US20210298767A1 - Powered drivers, intraosseous devices and methods to access bone marrow - Google Patents

Abstract

An apparatus for penetrating bone and accessing bone marrow is provided. The apparatus may include a penetrator assembly and a powered drill to penetrate the bone into the bone marrow. The penetrator assembly may include a trocar having a stylet. The penetrator assembly may also include an outer penetrator having a hollow cannula and a luer lock attachment. The powered drill may include a housing enclosing a motor and a power supply and associated circuitry. The powered drill may also include a connector receptacle for receiving a penetrator assembly connector of the penetrator assembly. The connector receptacle may releasably lock the penetrator assembly connector into place with the powered drill. The power supply may include a rechargeable battery within the housing for supplying power to the motor. A battery indicator may be provided to indicate a level of the battery.

Description

CROSS-REFERENCE IO RELATED APPLICATIONS
• The present application is a continuation of pending U.S. patent application Ser. No. 17/029,341, entitled “Powered Drivers, Intraosseous Devices And Methods To Access Bone Marrow,” filed Sep. 23, 2020, now published as U.S. Patent Application Publication No. 2021/0052286, which is a continuation-in-part of pending U.S. patent application Ser. No. 16/725,939, entitled “Powered Drivers, Intraosseous Devices And Methods To Access Bone Marrow,” filed Dec. 23, 2019, now published as U.S. Patent Application Publication No. 2020/0129186, which is a continuation of U.S. patent application Ser. No. 15/272,647, entitled “Powered Drivers, Intraosseous Devices And Methods To Access Bone Marrow,” filed Sep. 22, 2016, now U.S. Pat. No. 10,512,474, which is continuation of U.S. patent application Ser. No. 12/061,944, entitled “Powered Drivers, Intraosseous Devices and Methods to Access Bone Marrow,” filed on Apr. 3, 2008, now U.S. Pat. No. 9,451,968, which claims priority to U.S. Provisional Patent Application No. 60/910,122, entitled “Powered Drivers, Intraosseous Device and Methods to Access Bone Marrow,” filed Apr. 4, 2007; and U.S. patent application Ser. No. 12/061,944 is a continuation-in-part of U.S. patent application Ser. No. 11/253,959, entitled “Method and Apparatus to Access Bone Marrow,” filed Oct. 19, 2005, now U.S. Pat. No. 8,506,568, and is a continuation-in-part of U.S. patent application Ser. No. 11/253,467, entitled “Apparatus and Method to Access Bone Marrow,” filed Oct. 19, 2005, now U.S. Pat. No. 8,876,826, and is a continuation-in-part of U.S. patent application Ser. No. 10/449,476, entitled “Apparatus and Method to Access Bone Marrow,” filed May 30, 2003, now U.S. Pat. No. 7,699,850, which claims priority to U.S. Provisional Patent Application No. 60/384,756, entitled “Apparatus and Method to Provide Access to Bone Marrow,” filed May 31, 2002.
• U.S. patent application Ser. No. 17/029,341 is also a continuation-in-part of pending U.S. patent application Ser. No. 15/854,406, entitled “Vascular Access Kits and Methods,” filed Dec. 26, 2017, now U.S. Pat. No. 10,806,491, which is a divisional application of U.S. patent application Ser. No. 14/791,654, entitled “Vascular Access Kits and Methods,” filed Jul. 6, 2015, now U.S. Pat. No. 9,872,703, which is a continuation of U.S. patent application Ser. No. 11/380,340, entitled “Vascular Access Kits and Methods,” filed Apr. 26, 2006, now U.S. Pat. No. 9,072,543, which claims the benefit of U.S. Provisional Patent Application No. 60/675,246, entitled “Vascular Access Kit,” filed Apr. 27, 2005, and which is a continuation-in-part application of U.S. application Ser. No. 10/449,503, entitled “Apparatus And Method To Provide Emergency Access To Bone Marrow,” filed May 30, 2003, now U.S. Pat. No. 7,670,328, which claims the benefit of U.S. Provisional Patent Application No. 60/384,756, entitled “Apparatus and Method to Provide Access to Bone Marrow,” filed May 31, 2002.
• The entire contents of each of the above-referenced applications are incorporated herein by reference in their entirety.
TECHNICAL FIELD
• The present disclosure is related in general to medical devices operable to access bone marrow, and more specifically to an apparatus and method for penetrating a bone and associated bone marrow with a powered driver, inserting an intraosseous device into the bone and associated bone marrow, and providing access to the bone, bone marrow, and other portions of a patient's vascular system.
BACKGROUND
• Every year, millions of patients are treated for life-threatening emergencies in the United States. Such emergencies include shock, trauma, cardiac arrest, drug overdoses, diabetic ketoacidosis, arrhythmias, burns, and status epilepticus just to name a few. For example, according to the American Heart Association, more than 1,500,000 patients suffer from heart attacks (myocardial infarctions) every year, with over 500,000 of them dying from its devastating complications.
• Obtaining satisfactorily vascular access may be a critical problem in approximately five (5%) percent to ten (10%) percent of patients treated in either prehospital or hospital settings. In the U.S. approximately six million patients annually may experience problems with traditional intravenous (IV) access. An essential element for treating all such emergencies is the rapid establishment of an intravenous line in order to administer drugs and fluids directly into the circulatory system. Whether in the ambulance by paramedics, or in the emergency room by emergency specialists, the goal is the same—to start an IV in order to administer life-saving drugs and fluids. To a large degree, the ability to successfully treat such critical emergencies is dependent on the skill and luck of the operator in accomplishing vascular access.
• While it is relatively easy to start an IV on some patients, doctors, nurses and paramedics often experience great difficulty establishing IV access in approximately twenty (20%) percent of patients. These patients are probed repeatedly with sharp needles in an attempt to solve this problem and may require an invasive procedure to finally establish an intravenous route. A further complicating factor in achieving IV access occurs “in the field” e.g. at the scene of an accident or during ambulance transport where it is difficult to see the target and excessive motion make accessing the venous system very difficult. The success rate on the battlefield is often much lower where Army medics may only be about twenty-nine (29%) percent successful in starting an IV line during emergency conditions in the field. These patients are probed repeatedly with sharp needles in an attempt to solve this problem and may require an invasive procedure to finally establish an intravenous route.
• In the case of some patients (e.g., those with chronic disease or the elderly), the availability of easily-accessible veins may be depleted. Other patients may have no available IV sites due to anatomical scarcity of peripheral veins, obesity, extreme dehydration, and/or previous IV drug use. For these patients, finding a suitable site for administering lifesaving drugs becomes a monumental and frustrating task. While morbidity and mortality statistics are not generally available, it is known that many patients with life-threatening emergencies have died of ensuing complications because access to the vascular system with life-saving IV therapy was delayed or simply not possible. For such patients, an alternative approach is required.
• An accepted alternative route to give IV medications and fluids is through bone marrow by providing intraosseous (IO) access. Drugs and other fluids may enter a patient's vascular system just as rapidly via the intraosseous route as when given intravenously. Bone and associated bone marrow may be considered a large non-collapsible vein. The intraosseous route has been used for alternative emergency access in pediatric patients, whose bones are soft enough to permit manual insertion of intraosseous needles.
• Powered drivers associated with intraosseous devices typically include a housing with various types of motors and/or gear assemblies disposed therein. A rotatable shaft may be disposed within the housing and connected with a gear assembly. Various types of fittings, connections, connectors and/or connector receptacles may be provided at one end of the rotatable shaft extending from the housing to releasably engage an intraosseous device with the powered driver.
• Vascular system access may be essential for treatment of many serious diseases, chronic conditions and acute emergency situations. Yet, many patients experience extreme difficulty obtaining effective treatment because of inability to obtain or maintain IV access. An intraosseous space provides a direct conduit to a patent's vascular system and systemic circulation. Therefore, intraosseous access is generally an effective route to administer a wide variety of drugs, other medications and fluids equivalent to IV access. Rapid intraosseous access offers great promise for almost any serious emergency that requires vascular access to administer life saving drugs, other medications and/or fluids when traditional IV access is difficult or impossible.
• Bone marrow typically includes blood, blood forming cells, and connective tissue disposed in an intraosseous space or cavity surrounded by compact bone. Long bones such as the tibia typically have an elongated central cavity filled with yellow bone marrow and adipose or connective tissue. Such cavities may also be referred to as a “medullary cavity,” “bone marrow cavity” and/or “intraosseous space.”
• Compact bone disposed nearer the anterior or dorsal surface shall be referred to as “anterior compact bone” or “anterior bone cortex.” Compact bone disposed farther from the dorsal or anterior surface may be referred to as “posterior compact bone” or “posterior bone cortex.”
• The upper tibia proximate a patient's knee or the humeral head proximate a patient's shoulder may be used as insertion sites for an intraosseous device to establish access with the patient's vascular system. Sternal access may also be used as an insertion site. Availability of multiple intraosseous insertion sites and associated target areas in adjacent bone marrow have proven to be especially important in applications such as emergency treatment of battlefield casualties or other mass casualty situations. Teachings of the present disclosure may be used at a wide variety of insertion sites and target areas. Teachings of the present disclosure are not limited to power drivers and/or intraosseous devices which may be inserted at the proximal tibia, distal tibia, humerus, or sternum.
• Intraosseous access may be used as a “bridge” for temporary fluid and/or drug therapy during emergency conditions until conventional IV sites can be found and used. Conventional IV sites often become available because fluids and/or medication provided via intraosseous access may stabilize a patient and expand veins and other portions of a patient's vascular system. Intraosseous devices and associated procedures incorporating teachings of the present disclosure may become standard care for administering medications and fluids in situations when IV access is difficult or not possible.
• Intraosseous access may be used as a “routine” procedure with chronic conditions which substantially reduce or eliminate availability of conventional IV sites. Examples of such chronic conditions may include, but are not limited to, dialysis patients, patients in intensive care units and epilepsy patients. Intraosseous devices and associated apparatus incorporating teachings of the present disclosure may be quickly and safely used to provide intraosseous access to a patient's vascular system in difficult cases such as status epilepticus to give medical personnel an opportunity to administer crucial medications and/or fluids. Further examples of such acute and chronic conditions are listed near the end of this written description.
SUMMARY
• In accordance with teachings of the present disclosure, apparatus and methods are provided for gaining rapid access to a patient's bone marrow and vascular system.
• In one embodiment, an apparatus for penetrating a bone marrow is provided that includes a housing and a penetrator assembly. The penetrator assembly is operable to penetrate the bone marrow, having a removable inner trocar and an outer penetrator. A connector operable to releasably attach the penetrator assembly to a drill shaft is included. The drill shaft is operable to connect the penetrator assembly to a gear assembly. The gear assembly is operable to engage and rotate the drill shaft. A motor operable to engage the gear assembly and drive the penetrator into the bone marrow by rotation of the drill shaft and a power supply and associated circuitry operable to power the motor are also included. The power supply may comprise at least one rechargeable battery.
• In another embodiment, an apparatus for penetrating a bone marrow is provided that includes a housing and a penetrator assembly, operable to penetrate the bone marrow. A connector operable to releasably attach the penetrator assembly to a drill shaft, the drill shaft operable to connect the penetrator assembly to a reduction gear assembly is included. A reduction gear assembly operable to engage and rotate the drill shaft and a motor operable to engage the reduction gear assembly and drive the penetrator into the bone marrow by rotation of the drill shaft are also included. A power supply and associated circuitry operable to power the motor are also provided. The power supply may comprise at least one rechargeable battery.
• In one embodiment, a penetrator assembly operable to provide access to a bone marrow comprising an outer penetrator and a removable inner trocar operable to penetrate the bone marrow is provided. A connector operable to releasably attach the penetrator assembly to a power drill is also included.
• In another embodiment, a penetrator assembly operable to provide access to a bone marrow comprising an outer penetrator and a removable inner trocar operable to penetrate the bone marrow is provided. The inner trocar includes a handle, the handle including a grasping means that allows a user to grasp and manipulate the device. The outer penetrator includes a handle, the handle including a grasping means, and also includes a flange operable to engage an insertion site proximate the bone marrow. A connector operable to releasably attach the penetrator assembly to a power drill is also provided. The inner trocar is operable to releasably engage the connector.
• In one embodiment, a method of accessing a bone marrow is provided that includes inserting a penetrator assembly into the bone marrow by means of a powered apparatus, detaching the powered apparatus from the penetrator, removing an inner trocar from an outer penetrator of the assembly and attaching a right angle connector to the outer penetrator.
• In another embodiment, a method of accessing a bone marrow is provided that includes inserting a penetrator assembly into the bone marrow by means of a powered apparatus, detaching the powered apparatus from the penetrator, removing an inner trocar from an outer penetrator of the assembly and attaching an adapter suitable to convey medications or fluids to the bone marrow.
• In yet another embodiment, a method of manufacturing an apparatus operable to penetrate a bone marrow is provided that includes manufacturing a housing having a connector operable to releasably attach a penetrator assembly to a drill shaft, a drill gear assembly, a gear assembly operable to engage and rotate the drill shaft, a motor operable to engage the gear assembly and drive a penetrator assembly into the bone marrow and a power supply and associated circuitry operable to power the motor and manufacturing a penetrator assembly operable to releasably attach to the connector. The power supply may comprise at least one rechargeable battery.
• In a further embodiment, a kit for use in penetrating a bone marrow in an extremity is provided that includes a carrying case, an apparatus for penetrating the bone marrow including a housing and penetrator assemblies operable to penetrate the bone marrow, a removable inner trocar and an outer penetrator forming portions of at least one of the penetrator assemblies, at least one connector operable to releasably attach the penetrator assemblies to a drill shaft, a gear assembly operable to engage and rotate the drill shaft, a motor operable to engage the reduction gear assembly and drive at least one of the penetrator assemblies into the bone marrow and a power supply and associated circuitry to power the motor and a strap operable to immobilize the outer penetrator to a site in an extremity. The power supply may comprise at least one rechargeable battery.
• One embodiment may include a powered driver operable to insert an intraosseous device into a patient's bone marrow at a selected target site. The powered driver may include a variable speed mechanism such as a low voltage potentiometer or any other electrical device satisfactory to allow varying the speed of an associated motor.
• One embodiment of the present disclosure may provide an apparatus operable to insert an intraosseous device into a bone and associated bone marrow. The apparatus may include a housing, a drive shaft, a motor, a power supply and associated electrical circuit, and a light. The drive shaft may extend from an opening in the housing and may be operable to releasably engage the intraosseous device. The motor may be disposed within the housing and rotatably engaged with the drive shaft. The power supply and associated electrical circuit may be operable to power the motor. The light may extend from the housing and be connected to the power supply and the light may be operable to illuminate an insertion site for the intraosseous device.
• Another embodiment of the present disclosure may provide a powered driver operable to insert an intraosseous device into a bone and associated bone marrow. The powered driver may include a housing, a drive shaft extending from the housing, a motor, a power supply, electrical circuits, and a switch connected to the electrical circuits. The drive shaft may be operable to releasably engage the intraosseous device. The motor may be disposed within the housing and rotatably engaged with the drive shaft. The power supply and associated electrical circuit may be operable to power the motor. The switch may be operable to activate the motor to rotate the drive shaft.
• Another embodiment of the present disclosure may provide an apparatus operable to insert an intraosseous device into a bone and associated bone marrow and to assist with other medical procedures. The apparatus may include a powered driver, a drive shaft, a motor, a power supply and electrical circuits, a switch, and a suction pump. The powered driver may have a housing with one end of the drive shaft extending therefrom. The one end of the drive shaft may be operable to releasably engage the intraosseous device. The motor may be disposed within the housing and rotatably engaged with the drive shaft. The power supply and electrical circuits may be operable to power the motor. The switch may be operable to activate the motor to rotate the drill shaft. The suction pump may have a connector operable to be releasably engaged with the one end of the drive shaft whereby the powered driver may operate the pump.
• The present disclosure also relates to kits, apparatus contained in such kits and associated procedures to obtain access to a patient's vascular system. For some embodiments such kits may include intravenous access devices and intraosseous access devices. Such kits may be used in both emergency situations or more routine procedures associated with treating chronic conditions. The present disclosure may provide apparatus and methods to establish vascular access during treatment of a patient at a wide variety of locations and facilities including, but not limited to, accident sites, emergency rooms, battlefields, emergency medical services (EMS) facilities, oncology treatment centers, chromic disease treatment facilities and veterinary applications.
• Technical benefits of some embodiments may include providing portable kits with devices and components for rapid penetration of bone and bone marrow to provide access to a patient's vascular system.
• Technical benefits of some embodiments may include devices and components for rapid penetration of bone and associated bone marrow. Such devices and components may be placed in a kit for use in accessing a patient's vascular system.
• Technical benefits of some embodiments may include obtaining fast, inexpensive access to a patient's vascular system with minimal risk. Apparatus and methods incorporating teachings of the present disclosure may be used to provide IO and IV access so that drugs and/or fluids can be injected into associated bone marrow.
BRIEF DESCRIPTION OF THE DRAWINGS
• A more complete and thorough understanding of the present embodiments and advantages thereof may be acquired by referring to the following description taken in conjunction with the accompanying drawings, in which like reference numbers indicate like features, and wherein:
• FIG. 1A is a schematic drawing showing an isometric view of one embodiment of the present disclosure.
• FIG. 1B is a schematic drawing showing an isometric view of one embodiment of the present disclosure.
• FIG. 2A is a schematic drawing showing an isometric view of one embodiment of the present disclosure.
• FIG. 2B is a schematic drawing showing an isometric view of one embodiment of the present disclosure.
• FIGS. 3A-C illustrate a side and cross-sectional view of one embodiment of the present disclosure.
• FIGS. 4A-C illustrate various alternate embodiments of a reduction gear mechanism that may be included in an embodiment of the present disclosure.
• FIGS. 5A-C illustrate one embodiment of a penetrator assembly of the present disclosure.
• FIGS. 6A-C illustrate various alternate embodiments of a penetrator assembly connector of the present disclosure.
• FIG. 7A illustrates one embodiment of a penetrator assembly of the present disclosure.
• FIG. 7B illustrates a cross-sectional view of one embodiment of a penetrator assembly of the present disclosure.
• FIG. 7C illustrates one embodiment of an inner trocar in cross section of the present disclosure.
• FIG. 7D illustrates one embodiment of an outer penetrator in cross section of the present disclosure.
• FIGS. 7E-G illustrate examples of release mechanisms of the present disclosure.
• FIG. 8A illustrates one embodiment of a tip of a penetrator assembly of the present disclosure.
• FIG. 8B illustrates one embodiment of a tip of a penetrator assembly of the present disclosure.
• FIG. 9 illustrates one embodiment of a kit to access the bone marrow of the present disclosure.
• FIG. 10 illustrates one embodiment of a connector to attach to an outer penetrator of the present disclosure.
• FIG. 11A is a schematic drawing in section showing one embodiment of a rechargeable powered driver incorporating teachings of the present disclosure.
• FIG. 11B is a schematic drawing showing an isometric view of the rechargeable powered driver ofFIG. 11A;
• FIG. 12A is a schematic drawing showing one example of an electrical power circuit incorporating teachings of the present disclosure.
• FIG. 12B is a schematic drawing showing an example of one component of a variable speed controller satisfactory for use with a powered driver in accordance with teachings of the present disclosure.
• FIG. 12C is an isometric drawing showing an example of another component of a variable speed controller which may be used with a powered driver in accordance with teachings of the present disclosure.
• FIG. 12D is a schematic drawing showing an example of an electrical power circuit having an enable switch or safety switch incorporating teachings of the present disclosure.
• FIG. 13A is a schematic drawing showing a powered driver disposed in a charging cradle incorporating teachings of the present disclosure.
• FIG. 13B is a schematic drawing showing an isometric view of a powered driver having a battery charge indicator incorporating teachings of the present disclosure.
• FIG. 13C is a schematic drawing with portions broken away showing another example of a charge indicator for a powered driver incorporating teachings of the present disclosure.
• FIG. 13D is a schematic drawing with portions broken away showing still another example of a power supply status indicator for a powered driver incorporating teachings of the present disclosure.
• FIG. 14A is a schematic drawing showing an isometric view of a powered driver having a light in accordance with teachings of the present disclosure.
• FIG. 14B is a schematic drawing showing an isometric view of another example of a light disposed on a powered driver in accordance with teachings of the present disclosure.
• FIG. 14C is a schematic drawing showing another example of a rechargeable powered driver incorporating teachings of the present disclosure.
• FIG. 15A is a schematic drawing showing an isometric view of a powered driver having a safety switch incorporating teachings of the present disclosure.
• FIG. 15B is a schematic drawing showing an isometric view of another powered driver having an enable switch incorporating teachings of the present disclosure.
• FIG. 15C is a schematic drawing showing an isometric view of still another powered driver having a safety switch incorporating teachings of the present disclosure.
• FIG. 16A is a schematic drawing in section with portions broken away showing one example of a protective covering for a trigger assembly or switch assembly of a powered driver incorporating teachings of the present disclosure.
• FIG. 16B is a schematic drawing showing another example of a protective cover for a trigger assembly or switch assembly of a powered driver incorporating teachings of the present disclosure.
• FIG. 16C is an isometric drawing showing a cross-section of a powered driver incorporating teachings of the present disclosure.
• FIG. 17A is a schematic drawing showing a wall mounted cradle for a powered driver incorporating teachings of the present disclosure.
• FIG. 17B is a schematic drawing showing another isometric view of a cradle and powered driver ofFIG. 17B.
• FIG. 18A is a schematic drawing showing one example of an intraosseous needle set which may be inserted into a patient's vascular system using a powered driver.
• FIG. 18B is a schematic drawing showing an isometric view with portions broken away of a connector receptacle which may be releasably engaged with a powered driver incorporating teachings of the present disclosure.
• FIG. 19A is a schematic drawing showing an isometric view of one embodiment of a hub which may be installed by a powered driver in accordance with teachings of the present disclosure.
• FIG. 19B is a schematic drawing showing an isometric view of one embodiment of a connector which may be installed by a powered driver in accordance with teachings of the present disclosure.
• FIG. 20 is a schematic drawing showing an isometric view with portions broken away of a pump which may be operated by a powered driver in accordance with teachings of the present disclosure.
• FIG. 21 illustrates a powered driver including a battery indicator according to another aspect of the present disclosure.
• FIG. 22 illustrates a powered driver including a rechargeable battery according to another aspect of the present disclosure.
• FIG. 23A is a schematic drawing showing an isometric view of one example of a kit which may be used to obtain access to a patient's vascular system in a first, closed position.
• FIG. 23B is a schematic, drawing with portions broken away showing one example of a breakable seal which may be used to indicate status of the kit ofFIG. 23A.
• FIG. 24A is a schematic drawing showing an isometric view of the kit inFIG. 23A in an open position along with examples of intraosseous and intravenous devices and components disposed therein.
• FIG. 24B is a schematic drawing showing one side of a divider or panel which may be disposed in the kit ofFIG. 24A along with examples of intraosseous and intravenous devices and components attached thereto.
• FIG. 25 is a schematic drawing showing an isometric view of one example of a securing device which may be installed in a kit to releasably hold a drive in accordance with teachings of the present disclosure.
• FIG. 26 is a schematic drawing showing one example of a powered driver and penetrator assembly which may be included in a kit in accordance with teachings of the present disclosure.
• FIG. 27 is a schematic drawing showing an isometric view of one example of a powered driver and securing device releasably engaged with each other in accordance with teachings of the present disclosure.
• FIG. 28 is a schematic drawing showing an isometric view of one example of a kit in a second, open position with a powered driver installed in a securing device operable to recharge a battery carried within the powered driver in accordance with teachings of the present disclosure.
• FIG. 29A is a schematic drawing showing another example of a kit in a first, closed position incorporating teachings of the present disclosure.
• FIG. 29B is a schematic drawing showing an isometric view of the kit ofFIG. 29A in a second, open position.
• FIG. 30 is a schematic drawing in section showing an intraosseous device inserted into bone marrow of a patient after using various devices and components carried in a kit in accordance with the teachings of the present disclosure.
• FIG. 31 is a schematic drawing in elevation with portions broken away showing one example of a strap and supporting structure which may be carried in a kit and used to position an intraosseous device at a selected insertion site.
• FIG. 32 is a schematic drawing showing a plan view with portions broken away of another example of a strap and supporting structure which may be carried in a kit and used to position an intraosseous device at a selected insertion site.
• FIG. 33 is a schematic drawing in section and in elevation showing an intraosseous device inserted into bone marrow of a patient along with another example of a strap and supporting structure which may be carried in a kit in accordance, with teachings of the present disclosure.
• FIG. 34 is a schematic drawing in section showing an intraosseous device inserted into bone marrow of a patient along with another example of a strap and supporting structure which may be carried in a kit in accordance with teachings of the present disclosure.
• FIG. 35 is a schematic drawing in section showing an intraosseous device inserted into bone marrow of a patient along with another example of a strap and supporting structure which may be carried in a kit in accordance with teachings of the present disclosure.
• FIG. 36 is a schematic drawing in section showing another example of a strap and supporting structure which may be satisfactorily used to position an intraosseous device at a selected insertion site.
• FIG. 37 is a schematic drawing in section with portions broken away of the strap and supporting structure ofFIG. 36.
• FIG. 38 is a schematic drawing showing an isometric view with portions broken away of the strap and supporting structure ofFIGS. 36 and 37 releasably attached to the leg of a patient proximate the tibia.
• FIG. 39 is a schematic drawing showing another example of a powered driver which may be carried in a kit incorporating teachings of the present disclosure along with a strap and supporting structure for an associated intraosseous device.
• FIG. 40A is a schematic drawing showing an exploded view of a manual driver and associated intraosseous device which may be carried in a kit in accordance with teachings of the present disclosure.
• FIG. 40B is a schematic drawing showing an isometric view of a container with one example of an intraosseous device disposed therein.
• FIG. 41 is a schematic drawing showing another example of a manual driver which may be carried in a kit in accordance with teachings of the present disclosure.
DETAILED DESCRIPTION
• Preferred embodiments of the invention and its advantages are best understood by reference toFIGS. 1A-41 wherein like numbers refer to same and like parts.
• Apparatus and methods incorporating teachings of the present disclosure may be used to provide intraosseous access to a patient's vascular system in the sternum, the proximal humerus (the shoulder area), the proximal tibia (below the knee) and the distal tibia (above the inside of the ankle). The distal tibia may provide easier vascular access to morbidly obese patients. The distal tibia is usually a thinner area of the body. Using the distal tibia as an insertion site may allow emergency medical service personnel to pump medications and fluids into the body of obese patients when regular conventional IV access is difficult. EMS personnel may often not be able to start IVs in obese patients because their size may obscure many of the veins used for conventional IV access. Adipose tissue (fat) around normal IO access sites may be so thick that EMS personnel can't reach adjacent the bone with standard IO needles. Therefore, the distal tibia may provide an IO access site for the overweight population.
• One aspect of the present disclosure may include providing a powered driver and respective IO needle sets for safe and controlled vascular access to provide medication and fluids to bone marrow, to remove biopsies of bone and/or bone marrow and to aspirate bone marrow.
• Apparatus and methods incorporating teachings of the present disclosure may be used with patients of all ages and weights. For example, one IO needle set may be appropriate for patients within the weight range of 3 kilograms to 39 kilograms. A second IO needle set may be satisfactory for use with patients weighing 40 kilograms or more.
• For still other applications, teeth formed on one end of a cannula or catheter may be bent radially outward to reduce the amount of time and the amount of force required to penetrate bone and associated bone marrow using the cannula or catheter. For some applications a powered driver and aspiration needle set formed in accordance with teachings of the present disclosure may provide access to a patient's bone marrow using the same amount of torque. The length of time for penetrating a relatively hard bone may be increased as compared with the length of time required to penetrate a relatively softer bone.
• The circuit may limit current supplied to the motor to protect associated batteries and to protect the motor for high current flow. High current flow may correspond with high torque which indicates improper use or operation of the powered driver. High torque may also indicate that the powered driver is not driving into bone. Current flow through the motor may be directly related to torque produced by the drive shaft. For some applications the circuit may indicate when current flow through the motor is typical for penetrating the hard outer layer of a bone (compact bone issue) with an IO device. The circuit may also indicate when current flow through the motor decreases in response to the TO device penetrating associated bone marrow.
• For some embodiments the powered driver may include a trigger assembly operable to activate a low speed switch, a high speed switch and/or turn an associated motor off.
• For some embodiments the powered driver may include a drive shaft having one end with a generally hexagonal cross section operable to be releasably engaged with intraosseous devices including, but not limited to, biopsy needles and bone marrow aspiration needles.
• For some embodiments the powered driver may include a gear assembly rotatably attached to a motor. The gear assembly may have a speed reducing ratio between 60:1 and 80:1. For some applications the gear assembly may reduce speed of rotation of an attached motor at a ratio of approximately 66:1 or 77:1.
• Apparatus and methods incorporating teachings of the present disclosure may include using a first IO needle set having a fifteen (15) gage cannula with a length of approximately fifteen (15) millimeters to establish vascular access for patients weighing between approximately three (3) kilograms and thirty nine (39) kilograms. A second TO needle set having a fifteen (15) gage cannula with an approximate length of twenty-five (25) millimeters may be used to establish vascular access for patients weighing forty (40) kilograms and greater.
• For some applications intraosseous needles and needle sets incorporating teachings of the present disclosure may be formed from 304-stainless steel. Standard Luer lock catheter connections may be provided on each IO needle. IO needles and needle sets incorporating teachings of the present disclosure may be easily removed from an insertion site without the use of special tooling or equipment. The reduced size and weight of drivers and IO devices incorporating teachings of the present disclosure accommodate use in emergency crash carts and emergency medical vehicles.
• The term “driver” as used in this application may include any type of powered driver or manual driver satisfactory for inserting an intraosseous (TO) device including, but not limited to, a penetrator assembly, catheter, IO needle, IO needle set, biopsy needle or aspiration needle into a selected portion of a patient's vascular system. Various techniques may be satisfactorily used to releasably engage or attach an IO device and/or penetrator assembly with a driver incorporating teachings of the present disclosure. A wide variety of connectors and associated connector receptacles, fittings and/or other types of connections with various dimensions and configurations may be satisfactorily used to releasably engage an IO device with a driver. A battery powered driver incorporating teachings of the present disclosure may be used to insert an intraosseous device into a selected target area in ten seconds or less.
• The term “intraosseous (TO) device” may be used in this application to include any hollow needle, hollow drive bit, penetrator assembly, bone penetrator, catheter, cannula, trocar, inner penetrator, outer penetrator, IO needle or IO needle set operable to provide access to an intraosseous space or interior portions of a bone.
• For some applications an IO needle or IO needle set may include a connector with a trocar or stylet extending from a first end of the connector. A second end of the connector may be operable to be releasably engaged with a powered driver incorporating teachings of the present disclosure. An IO needle or IO needle set may also include a hub with a hollow cannula or catheter extending from a first end of the hub. A second end of the hub may include an opening sized to allow inserting the trocar through the opening and the hollow cannula. The second end of the hub may also be operable to be releasably engaged with the first end of the connector. As previously noted, the second end of the connector may be releasably engaged with a powered driver. A wide variety of connectors and hubs may be used with an IO device incorporating teaching of the present disclosure. The present disclosure is not limited toconnector1180 orhub1200 as shown inFIGS. 18A and 18B.
• Various features and benefits of the present disclosure may be described with respect to a kit having a driver to insert an intraosseous (IO) device into bone marrow of a patient at a selected insertion site. However, a kit with devices and components incorporating teachings of the present disclosure may be satisfactorily used to access various portions of a patient's vascular system. The present disclosure is not limited to IO devices and procedures.
• The term “kit” may be used in this application to describe a wide variety of bags, containers, carrying cases and other portable enclosures which may be used to carry and store intraosseous devices and/or intravenous devices along with related components and accessories. Such kits and their contents along with applicable procedures may be used to provide access to a patient's vascular system in accordance with teachings of the present disclosure.
• Various examples of an apparatus operable to access the bone marrow in accordance with the present invention are shown generally inFIGS. 1A and 1B at10.Apparatus10 as shown inFIGS. 1A and 1B generally includeshousing12 andpenetrator assembly14.Housing12 includeshandle16 that is sized and contoured to fit the hand of an operator.Handle16 may include on/offswitch22 andsafety24.Penetrator assembly14 includesouter penetrator18, inner trocar (not expressly shown) andpenetrator assembly connector20.
• FIGS. 2A and 2B illustrate an alternate embodiment of the present invention.Apparatus10agenerally includeshousing12 andpenetrator assembly14a.Housing12 includeshandle16 that is sized and contoured to fit the hand of an operator.Handle16 may include an on/offswitch22.Penetrator assembly14aincludesouter penetrator18, inner trocar (not expressly shown) andpenetrator assembly connector20.Penetrator assembly14amay includepenetrator shield26. An outer penetrator may include either a trocar, a needle, a cannula, a hollow tube, a drill bit or a hollow drill bit.
• FIGS. 3A and 3B illustrate yet another embodiment of the present invention.Apparatus10bgenerally includeshousing12 and a penetrator assembly (not expressly shown).Housing12 includeshandle16 and on/offswitch22. Penetrator assembly may include penetrator (not expressly shown) and a connector, for example apentagonal connector20 as shown inFIG. 3A. As shown inFIG. 3B,housing12 enclosesmotor30,power supply32, for example four or more AA batteries,motor connecting wires34 betweenpower supply32 andmotor30 andswitch connecting wires36 between on/offswitch22 andpower supply32. The power supply to the apparatus may be any suitable number of AA batteries or any other type of battery, a source of direct current, a source of alternating current or a source of air or gas power. The motor may be reciprocating or rotational.Thruster bearing45, for example a washer, may be located adjacent tohousing12 wheredrill shaft40 exitshousing12.Thruster bearing45 prevents the thrust or penetration force of drilling from being placed ongear assembly38 as penetrator is drilled into bone.FIG. 3C shows one embodiment of the invention wheredrill shaft40 may be separated into two interdigitating pieces at42 in order to allow the two ends ofdrill shaft40 to slide in and out as bone is penetrated to avoid applying excessive force to a gear assembly.
• InFIG.3B gear assembly38 is coupled tomotor30.Gear assembly38 may be a reduction gear assembly such as that shown inFIG. 3B that functions to reduce the revolutions per minute (RPMs) between the motor anddrill shaft40 and to increase drill shaft torque. Depending on the type of motor employed in the invention, gear assembly may or not be of the reduction type.
• By way of example and not limitation, a reduction gear assembly, for example a worm gear assembly is shown in more detail inFIG. 4A and may includefirst connector43 that connectsshaft44 ofmotor30 toworm gear46.Worm gear46 may engagespur gear47.Reduction gear assembly38 may be used to decrease the RPMs between the motor and penetrator assembly to provide an optimum RPM at the point of insertion of penetrator assembly into bone.Reduction gear assembly38 may also be used to increase the torque of drill shaft and drilling power.
• FIG. 4B illustrates one embodiment ofreduction gear assembly38 wherein afirst spur gear47 engages asecond spur gear49.FIG. 4C illustrates an alternate embodiment ofreduction gear assembly38 whereinspur gear47 is offset frommitered gear48 that may be preferable in some embodiments of the present invention. Other gears may be used in a reduction gear assembly, for example a planetary gear (not expressly shown) that may be used alone or in combination with a worm gear or a spur gear. In one embodiment of the current invention, gear assembly may be any suitable gear arrangement and is not limited to a reduction gear assembly.
• FIGS. 5A-5C illustrate one embodiment of apenetrator assembly55 operable to penetrate a bone marrow, having a removableinner trocar50 and anouter penetrator52. Also shown inFIG. 5A is apenetrator shield26 that may be used to shieldpenetrator assembly55 from inadvertent engagement and also serves to preserve needle sterility. In some embodimentsouter penetrator52 may be a type of needle or cannula.FIG. 5B illustratesouter penetrator52 may include amale connecting piece56 operable to engage a complementaryfemale connecting piece54 ofinner trocar50. Adjacent to male connectingpiece56 is connectingpiece locking mechanism58 that locks into position on female connectingpiece54. Alternatively outer penetrator may include a female connecting piece suitable to engage a complementary male connecting piece of an inner trocar.Luer lock attachment57 is coupled to male connectingpiece56 for connection to an intravenous tubing or syringe after the outer penetrator is positioned in the bone marrow. Male connectingpiece56 and female connectingpiece54 may also be of the luer-lock type.Inner trocar50 includesstylet53 that keepsouter penetrator52 from getting plugged with debris created during drilling.Stylet53 acts in combination withcannula portion51 of outer penetrator.Outer penetrator52 may includeflange60 that abuts or interfaces the skin of an insertion site and may be used to stabilize a penetrator assembly at the time of insertion.Penetrator assembly55 may include various types of connectors, such asconnector62 that may be used to connectpenetrator assembly55 to a powered drill.Connector62 may be pentagonal as shown inFIGS. 5A and 5C.
• In one embodiment, the invention may include a specialized connector between the penetrator assembly and a powered drill. The connector performs at least two functions, a connecting function and a releasing function. The connecting function may be performed by various mechanisms such as a pentagonal male-female fitting or various lock-and-key mechanisms such as one that may include a combination or series of grooves and ridges or bars that match and interlock on a connector.
• The releasing function may be performed by an O-ring connection, a magnetic connector, a chuck release mechanism, or a ball and detent mechanism with and without a spring. In one embodiment the releasing function may occur by means of a trigger mechanism whereby a trigger comes in contact with a holding mechanism and releases a penetrator or needle. In another embodiment a connecting mechanism may also include a trigger or retractable shield rod that slides up and contacts a holding mechanism or clamp that breaks away and releases a penetrator or needle after contact (not expressly shown).
• FIGS. 6A-C illustrate alternate embodiments of connectors operable to releasably attachpenetrator assembly55 topowered drill apparatus10.FIG. 6A illustratespenetrator assembly connector62 whereinconnector62 is formed to fit into aconnector receptacle64 and releasably lock into place. In this example,connector62 andconnector receptacle64 are pentagonal shaped. Advantages of this embodiment may be the ease of attachment and removal ofpenetrator assembly55 frompowered drill apparatus10.Penetrator assembly connector62 may be formed from metal or plastic.
• FIG. 6B illustrates an alternate embodiment of penetrator assembly connector wherein a female pentagonal receptacle65 is operable to engage pentagonal connectingpiece66 attached topowered drill apparatus10.FIG. 6C illustrates a further embodiment of a penetrator assembly connector whereinpenetrator assembly connector68 is a proprietary design having a pattern of ridges or bars73 that engage a matching pattern ofslots71 on a connectingreceptacle72. Example penetrator assembly connectors may include any type of lock and key design or a pentagonal design. Penetrator assembly connectors of any type may be held in place by either a magnet, an O-ring connector or a ball and detent mechanism with or without a spring (not expressly shown).
• In one embodiment, the penetrator assembly may include an outer penetrator such as a cannula, needle or hollow drill bit which may be of various sizes. Needles may be small (for pediatric patients), medium (for adults) and large (for over-sized adults). Penetrator, cannulas or needles may be provided in various configurations depending on the clinical purpose for needle insertion. For example, there may be one configuration for administering drugs and fluids and an alternate configuration for sampling bone marrow or for other diagnostic purposes although one needle configuration may be suitable for both purposes. Needle configuration may vary depending on the site chosen for insertion of a needle.
• FIGS. 7A-7D illustrate one embodiment of apenetrator assembly80 that includes a removableinner trocar82 and anouter penetrator84.FIG. 7B illustrates a cross-sectional view of one embodiment of a penetrator assembly having a removableinner trocar82 and anouter penetrator84.Outer penetrator84 includesflange86 andflange groove88.Flange86 may be used to stabilizepenetrator assembly80 against the skin of an insertion site.Flange groove88 is operable to engageplastic penetrator cover94. The surface of outer penetrator may include a series of discs formed along a longitudinal axis, a series of ridges or some other grasping means. This surface allows an operator to grasp the outer penetrator with two fingers and easily disengage theinner trocar82 fromouter penetrator84.Outer penetrator84 includes apenetrator cannula96 that is hollow whenstylet100 is removed.
• InFIG. 7Cinner trocar82 includeshandle98 that may have a surface such as a series of discs formed along a longitudinal axis of the trocar, or a series of ridges or some other grasping means.Handle98 allows an operator to easily grasp and manipulateinner trocar82 and disengage it fromouter penetrator84.Inner trocar82 also includesstylet100.Stylet100 exits an end ofpenetrator cannula96 wheninner trocar82 is inserted intoouter penetrator84Stylet100 includes a cutting tip and is operable to penetrate bone marrow. In one embodiment of the invention,inner trocar82 may includemetal disc95 to allow a magnetic connection between penetrator assembly and powered drill.Receptacle97 may also engage a penetrator assembly male-type connector piece operable to connect penetrating assembly to a powered drill, or any other suitable connector.
• FIGS. 7E-7G illustrate example release mechanisms that may be coupled to a connector and included inpenetrator assembly80.FIG. 7E illustrates one embodiment of a magnetic release mechanism wheremagnetic disc70 is included ininner trocar82. In this embodimentmagnetic disc70 is at the base of open area orreceptacle97. In alternative embodiments a magnetic disc could be included with a pentagonal connector or a lock and key connector or any other suitable connector.
• FIG. 7F illustrates another embodiment of a release mechanism where O-ring72 is included introcar98 as part of a connector. In this embodiment O-ring72 is in the wall ofreceptacle97. O-ring72 is able to engage a lock and key connector, a pentagonal connector or any other suitable connector.
• FIG. 7G illustrates yet another embodiment of a release mechanism using ball anddetent mechanism74. In this embodiment ball anddetent mechanism74 is in the wall ofreceptacle97. Ball anddetent mechanism74 is able to engage a lock and key connector, a pentagonal connector or any other suitable connector.
• FIG. 8A illustrates an embodiment of anouter penetrator needle110 andinner stylet112. Cuttingtip114 ofouter penetrator needle110 and tip ofinner stylet112 are operable to penetrate bone marrow. In one embodiment of the invention the outer penetrator needle and the inner stylet are ground together as one unit in the manufacturing process to ensure that the two pieces are an exact fit and act as a single drilling unit.
• FIG. 8B illustrates another embodiment of anouter penetrator needle96 and aninner stylet100. Cuttingtip102 ofinner stylet100 is operable to penetrate bone marrow. Inner stylet may also include alongitudinal groove104 that runs along the side ofstylet100 that allows bone chips and tissue to exit an insertion site as a penetrator assembly is drilled deeper into bone. Outer penetrator orneedle96 includes cuttingtip106 that facilitates insertion of outer penetrator orneedle96 and minimizes damage to outer penetrator orneedle96 aspenetrator assembly55 is inserted into bone marrow. In one embodiment of the invention the outer penetrator needle and the inner stylet are ground together as one unit in the manufacturing process to ensure that the two pieces are an exact fit and act as a single drilling unit.
• FIG. 9 illustrates one embodiment ofkit120 to penetrate bone marrow.Kit120 includesapparatus10 for penetrating bone marrow, alternative sizes ofpenetrator assemblies122, andstrap124 suitable to immobilize an outer penetrator on an extremity during insertion ofpenetrator assembly122. Carryingcase125 is also included.
• Once an outer penetrator or needle is inserted into a bone, it may be connected to a source of intravenous fluids or medication.FIG. 10 illustrates an example of a connector that may be used to connect the outer penetrator of a penetrator assembly totubing130, for example an intravenous tubing for providing intravenous fluids or medications to a person.Outer penetrator84 is inserted into the bone marrow of an extremity.Right angle connector132 is then used to connectintravenous tubing130 toouter penetrator84. Right angle connector has the advantage of allowing tubing to be connected to an outer penetrator or needle at an angle that will not kink or pinch off the lumen of the tubing. Other connectors or adapters may also be used to connect an outer penetrator to an intravenous tubing, another kind of tubing or to a syringe for use in providing medication or fluids to a person or for use in withdrawing a sample of blood from the bone marrow.
• A method for providing access to the bone marrow includes using a powered drill, capable of reciprocal or rotational motion, to insert a penetrator assembly that includes an outer penetrator and an inner trocar into a bone marrow cavity. The powered drill is then released from the penetrator assembly and the inner trocar is grasped and removed from the outer penetrator. A connector present on the end of the outer penetrator, for example a luer lock connector, is then available for attachment to either an adapter, such as a right angle connector or directly to an intravenous tubing or syringe.
• Various features of the present disclosure may also be described with respect topowered drivers1030 and1030a-1030f. Various features of the present disclosure may also be described with respect to intraosseous devices such as shown inFIGS. 18A and18B. However, the present disclosure is not limited to use withintraosseous device1160 or powereddrivers1030 and1030a-1030f.
• Powered driver1030 as shown inFIGS. 11A, 11B and 13A may be satisfactorily used to insert an intraosseous device at a desired insertion site adjacent to a bone and associated bone marrow (not expressly shown). For embodiments such as shown inFIGS. 11A, 11B and 13A powereddriver1030 may include one or more features of the present disclosure including, but not limited to, a light operable to illuminate an insertion site, charging contacts and associated charging circuitry, a power supply status indicator, trigger guard, variable speed controller, safety switch and/or timing circuit. At least one or more of the preceding features and/or additional features of the present disclosure may also be shown with respect to powered drivers1030-1030fand/or1330a-1330k.
• Various components associated withpowered driver1030 may be disposed withinhousing1032. For example a power source such asrechargeable battery pack1034 may be disposed withinhandle1036.Battery pack1034 may have various configurations and may include multiple batteries disposed within sealed packaging material. For other applications, a non-rechargeable battery pack may also be disposed withinhandle1036.
• Handle1036 may be generally described as an elongated, hollow container sized to receive battery pack orpower supply1034.Cap1038 may be disposed on one end ofhandle1036.Cap1038 may be removed to allow inserting and removingbattery pack1034 therefrom.Handle1036 may also includefinger grips1064 having generally ergonomic configurations.
• For embodiments such as shown inFIGS. 11A, 11B and13A cap1038 may include a pair of chargingcontacts1040aand1040b. A portion of eachcontact1040aand1040bmay extend fromcap1038 for engagement with an appropriate charging receptacle. SeeFIG. 13A. For some applications cap1038 and adjacent portions ofhandle1036 may have heavy duty screw on or thread connections (not expressly shown). For some applications cap1038 may be formed from relatively strong, heavy duty polymeric material.
• Motor1044 andgear assembly1046 may also be disposed within portions ofhousing1032 adjacent to handle1036. For embodiments represented by powered drivers1030-1030eand1330a-1330k,motor1044 andgear assembly1046 may be generally aligned with each other.Motor1044 may be connected with one end ofgear assembly1046.Drive shaft1052 may be engaged with and extend from another end ofgear assembly1046 opposite frommotor1044.
• For some applications bothmotor1044 andgear assembly1046 may have generally cylindrical configurations.Exterior portion1045 ofmotor1044 may correspond with the largest nominal outside diameter associated withmotor1044.Exterior portion1047 ofgear assembly1046 may correspond with the largest nominal outside diameter associated withgear assembly1046. For embodiments of the present disclosure represented by powered drivers1030-1030eand1330a-1330k,exterior portion1047 ofgear assembly1046 may represent a nominal outside diameter portion larger than any other outside diameter portion associated withmotor1044. In other embodiments of the present disclosure represented bypowered driver1330i,exterior portion1047 ofgear assembly1046 may be smaller than outside diameter portions associated withimpact device1044a.
• Portions ofhousing1032 may have generally similar cylindrical configurations corresponding with exterior portions ofmotor1044 andgear assembly1046. For example,segment1032aofhousing1032 may have a generally cylindrical, hollow configuration with an inside diameter compatible withexterior portion1045 ofmotor1044.Housing segment1032bmay have a generally cylindrical, hollow configuration with an inside diameter compatible withexterior portion1047 ofgear assembly1046. Since portions ofgear assembly1046 have an outside diameter that is larger than the outside diameter ofmotor1044,housing segment1032bmay have a larger outside diameter than the outside diameter ofhousing segment1032a.
• Motors and gear assemblies satisfactory for use with a powered driver incorporating teachings of the present disclosure may be obtained from various vendors. Such motor and gear assemblies are typically ordered as “sets” with one end of each motor securely attached to an adjacent end of an associated gear assembly. The gear assemblies may sometimes be referred to as “reduction gears” or “planetary gears”.
• A drive shaft having desired dimensions and configuration may extend from the gear assembly opposite from the motor. The drive shaft may be provided as part of each motor and gear assembly set. The dimensions and/or configuration of an associated housing may be modified in accordance with teachings of the present disclosure to accommodate various types of motors, gear assemblies and/or drive shafts. For example, powered drivers used with aspiration needles and/or biopsy needles may include gear assemblies with larger dimensions required to accommodate larger speed reduction ratios, for example between 60:1 and 80:1, resulting in slower drive shaft RPM. Powered drivers used to provide intraosseous access during emergency medical procedures may operate at a higher speed and may include gear assemblies having a smaller speed reduction ratio, for example between 10:1 and 30:1, resulting in higher drive shaft RPM. For some applications, the difference in size for gear assemblies may result in increasing the inside diameter of an associated housing by approximately two to three millimeters to accommodate larger gear assemblies associated with powered drivers used to insert biopsy needles and/or aspiration needles.
• Distal end orfirst end1048 ofhousing1032 may include opening1050 with portions ofdrive shaft1052 extending therefrom. For some applications the portion ofdrive shaft1052 extending fromhousing1032 may have a generally pentagonal shaped cross section with taperedsurfaces1054 disposed thereon.Tapered surfaces1054 may be disposed at an angle of approximately three (3°) degrees with respect to a longitudinal axis or rotational axis (not expressly shown) associated withdrive shaft1052. Relativelysmall magnet1056 disposed on the extreme end ofdrive shaft1052 opposite fromhousing1032. Fittings and/or connectors with various dimensions and/or configurations other thandrive shaft1052 and/ormagnet1056 may also be satisfactorily used with a powered driver incorporating teachings of the present disclosure.
• Intraosseous devices having corresponding tapered openings or connector receptacles may be releasably engaged with portions ofdrive shaft1052 extending fromhousing1032. For example, portions ofdrive shaft1052 extending fromdistal end1048 may be releasably engaged with taperedopening1186 inconnector1180 as shown inFIGS. 18A and 18B or taperedopening1156 inconnector receptacle1152 as shown inFIGS. 19 and 20.
• For embodiments such as shown inFIGS. 11A, 11B and 13A,powered driver1030 may also include light1060 disposed adjacent to triggerassembly1062. Electrical circuits and associated wiring contacts may also be disposed withinhousing1032 to supply electrical power to light1060.Trigger assembly1062 may be used to activate electrical circuits to provide electricity fromrechargeable battery1034 tomotor1044 and/or light1060. A block diagram showing one example of such electrical circuits is shown inFIG. 12A.
• A block diagram showing one example of electrical circuits and other components which may be satisfactory used with a powered driver incorporating teachings of the present disclosure is shown inFIG. 12A. Various features of the present disclosure may be described with respect toelectrical system1400 as shown inFIG. 12A.Electrical system1400 may include various components such as power supply orbattery pack1034, chargingcontacts1040aand1040b,motor1044, light1060 and/or enableswitch1062.Electrical system1400 may include a wide variety of electrical circuits and electrical components including, but not limited to, powersupply status indicator1070 andelectrical charging circuit1410,voltage regulator1430 andvariable speed controller1460. As previously noted, power supply orbattery pack1034 may include one or more rechargeable batteries. Various types of nickel metal hydride (NiMH) batteries may be used (particularly lithium batteries).Battery pack1034 may supply fourteen (14) to eighteen (18) volts of direct current (DC) power. However, a wide variety of chargeable and non-rechargeable batteries may be satisfactorily used with powered drivers incorporating teachings of the present disclosure.
• A wide variety of electrical circuits and/or electronic indicators may be used with powersupply status indicator1070. Additional information concerning such electrical circuits and displays may be described with respect to various power supply status indicators as shown inFIGS. 13B, 13C and 13D.
• A wide variety of charging circuits, voltage regulators and variable speed controllers may be satisfactorily used with a powered driver incorporating teachings of the present disclosure. Various examples of such charging circuits, voltage regulators and/or variable speed controllers are shown inFIGS. 12B and 12C. Various types of commercial available charging circuits, voltage regulators and/or variable speed controllers may be satisfactorily used with a powered driver incorporating teachings of the present disclosure. Various examples of commercially available microcontrollers may be satisfactory for use withvariable speed controller1460.Variable resistor1600aas shown inFIG. 12B andvariable resistor1600bas shown inFIG. 12C represents examples of mechanical devices having slidable contacts which may be used to vary current supplied tomotor1044. A trigger assembly incorporating teachings of the present disclosure may be satisfactory used to move one or more of theelectrical contacts1602aor1602b.
• Switch1062 may be provided to prevent inadvertent or undesired activation ofmotor1044.Switch1062 may prevent discharge ofbattery1034 when an associated powered device is carried in a backpack and/or mobile storage container. An associatedbutton1072amay be disposed on exterior portions of a housing to activate thevariable speed controller1460.Button1072amay be located at various positions on the exterior of a housing associated with a powered driver incorporating teachings of the present disclosure as shown inFIGS. 15A-15C. A wide variety of indicators including, but not limited to, light emitting diodes (LED), liquid crystal displays (LCD) and small more conventional light bulbs may be satisfactorily used with a powered driver according to teachings of the present disclosure.
• FIG. 13A shows one example of a cradle which may be used to recharge a powered driver in accordance with teachings of the present disclosure. Cradles and/or holders incorporating teachings of the present disclosure may be fabricated from a wide variety of thermoplastic and/or polymeric materials including, but not limited to, polycarbonates. Such materials may be filled with glass fibers or any other fibers satisfactory for use in forming a cradle or holder operable to hold and/or recharge a powered driver in accordance with teachings of the present disclosure. Nylon filled with glass may be used for some applications.
• Materials used to formcradle1280 may be relatively low cost but durable. Such materials may be relatively stiff to secure a powered driver therein and may also flex without breaking to allow inserting and removing a powered driver at least five hundred (500) times.
• Cradle1280 may have a length and width selected to be compatible with exterior portions ofhousing1032 and corresponding dimensions ofpowered driver1030. For some applicationsfirst end1281 andsecond end1282 may have generally rounded configurations. A notch (not expressly shown) may also be formed infirst end1281 to accommodate portions ofdrive shaft1052. Various types of holders, clamps or quick release mechanisms may be included as part ofcradle1280. For embodiments such as shown inFIG. 13A,cradle1280 may include a pair ofarms1284 projecting from respective edges ofcradle1280. Only onearm1284 is shown inFIG. 13A.
• Arms1284 may be relatively strong with sufficient flexibility to allow inserting and removing portions ofpowered driver1030 from engagement withcradle1280. The height ofarms1284 relative to adjacent longitudinal edges ofcradle1280 may be based at least in part on the corresponding dimensions ofhandle1036 and other portions ofhousing1032. The spacing or gap formed betweenarms1284 may be selected to accommodate the width ofhandle1036.Respective rib1286 may be formed on the end of eacharm1284. The configuration ofribs1286 may be selected to be compatible with a snug but releasable snap fit with adjacent portions ofhandle1036.
• For some applications walls orpartitions1290 may be formed adjacent to respective arms1294. Only onewall1290 is shown inFIG. 13A. Partitions orwalls1290 may be spaced from each other a sufficient distance to accommodate associated portions ofhousing1032 and may be sized to prevent accidental activation oftrigger assembly1062.
• End1282 ofcradle1280 may be modified to include electrical contact (not expressly shown) operable to engagerecharging contacts1040aand1040b.Electric power cable1292 may also extend fromend1282.Electrical power cable1292 may be inserted into an appropriate electrical outlet for use in rechargingpowered driver1030. A plurality oflights1296,1298 and1300 may be provided on exterior portions ofcradle1300 to indicate the status ofrechargeable battery1034. For example light1296 may indicate red whenrechargeable battery1034 is discharged below a desired level.Light1298 may be flashing yellow to indicate thatrechargeable battery1034 is being recharged and/or discharged.Light1300 may be steady green to indicate whenrechargeable battery1034 has been fully recharged.Lights1296,1298 and1300 may also alternately blink or have a steady state condition.
• Powered drive1030aas shown inFIG. 13B may include an indicator operable to indicate the status of a power supply disposed withinhandle1036. For someembodiments status indicator1070amay be disposed at proximal end orsecond end1049aofpowered driver1030a. A digital display indicating the number of insertions available from a power supply disposed withinhousing1032amay be provided byindicator1070 atproximal end1049aofhousing1032a. The power supply may be any type of battery or other suitable source of power.
• An embodiment of the present disclosure is shown inFIG. 13C which includesstatus indicator1070bdisposed on second end orproximal end1049bofpowered driver1030b.Status indicator1070bmay includedigital indication1072 showing the number of insertions remaining in an associated power source. In additionvariable indicator scale1074 may be provided to show the status of an associated power source between fully charged and recharge required. For example,variable indicator scale1074 may include a voltmeter, an amp meter, and/or any other component operable to measure the status of an associated power supply. As another example,variable indicator scale1074 may be calibrated to display a percentage of full charge and/or a number of insertions remaining.
• A further embodiment of the present disclosure is shown inFIG. 13D. For this embodiment lights1296,1298 and1300 may be disposed on proximal end orsecond end1049cofpowered driver1030c.Lights1296,1298 and1300 may function as previously describe with respect tocradle1280.
• FIGS. 17A and 17B show another embodiment of the present disclosure including powered driver1330jdisposed withincradle1280a.Cradle1280amay includearms1284aas described in relation toFIG. 13b.Arms1284amay be relatively strong with sufficient flexibility to allow inserting and removing portions of powered driver1330jfrom engagement withcradle1280a. The height ofarms1284arelative to adjacent longitudinal edges ofcradle1280amay be based at least in part on the corresponding dimensions of handle1336 and other portions of housing1332. The spacing or gap formed betweenarms1284 may be selected to accommodate the width of handle1336.
• Powered drivers1030dand1030eas shown inFIGS. 14A and 14B show alternative locations for a light disposed on a powered driver in accordance with teachings of the present disclosure.Powered driver1030dmay include substantially the same features aspowered driver1030 except light1060dmay be disposed onhousing segment1032bopposite fromtrigger assembly1062. For embodiments such as shown inFIG. 14B light1060emay be disposed on distal end orfirst end1048eofpowered driver1030e.Light1060emay extend approximately three hundred sixty degrees (360°) around the perimeter of associateddrive shaft1054.
• A further embodiment of a rechargeable powered driver incorporating teachings of the present disclosure is shown inFIG. 14C. For embodiments represented bypowered driver1030f, cap1038fmay be disposed on one end ofhandle1036.Cap1038 may include opening1040 sized to receivecharging connection1130 attached topower cable1132. A wide variety of recharging connectors may be used to provide power tocable1132.
• FIGS. 16A and 16B show examples of a protective covering1063 fortrigger assembly1062 orswitch assembly1062 of powered driver incorporating teachings of the present disclosure.Housing1032 may be sealed to prevent blood, other bodily fluids, and/or other contaminants from reaching interior portions ofhousing1032 and components disposed therein (e.g.,battery1034,motor1044, and/or gear assembly1046).FIGS. 16A and 16B showprotective covering1063aand1063bconfigured to seal withhousing1032. Protective covering1063aand1063bmay be formed with an elastomeric material chosen for resistance to wear, electrical current, impermeability, and/or any other characteristic sought as long as it allows operation ofswitch assembly1062 by the user.
• FIG. 16C showspowered driver1330iincorporating animpact device1044aassociated withgearbox1046 andpower sensor circuit1600c.Impact device1044amay be configured to operate in a similar manner to an impact wrench by storing energy in a rotating mass then delivering it suddenly togearbox1046. In some embodiments,impact device1044awill require less total power frompower supply1034.
• Power sensor circuit1600cmay detect current changes betweenimpact device1044aandpower supply1034. In some applications, current changes betweenimpact device1044aandpower supply1034 may indicate bone penetration is complete.Power sensor circuit1600cmay be operable to automatically reduce or cut power frompower supply1034 toimpact device1044aonce the associated intraosseous device has penetrated the cortex of the bone.
• An intraosseous device (IO), sometimes referred to as a penetrator assembly or IO needle set, may include an outer penetrator such as a cannula, needle or hollow drive bit which may be of various sizes. Needles may be small (for pediatric patients), medium (for adults) and large (for over-sized adults). Penetrator, cannulas or needles may be provided in various configurations depending on the clinical purpose for needle insertion. For example, there may be one configuration for administering drugs and fluids and an alternate configuration for sampling bone marrow or for other diagnostic purposes although one needle configuration may be suitable for both purposes. Needle configuration may vary depending on the site chosen for insertion of a needle.
• A wide variety of trocars, spindles and/or shafts may be disposed within a catheter or cannula during insertion at a selected insertion site. Such trocars, spindles and shafts may also be characterized as inner penetrators. A catheter, cannula, hollow needle or hollow drive bit may sometimes be characterized as an outer penetrator.
• For some applications a layer or coating (not expressly shown) of an anticoagulant such as, but not limited to, heparin may be placed on interior and/or exterior portions of a catheter or cannula to prevent thrombotic occlusion of the catheter or cannula. Anticoagulants may reduce platelet adhesion to interior surfaces of the catheter or cannula and may reduce clotting time of blood flowing into and through the catheter or cannula. Placing a layer of an anticoagulant on exterior portions of a catheter or cannula adjacent to an associated tip and/or side ports may be helpful to prevent clotting.
• Penetrator assembly1160 as shown inFIGS. 18A and 18B may includeconnector1180, and associatedhub1200,outer penetrator1210 andinner penetrator1220.Penetrator assembly1160 may include an outer penetrator such as a cannula, hollow tube or hollow drive bit and an inner penetrator such as a stylet or trocar. Various types of stylets and/or trocars may be disposed within an outer penetrator. For some applications outer penetrator orcannula1210 may be described as a generally elongated tube sized to receive inner penetrator orstylet1220 therein. Portions ofinner penetrator1220 may be disposed withinlongitudinal passageway1184 extending throughouter penetrator1210. The outside diameter ofinner penetrator1220 and the inside diameter oflongitudinal passageway1184 may be selected such thatinner penetrator1220 may be slidably disposed withinouter penetrator1210.
• Metallic disc1170 may be disposed withinopening1186 for use in releasably attachingconnector1180 withmagnet1056 disposed on the end ofdrive shaft1052.End1223 ofinner penetrator1220 is preferably spaced frommetallic disc1170 with insulating or electrically nonconductive material disposed therebetween.
• Tip1211 ofouter penetrator1210 and/ortip1222 ofinner penetrator1220 may be operable to penetrate bone and associated bone marrow. The configuration oftips1211 and/or1222 may be selected to penetrate a bone or other body cavities with minimal trauma. First end ortip1222 ofinner penetrator1220 may be trapezoid shaped and may include one or more cutting surfaces. In one embodimentouter penetrator1210 andinner penetrator1220 may be ground together as one unit during an associated manufacturing process. Providing a matching fit allowsrespective tips1211 and1222 to act as a single driving unit which facilitates insertion and minimizes damage as portions ofpenetrator assembly1160 are inserted into a bone and associated bone marrow.Outer penetrator1210 and/orinner penetrator1220 may be formed from stainless steel, titanium or other materials of suitable strength and durability to penetrate bone.
• Hub1200 may be used to stabilizepenetrator assembly1160 during insertion of an associated penetrator into a patient's skin, soft tissue and adjacent bone at a selected insertion site.First end1201 ofhub1200 may be operable for releasable engagement or attachment with associatedconnector1180.Second end1202 ofhub1200 may have a size and configuration compatible with an associated insertion site forouter penetrator1210. The combination ofhub1200 withouter penetrator1210 may sometimes be referred to as a “penetrator set” or intraosseous needle.
• Connector1180 and attachedinner penetrator1220 may be releasably engaged with each other by Luer type fittings, threaded connections or other suitable fittings formed onfirst end1201 ofhub1200.Outer penetrator1210 extends fromsecond end1202 ofhub1200.
• For someapplications connector1180 may be described as a generally cylindrical tube defined in part byfirst end1181 andsecond end1182. The exterior ofconnector1180 may include an enlarged tapered portion adjacent to end1181. A plurality oflongitudinal ridges1190 may be formed on the exterior ofconnector1180 to allow an operator to grasp associatedpenetrator assembly1160 during attachment with a drive shaft. SeeFIG. 18B.Longitudinal ridges1190 also allowconnector1180 to be grasped for disengagement fromhub1200 whenouter penetrator1210 has been inserted into a bone and associated bone marrow.
• Second end1182 ofconnector1180 may include opening1185 sized to receivefirst end1201 ofhub1200 therein.Threads1188 may be formed inopening1185 adjacent tosecond end1182 ofconnector1180. Threaded fitting1188 may be used in releasably attachingconnector1180 with threaded fitting1208 adjacent tofirst end1201 ofhub1200.
• First end1201 ofhub1200 may include a threadedconnector1208 or other suitable fittings formed on the exterior thereof.First end1201 may have a generally cylindrical pin type configuration compatible with releasably engaging second end orbox end1182 ofconnector1180.
• For some applications end1202 ofhub1200 may have the general configuration of a flange. Angular slot orgroove1204 sized to receive one end of protective cover or needle cap1234 may be formed inend1202. Slot orgroove1204 may be used to releasable engage a needle cover (not expressly shown) withpenetrator assembly1160.
• For some applications a penetrator assembly may include only a single, hollow penetrator. For other applications a penetrator assembly may include an outer penetrator such as a cannula, hollow needle or hollow drive bit and an inner penetrator such as a stylet, trocar or other removable device disposed within the outer penetrator.Penetrator1210 is one example of a single, hollow penetrator.
• The size of a penetrator may vary depending upon the intended application for the associated penetrator assembly. Penetrators may be relatively small for pediatric patients, medium size for adults and large for oversize adults. By way of example, a penetrator may range in length from five (5) mm to thirty (30) mm. The diameter of a penetrator may range from eighteen (18) gauge to ten (10) gauge. The length and diameter of the penetrator used in a particular application may depend on the size of a bone to which the apparatus may be applied. Penetrators may be provided in a wide variety of configurations depending upon intended clinical purposes for insertion of the associated penetrator. For example, there may be one configuration for administering drugs and/or fluids to a patient's bone marrow and an alternative configuration for sampling bone marrow and/or blood from a patient. Other configurations may be appropriate for bone and/or tissue biopsy.
• For someapplications connector1180 may be described as having a generally cylindrical configuration defined in part byfirst end1181 andsecond end1182. SeeFIG. 18B. Exterior portions ofconnector1180 may include an enlarged tapered portion adjacent to end1181. A plurality oflongitudinal ridges1190 may be formed on the exterior ofconnector1180 to allow an operator to grasp associatedpenetrator assembly1160 during attachment with a drive shaft.Longitudinal ridges1190 also allowconnector1180 to be grasped for disengagement fromhub1200 whenouter penetrator1210 has been inserted into a bone and associated bone marrow.
• First end1181 of connector of1180 may include opening1186 sized to receive portions driveshaft1052 therein. A plurality ofwebs1136 may extend radially outward fromconnector receptacle1186.Webs1136 cooperate with each other to form a plurality ofopenings1138 adjacent tofirst end1181.Opening1186 andopenings1138 cooperate with each other to form portions of a connector receptacle operable to receive respective portions ofconnector1030 therein.FIGS. 19A and 19B show isometric views of embodiments ofconnector1180aandhub1200a.
• A wide variety of accessory tools and devices are frequently carried by emergency medical service personnel and/or first responders.Pump assembly1130 as shown inFIG. 20 represents an example of an accessory tool which may be operated by a powered driver incorporating teachings of the present disclosure.Pump assembly1130 may include housing1134 withconnector receptacle1152 extending therefrom. Various components of pump assembly1130 (not expressly shown) may be disposed within housing1134 and rotatably attached withconnector receptacle1152.Inlet tubing1131 may be provided to communicate fluids with interior portions of pump housing1134.Outlet tubing1132 may be provided to direct fluids exiting frompump assembly1130. Such fluids may be various types of liquids associated with medical procedures. Such fluids may include small particulate matter.Pump assembly1130 may sometimes function as a vacuum or suction pump for such procedures.
• First end1154 ofconnector receptacle1152 may include opening1156 similar toopening1186 as described with respect toconnector1180. End1252 extending from power driver1230amay be disposed withinopening1156 to rotateconnector receptacle1152 and attached components of pump assembly1130a. As a result, powered driver1230amay be used to pump fluids frominlet1131 through pump assembly1130aand outwardly fromoutlet1132.
• One embodiment of the device calls for it being disposable. Another embodiment is designed for the body (driver) to be reusable and the needle to be disposable. This is made possible by providing a chuck that mates with a proprietary shaft attached to the needle's Luer lock. The needles must maintain sterility during storage and mounting of the needle while the driver does not have to be sterile. The driver will be rugged in design and the battery (or other power source) will be rechargeable or the battery will be easy to replace with off-the-shelf batteries.
• FIG. 21 shows the configuration of a driver without a needle inserted. Ahousing2014 and atrigger2015 are shown. Abattery indicator2040 is also shown.
• FIG. 22 shows themotor2011,gearbox2017,gear2018, andbattery2010 of the reusable driver. It also shows thechuck2037, which is designed to accept the keyed needle or “unit dose” ampule. It is important in the reusable design to have a rechargeable battery or the ability to easily change off-the-shelf batteries i.e. a 9-volt battery. It may also incorporate a battery level indicator or other battery reserve indicator (not expressly shown).
• The present disclosure includes a wide variety of kits, devices and associated components which may be used to obtain vascular access to a patient. In some embodiments, such kits may include apparatus operable to access a patient's bone marrow using a driver, an intraosseous needle and one or more connectors to communicate fluids with the patient's bone marrow. Such kits may also include apparatus which allows monitoring a patient.
• Kits incorporating teachings of the present disclosure may be rigid, semi-rigid or soft-sided. Such kits may provide a convenient way to carry various components and devices operable to achieve vascular access in an organized and systematic fashion. Such kits may present EMS first responders and other medical personnel with a well organized collection of components and devices to achieve vascular access by placement of peripheral intravenous (IV) catheters and/or intraosseous (TO) catheters. For some embodiments, a kit incorporating teachings of the present disclosure may be combination an IV kit, an IO kit and/or a unit dose kit in one convenient bag. Examples of various types of devices and components which may be carried in a kit in accordance with teachings of the present disclosure are shown inFIGS. 29A-41.
• Securing devices incorporating teachings of the present disclosure may be provided in kits to allow easy removal and replacement of associated drivers. Such securing devices may include a wide variety of cradles and other types of holder's with relatively rugged snap-in features to prevent undesired release of a driver from an associated securing device. Securing devices may be formed from plastic and/or glass composite materials to provide durability for repeated replacement and use of an associated driver. Such securing devices may releasably hold an associated driver in place within a kit so that the driver does not interfere with other devices and components disposed in the kit. A securing device may be positioned in a kit to clearly present an associated driver to a user during consideration of alternate vascular access routes.
• Securing devices incorporating teachings of the present disclosure may make it easy for a user to extract an associated driver from a kit using only one hand. Other components such as penetrator assemblies and IO needles may be conveniently located in the kit to further minimize time and manipulations required for a user to attach an IO needle and insert the IO needle at a desired site in a patient. Such securing devices may also provide an easy site to return the driver to the kit after use. The associated driver may snap into place to securely protect the driver against accidental deployment until required for use in presiding another IO access.
• Kits incorporating teachings of the present disclosure may be used in locations where ruggedness and durability are of paramount importance. Such kits may be washable, water proof, temperature resistant, and/or crush proof. Such kits may have a wide variety of different shapes and colors. Kits incorporating teachings of the present disclosure may be any size as required to contain selected IO devices and IV devices which may be used to obtain vascular access. In some embodiment kits may be approximately ten inches in length by six to eight inches in width.
• For some applications kits incorporating teachings of the present disclosure may be designed for use in military applications. Such kit may be as compact as feasible with components disposed in one or more compartments as necessary for an efficient use of space. Such kits may also include a manual intraosseous driver and related intraosseous components to access a patient's vascular system. Such kits may include intraosseous catheters, intravenous catheters, containers with sterile normal saline, tourniquets and IO/IV securing devices. Various components may be configured for particular branches of the military, e.g., Army, Navy, Air Force, Coast Guard and Special Forces.
• Another benefit of the present disclosure may include forming a kit with one or more dividers having components and devices arranged in order on page one and page two corresponding with steps of a procedure such as treating a patient with an emergency condition or treating a patient for a chronic condition. The pages in a kit may be arranged to accommodate a wide variety of procedures. For example, if a kit will be used in an oncology related application or for treatment of other chronic conditions, the “pages” in the kit may be arranged based on the steps required to provide access to a patient's vascular system and to carry out a planned treatment.
• Various techniques and procedures may be used to position and securely engage a supporting structure for an IO device at an insertion site. For some applications, various types of straps may be used. SeeFIGS. 30 and 33-39. Alternatively, various types of medical grade tape and adhesive materials (not expressly shown) may be used. Also, Velcro strips may be used (seeFIGS. 37 and 38).
• Some features and benefits of the present disclosure may be described with respect to kit3020 (SeeFIGS. 23A, 23B, 24A) andkit3020a(SeeFIG. 28) and kit3120 (SeeFIGS. 29A and 29B). However, the present disclosure is not limited to kits with designs, features and/or contents as shown inFIGS. 23A-41.
• For someapplications kits3020,3020aand/or3120 may be semi-rigid or soft, sided.Kits3020,3020aand3120 may be formed from a wide variety of materials including, but not limited to, nylon, corduroy type materials, various types of polymeric and plastic materials. For someapplications kits3020,3020aand/or3120 may be formed from relatively soft materials such as canvas, polyesters and similar materials. For other applications kits incorporating teachings of the present disclosure may be relatively rigid and formed from materials such as lightweight aluminum alloys and similar hard materials.
• For embodiments such as shown inFIGS. 23A-24A and 28,kits3020 and3020amay be formed using compression molded techniques. For other applications,kits3020 and3020amay be formed with a foam liner having desired configuration and dimensions with an outer layer of sewn fabric. Such foam liners may be designed to protect the contents carried in the resulting kit from being damaged or crushed. Other alternative low-cost, and reliable manufacturing techniques may be satisfactorily used to form kits in accordance with teachings of the present disclosure.
• For some applications,kits3020 or3020amay be generally described as a two part molded case formed at least in part by compression molding ethylene vinyl acetate (EVA) foam. EVA may be generally described as a polymeric material with some of the characteristics of elastomeric materials and some characteristics of thermal plastic materials. However kits incorporating teachings of the present disclosure may be formed from a wide variety of polymeric materials, elastomeric materials and/or thermoplastic materials.
• Kits3020 and/or3020amay have a nominal wall thickness of approximately 0.19 inches. Exterior surfaces ofkits3020 and/or3020amay be covered by a durable layer of heavy linear polyester or other suitable material. Interior portions ofkits3020 and/or3020amay be formed in part by relatively smooth layers of urethane or relatively smooth layers of polyvinyl chloride (PVC). Such materials allow interior portions ofkits3020 and/or3020ato be more easily cleaned, particularly after use during an emergency at a field location.
• Kits3020 and/or3020amay have two segments orenclosures3022 and3024 with generally hollow, rectangular configurations and compatible dimensions. As a resultfirst segment3022 andsecond segment3024 may be releasably engaged with each other to form an enclosure having desired dimensions and configurations to efficiently carry IO and IV devices and components associated withkits3020 and3020a. For some applications,first segment3022 andsecond segment3024 may have approximately the same dimensions and configurations such that eachsegment3022 and3024 may form approximately one-half of the resulting kit. For applications such as shown inFIGS. 23A-24A and 28,first segment3022 may have a greater height or depth as compared withsecond segment3024. Interior portions offirst segment3022 may be sized to contain intravenous fluid bags, intravenous tubing and extension tubing, various types of connectors, syringes and Lidocaine or other anesthetizing agents.
• For purposes of describing various features of the present disclosure,first segment3022 may be described as having generally rectangular bottom layer or base3030 with respective pairs ofwalls3034 and3036 extending therefrom.Base3030 may also include first surface or interior surface3031 (SeeFIGS. 24A and 28) and a second, exterior surface (not expressly shown). Onewall3034aofkit3020amay be modified as compared to correspondingwall3034 ofkit3020.Wall3034awill be discussed later in more detail. Generally roundedcorners3038 may be formed betweenadjacent walls3034 and3036.
• Second segment3024 may be defined in part by top layer orcover3040. Sometimestop layer3040 may also be referred to as a lid.Top layer3040 may include first surface or interior surface3041 (SeeFIGS. 24A and 28) and second surface or exterior surface3042 (SeeFIG. 23A). Respective pairs ofwalls3044 and3046 may extend fromtop layer3040. Respectiverounded corners48 may be formed betweenadjacent walls3044 and3046.
• For some applications, a pair ofzippers3028 and3029 may be used to releasably engagesecond segment3024 withfirst segment3022 when associatedkits3020 or3020ais in their respective first, closed position. (SeeFIG. 23A). For other applications a single zipper may be satisfactorily used. For some applications a fluid seal (not expressly shown) may be formed when the perimeter offirst enclosure3022 is engaged with the perimeter ofsecond enclosure3024 whenkits3020 and/or3020aare in their first, closed position.
• First segment3022 andsecond segment3024 may be hinged with each other along one side ofrespective kits3020 and3020a.Fabric type hinge3058 or other suitable low cost, reliable hinge mechanism may be used to allow movement ofsecond segment3024 relative tofirst segment3022 to open and close the associatedkit3020 or3020a.Handle3026 may be attached with exterior portion ofkits3020 and3020aopposite from thehinge3058 located on interiors ofkits3020 and3020a.Handle3026 may be formed from lightweight, durable web type material or any other suitable material.
• Zippers3028 and3029 may be moved around the three edges of contact betweenfirst enclosure3022 andsecond enclosure3024 to engage and disengage adjacent portions ofenclosures3022 and3024.Zippers3028 and3029 and associated zipper mechanisms may be formed from durable, rustproof material and extend along three edges of contact betweenfirst enclosure3022 andsecond enclosure3024.
• Afterkits3020 and/or3020ahave been used at a field location or at a medical facility, the used kit may be returned to a central location for cleaning and replacement of any missing components or devices. For some applications breakable seal3023 (SeeFIG. 23B) may be engaged withzippers3028 and3029 to indicate that the associatedkit3020 or3020ahas been cleaned, inspected, any missing components or devices replaced and is now ready to be used to provide access to a patient's vascular system.
• One or more panels or dividers may be disposed within kits incorporating teachings of the present disclosure. The dividers may also be referred to as “boards.” For embodiments represented bykits3020 and3020aone edge of eachdivider3050 may be engaged with associatedhinge3058 to allow rotating movement of eachdivider3050 relative to hinge3058 when associatedkit3020 or3020ais in its first, open position.
• Dividers3050 may be formed from polyvinyl chloride (PVC) or other suitable materials. Eachdivider3050 may have a generally rectangular configuration with dimensions compatible with nesting each divider withinsegments3022 and3024 when associatedkit3020 or3020ais in its first, closed position. For someapplications dividers3050 may be about 0.050 to 0.060 inches thick. The width and other characteristics ofhinge3058 may also be selected to accommodate nesting of eachdivider3050 withinsegments3022 and3024 when associatedkit3020 or3020ais in its first closed position.
• Eachdivider3050 may also includefirst surface3051 and asecond surface3052.Surfaces3051 and3052 may sometimes be referred to as “pages.” For embodiments such as shown inFIGS. 24A, 24B and 28,first surface3051 orpage1 andsecond surface3052 or page2 may include a plurality of holders such as elastic straps orbands3054 and pockets3056. Velcro type straps, holders and elastic bands may also be used.
• For example, “page one” orfirst surface3051 ofdivider3050 may present EMS personnel with devices, components and instructions used to select and clean a site for vascular access. Such components and devices may includecontainers3062 with cleaning fluids, alcohol wipes or other prep materials,flashlight3064 and a tourniquet (not expressly shown). Written instructions for selecting an insertion site and/or locating a vein may be provided inpockets3056 on page one.
• “Page Two” orsecond surface3052 ofdivider3050 may include devices and components that allow EMS personnel to access a patient's vascular system via a peripheral vein or an intraosseous route. Such components may include intravenous catheters, intraosseous needles and other components that may be used to access a patient's vascular system. As shown inFIG. 24B, one ormore containers3230 with respective IO devices disposed therein may be releasably engaged withsecond surface3052 or page two ofdivider3050. One or more IV devices such as IV needle sets3136 may also be releasably engaged withsecond surface3052. Each IV needle set3136 may include a syringe, IV needle and cover for the IV needle.
• For some applications,interior surface3041 ofcover3040 may also function as page three with additional devices, components and instructions attached thereto. For example, whenkits3020 and/or3021aare used in an emergency environment to provide IO access to a patient,interior surface3041 or page three may include devices and components used to secure and intraosseous device and/or an IV device at the insertion site and to further prepare the patient for movement to an EMS treatment facility. Components and devices such as tape, dressing materials, an arm-board or splint and other components operable to secure a catheter or an intraosseous line may be provided on page three. Various types of straps and supporting structures for IO devices may be releasably attached to page three orinterior surface3041. See some examples inFIGS. 30-39.
• Outsidepocket3060 formed from mesh type material may be attached toexterior surface3042 ofcover3040. Outsidepocket3060 may hold printed reference materials such as quick reference cards. For some applications elastic cords (not expressly shown) may also be provided on exterior portion ofkits3020 and3020ato hold such materials.
• Velcro or elastic strips or loops or any other fastening device may be used to position components ondividers3050. In lieu ofdividers3050, IO and IV devices and related components may be configured in some other arrangement or organizing mechanism such as compartments or smaller containers carried in a kit.
• A device for accessing an intraosseous space such as a powered driver (SeeFIG. 26) or a manual driver (SeeFIGS. 40A and 41) may be carried infirst segment3022. For some applications a securing device such as shown inFIGS. 24A, 25, 27 and 28 may be disposed withinfirst segment3022 to releasably hold a driver. For other applications a powered driver and/or manual driver may be placed in a collapsible bag or pouch and placed withinfirst segment3022 or other portions ofkit3020 and/or3020a. For still other applications a powered driver and/or manual driver may be carried in a bag or pouch attached to exterior portions (not expressly shown) ofkit3020 and/or3020a.
• Powered driver3200 may includehousing3202 with various types of motors and/or gear assemblies disposed therein (not expressly shown). A rotatable shaft (not expressly shown) may be disposed withinhousing3202 and connected with a gear assembly. Various types of fittings and/or connectors may be disposed proximate one end of the rotatable shaft extending fromend3204 ofhousing3202. For some applications a pin type fitting or connector such asdrive shaft3216 may be used. A matching box type fitting or connector receptacle may be provided on an intraosseous device such thatpower driver3200 may be releasably engaged with the intraosseous device. For some applications,drive shaft3236 may have a pentagonal shaped cross section with tapered surfaces formed on the exterior thereof. Fittings and/or connections with various dimensions and configurations may be satisfactorily used to releasably engage an intraosseous device with a powered driver.
• Container3230 as shown inFIGS. 24B and 40B may includelid3232 along with associatedtab3234.Tab3234 may be configured to be flipped open with one or more digits of an operator's hand. Withlid3232 open, an operator may releasably engage a driver with an IO device disposed incontainer3230. For example,drive shaft3216 ofpowered driver3200 may be releasably engaged with box type connector orreceptacle3258 ofpenetrator assembly3240. SeeFIGS. 26 and 40A.Flexible strap3236 may be used to retainlid3232 withcontainer3230 afterlid3232 has been opened.
• Handle3206 may include a battery (not expressly shown) or other power source. Handle3205 may also includetrigger assembly3208 for use in activatingpowered driver3200. Examples of powered drivers are shown in U.S. patent application Ser. No. 10/449,503, filed May 30, 2003, entitled “Apparatus and Method to Provide Emergency Access To Bone Marrow,” now U.S. Pat. No. 7,670,328; U.S. patent application Ser. No. 10/449,476, filed May 30, 2003, entitled “Apparatus and Method to Access Bone Marrow,” now U.S. Pat. No. 7,699,850; and U.S. patent application Ser. No. 11/042,912, filed Jan. 25, 2005, entitled “Manual Intraosseous Device,” now U.S. Pat. No. 8,641,715.
• Various types of intraosseous devices, intraosseous needles and/or penetrator assemblies may be carried in a kit incorporating teachings of the present disclosure. See for exampleFIG. 24B.Intraosseous devices3160 and3160awhich are shown inFIGS. 30, 33, 34 and 35 may be carried in a kit along withpowered driver3200 and inserted into a patient's bone marrow in accordance with teachings of the present disclosure.
• For some applications a securing device designed to accommodate one or more specific types of drivers may be disposed withinfirst segment3022. For other applications more generic types of holders or cradles may be placed withinfirst segment3022. For embodiments such as shown inFIGS. 24A, 25, 27 and 28, securing device orcradle3080 may be designed to accommodate powered drivers such aspowered driver3200. Cradles and holders incorporating teachings of the present disclosure may be fabricated from a wide variety of thermoplastic and/or polymeric materials filled with glass fibers.
• Length3082 andwidth3084 ofcradle3080 may be selected to be compatible with interior dimensions offirst enclosure3022 and similar dimensions associated with a driver that will be releasably engaged withcradle3080. For some applicationsfirst end3086 andsecond end3088 may have generally rounded configurations.Notch3090 may be formed infirst end3086 to accommodatedrive shaft3216 extending fromend3204 ofpower driver3200.
• Firstlongitudinal edge3091 and secondlongitudinal edge3092 may be spaced from each other and extend generally parallel with each other betweenfirst end3086 andsecond end3088. For some applications, ends3086,3088 andlongitudinal edges3091,3092 may fit flush withinterior surface3031 ofbottom layer3030. Maintaining close contact betweeninterior surface3031 and adjacent portions ofcradle3080 may substantially reduce or minimize problems associated with cleaning an associated kit after use, particularly after used during an emergency at a field location.
• Various types of holders, clamps and/or quick release mechanisms may be provided on a cradle incorporating teachings of the present disclosure. For embodiments represented by cradle3080 a pair ofarms3094 and3096 may project from respectivelongitudinal edges3091 and3092.Arms3094 and3096 may be relatively strong with sufficient flexibility to allow inserting and removingportions driver3200 from engagement withcradle3080. The height ofarms3094 and3096 relative tolongitudinal edges3091 and3092 may be based at least in part on the height or depth offirst enclosure3022 and corresponding dimensions ofdriver3200.Support surface3098 may be disposed betweenarms3094 and3096 in an elevated position relative tolongitudinal edges3091 and3092. The location ofsupport surface3098 may be selected to accommodate corresponding dimensions ofdriver3200 and particularly handle3206.
• The spacing or gap formed betweenfirst arm3094 andsecond arm3096 may be selected to accommodate the width ofhandle3206 ofdriver3200.Respective ribs3100 may be formed approximate the end of eacharm3094 and3096 opposite fromlongitudinal edges3091 and3092.Ribs3100 preferably extend inwardly relative to associatedarm3094 and3096. The dimensions ofarms3094 and3096, the gap formed therebetween, and associatedribs3100 may be selected to be compatible with forming a snug but releasable snap type fit with adjacent portions ofhandle3206 ofdriver3200.
• For some applicationsfirst wall3104 andsecond wall3106 may be disposed betweenfirst end3086 and supportingsurface3098 such as shown inFIG. 25. The spacing betweenfirst wall3104 andsecond wall3106 may be selected to correspond with corresponding dimensions ofhandle3206 ofdriver3200 and particularly dimensions associated withtrigger assembly3208.Walls3104 and3106 may cooperate with each other to provide a “trigger guard” to prevent accidental activation ofdriver3200 whenkit3020 and/or3020aare in their first, closed position.
• One ormore holes3108 may be formed incradle3080 approximatefirst end3086 andsecond end3088.Holes3108 may be sized to receive various types of fasteners such as rivets and/or screws (not expressly shown). Such fasteners may be used to securecradle3080 at a desired location withinfirst enclosure3022.
• Materials used to formcradle3080 may be relatively low cost but must also have sufficient durability for repeated insertion and removal of an associated driver. For someapplications arms3094 and3096 may be designed to allow insertion and removal of an associated driver at least five hundred times.Arms3094 and3096 may also have sufficient stiffness and strength to allow associateddriver3200 to snap into place. The stiffness ofarms3094 and3096 may be selected such thatdriver3200 will not be inadvertently released fromcradle3080 ifkit3020 or3020ashould be dropped or otherwise mishandled.
• For embodiments such as shown inFIG. 28, second end3088 (not expressly shown) of cradle3080amay be modified to include electrical contacts used to charge a battery or other power source disposed inhandle3206 ofdriver3200.Electrical connector assembly3070 may be disposed on exterior portions ofwall3034ato accommodate inserting chargingcable3072 extending from an appropriate charger (not expressly shown).Lights3074 and3076 may be provided as part ofelectrical connector assembly3070 to indicate the status of a battery or other power source disposed inhandle3206 after each use ofpowered driver3200 and to indicate the status of rechargingpowered driver3200.
• Various types of indicator lights may be used. For some applications light3074 may be yellow to indicate that a battery (not expressly shown) inpower driver3200 needs to be recharged.Light3076 may be green to indicate that the charging is not required or that charging of associatedpowered driver3200 has been satisfactorily completed. For some applications,kit3020awill preferably be in its first, open position during charging ofpowered driver3200.
• Prehospital and combat situations are often ideally suited to use “unit dose” containers of various types of medications. Emergency medical personnel often need only a one-time dose of medication, such as an antidote for poison or epinephrine to stabilize the patient. Unit dose ampules are widely used by paramedics to give a predetermined amount of medication for a particular indication. A limited number of drugs may satisfactorily fill such needs.
• Kit3120 as shown inFIGS. 29A and 29B represents one example of a kit containing unit doses in accordance with teachings of the present disclosure. For some applications,kit3120 may be carried separate from previously discussedkits3020 and3020a. Forother applications kit3120 may be disposed withinkits3020 and/or3020a.Kit3120 is shown inFIG. 29B in its second, open position withcover3140 removed to provide access to ampules3123-3127 containing respective unit doses of medication.
• Kit3120 may includebase portion3130 andcover3140.Zipper3122 or other types of closures may be satisfactorily used to releasably engagecover3140 withbase portion3130. For some applications a pair of zippers and a breakable seal such as shown inFIG. 23B may be used withkit3120.Kit3120 is shown inFIG. 29A in its first, closed position withcover3140 releasably engaged withbase portion3130.
• For embodiments such as shown inFIGS. 29A and 29B,kit3120 may be described as having a generally rectangular configuration with rounded corners.Cover3140 may be generally described as a hollow enclosure defined in part by top layer142 with four (4) walls extending therefrom.Walls3143 and3144 are shown inFIG. 29A. Interior portions ofcover3140 are preferably open to accommodate storage of ampules3123-3127.
• Base3130 may be formed from a relatively thick layer of material satisfactory for use. A plurality of holes may be formed in interior surface3032 ofbase3130 satisfactory to accommodate releasably storing each ampule3123-3127 in a respective hole. The exterior configurations ofbase3130 may also be defined in part by walls and rounded corners which are preferably compatible with the walls and rounded corners associated withcover3140.
• Base portion3130 as shown inFIG. 29B may function as a rack releasably holding a plurality of single use (unit dose) ampules which may meet many (if not most) of an emergency medical service provider's immediate needs. For example,ampule3123 may contain epinephrine for cardiac arrest and life threatening allergies.Ampule3124 may contain atropine for cardiac arrest and chemical exposures.Ampule3125 may contain diazepam for seizures and emergency sedation.Ampule3126 may contain amiodarone for cardiac arrhythmias.Ampule3127 may contain narcan for drug overdose. Each ampule3123-3127 may be clearly labeled so that an appropriate drug may be quickly and accurately selected in an emergency. As shown inFIGS. 29A and 29B,kit3120 may contain medications in an easy to carry and maintain rack or stand such asbase3130.Kit3120 may includezip lock cover3140 which is easy to remove in an emergency.
• The ability to satisfactorily insert an IO device such as an IO needle at a desired insertion site may be problematic when a patient is moving or has the potential to move. Inserting an IO device in the wrong place may expose a patient to potential harm. Patient movement may be of special concern for patients suffering from status epilepticus or violent patients (drug overdoses or mental status changes) that need to be controlled for their safety and treatment. Epileptic patients may shake violently for prolonged periods which makes starting a conventional IV nearly impossible. Likewise, it may be difficult to accurately place an IO device at a desired insertion site in these patients. Although target areas for successful IO placement such as a patient's tibia and humerus are often larger than target areas for placement of an IV device, problems with inserting an IO device at a desired insertion site may be minimized by using stabilization devices and supporting structures incorporating teachings of the present disclosure. Such devices and supporting structures may be easy to apply, even in difficult field environments.
• FIGS. 30, 33, 34, 35, 36 and 39 show various examples of an intraosseous device inserted into a patient's bone marrow to provide vascular access in accordance with teachings of the present disclosure.Bone3152 and associatedbone marrow3154, shown inFIGS. 30, 33, 34, 35, 36 and 39, may be representative of the tibia in a patient's leg. The upper tibia proximate a patient's knee may often be used as an insertion site for IO access to a patient's vascular system. A humerus may also be used as an insertion site for IO access to a patient's vascular system.
• FIG. 30 shows one example of an intraosseous device which may have been inserted into a patient's bone marrow using a kit containing various devices and components in accordance with teachings of the present disclosure. For this example,intraosseous device3160 may be generally described as intraosseous (IO) needle3160 having a hollow, longitudinal bore extending therethrough (not expressly shown).IO devices3160 may be releasably attached to page2 ofkits3020 and/or3020a.
• First end ortip3161 ofIO needle3160 may be designed to drill or cut throughbone3152 and penetrate associatedbone marrow3154.Tip3161 may be open to allow communication of fluids withbone marrow3154. Also, one ormore side ports3164 may be formed inIO needle3160 to allow communication of fluids therethrough.Second end3162 ofIO needle3160 may have various types of connections including, but not limited to, a conventional Luer lock connection (not expressly shown) associated with supplying IV fluids and medications to a patient.
• Strap3170 and supportingstructure3180 such as shown inFIGS. 30 and 31 may be carried in a kit in accordance with teachings of the present disclosure.Strap3170 may be formed from various types of elastomeric and/or nonelastomeric materials compatible with contactingskin3156 and other soft tissue covering a patient's bone at a selected insertion sight. The dimensions and configuration ofstrap3170 may be selected to form satisfactory engagement with adjacent portions ofleg3150, an arm, or other desired sites for providing IO access to a patient's vascular system.
• Strap3170 may includefirst end3171 andsecond end3172 sized to be inserted throughholes3181 and3182 of supportingstructure3180.Strap3170 and supportingstructure3180 cooperate with each other to prevent accidental removal or withdrawal ofJO needle3160 from an insertion site.Strap3170 and supportingstructure3180 also cooperate with each other to prevent excessive movement or rocking ofJO needle3160 relative to the insertion site.
• Supportingstructure3180 may include relatively short,hollow cylinder3184 with a pair of flanges orwings3186 extending therefrom.Holes3181 and3182 may respectively be formed in each wing orflange3186.Wings3186 may be formed from relatively flexible material which will conform with adjacent portions of a patient's skin, soft tissue and bone.Hollow cylinder3184 may be formed from relatively rigid material to prevent undesired movement of associated3010needle3160. Interior dimensions ofhollow cylinder3184 may correspond approximately with the exterior dimensions ofIO needle3160 to provide a relatively snug fit therebetween.
• For embodiments such as shown inFIG. 32, supportingstructure3180amay include wings ortabs3186awhich have been modified to includerespective projections3181aand3182aextending there from.Strap3170amay be modified as compared withstrap3170 by attachingrespective buckles3174 withfirst end3171aandsecond end3172a. Eachbuckle3174 may includerespective hole3176 sized to receive associatedprojection3181aand3182aformed ontabs3186a.
• Supportingstructure3180amay be placed at an JO insertion site. Buckle3174aatfirst end3171aofstrap3170amay be releasably engaged withcorresponding projection3181a.Strap3170amay then be extended around patient's leg or other bone to allow engaging buckle3174aatsecond end3172awith associatedprojection3182a. For such applications,strap3170amay be formed from elastomeric material.
• For someapplications supporting structure3180 may be placed at an insertion site prior to installingJO device3160.JO device3160 may then be inserted through the longitudinal bore of supportingstructure3180. For other applications an JO device with exterior dimensions and exterior configuration of the JO device may be compatible withinterior dimensions3188 of supportingstructure3180 may first be installed at a desired insertion site. Supportingstructure3180 may then be fitted over the installed JO device (not expressly shown) by placing the JO device through the longitudinal bore of supportingstructure3180.Strap3170amay then be engaged withrespective projections3181 and3182.
• FIG. 33shows IO needle3160 inserted intobone marrow3154. Supportingstructure3180bmay be used to stabilizeIO needle3160 and limit excessive movement relative tobone3152. Supportingstructure3180bmay be generally described as having a domed shape configuration. The dimensions of supportingstructure3180bmay be selected to be compatible with a desired insertion site. A longitudinal bore or a longitudinal opening (not expressly shown) may extend through supportingstructure3180b. The longitudinal bore may have dimensions compatible with exterior dimensions ofIO needle3160. Supportingstructure3180bmay be formed from various types of semi-rigid silicone based materials and/or materials satisfactory for providing required support. A pair of holes (not expressly shown) may be provided in supportingstructure3180bto accommodate the use ofstrap3170. However, other straps such as shown inFIGS. 32, 36 and 37 and/or adhesive materials (not expressly shown) may be satisfactory used to position supportingstructure3180 at a desired insertion site.
• FIG. 34shows IO3160 inserted intobone3152 and associatedbone marrow3154.Strap3170 may be placed aroundbone3152 and attached to supportingstructure3180 as previously described.Sensor3178 may be attached tostrap3170 for use in measuring various parameters associated with providing fluids and/or medications throughIO device3160 tobone marrow3154. Such parameters may include, but are not limited to, pressure and/or changes in the size of a patient's leg, temperature and/or pulse rate. Whensensor3178 detects a preset value for one or more of these parameters, an alarm may be sounded. For someapplications sensor3178 may be coupled withmonitor3190 and/or a general purpose computer (not expressly shown). The general purpose computer may include one or more programs operable to stop infusion of fluids and/or medication through associatedIO device3160 in the event one or more parameters exceeds preset limits.
• FIG. 35 showsIO device3160ainserted intobone3152 and associatedbone marrow3154.IO device3160amay be equipped withpressure transducer3192proximate tip3161 to measure intraosseous pressure. For some applications, a similar needle (not expressly shown) may be placed in a leg muscle to measure intra-compartment pressure.
• Seal assembly3195 may be used to isolatetransducer wire3196 so that infusions of fluids may proceed while, at the same time, measuring intravenous pressure attip3161. Measurements fromsensor3192 may be analyzed by a computer (not expressly shown) to manage changes in a patient's condition by initiating pre-set increases in infusion pressure, controlling the rate of infusion or stopping infusion all together and alarming the patient and/or medical personnel if pressure limits are exceeded.
• FIGS. 36, 37 and 38 show one example of a supporting structure or guide which may be disposed at a desired insertion site such as the upper tibia proximate a patient's knee. Supporting structure or guide3180cmay be generally described as having a dome shaped configuration with cavity orrecess3194 formed therein and sized to receive an intraosseous device. For example,recess3194 may be sized to accommodate an intraosseous device such aspenetrator assembly3240. See for exampleFIG. 39.
• Supporting structure or guide3180cmay be formed from various polymeric and/or thermoplastic materials having desired rigidity and strength to direct insertion of an intraosseous device at a de sired insertion site. Supportingstructure3180cmay also be formed from various types of elastomeric and/or nonelastomeric materials satisfactory for use in forming a guide or supporting structure to direct insertion of an intraosseous device at a desired insertion site.
• For some applications strap3170cmay include one or more strips of hook and loop type material3198 (sometimes referred to as Velcro® strips) disposed proximatefirst end3171candsecond end3172cofstrap3170c. The configuration, size and dimensions of Velcro® strips3198 may be modified to allowstrap3170cto releasably attach supportingstructure3180cwith a leg or other portions of a patient's body having various dimensions. For someapplications supporting structure3180cmay includetarget3199 disposed withinrecess3194 for use by an operator to more precisely direct insertion of an associated IO device at a desired insertion site.
• FIG. 39 shows powereddriver3200 being used to insertpenetrator assembly3240 at an insertion site identified by guide or supportingstructure3180c.Powered driver3200 may be further stabilized with various types of straps and/or medical grade tape (not expressly shown) prior to insertingpenetrator assembly3240.
• FIGS. 40A and 41 show examples of manual drivers which may be carried in a kit in accordance with teachings of the present disclosure. For some applications, a kit may contain only a powered driver or only a manual driver. For other applications, a kit incorporating teachings of the present disclosure may include both a powered driver and a manual driver. Examples of manual drivers are shown in U.S. patent application Ser. No. 10/449,503, filed May 30, 2003, entitled “Apparatus and Method to Provide Emergency Access To Bone Marrow,” now U.S. Pat. No. 7,670,328; and U.S. patent application Ser. No. 11/042,912, filed Jan. 25, 2005, entitled “Manual Intraosseous Device,” now U.S. Pat. No. 8,641,715.
• Manual driver3200amay include handle3212 with drive shaft216 extending therefrom.Manual driver3200amay also include an optional ratchet mechanism (not expressly shown).Handle3212 may be formed in a variety of shapes, such as with finger grips3214.Handle3212 may be formed from materials satisfactory for multiple uses or may be formed from materials satisfactory for one time or disposable use.Handle3212 may have an ergonomically designed shape suitable for grasping with a hand and/or fingers during manual insertion of an IO device into bone and associated bone marrow.
• FIG. 40A shows an exploded view ofmanual driver3200aandpenetrator assembly3240.Penetrator assembly3240 may include an outer penetrator such as a cannula, hollow tube or hollow drill bit and an inner penetrator such as a stylet or trocar. Various types of outer penetrators may be used to form a portion ofpenetrator assembly3240. Various types of stylets and/or trocars may be disposed within an outer penetrator.
• For someapplications penetrator assembly3240 may includeconnector3250 with inner penetrator ortrocar3260 extending therefrom andhub3270 with outer penetrator orcannula3280 extending therefrom.Connector3250 andhub3270 may be releasably engaged with each other using Luer type fittings, threaded connections or other suitable fittings formed onsecond end3252 ofconnector3250 and first end3271 ofhub3270.Outer penetrator3280 may extend fromsecond end3272 ofhub3270.
• For some applications outer penetrator orcannula3280 may be described as a generally elongated tube sized to receive inner penetrator orstylet3260 therein. Portions ofinner penetrator3260 may be disposed within alongitudinal passageway3276 extending throughouter penetrator3280. The outside diameter ofinner penetrator3260 and the inside diameter oflongitudinal passageway3276 may be selected so thatinner penetrator3260 may be slidably disposed withinouter penetrator3280.Outer penetrator3280 may be formed from stainless steel, titanium or other materials of suitable strength and durability to penetrate bone and magnetic characteristics to allow releasable engagement withdisc3254.
• Tip3281 ofouter penetrator3280 and/ortip3261 ofinner penetrator3260 may be operable to penetrate bone and associated bone marrow. The configuration oftips3261 and/or3281 may be selected to penetrate a bone or other body cavities with minimal trauma. First end ortip3261 ofinner penetrator3260 may be trapezoid shaped and may include one or more cutting surfaces. In one embodimentouter penetrator3280 andinner penetrator3260 may be ground together as one unit during an associated manufacturing process.Inner penetrator3260 may also include a longitudinal groove (not expressly shown) that runs along the side ofinner penetrator3260 to allow bone chips and/or tissues to exit an insertion site aspenetrator assembly3240 is drilled deeper into an associated bone.
• Hub3270 may be used to stabilizepenetrator assembly3240 during insertion ofouter penetrator3280 into a patient's skin, soft tissue and adjacent bone at a selected insertion site. First end3271 ofhub3270 may be operable for releasable engagement or attachment with associatedconnector3250.Second end3272 ofhub3270 may have a size and configuration compatible with an associated insertion site. The combination ofhub3270 withouter penetrator3280 may sometimes be referred to as a penetrator set or an intraosseous needle.
• For someapplications connector3250 may be described as a generally cylindrical tube defined in part byfirst end3251 andsecond end3252. The exterior ofconnector3250 may include an enlarged tapered portion adjacent to end3251. A plurality oflongitudinal ridges3256 may be formed on the exterior ofconnector3250 to allow an operator to grasp associatedpenetrator assembly3240 during attachment withdrive shaft3216.Longitudinal ridges3256 also allowconnector3250 to be grasped for disengagement fromhub3270 afterouter penetrator3280 has been inserted into a bone and associated bone marrow.Disc3254 may be disposed within receptacle oropening3256 for use in releasably attachingconnector3250 withdrive shaft3216.
• For someapplications disc3254 may be a magnet. For such applications driveshaft3216 may be formed from various types of metallic materials with magnetic characteristics compatible with releasable engagement ofdrive shaft3216 with themagnetic disc3254 disposed inpenetrator assembly3240. For other applications a magnet (not expressly shown) may be formed on the end ofdrive shaft3216. Forsuch applications disc3254 may be formed from various types of metallic material with characteristics compatible with releasably engagingpenetrator assembly3240 with the magnet formed on the end ofdrive shaft3216.
• First end3271 may have a generally cylindrical pin type configuration compatible with releasably engaginghub3270 with second end orbox end3252 ofconnector3250.Second end3252 ofconnector3250 may include opening3258 sized to receive first end3271 ofhub3270 therein.Threads3259 may be formed inopening3258 adjacent tosecond end3252 ofconnector3250.Threads3273 may be formed proximate end3271 ofhub3270.Threads3259 and3273 may be used to releasably attachconnector3250 with first end3271 ofhub3270.
• For some applications end3272 ofhub3270 may have the general configuration of flange. Angular slot orgroove3274 sized to receive one end of protective cover orneedle cap3290 may be formed inend3272. Slot orgroove3274 may be used to releasable engagecover3290 withpenetrator assembly3240. For some applications cover3290 may be described as a generally hollow tube having roundedend3292.Cover3290 may be disposed within associatedslot3274 to protect portions ofouter penetrator3280 andinner penetrator3260 prior to attachment with a driver.Cover3290 may include a plurality of longitudinal ridges3294 formed on the exterior thereof. Longitudinal ridges3294 cooperate with each other to allow installing and removing cover orneedle cap3290 without contaminating portions of an associated penetrator.Cover3290 may be formed from various plastics and/or metals.
• FIG. 40B showscontainer3230 withpenetrator assembly3240 disposed therein. One of the benefits of the present disclosure includes providing a kit which allows an operator to remove a driver from a holder contained within the kit using one hand. The other hand of the operator may removecontainer3230 from page two ofdivider3050 andopen lid3232 ofcontainer3230 using one hand.Drive shaft3216 may be releasably engaged withreceptacle3258 inend3251 ofconnector3250.
• FIG. 41 shows another example of a manual driver which may be used to insert an IO device into bone marrow in accordance with teachings of the present disclosure.Manual driver3200bmay include pistolgrip type handle3212bwithdrive shaft3216 extending therefrom.Manual driver3200bmay also include an optional ratchet mechanism (not expressly shown).Manual driver3200bmay be releasably engaged withpenetrator assembly3240 or any other IO device incorporating teachings of the present disclosure.
• Examples of acute and chronic conditions which may be treated using powered drivers, intraosseous devices, kits, and procedures incorporating teachings of the present disclosure include, but are not limited to, the following:
• • Anaphylaxis (epinephrine, steroids, antihistamines, fluids, and life support)
  • Arrhythmia (anti-arrhythmics, electrolyte balance, life support);
  • Burns (fluid replacement, antibiotics, morphine for pain control);
  • Cardiac arrest (epinephrine, atropine, amiodarone, calcium, xylocaine, magnesium);
  • Congestive heart failure (life support, diuretics, morphine, nitroglycerin);
  • Dehydration (emergency port for life support, antibiotics, blood, electrolytes);
  • Diabetic Ketoacidosis (life support, electrolyte control, fluid replacement);
  • Dialysis (emergency port for life support, antibiotics, blood, electrolytes);
  • Drug overdose (naloxone, life support, electrolyte correction);
  • Emphysema (life support, beta adrenergics, steroids);
  • Hemophiliacs (life support, blood, fibrin products, analgesics);
  • Osteomyelitis (antibiotics directly into the site of infection, analgesics);
  • Pediatric applications (shock, dehydration, nutrition, electrolyte correction);
  • Renal Failure (both acute and chronic kidney failure, inability to purify blood);
  • Seizures (anti-seizure medications, life support, fluid balance);
  • Shock (life support fluids, pressor agents, antibiotics, steroids);
  • Sickle cell crisis (fluid, morphine for pain, blood, antibiotics); and
  • Trauma (emergency port for life support fluids, antibiotics, blood, electrolytes).
• More than 35,000 Advanced Cardiac Life Support (ACLS) ambulances are in service in the U.S. Each is equipped with emergency drugs and devices. Most are required to carry intraosseous needles and paramedics are trained in their use for pediatric emergencies. Kits incorporating teachings of the present disclosure may be used to administer medications and treats before permanent damage to a patient occurs.
• More than 4,000 emergency rooms in the U.S. are required to treat life-threatening emergencies like shock trauma and cardiac arrest. ERs are stocked with the latest devices and equipment to help patients receive state-of-the-art treatment. However, there is no more exasperating situation for the physician or potentially catastrophic condition for the critical patient, than the inability to establish intravenous access. Kits with IO devices incorporating teachings of the present disclosure may provide a simple and straightforward solution for extremely difficult clinical problems.
• Hospitals are required to provide crash carts on every patient ward. It is estimated that 6,000 U.S. hospitals stock more than 60,000 crash carts. These crash carts are stocked with defibrillators, IV access devices, including central venous catheters, IV fluids and drugs for common emergencies. Nurses and other healthcare workers using these crash carts are often inexperienced in such emergencies and have difficulty establishing IV access. A kit with IO devices incorporating teachings of the present disclosure may provide the long sought IV alternative for difficult patients.
• Automatic injectors are widely used in the military. During Desert Storm, combat soldiers carried an atropine auto-injector for nerve gas poisoning. Current auto-injectors are limited to intramuscular injections. The Kits with IO devices may vastly expand the scope of treatment to include intravenous drugs, without having to be skilled in the technique of intravenous insertion.
• Most acute care hospitals in the U.S. operate Intensive Care Units (ICUs) for seriously ill patients. Establishing and maintaining venous access in these patients is often a challenge. IO access may be a welcome procedure for administration of drugs and fluids to these critical patients.
• Ten percent of the population experience a major seizure in their lifetime and more than 2,500,000 people in the United States have epilepsy. Grand mal seizures represent one of the most dramatic events in medicine. During the seizure, which usually lasts 60 to 90 seconds, patients typically fall to the ground, become rigid with trunk and extremities extended, and shake violently. The most dreaded progression of seizures is status epilepticus, a condition defined as a continuous seizure lasting more than 30 minutes or two or more seizures that occur without full conscious recovery between attacks. Convulsive status epilepticus requires urgent, immediate treatment. Patients are at risk for serious injury, hypoxemia, circulatory collapse, permanent brain damage and death. The overall mortality of convulsive status epilepticus is up to 35 percent.
• Intravenous access with a large bore needle/catheter must be established to administer anticonvulsant medications. These include a benzodiazepine followed by phenytoin and/or phenobarbitol for immediate seizure control and prevention of further seizures. There are no satisfactory oral, rectal, or intramuscular medications that will control status epilepticus.
• The problem facing clinicians and paramedics treating patients with status epilepticus is the difficulty establishing venous access. Without adequate venous lines none of the effective anticonvulsants can be given. During seizures the violent shaking makes accessing a satisfactory vein difficult. Often after the line is established, further shaking dislodges the IV or causes it to infiltrate.
• Further, caregivers are at great risk of puncturing themselves with a needle when attempting to establish venous access in a patient during a seizure. Through no fault of their own, seizing patients, by jerking and thrashing around, turn the safest procedure into a terrifying venture. Doctors, nurses, and paramedics work in mortal fear of contracting AIDS and hepatitis through an inadvertent puncture with a contaminated needle.
• In an attempt to solve the venous access problem, emergency physicians and intensivists have turned to establishing a central line (intravenous catheter placed in a large central vein such as the subclavian or femoral vein). However, with this method, even under ideal conditions, there is an increased incidence of serious side effects such as pneumothorax, hemothorax, inadvertent puncture of a major artery, infection, venous thrombosis, and embolus. In the case of a patient with status epilepticus, this method becomes increasingly difficult and dangerous for all of the above-mentioned reasons. Therefore, most doctors are reluctant to even attempt a central line until seizures have ceased.
• Dialysis patients who often come to the emergency room in life threatening situations such as pulmonary edema (water on the lungs) or high potassium leading to cardiac arrest. These patients typically have troublesome or non-existent veins. The IO access may give these patients hope for a better quality of live and decrease their mortality.
• Drug overdose victims, often comatose, generally require immediate IV access to give antidotes and life saving medications such as Narcan. These patients usually have difficult venous access due to long term abuse of their veins. IO access may give these patients an alternate route for delivery of medications and fluids while improving the safety of the healthcare workers.
• Trauma victims and attempted suicide patients, often in shock due to blood loss, may also require swift replacement of fluids to save vital organs. Because of the shock condition (decreased blood pressure), veins collapse and are often impossible to find. IO access may save precious minutes for paramedics and trauma surgeons responsible for their care.
• Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alternations can be made herein without departing from the spirit and scope of the invention as defined by the following claims.

Claims (20)

What is claimed is:

1. An apparatus for penetrating bone and accessing bone marrow, the apparatus comprising:

a penetrator assembly operable to penetrate bone and bone marrow, the penetrator assembly comprising:

a trocar including a stylet and a first connector, the first connector forming a first connecting piece at a first end of the first connector, and a penetrator assembly connector at a second end of the first connector opposite to the first end of the first connector; and

an outer penetrator including a hollow cannula and a second connector, the second connector forming a second connecting piece complementary to the first connecting piece on the first connector of the trocar, the hollow cannula configured to receive the stylet of the trocar, and the first connecting piece of the trocar configured to engage the second connecting piece of the outer penetrator; and

a powered drill having a housing defining a handle, the housing enclosing a motor and a power supply and associated circuitry to power the motor, the powered drill further including a switch connected to the power supply and operable to activate the motor to rotate the penetrator assembly when said penetrator assembly is releasably attached to the powered drill;

the powered drill further comprising a third connector, the third connector configured to connect to the penetrator assembly connector of the penetrator assembly, and the third connector further configured to releasably lock the penetrator assembly connector into place with the powered drill;

wherein the second connector of the outer penetrator is configured to connect to an intravenous tubing;

wherein the power supply comprises a battery disposed within the housing and configured to supply power to the motor; and

the powered drill further including a battery indicator operable to indicate a level of the battery.

2. The apparatus according toclaim 1, wherein the battery is a rechargeable battery, and wherein the handle further comprises a charging contact and associated charging circuitry operable to charge the rechargeable battery.

3. The apparatus according toclaim 2, wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the rechargeable battery.

4. The apparatus according toclaim 1, wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the battery.

5. The apparatus according toclaim 1, wherein the hollow cannula comprises a cutting tip, and the cutting tip of the hollow cannula and a tip of the stylet are operable to penetrate bone marrow as a single drilling unit.

6. The apparatus according toclaim 5, further comprising a magnetic connection to releasably lock the penetrator assembly connector into place with the powered drill.

7. The apparatus according toclaim 5, wherein the outer penetrator and the stylet are ground together as one unit during a manufacturing process.

8. The apparatus according toclaim 5, wherein the battery is a rechargeable battery, and the handle further comprises a charging contact and associated charging circuitry operable to charge the rechargeable battery.

9. The apparatus according toclaim 8, wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the rechargeable battery.

10. The apparatus according toclaim 5, wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the battery.

11. The apparatus according toclaim 1, further comprising a magnetic connection to releasably lock the penetrator assembly connector into place with the powered drill.

12. The apparatus according toclaim 11, wherein the outer penetrator further comprises a flange operable to abut skin of a patient during an insertion procedure for stabilizing the penetrator assembly.

13. The apparatus according toclaim 11, wherein trocar includes a magnetic disc operable to allow the magnetic connection between the penetrator assembly connector and the powered drill.

14. The apparatus according toclaim 11, wherein trocar includes a metal disc operable to allow the magnetic connection between the penetrator assembly connector and the powered drill.

15. The apparatus according toclaim 1, wherein the outer penetrator further comprises a flange operable to abut skin of a patient during an insertion procedure for stabilizing the penetrator assembly.

16. The apparatus according toclaim 1, wherein the battery is a rechargeable battery, and the handle further comprises a charging contact and associated charging circuitry operable to charge the rechargeable battery,

wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the rechargeable battery,

wherein the hollow cannula comprises a cutting tip, and the cutting tip of the hollow cannula and a tip of the stylet are operable to penetrate bone marrow as a single drilling unit, and

wherein the outer penetrator further comprises a flange operable to abut skin of a patient during an insertion procedure for stabilizing the penetrator assembly.

17. The apparatus according toclaim 1, wherein the battery is a rechargeable battery, and the handle further comprises a charging contact and associated charging circuitry operable to charge the rechargeable battery,

wherein the battery indicator further comprises a plurality of lights operable to indicate a status of the rechargeable battery,

wherein the hollow cannula comprises a cutting tip, and the cutting tip of the hollow cannula and a tip of the stylet are operable to penetrate bone marrow as a single drilling unit, and

further comprising a magnetic connection to releasably lock the penetrator assembly connector into place with the powered drill.

18. The apparatus according toclaim 1, wherein the second connecting piece comprises a connecting piece locking mechanism configured to lock into position on the first connecting piece.

19. The apparatus according toclaim 1, wherein the switch is disposed on an outer surface of the housing and proximate to a first end of the housing on which the third connector is provided.

20. The apparatus according toclaim 1, wherein the penetrator assembly further includes a penetrator shield configured to shield a tip of the stylet of the trocar.

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