalize” preferably refers to transforming magnitudes of the corrected values of the optical power Φ₆and the optical power Φ₁₆to corresponding intensities that can be compared in a meaningful way. According to one embodiment,controller6110 preferably computes (i) a first arithmetic meanΦ₆of a first collection of corrected values of the optical power Φ₆; and (ii) a second arithmetic meanΦ₁₆of a second collection of corrected values of the optical power Φ₁₆. Preferably, the first collection includes a finite number of consecutive corrected values of the optical power Φ₆beginning with the first cycle, and the second collection includes a finite number of consecutive corrected values of the optical power Φ₁₆beginning with the first cycle. The finite number(s) preferably correspond to a number of cycles (e.g., 5000 cycles) or a time period (e.g., 5 minutes).Controller6110 preferably computes a first set of normalized values {circumflex over (Φ)}₆by dividing each corrected value of the optical power Φ₆by the first arithmetic meanΦ₆, and computes a second set of normalized values {circumflex over (Φ)}₁₆by dividing each corrected value of the optical power Φ₁₆by the second arithmetic meanΦ₁₆. Preferably, individual normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆are in a range between 0.3 and approximately 1.3. Typically, normalized values less than 1.0 indicate a signal decrease relative to an arithmetic mean and values greater than 1.0 indicate a signal increase relative to the arithmetic mean. Accordingly, the normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆are indicative of percentage changes in the first and second collectedelectromagnetic radiation3006 and3016 and are used bycontroller6110 in computations to determine if an infiltration/extravasation examination is indicated or contraindicated. According to other embodiments ofpatient monitoring device6000, optical power magnitude rather than relative intensity preferably is used in comparisons and/or computations to determine if an infiltration/extravasation examination is indicated or contraindicated. Preferably, values of optical power Φ₂, Φ₁₂and Φ₀, as well as the uncorrected and corrected values of optical power Φ₆and Φ₁₆, are measured in or converted to a common unit of optical power, e.g., milliwatts, for use in comparisons or computations bycontroller6110.
• The requirement to specify finite number(s) of consecutive corrected values preferably is eliminated according to other embodiments. Preferably,controller6110 analyzes the rates of change of the corrected values of the optical power Φ₆and the optical power Φ₁₆and identifies corresponding stable values of optical power when the corresponding rate of change is approximately zero for a preferred duration.Controller6110 preferably computes sets of normalized values by dividing each corrected value of the optical power by the corresponding stable value rather than dividing by an arithmetic mean. Accordingly, an advantage of analyzing rates of change is that a stable value may be determined in less time than it takes to collect a finite number of corrected values.
• Referring again toFIG. 29,patient monitoring device6000 preferably includes atemperature sensor6140 to measure temperature changes that affect at least one of first and secondlight emitting diodes6124aand6124b. Typically, the optical power Φ emanating from first and secondlight emitting diodes6124aand6124bis affected by ambient temperature changes. This accordingly affects the optical power Φ₆and Φ₁₆of first and second emittedelectromagnetic radiation3002 and3012.Temperature sensor6140 preferably measures the ambient temperature and provides tocontroller6110 an electrical signal that may be used to adjust at least one of the first and second digital electrical signal supplied to first and second digital-to-analog converters6122aand6122b, respectively. Accordingly, the optical power output of at least one of first and secondlight emitting diodes6124aand6124bmay be generally maintained at a preferable level for a given ambient temperature. According to one embodiment,temperature sensor6140 preferably is disposed intransceiver6125 in proximity to first and secondlight emitting diodes6124aand6124b. According to other embodiments,temperature sensor6140 preferably is supported on the printed circuit board foroptics bench6120. According to other embodiments,temperature sensor6140 preferably is disposed on a printed circuit board forcontroller6110. According to other embodiments,temperature sensor6140 preferably is supported on the exterior ofshell6010.
• Notification section6150 provides visual or audible indications preferably to describe the status ofsystem100 or to alert a healthcare giver to perform an infiltration/extravasation examination. Preferably, visual indicators innotification section6150 includeindicator set6040 anddisplay6050.Display6050 preferably is coupled tocontroller6110 via adisplay driver6152. An audible indicator preferably includes a digital-to-analog converter6154, anaudio amplifier6156, and aspeaker6158. Preferably,display driver6152 and digital-to-analog converter6154 communicate withcontroller6110 via a communication link.Audio amplifier6156 preferably drivesspeaker6158. According to one embodiment, the output fromspeaker6158 includes at least one of an alarm or a notification. Alarms preferably comply with a standard such as IEC 60601-1-8 promulgated by the International Electrotechnical Commission. Preferably, notifications include, for example, a tone, a melody, or a synthesized voice. The embodiment ofoperating device6100 shown inFIG. 29 includes a pair of visual indicators and a single audible indicator; however, other combinations of visual and audible indicators are also envisioned.
• According to one embodiment, a graphical user interface preferably includes certain features of notification and input/output sections6150 and6160. Preferably, the graphical user interface combines in a generally common area on the exterior ofshell6010 at least one of indicator set6040 anddisplay6050 with at least one ofsoft keys6060,mute button6070, andcheck button6080. For example,patient monitoring device6000 shown inFIG. 28A includes a graphical user interface that combines, inter alia, labels6052 ondisplay6050 withsoft keys6060.
• Input/output section6160 preferably facilitates inputting commands tooperating device6100 or outputting data from operatingdevice6100. Preferably, input/output section6160 includes akeypad6162, at least one input/output port6164 orwireless communication device6166, and an input/output interface6168 tocouple keypad6162, port(s)6164 anddevice6166 tocontroller6110 via a bi-directional communication link. According to one embodiment,keypad6162 includessoft keys6060,mute button6070, andcheck button6080. According to other embodiments,keypad6162 preferably includes a keyboard or a touchscreen. According to other embodiments, commands tooperating device6100 preferably are input via a pen device or voice recognition device. Input/output ports(s)6164 preferably include connections for communicating with peripheral devices according to at least one standard. Examples of suitable communication standards preferably include, e.g., RS-232 and Universal Serial Bus (USB).Wireless communication device6166 preferably provides an additional or alternate means for communicating with a peripheral device. The embodiment of input/output section6160 shown inFIG. 29 includes three communication options; however, more or less than three options are also envisioned for enablingoperating device6100 to communicate with peripheral devices.
Algorithm
• Algorithms for mitigating false alerts to perform an infiltration/extravasation examination preferably include distinguishing between accumulating fluid and changing tissue blood volume. Preferably,controller6110 runs an algorithm to analyze the first and second sets of normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆for determining if an infiltration/extravasation examination is indicated or contraindicated.
• The inventors discovered, inter alia, an infiltration/extravasation examination is indicated when there is an anatomical change over time even when there is a coexistent physiological change. In particular, an infiltration/extravasation examination is indicated when an algorithm determines the infusate F is accumulating in the perivascular tissue P and the tissue blood volume is changing in the monitoring path ofelectromagnetic radiation sensor3000. The inventors further discovered, inter alia, an infiltration/extravasation examination is contraindicated when there is a physiological change that is not coexistent with an anatomical change over time. In particular, an infiltration/extravasation examination is contraindicated when an algorithm determines the tissue blood volume is changing in the monitoring path ofelectromagnetic radiation sensor3000 and the infusate F is not accumulating in the perivascular tissue P. Preferably, an infiltration/extravasation examination is contraindicated when a tissue blood volume change due to patient posture change is not coexistent with the fluid F infusing the perivascular tissue P.
• Several embodiments of algorithms according to the present invention determine whether an infiltration/extravasation examination is indicated or contraindicated. One embodiment of an algorithm preferably analyzes the first set of normalized values {circumflex over (Φ)}₆to evaluate if a change is sensed in the monitoring path ofelectromagnetic radiation sensor3000 and analyzes the second set of normalized values {circumflex over (Φ)}₁₆to evaluate if the sensed change is due to a tissue blood volume change rather than an anatomic change over time. Referring toFIGS. 18A-18F, the sizes of the arrows for first and second collectedelectromagnetic radiation3006 and3016 preferably correspond to the optical power Φ₂and Φ₆. Preferably, the decrease in the optical power Φ₆fromFIG. 18A toFIG. 18C shows that an infiltration/extravasation examination possibly is indicated and a comparison of the relative decreases in the optical power Φ₆and Φ₁₆fromFIG. 18A toFIG. 18C shows that an infiltration/extravasation examination preferably is indicated. According to one embodiment, the algorithm preferably indicates an infiltration/extravasation examination when (i) the first set of normalized values {circumflex over (Φ)}₆decreases at least approximately 5%; and (ii) the first set of normalized values {circumflex over (Φ)}₆decreases more than the second set of normalized values {circumflex over (Φ)}₁₆. According to other embodiments, an infiltration/extravasation examination preferably is indicated by the algorithm when (i) the first set of normalized values {circumflex over (Φ)}₆decreases at least approximately 10%; and (ii) a ratio of the decrease in the second set of normalized values {circumflex over (Φ)}₁₆to the decrease in the first set of normalized values {circumflex over (Φ)}₆is greater than approximately 0.97. Referring toFIGS. 18D and 18F, the decrease in the optical power Φ₆shows that an infiltration/extravasation examination possibly is indicated and a comparison of the relative decreases in the optical power Φ₆and Φ₁₆shows that an infiltration/extravasation examination preferably is contraindicated. According to one embodiment, the algorithm preferably contraindicates an infiltration/extravasation examination when (i) the first set of normalized values {circumflex over (Φ)}₆decreases less than approximately 5%; or (ii) the first set of normalized values {circumflex over (Φ)}₆decreases less than the second set of normalized values {circumflex over (Φ)}_m. According to other embodiments, an infiltration/extravasation examination preferably is contraindicated by the algorithm when (i) the first set of normalized values {circumflex over (Φ)}₆decreases less than approximately 10%; and (ii) a ratio of the decrease in the second set of normalized values {circumflex over (Φ)}₁₆to the decrease in the first set of normalized values {circumflex over (Φ)}₆is less than approximately 0.9.
• Other embodiments of algorithms according to the present invention preferably are based on changes in ordered pairs of the normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆to determine if an infiltration/extravasation examination is indicated or contraindicated.FIG. 31A schematically illustrates individual ordered pairs of the normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆plotted for each cycle. Preferably, a known curve fitting technique is used to construct a fitted curve FC for the ordered pairs contained in a first collection C1. The number of ordered pairs in the first collection C1 includes (i) a preferred number of ordered pairs; or (ii) a minimum number of ordered pairs that preferably are sufficient for trending toward one of a group of empirically established fitted curves FC. According to the embodiment shown inFIG. 31A, the fitted curve FC preferably is a straight line described by a first-degree polynomial function, also known as a linear equation. According to other embodiments, the fitted curve FC preferably is described by higher order polynomial functions including, for example, a second-degree polynomial function (quadratic equation) or a third-degree polynomial function (cubic equation). Preferably, ordered pairs that are spaced generally along the fitted curve FC correlate with different tissue blood volume levels and an ordered pair laterally displaced with respect to the fitted curve FC correlates with different structures of the Animalia body. Shifts between ordered pairs that are within the first collection C1 preferably correlate with tissue blood volume changes or generally insubstantial anatomical changes. Preferably, an infiltration/extravasation examination is contraindicated by shifts between ordered pairs within the boundary of the first collection C1. Referring toFIG. 31B, a second collection C2 contains a preferred minimum number of ordered pairs that are at least a preferred minimum perpendicular displacement δ from the fitted curve FC. The ordered pairs in the second collection C2 preferably are collected within a number of cycles that approximately equal the preferred number of ordered pairs in the second collection C2. Preferably, an infiltration/extravasation examination is indicated when the preferred minimum number, e.g., at least approximately 300, of ordered pairs are collected in the second collection C2. According to the embodiment shown inFIG. 31B, the minimum perpendicular displacement δ includes a vertical component δ₆(e.g., change in the normalized values {circumflex over (Φ)}₆) and a horizontal component δ₁₆(e.g., change in the normalized values {circumflex over (Φ)}₁₆). Preferably, an infiltration/extravasation examination is indicated by the algorithm when (i) the vertical component δ₆decreases at least approximately 5%; and (ii) the horizontal component changes less than the vertical component.
• Other embodiments of algorithms according to the present invention compute a predicted signal τ that preferably is compared with a sensed signal for determining if an infiltration/extravasation examination is indicated or contraindicated. Preferably, a calibration function for generating the predicted signal τ is computed bycontroller6110 according to the algorithm.FIGS. 32A and 32B schematically illustrate examples of (i) the first set of normalized values {circumflex over (Φ)}₆for an infrared radiation signal; (ii) the second set of normalized values {circumflex over (Φ)}₁₆for a visible light signal; and (iii) the corresponding predicted signal τ. Preferably, coefficients of the calibration function are computed bycontroller6110 based on the normalized values {circumflex over (Φ)}₆and {circumflex over (Φ)}₁₆during a finite number of cycles, e.g., similar to the aforementioned use of a known curve fitting technique to describe the fitted curve FC. Similarly also, a preferred minimum number of cycles may be sufficient for trending toward one of a group of empirically established calibration curves. Preferably,controller6110 computes the predicted signal τ based on the calibration function and the normalized values {circumflex over (Φ)}₁₆for each cycle and then compares the predicted signal τ with the first set of normalized values {circumflex over (Φ)}₆. According to one embodiment, an infiltration/extravasation examination is indicated after a preferred number of cycles, e.g., 1000 cycles, during which (i) the predicted signal τ is at least approximately 5% lower; and (ii) the predicted signal τ differs less than approximately 10% from the first set of normalized values {circumflex over (Φ)}₆. According to other embodiments, an infiltration/extravasation examination is indicated after approximately 2 minutes during which (i) the predicted signal τ is at least approximately 10% lower; and (ii) the predicted signal τ differs less than approximately 5% from the first set of normalized values {circumflex over (Φ)}₆.FIG. 32A shows an embodiment when an infiltration/extravasation examination preferably is contraindicated because the predicted signal τ drop is less than approximately 10%. Drops of at least 10% in the first set of normalized values {circumflex over (Φ)}₆are shown after approximately 7-10 minutes and approximately 18-20 minutes; however, the cause of these drops is determined by the algorithm to be tissue blood volume changes rather than anatomic changes over time.FIG. 32B shows an embodiment when an infiltration/extravasation examination preferably is indicated after approximately 47 minutes when (i) the predicted signal τ drops at least approximately 10%; and (ii) the predicted signal τ and the first set of normalized values {circumflex over (Φ)}₆differ less than approximately 5%.
• While the present invention has been disclosed with reference to certain embodiments, numerous modifications, alterations, and changes to the described embodiments are possible without departing from the sphere and scope of the present invention, as defined in the appended claims. For example, dressing1000 preferably is devoid of materials, e.g., metal, that may harm a patient or damage diagnostic equipment during magnetic resonance imaging, computerized axial tomography, x-rays, or other procedures that use electromagnetic radiation. For another example, operation of the sensor may be reversed, e.g., collecting electromagnetic radiation with a waveguide that is otherwise configured for emission as discussed above and emitting electromagnetic radiation with a waveguide that is otherwise configured for detection as discussed above. For another example, relative sizes of the emission and detection waveguides may be adjusted, e.g., the emission waveguide may include more optical fibers than the detection waveguide and visa-versa. Accordingly, it is intended that the present invention not be limited to the described embodiments, but that it has the full scope defined by the language of the following claims, and equivalents thereof.

• TABLE A
  				Absorption
  Skin Tissue	Thickness	Refractive	Scattering	Coefficient
  Layer	(mm)	Index	Coefficient (mm−1)	(mm−1)

  epidermis	0.0875	1.5	3.10-7.76	0.24-0.88
  dermis	1	1.4	0.93-2.24	0.01-0.05
  hypodermis	4	1.4	1.22-1.60	0.01-0.04

Claims (19)

What is claimed is:

1. A system to aid in diagnosing at least one of infiltration and extravasation in Animalia tissue, the system comprising:

a sensor including —

a housing including a surface configured to confront an epidermis of the Animalia tissue;

a first waveguide being partially disposed in the housing and configured to transmit first and second signals that enter the Animalia tissue through the epidermis, the first signal having a peak wavelength between approximately 800 nanometers and approximately 1,050 nanometers, and the second signal having a peak wavelength between approximately 570 nanometers and approximately 620 nanometers; and

a second waveguide being partially disposed in the housing and configured to transmit third and fourth signals that exit the Animalia tissue through the epidermis, the third signal including a portion of the first signal that is at least one of reflected, scattered and redirected from the Animalia tissue, and the fourth signal including a portion of the second signal that is at least one of reflected, scattered and redirected from the Animalia tissue;

a dressing being configured to couple the sensor to the epidermis;

a device being configured to evaluate the third and fourth signals, the device including —

an optics bench including a first light emitting diode, a second light emitting diode and a photodiode, the first light emitting diode being configured to emit the first signal transmitted by the first waveguide, the second light emitting diode being configured to emit the second signal transmitted by the first waveguide, and the photodiode being configured to detect the third and fourth signals transmitted by the second waveguide;

a processor coupled to the optics bench, the processor being configured to (i) compute normalized values of the third and fourth signals, (ii) compare the normalized value of the third signal with a threshold value, and (iii) compare the normalized values of the third and fourth signals; and

an indicator coupled to the processor, the indicator being configured to output a notice when (i) the normalized value of the third signal is less than the threshold value and (ii) the normalized value of the fourth signal is greater than the normalized value of the third signal; and

a cable coupling the sensor and the device, the cable including portions of the first and second waveguides.

2. The system ofclaim 1 wherein the peak wavelengths of the first and third signals are between approximately 930 nanometers and approximately 960 nanometers.

3. The system ofclaim 1 wherein the peak wavelengths of the first and third signals are centered about approximately 940 nanometers, and the peak wavelengths of the second and fourth signals are centered about approximately 610 nanometers.

4. The system ofclaim 1 wherein the peak wavelengths of the second and fourth signals generally correspond to an isosbestic point of oxyhemoglobin and deoxyhemoglobin.

5. The system ofclaim 1 wherein the peak wavelengths of the second and fourth signals are centered about approximately 586 nanometers.

6. The system ofclaim 1 wherein the first waveguide includes a plurality of emission optical fibers and the second waveguide includes a plurality of detection optical fibers.

7. The system ofclaim 6 wherein the cable comprises a sheath cincturing the pluralities of emission and detection optical fibers.

8. The system ofclaim 1 wherein the dressing comprises a fitting having first and second arrangements, the first arrangement being configured to retain the housing with respect to the epidermis, and the second arrangement being configured to release the housing from the first arrangement.

9. The system ofclaim 8 wherein the dressing comprises a body coupled to the fitting and configured to prevent contiguous engagement between the housing and the epidermis.

10. The system ofclaim 1 wherein the threshold value is not greater than approximately 0.95.

11. The system ofclaim 1 wherein the threshold value is approximately 0.90.

12. The system ofclaim 1 wherein the processor is configured to evaluate the third signal for infusate accumulation over time in the Animalia tissue and to evaluate the fourth signal for changing tissue blood volume in the Animalia tissue.

13. The system ofclaim 1 wherein the notice comprises an aid to diagnosing at least one of infiltration and extravasation in the Animalia tissue.

14. The system ofclaim 1 wherein the first waveguide includes an emitter face configured to confront the epidermis, the second waveguide includes a detector face configured to confront the epidermis, and the surface cinctures the emitter and detector faces.

15. The system ofclaim 14 wherein the housing comprises an electromagnetic radiation energy absorber configured to generally absorb portions of the first, second, third and fourth signals that (i) are at least one of reflected, scattered and redirected from the Animalia tissue, and (ii) impinge on the surface.

16. The system ofclaim 14 wherein each individual point of the emitter end face is disposed a minimum distance not less than 3 millimeters from each individual point of the detector end face, and each individual point of the emitter end face is disposed a maximum distance not more than 5 millimeters from each individual point of the detector end face.

17. The system ofclaim 1 wherein the cable includes a plug and the optics bench includes a transceiver configured for consistent optical coupling with the plug, the transceiver includes a common enclosure for the first light emitting diode, the second light emitting diode, and the photodiode.

18. The system ofclaim 1 wherein the device comprises a shell generally encasing first and second printed circuit boards, the optics bench is mounted on the first printed circuit board, the processor is mounted on the second printed circuit board, and the second printed circuit board is spaced from the first printed circuit board.

19. The system ofclaim 1 wherein the device comprises a temperature sensor coupled to the processor.

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