Abstract:
There are many medical situations that require removal of fluid from a patient. There are many ways to remove the fluid but many of these situations have not been solved. Herein, inventions are disclosed that generate osmotic pressure that can be used to remove these fluids very effectively, a technique which requires no harsh suction or pumping. One embodiment involves implanting a reservoir that has a semipermeable membrane sidewall. The reservoir contains trapped osmotic solutes that can not pass out through the membrane. But fluid from the patient can flow in. The osmotic pressure from the trapped solutes in the reservoir draws fluid from the patient across the semipermeable membrane and into the device. In some versions, the membrane can be changed as desired during the lifetime of the device by pulling the membrane out through the implanted device and putting a new one back in.

Description:
This application claims priority to U.S. provisional patent Ser. Nos. 61/127,440 filed May 13, 2008, and 61/137,921 filed Aug. 5, 2008 which are hereby incorporated by reference herein. 
    
    
     BACKGROUND 
     Many persons suffer from conditions such as diabetes, edema, congestive heart failure, or ascites. Many therapies exist for these conditions but many unresolved problems remain to be addressed. 
     SUMMARY 
     Herein, devices and methods are disclosed that remove fluids very effectively using osmotic pressure and flow, a technique which requires no harsh suction, vacuum, or pumping. One embodiment involves implanting a reservoir that has a semipermeable membrane sidewall. The reservoir contains trapped osmotic solutes that can not pass out through the membrane. But fluid from the patient can flow in. The osmotic pressure from the trapped solutes in the reservoir draws fluid from the patient across the semipermeable membrane and into the device. The fluid is disposed of, or redirected. Very small or very large osmotic pressures can be generated to treat a wide range of situations. 
     In general, reservoirs and catheters are described herein for removing fluid from a patient or moving fluid from one location to another in the body. These devices include a semipermeable membrane that traps solutes inside the membrane to create an osmotic driving force to pull fluids and other materials below the molecular weight cut-off (MWCO) of the membrane into the device for removal or redirection within the body. 
     The osmotic pressure that the device creates to drive fluids may be set to be very high. As a result, fluids may be readily moved without resorting to suction, vacuum, compression, or gravity drainage techniques. Applications include, e.g., dialysis, peritoneal dialysis, edema, edema of the limbs, torso, or cranium, pulmonary edema, or ascites. 
     Some embodiments have an external reservoir that connects to an internal reservoir and/or catheter. The external reservoir is attached permanently or reversibly, or from time to time. The internal reservoir may be a container that collects fluids directly and/or a container that has tubing that collects fluid into the container, with the tubing and container having common fluid communication so that osmotic pressure in the container is shared by the collector-tubing. 
     Some embodiments have an internal reservoir that collects fluid directly or via tubing that draws fluid into the internal reservoir. The internal reservoir can be percutaneously accessed or have a transcutaneous port for permanent or reversible connection to devices external to the body. 
     Some embodiments relate to systems for changing-out a fluid collection system. A container or cage is implanted in the patient and the fluid collector is passed into the container/cage and secured to accomplish fluid removal. The collector can also be removed through the collector/cage. One benefit of this approach is that semipermeable membranes on the fluid collector can be changed out from time to time if they become biofouled. In some embodiments, the fluid collector is an insert that seats in an internal-reservoir container and the reservoir and collector share a common solution of trapped osmotic solutes. In some other embodiments, the fluid collector fits into the cage, which provides structural support for the insert but does not help to contain trapped osmotic solutes within the collector. 
     In other embodiments, the fluid collector has a semipermeable membrane and trapped osmotic solute integrated with a catheter, needle, or other structure to provide a fluid collection system. 
     Various medical applications for the fluid collection are described. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1A  depicts a semipermeable membrane fluid collection system with an implantable catheter and an external reservoir; 
         FIG. 1B  depicts a semipermeable membrane fluid collection system with an implantable reservoir and an external reservoir; 
         FIG. 1C  depicts a semipermeable membrane fluid collection system with an implantable reservoir equipped with a percutaneous access port; 
         FIG. 1D  depicts a semipermeable membrane fluid collection system with an implantable catheter and an external reservoir that redirects fluid from the reservoir for disposal; 
         FIG. 2A  depicts an alternative semipermeable membrane fluid collection system with an implantable catheter and an external reservoir; 
         FIG. 2B  depicts an alternative semipermeable membrane fluid collection system with an implantable catheter and an external reservoir; 
         FIG. 3A  is a perspective view of an implantable fluid collection reservoir bounded by a semipermeable membrane on all its faces; 
         FIG. 3B  is a bottom perspective view of the embodiment of  FIG. 3A : 
         FIG. 3C  is a perspective view of an implantable fluid collection reservoir with a lumen partially bounded by a semipermeable membrane; 
         FIG. 3D  is a perspective view of the embodiment of  FIG. 3C  with the access port furnished with a cuff for a transcutaneous application; 
         FIG. 3E  depicts a fluid collection system with an implantable reservoir fluidly connected to an external rigid reservoir; 
         FIG. 3F  depicts a fluid collection system with an implantable impermeable reservoir with a semipermeable appendage in combination with an external expandable reservoir; 
         FIG. 3G  is a perspective view of a fluid collection system with an impermeable reservoir and a catheter with a distal portion having a semipermeable membrane for passage of native fluids into the device; 
         FIG. 3H  is a perspective view of a fluid collection system with an reservoir at least partially bounded by a semipermeable membrane and a catheter for redirecting fluid out of the device; 
         FIG. 3I  is a perspective view of a fluid collection system with an appendage having a semipermeable portion and a reservoir having a device for manually forcing fluid out of the collection system and a catheter for redirecting the fluid; 
         FIG. 4A  is a cross-sectional view of a fluid collection device having a semipermeable membrane and an access port; 
         FIG. 4B  is a top view of the embodiment of  FIG. 4A ; 
         FIG. 5A  is a perspective view of an implantable cage; 
         FIG. 5B  is a perspective view of an implantable cage; 
         FIG. 6A  is a cross-sectional view of a port that provides for passage of devices therethrough and includes a seat and fastener for a device; 
         FIG. 6B  is a top view of the embodiment of  FIG. 6A ; 
         FIG. 7A  depicts introduction of a fluid collection device through the embodiment of  FIG. 6A ; 
         FIG. 7B  depicts the device of  FIG. 7A  being seated in the embodiment of  FIG. 6A ; 
         FIG. 7C  depicts the embodiment of  FIG. 7B  with the fluid collection device in an expanded position; 
         FIG. 8A  depicts a reservoir with a pass-through channel; 
         FIG. 8B  depicts the seat of the embodiment of  FIG. 8A ; 
         FIG. 8C  depicts an insert for passage through the channel and seating in the seat of  FIGS. 8A and 8B ; 
         FIG. 9A  depicts a fluid collection device with a fastener; 
         FIG. 9B  depicts a catheter with a fastener for use in combination with the embodiment of  FIG. 9A ; 
         FIG. 9C  depicts an alternative embodiment of a fluid collection device that includes a fastener and a cage; 
         FIG. 9D  depicts an alternative embodiment of a cage with a fastener that cooperates with the embodiment of  FIG. 9A ; 
         FIG. 9E  depicts an alternative embodiment of a catheter with a cage and a seat; 
         FIG. 9F  depicts an outer catheter and an inner catheter that comprises a semipermeable membrane outside the outer catheter; 
         FIG. 9G  depicts the embodiment of  FIG. 9F  with the membrane deployed inside the outer catheter; 
         FIG. 10A  depicts a fluid collection device internal to an outer catheter; 
         FIG. 10B  depicts the fluid collection device of  FIG. 10A  in a deployed position external to the outer catheter. 
         FIG. 11  depicts some applications of a fluid collection device; 
         FIG. 12  depicts some applications of a fluid collection device that comprises at least one appendage to draw fluid into the device; 
         FIG. 13  depicts an example of placement of an internal reservoir; 
         FIG. 14  depicts an example of placement of an internal reservoir and a collection appendage in the context of upper limb edema; 
         FIG. 15A  depicts a fluid collection device; 
         FIG. 15B  depicts a placement of the device of  FIG. 15A ; 
         FIG. 16A  depicts a fluid collection device; 
         FIG. 16B  depicts the device of  FIG. 16A  after collection of fluid and in the context of a system that includes a fluid withdrawal device; 
         FIG. 16C  depicts an alternative embodiment of a fluid collection device; 
         FIG. 17  depicts a fluid collection system in use on a patient; 
         FIG. 18A  is a cross-sectional view of an access that provides for pass-through and seating of a fluid collection device; 
         FIG. 18B  is a cross-sectional view of the device of  FIG. 18A  in place in a peritoneal space; 
         FIG. 19  depicts a fluid collection device with a lumen for introducing material directly into a patient; 
         FIG. 20  is a cross-sectional view of a fluid collector for collecting fluid and redirecting the collected fluid; 
         FIG. 21  depicts a prior art Southey tube; 
         FIG. 22A  depicts an embodiment of a fluid collection system; 
         FIG. 22B  depicts an alternative needle for the system of  FIG. 22A ; 
         FIG. 22C  depicts an alternative embodiment of a fluid collector for use in system of  FIG. 22A ; 
         FIG. 23  depicts prior art use of prior art Southey tube; and 
         FIG. 24  depicts an application of the embodiment of  FIG. 22C . 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Osmotic pressure may be used to move fluids within, or remove fluids from, a patient.  FIG. 1  is a schematic. At  FIG. 1A , device  101  has an implanted semipermeable membrane  100  that defines a lumen  102  with trapped osmotic solutes  108  that create osmotic pressure that draws fluid  104  into the lumen. The lumen is in fluid communication with an external reservoir  106  that fills by osmotic pressure, as at arrow B. Transdermal connector  109  connects lumen  102  and reservoir  106 . The osmotic pressure is created by the presence of trapped osmotic solutes  108  that can not pass through the semipermeable membrane  100 . In use, fluid  104  that passes into the device is drawn off and solutes  108  are replaced as needed to maintain a desired osmotic pressure. Reservoir  106  is elastic and expands as fluid  104  enters the device. Lumen  102  may have a relatively low volume so as to be positionable in a wide variety of bodily spaces, with reservoir  106  having a larger capacity to store fluids. In some embodiments, the lumen  102  is the lumen of a catheter or hollow fiber membrane. 
     Alternatively, a rigid reservoir may be used, as in reservoir  110  in  FIG. 1B , which has a semipermeable membrane  112  that defines lumen  114 . Fluid, as at arrow B, flows through tubing  116  into reservoir  110  by osmotic pressure. Lumen  114  is relatively larger than lumen  102  and can serve as a temporary depot for fluid storage. Accordingly, reservoir  110  may be intermittently connected to lumen  114 . In some embodiments, reservoir  110  is replaced with a device that removes fluid from lumen  114  without reference to osmotic forces, e.g., a catheter at atmospheric pressure or under vacuum, a syringe, or a vacuum pump 
       FIG. 1C  depicts implanted device  120  with semipermeable membrane  122  that defines lumen  124  that contains trapped osmotic solutes  126 . The device is fully implanted, meaning it has no members that are external to the body. Fluid  127  passes into lumen  124 . Port  128  is accessed through the skin, e.g., by a needle and syringe, to remove fluid  128  and replace or supplement solutes  126  as desired.  FIG. 1D  shows alternative device  130  with semipermeable membrane  132  that contains trapped solutes  134  in lumen  135 . Catheter  136  directs fluid out of the device, either to another location in the body (e.g., intraperitoneal space, bladder) or externally to a reservoir or ostomy bag. Optional 1-way valve  138  prevents backflow into lumen  135  and may further have a semipermeable membrane sized to prevent exit of trapped solutes  134  from the device. Optional device  140  may be a push-button or diaphragm or other mechanism to generate internal pressure to force fluid into catheter  136  and/or a fill/drain port for access by a needle and a vacuum device, e.g, syringe, vacuum tube, pump. 
     To use such a device, a user may implant the device in a patient with ports or catheters, if present, passing through the patient&#39;s skin. The device lumen is loaded before or after implantation with fluid that contains trapped osmotic solutes. Native fluids from the patient are drawn into the device by osmosis. The fluids are then redirected or disposed of. Osmotic trapped solutes are internal to the device and can not pass through the semipermeable membrane; the ongoing presence of these solutes contributes osmotic pressure that draws native fluids into the device. The loaded fluid, meaning fluid introduced into the device by a user, may alternatively or additionally have solutes with molecular weights less than the molecular-weight cut-off, referred to as diffusible solutes. Solutes that pass from the subject into the device are diffusible solutes and may be specifically referred to as native diffusible solutes. Similarly, fluids passing into the device are physiological fluids and may be specifically referred to as recovered native fluids; these fluids are water with various diffusible solutes. Native fluid is the fluid present in the patient. Physiological saline is a term for osmotically balanced solutions, and such salines made ex vivo and placed in the device may specifically be referred to as exogenous physiological saline. A solute is a moiety dissolved in a solvent. 
     In general, this approach may be used to create very powerful forces for moving fluids. The osmotic pressures can be much greater than gravity such that fluids can travel against the force of gravity to flow into the device or out of the device into a reservoir. At the same time, however, osmotic forces rely on the diffusion of water as opposed to suction. 
     Such devices may be provided in a variety of configurations. Features that may be mixed-and-matched to make a device include, for example: one or more of an external reservoir, an internal reservoir, an appendages for fluid collection, a location of the semipermeable membrane, a fluid removal motif, (percutaneous, internal redirection, transcutaneous port), and a port.  FIGS. 1A and 1B  depict how the trapped osmotic solutes are distributed in a solvent and in fluid communication throughout the internal portions of the device, with some device portions being inside the patient and some outside the patient. Any shape of the device may be made to accommodate the fluids. Accordingly, reservoir(s) may be used in the device in combination with variously shaped appendages sized and dimensioned as needed for placement in a patient. The term appendage and reservoir are sometimes used to distinguish between portions of the device as it is generally configured for practical use and for the convenience of description; thus a reservoir generally has a volume of more than about 50 ml and an appendage has less than about 50 ml volume. Appendages may be, e.g., from 0.1 ml to about 50 ml in volume; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., less than 10 ml, from about 0.2 ml to about 10 ml, or 0.5 ml to about 5 ml. Moreover, some appendages are conveniently shaped for placement by trocar or tunneling and, at the time of placement, are sized to pass through an opening (e.g., a catheter interior, a port, a tunnel in a tissue) with of less than about 1 mm 2  to about 200 mm 2  cross-sectional area; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., 1.5 mm 2  or from about 1 to 50 mm 2 . Examples of appendages are tubes, hollow tube fibers, catheters, ovoids, bags. Reservoirs may be any size, e.g., from about 50 ml to about 10,000 ml; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., about 50 ml to about 2000 ml or 100 ml to about 1000 ml. 
     For example,  FIG. 2A  depicts device  200  having external reservoir  202  in fluid communication via tubing  203  with lumen  204  of appendage  206  that comprises semipermeable membrane  208 . Transcutaneous connector  210  links the appendage and reservoir. Tubing  203  may be reversibly or permanently connected to connector  210 . Appendage  206 , as depicted, is not a reservoir, but has an elongated and narrow shape for ease of placement, e.g., a tubular shape with a maximum diameter of about 5 mm. And  FIG. 2B  depicts a device  220  with reservoir  222 , tubing  224 , appendage  226  having lumen  228  and semipermeable membrane  228 . A fill/drain port  230  is provided for the external reservoir  222 . Appendage  206  is relatively narrow at connection  232  and expands distally to terminus  234 . 
       FIG. 3  depicts further examples of said mixed-and-matched features. Device  300  has reservoir  301  with a top side  302  connected to a bottom side  306  by a side  304  that each comprises a semipermeable membrane. Fill/drain port  308  allows access to reservoir  301 . Reservoir  301  is implanted in a patient with port  308  being fully internal to the patient for percutaneous access or extending transcutaneously through the patient&#39;s skin for external access. Native fluid has access to the reservoir from all sides  302 ,  304 ,  306 .  FIG. 3C  depicts a device  310  with semipermeable membrane disposed only at its peripheral edges  312 . Top portion  314  and bottom portion (not shown) are not permeable. Fill/drain port  316  allows access to reservoir  311 .  FIG. 3D  is an alternative embodiment of  FIG. 3C , with device  313  having an intradermal skin cuff  318  on fill/drain port  316 . 
       FIG. 3E  depicts device  320  having internal reservoir  322  that has semipermeable membrane disposed on its edge  324  and bottom (not shown) but not on its top  326 . Lumen of reservoir  322  is in fluid communication with external rigid reservoir  328  via tubing  330  and transcutaneous port  332 . Tubing  330  is reversibly connectable to port  332  for convenient refreshing of reservoir  322 . 
       FIG. 3F  depicts device  340  having internally implanted reservoir  342  that is made of non-water-permeable materials that is in fluid communication with a lumen of appendage  344  that is comprised of a semipermeable material. External reservoir  348  (which expands under pressure as fluid enters the device) is in fluid communication with reservoir  342  via tubing  350  and port  352 . 
       FIG. 3G  depicts device  360  with non-water-permeable reservoir  362  connected to appendage  364 , which has a non-water-permeable portion  366  that is continuous with semipermeable membrane portion  368 . The reservoir  362  may be fully implantable with port serving as a percutaneous fill/drain port or reservoir  363  may be external, with nonpermeable portion  366  being transcutaneous. 
       FIG. 3H  depicts device  380  with fully implantable reservoir  382  having a semipermeable membrane portion  384  and port  386 . Tubing  388  is used for redirecting fluid from reservoir  382  to other portions of the body, or externally through the skin to a collector. 
       FIG. 3I  depicts device  390  that is disc-shaped with a flexible diaphragm portion  392  on reservoir  394 , which also has appendage  396  that is tube-shaped with semipermeable membrane portion  398  at its distal segment. Tube  399  is used for redirecting fluid from reservoir  382  to other portions of the body, or externally through the skin to a collector. A user presses on the diaphragm to reduce the interior volume of the reservoir to create pressure to drive fluid out of the reservoir. The appendage  396  may also have a one-way valve to prevent backflow of fluids from the reservoir into the appendage. Tube  399  may also have a one-way valve for preventing backflow into the reservoir, and may also have a filter for retraining trapped osmotic solutes in the reservoir. 
     In general, a user may implant a device in patient with a semipermeable membrane portion being disposed inside the patient. The device interior is loaded before or after implantation with fluid. The fluid may have trapped solutes having a molecular weight equal to or greater than the molecular weight cut-off of the semipermeable membrane. The fluid may alternatively or additionally have solutes with molecular weights less than the molecular-weight cut-off (diffusible solutes). A solute is a moiety dissolved in a solvent. Thus some embodiments include a lumen at least partially bounded by a semipermeable membrane, meaning that there is a structure that has a lumen (a bore or cavity) with the semipermeable membrane being part of the structure around the lumen. For instance a tube with a sidewall that comprises a semipermeable membrane has a lumen partially bounded by the membrane. Or a container with one or more walls being made of a semipermeable membrane has a lumen at least partially bounded by the membrane. The lumen may be in fluid communication with other specified portions of the device, meaning that trapped osmotic solutes in the lumen may diffuse with or through the solvent to the other specified portions. Thus a lumen in fluid communication with a bore or catheter provides for diffusion of trapped osmotic solutes to the bore or catheter as well as movement of the solvent for the solutes. While a semipermeable membrane does allow fluids to pass, the term “fluid communication” is not used in that sense herein. The term “diffusible fluidic communication” may be used to specifically indicate diffusive/osmotic flow across a semipermeable membrane. 
     Osmotic solutes in a fluid removal device may include synthetic molecules. Synthetic refers to a molecule not naturally found in a human body. Some osmotic solutes may be synthetic hydrophilic polymers. Hydrophilic refers to a material that has a solubility in water of at least 1 gram per liter. Examples of such polymers are polyethylene glycols (PEG) and polylysines. Natural or synthetic polymers may be used, e.g., polyamino acids such as proteins, polysaccharides, or glycosaminoglycans. Some osmotic solutes are neutral while others are charged to increase ionic attraction and osmolarity. Further exemplary solutes are polyacrylic acid, polyethyleneimine, xanthum gum, sorbates, hyaluronic acid, polyvinyl pyrrolidone, polyacrylamide, polyvinyl alcohol, polyesters. 
     Trapped osmotic solutes may be present in a fluid collection device according to the molecular weight (MW) of the solute, which relates to the molecular weight cut-off (MWCO) of the semipermeable membrane. Table 1 shows some combinations for MWCO from 100-10,000 with solute MW ranging from 200-12000. The osmotic pressure available to drive fluids is very high. Typical human blood pressure is about 125 Torr or mm Hg (2.4 psi). The inside and the outside of the semipermeable membrane can be expected to approximately equilibrate with respect to the salt content of physiological fluids, such that bodily salt effects on osmotic pressure across the semipermeable membrane of the device may be negligible. The solubility of a 4000 MW PEG in water at room temperature is about 50%, so high concentrations of PEG, for instance, are available as a solute to drive osmosis. Table 1 shows that osmotic driving pressures of more than 60× physiological blood pressure can be generated. MWCOs of more than 10,000 may be used, e.g., MWCO from 12,0000 to 100,000; artisans will immediately appreciate that all the ranges and values within the explicitly stated ranges are contemplated, e.g., about 12,000, about 15,000, about 45,000 or between about 12,000 and about 60,000. As is evident from this disclosure, a trapped osmotic solute may be used at a concentration to generate an osmotic pressure of more than 50,000 Torr or a very low pressure, e.g., 1 Torr; artisans will immediately appreciate that all the ranges and values within the explicitly stated ranges are contemplated, e.g., 1 to 50,000 Torr, 10 to 10,000 Torr, 10 to 5,000 Torr, 10 to 1,000 Torr, 1 to 125 Torr, 5 to 250 Torr, at least 2 Torr, 1,000 to 50,000 Torr, 2,000 to 20,000 Torr, 3,000 to 10,000 Torr. While some of these pressure are quite high, resort may be had to high-strength steel and ceramic materials formed with the desired MWCO. As is evident from this disclosure, a trapped osmotic solute may be used at a concentration as needed to generate a predetermined osmotic pressure or pressure range, e.g., from 0.1 to 10,000 mM; artisans will immediately appreciate that all the ranges and values within the explicitly stated ranges are contemplated, e.g., 2 to 5000 mM, 4 to 2500 mM, at least 2 mM, less than 10,000 mM, 1 to 1000 mM, 50 to 5825 mM. Moreover, the disclosed MWCO, solute MWs and pressures may be mixed-and-matched in combination with each other as appropriate, bearing in mind that selecting one affects choices available for the other two, as is evident. 
     
       
         
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 Polymer Solute 
                 Semipermeable 
                 Polymer Solute 
                 Pressure, Torr or 
               
               
                 Molecular 
                 Membrane 
                 Concentration, 
                 (psi) at 37 C. or as 
               
               
                 Weight 
                 MWCO 
                 mM or (mg/ml). 
                 indicated. 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 200 
                 100 
                 2500 (500)  
                 63.6 atmospheres 
               
               
                 600 
                 500 
                 833 (500) 
                 21.2 atmospheres 
               
               
                 1200 
                 1000 
                 400 (500) 
                 7828 (151) 
               
               
                 1200 
                 1000 
                 40 (50) 
                 782 (15) 
               
               
                 6000 
                 5000 
                  8 (50) 
                  152 (2.9) 
               
               
                 12000 
                 10000 
                  4 (50) 
                   76 (1.5) 
               
               
                   
               
             
          
         
       
     
     Semipermeable materials may be made with a molecular weight cut-off, e.g., from about 50 to about 200,000 molecular weight; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., with a range from about 100 to about 10,000, from about 500 to about 5,000, less than 40,000, or less than about 1,000, less than about 2,000, from about 200 to about 4,000, from about 1,000 to about 50,000, or from about 2,000 to about 70,000. The term membrane, as in a semipermeable membrane, is used broadly to refer to a membrane or other solid porous and permeable structure with a MWCO. Processes for making materials with a particular molecular weight cut-off are known in the arts of dialysis and reverse osmosis. Options for such materials include, for example, membranes, plates, and hollow tube fibers. Processes for making such materials include, for example, spin-casting, sintering, and laser perforation. Materials include, for example, ceramics, celluloses, cellophanes, regenerated cellulose, cellulose ester (CE), and polyvinylidene difluoride (PVDF), nanoporous alumina, polysulfone, and cellulose triacetate, or polytetrafluoroethylene (PTFE). The term non-permeable material refers to a material that does not normally allow passage of an aqueous fluid therethrough under atmospheric pressure and at room temperature. 
     Fluid ports that allow for introduction of fluids in or out of the body may generally be used, e.g., as in U.S. Pat. No. 4,892,518, U.S. Pat. No. 5,833,654, U.S. Pat. No. 5,989,216, U.S. Pat. No. 6,699,225, U.S. Pat. No. 6,997,914, or U.S. Pat. No. 7,261,705.  FIG. 4  depicts device  400 . In this embodiment, the device  400  has an internal fluidic port  402  with septum  404  over permeable portion  406  that communicates with reservoir  408  having semipermeable portion  410 . Device  400  may be implanted inside a person and osmotic solutes internal to reservoir  408  draw native fluids into reservoir  408  through one or more semipermeable portions  410 . Users access port  402  with a syringe needle to pierce the patient&#39;s skin and self-sealing septum  404  to draw fluids in and out of the device. Port  406  is made of sturdy materials that are not pierced by the needle, e.g, ceramics or certain engineering plastics. Thus the port comprises a backstop (also termed a guard) that allows users to push needles or other devices into the port without fear of damaging the underlying device because the backstop will catch the needle or other object. Permeable portion  406  allows fluids to flow in and out of the reservoir and port. Optional tubing and valves (not depicted) may also be used to move the fluid to other portions of the body or, in a partially implantable version, out through the body to an ostomy bag or other collector. Or a pump may be used, e.g., as in US Pub. No. 2004/014787. 
     Embodiments include use of an adjustable flow control valve in which the resistance properties of the valve can be changed non-invasively by the user or caregiver. Specifically, for example, a valve designed to minimize overdrainage of a first fluid and maintain intraventricular pressure (IVP) within a normal physiologic range, regardless of patient position may be adapted after reading this application, for instance, a PS MEDICAL STRATA valve. The normally closed DELTA chamber mechanism opens in response to positive pressure. Working with the ball and spring valve mechanism, overdrainage is minimized by utilizing the principle of hydrodynamic leverage. The DELTA chamber designed by Medtronic provides The Medtronic PS MEDICAL DELTA chamber has two silicone elastomer diaphragms, lying flat against two base outlet ports. Fluid flowing from a positive pressure side pushes the diaphragm surfaces away from the outlet ports, allowing fluid to flow through the ports and out the distal tubing. In the DELTA chamber, the inlet area of the diaphragms acted on by fluid flowing under pressure is 20 times greater than the outlet area of the diaphragms acted on by negative hydrostatic pressure or atmospheric pressure from the distal tuning. The normally closed DELTA chamber mechanism opens in response to positive pressure. Accordingly, such a valve may be associated with a housing, reservoir, or tubing of a fluid removal device described herein. 
     In general, a fluid collection device is configured to capture native fluids for removal, with the native fluids being gathered into the device by osmotic pressure although diffusion in and out of the device does occur. This configuration is distinct from osmotic pumps or other devices that operate by using osmotic pressure to drive a piston or valve or release solutes from the device, with the native fluids ultimately being retained without removal from the device, or with the device being unsuited to periodic removal of the fluids. Another aspect is that the physiological fluids may pass into the device through a semipermeable membrane and are removed from the interior of the reservoir or the device generally, in contrast to devices that require release of solutes and removal of fluid from locations external to the device or a reservoir joined to the device. 
     A semipermeable membrane surface area may be sized to achieve a desired flow rate in light of its interior osmotic pressure and site of implantation for the particular application. A projected surface area is a projection of the surface area onto a flat surface from three-dimensional space and does not account for roughness or corrugations in the surface that increase the actual surface area. Exemplary ranges for the projected surface area or surface area are from about 1 cm 2  to about 10,000 cm 2 ; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., about 100 to about 1000 cm 2 , from about 200 to about 5,000 cm 2 , or at least about 500 cm 2 . 
     In some embodiments, the reservoirs may be loaded with diffusible solutes that are intended to be released from the device. For instance, therapeutic agents may be introduced into the device, e.g., into an internal or external reservoir or catheter. Such agents may include, for example, drugs, diagnostics, or imaging agents. Examples are anti-inflammatory agents, antibiotics, antimitotics, antimicrobials, antifungals, immunosuppressants, preservatives, or imaging agents, e.g., directly visible agents such as dyes, or indirectly visible imaging agents that require mediation of a machine for visualization, as in radiocontrast or MRI agents. 
     Loaded fluids may be changed from time to time, e.g., by removing substantially all loaded fluids from a device or by changing out a portion of the device that contains the loaded fluids. For instance, loaded fluids may be changed out in a device that has a reservoir and appendage by replacing the reservoir, at least partially emptying the reservoir, or emptying the reservoir and replacing the removed fluids. The frequency of the changes may be periodic, intermittent, or as-desired. For example, hourly, daily, twice daily, twice a week, once a week, and bi-weekly are all options. Or replacement upon collection of a certain volume may be performed, e.g., 0.05 to 5 liters; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., 250 ml, 200 to 1000 ml, and so forth. 
     Other embodiments provide for a cage to hold a reservoir and/or appendage. The cage is implanted and allows materials to pass freely in and out of the cage; no molecular weight cut-off is provided. A structure that comprises a lumen at least partially defined by a semipermeable membrane is inside the cage, either at the time of implantation, introduced afterwards, or removed and replaced after implantation of the cage.  FIG. 5A  depicts cage  500  with access  502 . The cage is at least partially made of a mesh  504  and has an interior space (not depicted) accessible through opening  506 .  FIG. 5B  depicts an alternative embodiment  510  with a series of structural members  512  that collectively define interior space  514 . A portion  516  is not permeable. Access  518  has opening  520  that allows access to interior space  514 . 
       FIG. 6A  (cross-sectional elevated view) and  FIG. 6B  (top plan view) depict an embodiment for an access port, e.g, as in access  502  or  518  of  FIG. 5 . The access port allows for pass-though placement and/or retrieval of a device that comprises a semipermeable membrane. Such a port may be used in combination with other embodiments described herein. For instance, an implantable reservoir may comprise an access so that semipermeable membranes or other devices may pass through it. The access port  600  has a bore  602  that passes through the device. Bore  602  has inlet  604 , proximal portion  606  that comprises fasteners (e.g., threads  608 ), lip  610 , stop  612 , and outlet  614 . Access port  600  has base  616  that tapers to top  618 , with groove  620  for receiving a structure to anchor base  616 , e.g, a cage or a semipermeable membrane. In use, a user passes a catheter through inlet  604  until it stops on lip  610  and pushes a device through the catheter and through port  600 . Such a device may have a flange that mates with stop  612  such that another (e.g., threaded) fastener may be secured over the flange by engaging the fastener in bore  602 , i.e., in this example, threads  608 . 
       FIG. 7  shows a specific example of a use of port  600 . A catheter  702  is passed through inlet  604  and forced against lip  610 . A pusher  704  pushes fluid collector  706  through catheter  702  and through bore  602  as indicated by arrow A. Fluid collector  706  has collar  708  joined to semipermeable membrane  710 . Collar  708  has mating flange  712  and bore  714 . Semipermeable membrane  710  has a lumen  716  that is connected to bore  714 . Collector  706  is pushed until mating flange  712  rests securely against flange  612 . Catheter  702  and pusher  704  are withdrawn. Bored securing fastener  720  with bore  721  is fastened inside bore  602  to secure collar  708  in port  600 , e.g., by engaging threads  722  of fastener  720  with threads  608  of port  600 .  FIG. 7C  shows securing fastener  720  with optional semipermeable membrane  726 . Alternatively, a septum (not shown) may be used in the place of membrane  726  or placed above securing fastener  720 . The septum may provide for repeated access and resealing, e.g., as in a resilient material that closes after perforation by a needle. Flanges  612  and  712  mate to provide a seal. As is evident, alternative fasteners (e.g., LUER-LOK, friction fit, mortise-and-tenon, tongue-and-groove, compression fit, O-ring seals) may be used and/or flanges  612 ,  712  may have an arcuate shape as depicted to ease passage of materials or other conformations. Membrane  710  is located within a patient after placement and may be provided before and/or after placement with trapped osmotic solutes to drive collection of fluids into lumen  716 . The fluids may be removed as desired through bores  721  and  602 , e.g., suction, syringe, gravity, or fluid connection to a reservoir with trapped osmotic solutes. Port  600  is adaptable to, among other things, (internal or external) reservoirs and/or (internal or external) catheters. 
     In the case of an access port, e.g., port  600 , used in combination with a cage, e.g., cage  500  or  510 , the port is attached to the cage with its bore in communication with the cage&#39;s interior. The cage may be placed inside a patient and a fluid collection device comprising a semipermeable membrane that contains trapped osmotic solutes is placed inside the cage. Fluids pass freely through the cage and into the fluid collection device. The fluids are then redirected or removed from the patient. The fluid collection device may be retrieved and replaced as desired through the access port. Grooves or indents may further be provided on the fluid collection device to facilitate retrieval. For instance, a tool with ears or a ring is introduced into bore  714  after removal of securing fastener  720  and engages indents or a groove in collar  708 , and a user pulls the fluid collection device out through port  600 . 
     An alternative pass-through system is depicted in  FIG. 8 . System  800  has reservoir  801  with inlet  804  and outlet  806  connected by interior channel  802 . Devices may be passed through the reservoir  801  by passing the devices through the channel  802 , which guides the devices from inlet  804  to outlet  806 . Channel  802  is in fluid communication with reservoir interior  808 , e.g., by holes  810 , or other means. In this example, outlet  806  is connected to tubing  812  with perforations  814 . Inlet  804  is connected to access port  816  that is connected to connector  818  that comprises fitting  820  for connection to tubing. 
     One method for using this device is to implant reservoir  801  in the patient and insert fluid collection device  821  through access port  816  and into tubing  812 . Device  821  seats in seat  822 . Fluid collection device  821  has a semipermeable membrane  824  that at least partially defines lumen  826  which communicates with bore  828  of collar  830 , which is attached to membrane  824 . Collar  830  has ribs  832  that engage grooves  834  of seat  822 . Reservoir  801  and lumen  826  are loaded with osmotic solutes that drive fluids into lumen  826  and reservoir interior  808  for removal via port  816 . Reservoir  801  is depicted as a (rigid) cylinder but may be flexible or elastic and any shape, with channel  802  providing enough structural definition to provide for passage of devices therethrough. Membrane  824  may be contained entirely within tubing  812 , which may be open-ended or close-ended, or the membrane may pass out of tubing  812 . Alternatively, tubing  812  may not be present, with a membrane passing out of reservoir  801  directly into the patient. 
     A semipermeable membrane may thus be provided in a module that may be removed and replaced through a port in a reservoir. The catheter may also accessible through the port to clean the catheter, e.g., in the case of blockage. For instance, a brush, scraper, or ream may be introduced through the port and passed through the reservoir and through the catheter. 
     Another embodiment is a fluid collector that is directly implanted with a suitable port or transcutaneous access, used inside or at least partially inside a catheter, or used in combination with an internal or external reservoir. For instance,  FIG. 9A  depicts a fluid collector  900  with a semipermeable membrane  902  that at least partially surrounds a lumen  904 , with a collar  906  that can receive a port and/or mate with a catheter and/or mate with a reservoir. Collar  906  has bore  908 , flange  910  that seals with membrane  902 , and threads  907 . For instance, catheter  910  ( FIG. 9B ) has external threads  912  that engage collar threads  907  to secure the collector at least partially inside catheter  910 . Alternatively, the embodiment of  FIG. 8  may be adapted to receive collector  900 , e.g., by substituting male threads at seat  822  or adapting both to another fastening system. A port (not shown) may also engage collar  906  to form a fluid connection, with the port being an access port or connected to other system components. 
       FIG. 9C  depicts alternative fluid collector embodiment  920  having collar  922  joined to structural members  924  that serve as a cage, with collar  922  also having bore  926  fluidly connected to lumen  928  surrounded by semipermeable membrane  930 . External threads  932  may be used to secure fluid collector  920  in another system component, e.g., a reservoir, tubing, or catheter. 
       FIG. 9D  depicts an alternative catheter  940  with structural members  942  around an otherwise open interior space  944 . The structural members  942  are secured to end piece  946  and upper closed portion  948 , which has threads  950  and bore  952 . Fluid collector  900  may be passed into catheter  940  with semipermeable membrane  902  at least partially disposed in interior space  944 . External threads  950  mate with threads  907  to secure collar  906  to catheter  940 . 
       FIG. 9E  depicts another alternative catheter  960  with a plurality of longitudinal structural members  962  secured at end piece  963  and structural rings  964  secured to members  962 . Interior space  966  is caged by members  962 ,  964  and otherwise open to communicate with its surroundings. Tube  968  has flange  970  and internal ribs  972 . The flange  970  may be used to seat a fluid collector (e.g., as adapted from  FIG. 7 ) and ribs  972  may be used as fasteners to secure a securing device (not shown) for the fluid collector (not shown). Catheter  960  may be a component in a system that includes a reservoir or used directly inside the body, e.g., in the peritoneal space, and may be further provided with peritoneal and/or subcutaneous cuffs (not shown). The structural members may be coiled and joined by ring-shaped cross members to provide a framework. A semipermeable membrane that communicates with a reservoir external to the patient can be reversibly removed/placed in the catheter or the membrane can be a permanent part of the catheter. 
     The structural members may be rigid or flexible and may be made of suitable biocompatible materials, e.g., stainless steel, polyurethane, polytetrafluoroethylene, or PEEK. The structural members may be joined to an endpiece rounded for ease of insertion and indwelling. In some embodiments, the semipermeable membrane is attached to a connector, e.g., the connector has threads to connect to the portion of the catheter that remains outside the body. The membrane can be filled and pushed into the catheter, or pushed through the catheter with a blunt tool, e.g., a plastic rounded rod. In some embodiments, the structural members are part of a unit integral to the membrane which is joined to the endpiece; a single unit can thus be eased in and out of a catheter. 
     In certain embodiments, an outer catheter and an inner catheter are used. The outer catheter is placed in the patient as an indwelling catheter. The inner catheter is advanced through the outer catheter and deploys a semipermeable membrane in communication with one or more lumens of the inner catheter, with one or more of those lumens being in fluid communication with a reservoir. The semipermeable membrane is exposed to the fluids of the body space where it is deployed and draws fluid into the reservoir by osmosis since the membrane contains solutes trapped inside the membrane. The inner catheter may be completely contained within the outer catheter, or may extend past the distal end of the outer catheter. 
       FIG. 9F  depicts system  980  with indwelling catheter  982  partially containing semipermeable membrane  984  that has lumen  986 .  FIG. 9G  depicts system  990  with indwelling catheter  992  partially containing semipermeable membrane  994  that has lumen  996 . 
     For example, a fluid collecting device may be introduced through an outer catheter, with a semipermeable membrane portion being self-expanding by virtue of entry of fluids into the device, or with the membrane having integral self-expanding structural members. For example,  FIG. 10A  is a cross-sectional view of an outer catheter  1002  containing fluid collector  1004  that has semipermeable membrane  1006  with lumen  1007  and integral biased wire members  1008  joined to end piece  1010  and tubing  1012 .  FIG. 10B  depicts fluid collector  1004  in an open, deployed position external to outer catheter  1002 . The outer catheter  1002  may subsequently be withdrawn or left in place. Tubing  1012  is depicted with one lumen but may alternatively have a plurality of lumens, e.g., for simultaneous introduction and removal of lumen  1007  contents. Thus a self-deploying semipermeable membrane may be delivered through an outer catheter. The outer catheter may be placed in the subject and left in place as an indwelling catheter. The inner catheter may be advanced through the outer catheter and open when it exits the end of the catheter. The structural members may be biased to spring open when not restrained by the outer catheter. A semipermeable membrane may surround, or be attached to, structural members such that its interior space communicates through an inner catheter to a reservoir. The inner catheter may have two lumens that communicate with the interior of the catheter so that one lumen may provide fluid to the membrane interior space and the other lumen may withdraw the fluid. 
       FIG. 11  depicts examples of placement of a fluid collector. Placement may include, for example, lower limb  1100 , abdominal trunk  1102 , upper thoracic  1104 , or upper limb  1106 . Fluid collector  1108  comprises a lumen at least partially bounded by a semipermeable membrane in contact with a tissue for trapping osmotic solutes to create osmotic pressure to draw a fluid into the collector. The collector has a port  1110 . As is evident, the various embodiments of collectors and features described herein may be combined to make a fluid collector. These positions indicate examples of where such collectors may be placed. 
       FIG. 12  depicts further examples of placement of a fluid collector. Placement may include, for example, lower limb  1200 , abdominal trunk  1202 , upper thoracic  1204 , or upper limb  1206 . Fluid collector  1208  comprises a lumen at least partially bounded by a semipermeable membrane in contact with a tissue for trapping osmotic solutes to create osmotic pressure to draw a fluid into the collector; in this embodiment, the semipermeable membrane  1212  is located distal to the reservoir  1214  of collector  1208 , as indicated by the thickened portions of catheter(s)  1216 . The collector has a port  1210 . The semipermeable portions  1216  provide for points of entry of native fluids into the collector, which may be removed through reservoir  1214 . The fluid collector may be internally placed or externally placed with at least a portion disposed interior to a patient. As is evident, the various embodiments of collectors and features described herein may be combined to make a fluid collector. These positions indicate examples of where such collectors may be placed. 
       FIG. 13  depicts an example of a subdermal reservoir placement. Fluid collector  1200  has reservoir  1202 , port  1204 , and catheter  1206 . The reservoir and/or the catheter comprise a semipermeable membrane that at least partially borders a lumen that communicated with interior of reservoir  1202 . As is evident from this disclosure, alternative embodiments have the semipermeable membrane at all or various locations of the reservoir and/or on the catheter, or have no catheter, have a port that is entirely implanted, or have no port but instead have a catheter to redirect fluid to other parts of the body. 
     Accordingly, fluid collector placement may be made to collect fluid from a lower limb, a lower trunk, an upper trunk, an upper limb, or other portions of the body. Some embodiments are directed to recovery of excess fluid in the pleural or lung area, with a collector, typically a catheter, being placed at or near the lung. Some embodiments are directed to placement of a fluid collector reservoir in a position that mimics a breast implant to provide a convenient and possibly cosmetically appealing option. 
     Implants of fluid collectors or fluid collector portions may be placed as needed for the intended application. Placement options include subglandular, subfascial, and submuscular, or mixtures of the same, e.g., subpectoral. A subglandular implant can be made, for example, between tissue and muscle, e.g., between breast tissue and the pectoralis muscle. This position resembles the plane of breast tissue and can also be cosmetically appealing to some patients in the case of a reservoir implanted at this location. An example of a subfascial placement is underneath a muscle fascia. For instance, underneath the fascia of the pectoralis muscle. An example of submuscular placement is below a muscle, for instance, below the pectoralis without release of the interior origin of the muscle. Subpectoral implantation may involve placement under the pectoralis major muscle to be partially under the pectoralis and the subglandular plane. 
     Fluid diffuses through the interstitial tissue of the patient so that withdrawals that are not fully in contact with the edemic tissue may nonetheless draw out fluids to create a movement of fluids out of the edemic tissue for relief of the edema. For instance,  FIG. 14  depicts a subcutaneous placement with a transcutaneous port and a catheter extending to an edemic arm. Fluid collector  1400  has reservoir  1402  with transcutaneous port  1404  and catheter  1406 . Catheter  1406  has distal region  1408  that comprises a semipermeable membrane  1410 . Trapped osmotic solutes internal to the fluid collector create osmotic pressure to draw native fluids, indicated at arrow A, from edemic limb  1412 . A user withdraws fluids from time to time from reservoir  1402  through port  1404 . The catheter may extend fully into a edemic portion of a limb, be placed within a few inches of the edemic portion, e.g., 1 to 12 inches, or at a distance from the limb, e.g., 12 or more inches. As such, catheter  1406  in  FIG. 14  may be omitted, with reservoir  1402  comprising at least one portion that has a semipermeable membrane to draw native fluids into the reservoir for collection. 
     Another embodiment of a fluid removal device is depicted in  FIG. 15 . Fluid removal device  1500  has internal member  1502  for gathering physiological fluids, transcutaneous member  1504  for access to the internal member, and extracorporeal member  1506  to provide osmotic solutes. Internal member  1502  has semipermeable membrane  1508  (e.g., a hollow tube fiber or sintered construction) and connector collar  1510  that connects semipermeable membrane  1508  to the transcutaneous member. Transcutaneous member  1504  is a fluid port with connector  1512  to join to the internal member, skirt  1514  for subdermal placement, e.g., a suturing collar or porous anchor for ingrowing tissues, internal conduit  1516  that receives optional semipermeable membrane  1518 , with external portion  1519  remaining outside the body. Extracorporeal member  406  has connector  1520  with bore  1522  communicating with reservoir  1524 . In use, internal member  1502  is implanted internally, e.g., by a trochar, minimally invasive surgery, or incision with transcutaneous member  1504  being places under the skin of the patient with the external portion  1519  outside the body. Semipermeable membrane  1518  may be present. Extracorporeal member  1506  is filled with osmotic solute and connected to external fluid port portion  1519  via connector  1520 . Osmotic solute in  1524  communicates with interior of semipermeable member  1518 , which may be implanted filled with an aqueous medium in the absence of air so that it is internally wetted. When osmotic solute is present at a concentration that creates an osmotic pressure, physiological fluid flows into the device and diffuses through the device, including reservoir  1524 . When reservoir  1524  is full or at a predetermined time, it may be replaced by a fresh reservoir, e.g., daily, twice daily, every other day, or once a week. Reservoir  1524  may be sized as needed for the application, e.g., from 100 ml to 10 liters; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., 500 ml to 1500 ml at capacity. Semipermeable membrane  1518  may be used to enhance safety, bearing in mind that bacteria are generally too large to pass through membranes sized for osmotic applications; membrane  1518  may have a MWCO lower than the MW of trapped osmotic solutes in reservoir  1524 . Device  1500  is depicted with a single semipermeable membrane  1508  but a plurality of such membranes may be used to enhance surface area and distribution with the patient  1550 ; e.g., by joining them to each other is a series or connecting them to internal member  1512  after adapting it with a plurality of connectors or other unions. Various fasteners  1530  may be employed for reversible or alternatively permanent union of the pieces. 
     As is evident, a catheter comprising a semipermeable portion may be implanted internally in a patient at a desired location in combination with a transcutaneous port that provides for reversibly connection to a reservoir that fluidly communicates with a lumen of the catheter, with the system containing trapped osmotic solutes that creates an osmotic pressure to draw fluid into the lumen and the reservoir; the reservoir may be periodically removed, re-loaded and re-used, or disposed of with a fresh unit being used in its place. Alternatively, a larger reservoir may be used. The osmotic solutes of the catheter may be introduced or withdrawn through the port. The semipermeable membrane may be removable and replaceable through the port. 
       FIGS. 16A and 16B  show a system  1600  with a housing  1602  partially ( FIG. 16A ) or more fully ( FIG. 16B ) filled. Housing  1602  has port  1604  that may be transcutaneous (meaning having a portion that passes out of the body through the skin) or percutaneous (meaning the port has no portion external to the body but accessible through the skin), and a fluid egress  1606  that provides for fluid to be collected, e.g., with a catheter with a semipermeable portion connected thereto and placed internally to a patient. The term egress refers to an exit point. A point of exit for a fluid may often serve as a point of entry, but such is not always the case, as in a one-way-valve-egress or in certain methods that use an opening to introduce a fluid but not withdraw it. A semipermeable membrane  1608  serves as the reservoir and provides lumen  1610  that is loaded with osmotic solutes  1612  and is fluidly connected to port  1604  and egress  1606 . As fluid is drawn into lumen  1610 , it expands the membrane. Syringe  1616  with optional syringe filter  1618  may be used to move fluids in and out of the lumen. The syringe filter may be used to provide an extra degree of sterility, e.g., with a filter sized to screen-out bacteria, and/or be sized to retain osmotic solutes  1610  in the lumen, e.g., with the filter being too fine to allow the trapped solutes to be removed. These figures show an expandable/collapsible semipermeable membrane inside a housing, which may be altogether rigid, altogether flexible and/or collapsible, or partially one or the other. Alternatively, as at  FIG. 16C , the housing  1602  can have no semipermeable membrane component and/or can have no membrane and simply communicate with the contents of the semipermeable membrane interior to the patient. A syringe (as depicted) or syringe pump, peristaltic pump, or gravity feed/drainage may be used to fill or empty the reservoir. 
     Alternatively, the devices of  FIG. 16  may be adapted for use with reservoir  1602  external to the patient. As at  FIG. 17 , the reservoir  1602  may be secured to the patient with belt  1702  and a catheter  1704  affixed to egress  1606 . Catheter passes transcutaneously into the patient at  1706  and is in fluid communication with a lumen at least partially bounded by a semipermeable membrane. Reservoir  1602  and catheter  1704  are loaded with osmotic solutes to draw fluids in. 
       FIG. 18A  depicts an example of some of the various features already described in combination with each other as placed in a peritoneal cavity for collection of fluid therefrom by osmotic flow. System  1800  has transcutaneous port  1802  has external threads  1804  on cylinder  1806 , bore  1808 , cuffs  1810 , and internal threads  1812 . Semipermeable membrane assembly  1814  has collar  1816  with external threads  1818 , structural members  1820  that join to collar  1816  and endpiece  1822 , and semipermeable membrane  1824  that bounds lumen  1826  that is fluidly connected to bore  1828  of collar  1816 . In use, port  1802  is surgically placed transcutaneously, e.g., as depicted with cuffs  1810  in adipose layer  1830 , which lies between dermis  1832  and peritoneal membrane and fascia  1834 . Epidermis  1836  is external to the dermis. Assembly  1824  is passed through bore  1808  and screwed into threads  1812  with assembly threads  1818 . Alternative fastening systems may be employed and/or a flange to nest assembly  1824  and/or a securing fastener may be placed to further secure assembly  1824 . Assembly bore  1828  is in fluid communication with bore  1808  and both are in fluid communication with lumen  1826 . Lumen  1826  is loaded with trapped osmotic solutes and fluid, as at arrow A, is drawn in from peritoneal space  1828 . A cap (not shown) may be used to cover port  1802 , e.g., by screwing onto threads  1804 . Port  1802  may be secured to tubing that leads to a reservoir or other fluid collection or disposal system.  FIG. 18B  depicts an exemplary use in a peritoneal cavity, with system  1800  transcutaneously placed and loaded with osmotic solutes to draw fluid into the collector. Connector  1850  is depicted for connection to other components as desired (not shown). As applied to peritoneal placement, system  1800  is loaded with osmotically trapped solutes to create an osmotic pressure to drive fluids into the device through the semipermeable membrane. 
     As is evident, removal of fluids by use of devices having trapped osmotic solutes can be used to remove unwanted materials from the patient that are in the patient&#39;s fluids, as in hemodialysis or peritoneal dialysis. The fluids collected into the osmolar-collection devices may be removed continuously or from time to time. One benefit of this approach is that users may consume liquids and the osmotic pressure and flow into the system can be adjusted to remove fluids at a desired rate. Osmotic pressure may be adjusted by increasing or decreasing the amount of trapped osmotic solutes. The surface area of the semipermeable membrane can be sized to increase or decrease a flow rate. 
     Accordingly, a method of cleansing fluids generally in a patient is to adjust fluid intake and fluid removal. The fluid may be collected from the peritoneal space or other tissues. For instance, a patient may be directed to consume certain amounts of fluids, e.g., water, water with osmotic solutes, osmotically balanced drinks, beverages. Or the patient may be directed to drink a volume of liquid proportionate to, or matched to, the fluid volume that is collected. Or a user or patient may alternatively or additionally adjust the removal of fluids from the patient as desired, e.g., by more frequent replacement of the osmotically loaded solutes in the system or more frequent redirection of fluids out of the collector. In some embodiments, a user is directed to drink between about 0.5 and about 5 liters of a fluid daily; artisans will immediately appreciate that all ranges and values between the explicitly stated values are contemplated, e.g., 1-3 liters or 0.5-2 liters. In some embodiments, between about 0.5 to about 5 liters are daily removed, with adjustments being made as needed to provide for a desired volume of fluids in the patient. 
       FIG. 19  depicts an alternative system  1900  with semipermeable membrane  1902  defining a lumen in fluid communication with lumen of catheter  1904  that is connected to bore  1906  of port  1908 . A second lumen or catheter  1910  is also connected to port  1908  via separate bore  1912 . An example of use is the placement of system  1900  in a patient with membrane  1902  internal to the patient to collect fluids internal to the patient, e.g., in a peritoneal space or other tissue. Fluids may be introduced via catheter  1910  into the patient. In the context of placement in peritoneal tissue, catheter  1910  may be used to introduce or remove fluid. In some embodiments, substantially conventional peritoneal dialysis is conducted with osmotically-driven fluid collection serving as an adjunct system to remove fluids. Accordingly, in some embodiments, a conventional peritoneal dialysis solution is introduced into the peritoneal space and fluid is withdrawn from that space by an osmotic process. Thus catheter  1910  may be used to introduce or remove fluids from time to time, e.g., to introduce dialysate for dialysis or to expand the peritoneal space. In other embodiments, the peritoneal space is expanded by injection of fluids prior to introduction of a fluid collection device. 
     It is possible to create large driving forces to collect fluids; one benefit is that the driving force may be adjusted as desired to achieve a desired fluid collection rate. Similarly, the membrane of the fluid collection device may be changed out through an access port so that further control over the MWCO of collected materials may be exercised. These features can be manipulated to extend the useful life of a peritoneal dialysis programme when the peritoneal membrane begins to fail or the peritoneal dialysis process otherwise begins to fail due to changes in the patient&#39;s physiological state. 
     In other embodiments, a catheter with a plurality of lumens communicates with a lumen of a fluid collection device, with the catheter lumens being available for simultaneous introduction and withdrawal of fluid. 
     Methods include withdrawing fluid from a patient suffering from congestive heart failure (CHF). In the case of CHF, lung edema is part of the vicious cycle of CHF progression such that removal of excess fluid is useful. 
     In some embodiments, an appendage for osmotically-driven fluid collection (e.g., hollow tube fiber, catheter or a plurality of catheters) is threaded or tunneled into a region at or near a lymph collection node, e.g., within about 1, about 2, about 3, about 4, or about 5 cm. As already described, a catheter may be introduced into the patient and a fluid collection device introduced through the catheter, which may be fully or partially withdrawn, or left in place. It may be useful to place the collectors near the highest mediastinal node (position 1) or other nodes, e.g., (i) Superior Mediastinal Nodes 1-4: 1. Highest Mediastinal: above the left brachiocephalic vein; 2. Upper Paratracheal: above the aortic arch, but below the left brachiocephalic vein; 3. Pre-vascular or Pre-vertebral—these nodes are not adjacent to the trachea like the nodes in station 2 since they are either anterior to the vessels or behind the esophagus, which is prevertebral; 4. Lower Paratracheal (including Azygos Nodes): below upper margin of aortic arch down to level of main bronchus, (ii) Aortic Nodes 5-6: 5. Subaortic (A-P window)-nodes lateral to ligamentum arteriosum, these nodes are not located between the aorta and the pulmonary trunk, but lateral to these vessels; 6. Para-aortic (ascending aorta or phrenic)-nodes lying anterior and lateral to the ascending aorta and the aortic arch. (iii) Inferior Mediastinal Nodes 7-9: 7. Subcarina; 8. Paraesophageal (below carina); 9. Pulmonary Ligament, nodes lying within the pulmonary ligaments (iv) Hilar, Interlobar, Lobar, Segmental and Subsegmental Nodes 10-14: 10-14: these are located outside of the mediastinum. 
     Procedures for tunneling that may be adapted to this and other embodiments after reading this disclosure are described, e.g., U.S. Pat. Nos. 5,234,438, 5,782,841, 5,885,217, 6,004,326, and 7,018,384. As already described, a catheter may, e.g., exit the body directly, be part of a system to redirect fluid, or interface with a reservoir inside or outside the patient. For instance, a reservoir may be implanted in a pocket analogous to a breast implant or a cardiac pacemaker, with an appendage placed at or near a lung site. The reservoir may have a transcutaneous or percutaneous port. Fluid may be withdrawn periodically or on demand. 
     Chronic wounds, e.g., pressure ulcers, decubitus ulcers, or skin lesions may be treated. In these methods, a fluid collection device is introduced internally to the patient, e.g., subcutaneously or subdermally, in or near (within about 1, about 2 about 3, about 4, or about 5 cm) the wound site. A semipermeable membrane with a lumen of trapped solutes, or other device described herein, draws fluids out of the wound area. The drainage of waste fluid and introduction of fresh interstitial fluids (oxygenated and nutritive) serves to promote healing. Drugs may be introduced at the same time across the membrane (e.g., VEGF, IGF-I, IGF-II, EGF, FGF, bFGF, antimicrobials, antifungals, antibiotics). 
     Ascites is marked by a build-up of fluid in the peritoneal space, and can also cause edema in other areas. Devices and methods described herein may be used to remove such fluid. In some embodiments, the MWCO of the semipermeable membrane is adjusted to exclude albumin, e.g., is 40,000 or less. In contrast, paracentesis, a method of removing fluid from the peritoneal space, often removes albumin and harms the patient. Shunts may also be used. Conventional shunts used are portacaval shunt, peritoneovenous shunt, and the transjugular intrahepatic portosystemic shunt (TIPS). These conventional shunts are essentially tubes. 
     An alternative shunting system, for ascites or other applications, uses a device as disclosed herein that includes a semipermeable membrane and a pumping mechanism. The device is loaded with trapped osmotic solutes to actively pull fluids in, and the pump serves to provide motive force to move the fluids out of the device to the intended site. The device may further comprise one or more check valves or other valves to provide unidirectional fluid movement. And, for instance, an adjustable flow control valve may be included.  FIG. 20  is a schematic depiction of one such arrangement. System  2000  has manually operated pump  2002 , fluid collector  2004 , and catheter  2006 . Pump  2002  has a housing  2008  that forms a container with a siding  2010  that is a flexible diaphragm. Fluid collector  2004  has a semipermeable membrane  2012  connected to catheter  2014  that connects to housing  2008 . One-way valves  2018  have a ball seat  2020 , ball  2021 , stops  2022  for the ball, and provide for flow in a direction as indicated by arrow A. The semipermeable membrane  2012  is placed in a tissue area and, when the device is loaded with osmotic solutes, fluid flows into the device. A user presses diaphragm  2010  to force fluid in pump  2002  to move through filter  2030  and into catheter  2006 , from whence it exits. One-way valves  2018  prevent undesired backflow. The depicted ball valve allows for the pump interior  2008  to be in fluid communication with the fluid collector  2004  until the pressure in the pump is increased and fluid is forced back into the collector, at which point the valve shuts. The filter  2030  may be sized to prevent release of trapped osmotic solutes. The pump may be manually-actuated or remotely or automatically operated. 
     A variety of embodiments for treating edema have already been described. For instance, a limb with poor or overloaded lymphatic drainage can directly receive a semipermeable membrane connected to a reservoir of osmotic fluid to directly remove excess native fluid. In the case of edema, patients have few options for fluid removal, and direct removal by osmotic pressure may avoid surgeries or provide an alternative to diuretic programs, which can be effectively used only until resistance is developed. In some cases, lymphatics are fully or partially blocked and drain the afflicted body portion slowly or not at all such that systemic diuretic treatment is never effective. 
     One prior art approach to edema is use of the Southey tube ( FIG. 21 ). Southey tube  2100  is a needle with perforations  2014  oat its distal end  2106  and a proximal end  2108  that is typically connected via a connector  2110  to a tube  2112  that empties into a reservoir outside the body that is filled by gravity, i.e., is located below the needle so that flow in the tube is down into the reservoir. The Southey tube tended to be part of a medical doctor&#39;s toolkit in the early 1900&#39;s but has since fallen into disfavor. In use, it was forced into the patient&#39;s edemic area and fluid in the area was allowed to drain as needed. 
     A perforated or slotted needle may be used in combination with an insert that includes a semipermeable membrane that at least partially bounds a lumen for collecting fluids. Many suitable embodiments have already been described. In one method, the tube is placed in the patient and allowed to provide drainage and the insert is later introduced, e.g., when fluid flows slows or ceases, or for long-term drainage.  FIG. 22A  depicts an example. System  2200  has needle  2202 , insert  2204 , and reservoir  2206  with connecting tubing  2208 . The system may be loaded with trapped osmotic solutes  2210 . Needle  2202  has openings, e.g., slots  2212  or and/or round perforations  2214 , and a connector  2216 , here depicted with threads  2218  but other fasteners may be used. Insert  2204  has semipermeable membrane  2220  that partially bounds lumen  2222  that is joined to collar  2224  that has fastener  2226  to engage the needle connector and fastener  2228  for connection to tubing  2208 .  FIG. 22B  is an alternative embodiment of a needle, with needle  2230  having a large opening  2232  and connector  2234 .  FIG. 22C  is an alternative embodiment of a needle, with blunt needle  2350  having structural members  2352  that provide access to internal fluid collecting semipermeable membrane  2354 . 
       FIG. 23  depicts a prior art Southey tube system  2300  in use. Edemic limb  2302  is transcutaneously pierced at entry point  2304  by Southey tube  2306 . Tubing  2308  provides gravity drainage to waste collector  2310 . 
       FIG. 24  depicts the embodiment of  FIG. 22C  in use. Blunt needle  2350  is in place in edemic limb  2352 , and has been placed through transcutaneous entry point  2354  Connector  2356  is connected to tubing  2358 , which is connected to container  2360 , which is secured by strap  2362  to the patient. Trapped osmotic solutes  2364  provide osmotic force to draw native fluids into the device, as at arrows labeled “body fluids”. The fluid from the patient can readily flow up, against gravity, into the container since the osmotic pressure can be set to overcome gravity. A benefit of this feature is that the patient may be ambulatory through the treatment. Another benefit is that osmotic pressure in the device will collect more fluid than can be collected with the Southey Tube method because the osmotic pressure draws fluid even after internal pressures in the patient are not favorable for expelling fluid without assistance. In some embodiments, a disposable insert is provided to the patient for placement into the needle or catheter. The patient disposes of the insert and replaces it as needed. An indwelling needle or catheter can also be provided with a cap or other closure for the user to fix to the same in between treatment sessions. 
     Another application is for catheters. Catheters are often used for drainage, either short-term after a surgery, or longer-term. The catheters are often connected to a waste collector or allowed to drain into bandages. Use of an osmotic fluid collection system can facilitate removal of fluids. Many embodiments have already been described for making a combination of a catheter with such a fluid collection device as will be evident to artisans reading this disclosure. In some embodiments, the catheter is equipped to reversibly receive an osmotically-driven fluid collector so that the catheter may be operated with or without such a collector. Another embodiment is a fluid collection device that can be passed through a catheter and into a patient to collect fluids without removal of the catheter. The pass-through device can be entirely within the catheter, within the catheter except for a portion that passes out of the catheter into the patient, and/or have a portion outside the patient, e.g., a tube or an external reservoir. Or the catheter can be provided with a fastener or seat to receive a fluid collector insert so that the insert may be used intermittently or continuously in combination with the catheter. 
     Embodiments include a device for, and a method of, collecting fluids from a patient comprising placing, in a patient, a fluid collection device (e.g., catheter, tube, reservoir, appendage) that comprises a semipermeable membrane (e.g., hard, flexible, metal, ceramic, high strength, cellulose, polysulfone, dialysis membranes) that at least partially bounds (e.g., a sidewall of a container or tube, a part of a container, forms a container, forms a bag, forms a pocket) a lumen containing trapped osmotic solutes in aqueous solution (the trapped osmotic solutes can not pass out of the membrane, there is often an opening for removal, or a valve), with the lumen being in fluid communication with a transcutaneous port (through the skin) or percutaneous port (under the skin), wherein the trapped osmotic solutes have a molecular weight greater than a molecular weight cutoff of the semipermeable membrane and create an osmotic pressure that draws physiological fluid from the patient across the membrane and into the lumen. The osmotic solutes may be, for example, (a) present at a concentration to produce the osmotic pressure of between 50 and 100,000 Torr and/or (b) have an average molecular weight in a range from about 500 to about 50,000 (e.g., polymer with an average MW used as a trapped solute) and/or (c) trapped osmotic solutes are polymers and/or the concentration is from 1 millimolar to 10 molar. The port can be integral with the membrane (all one device connected together) or part of a system of components designed to cooperate with each other. For instance, the port can be connected up to an external reservoir that also contains the trapped osmotic solutes, with the physiological fluids passing also into the external reservoir. The osmotic pressure can make the fluids flow against gravity. The device can have membranes or inserts that are replaceable through a port, e.g., an insert as described. Internal channels in a reservoir can also be used to guide an insert or a fluid collection device through a reservoir. For instance, the port may be part of an internally implanted cage or internal reservoir and the fluid collection device is passed through the port and secured to (e.g., fastened, screwed into, put into a seat, snapped-in, force-fit) the cage or reservoir. The entire device or the part of the device that has the semipermeable membrane can be put in a tissue to withdraw fluid, e.g., peritoneal space, in an arm, in a leg, or in the patient at or near a lymph node or collection area that collects lung fluids. 
     Embodiments include a fluid collection system with a catheter or a needle and an insert that fits into the catheter or needle to create osmotic pressure that draws physiological fluid into the catheter or needed and can be secured therein, the system comprising a catheter or needle, an insert that comprises a collar having a bore that opens into a lumen at least partially bounded by a semipermeable membrane trapped osmotic solutes in the lumen to create osmotic pressure to draw fluids across the membrane into the lumen, wherein the membrane is joined to the collar, and the insert passes at least partially into the catheter or needle and the insert has a fastener and/or seat that mates with the catheter or needle to secure the insert. The needle or catheter can have openings, perforations, slots, or be just a cage, e.g., structural members that define a lumen. 
     As is evident, embodiments include (i) An assembly for a medical device that provides for fluid collection from a patient by osmotic pressure from trapped osmotic solutes contained within a semipermeable membrane that allows passage of native fluids from the patient across the membrane and into a lumen for removal of the fluid from the device, the assembly comprising a first opening and a second opening into an interior of a housing, an insert, wherein the insert is sized to pass through the first opening and into the interior, with the insert comprising a lumen at least partially bounded by a semipermeable membrane, and a fastener in a position to secure at least a portion of the insert within the housing with the lumen in fluid connection with the housing interior, wherein trapped osmotic solutes with a molecular weight greater than a molecular weight cut-off of the semipermeable membrane are trapped within the device when the first opening is in a closed disposition. (ii) The assembly of (i) wherein the fastener comprises a first set of threads on the insert that mates with a second set of threads on the housing. (iii) The assembly of (ii) wherein the first set of threads are external threads and the second set of threads are internal threads. (iv) The assembly of (iii) wherein the first opening is in a port on the housing that comprises a bore that comprises the internal threads, with the bore leading to the interior. (v) The assembly of (i) wherein the housing is a tube, hollow disk, or hollow ovoid. (vi) The assembly of (v) wherein the housing is the tube and the fastener comprises a seat in the tube and the insert comprises a flange to mate with the seat. (vii) The assembly of (v) wherein the housing is the tube and the membrane, when the insert is fastened to the tube, extends out of the tube. (viii) The assembly of (v) wherein the housing is the tube and the tube has threads on a proximal end and the insert is threadedly connectable to the external threads. (ix) The assembly of claim  1  wherein the insert comprises a collar that defines a bore, with the semipermeable membrane being connected to the collar and the lumen opening into the bore, with the collar comprising the fastener. (x) The assembly of (ix) wherein the collar has threads fastenable to threads on a port on the housing that comprises the first opening. (xi) The assembly of (ix) wherein the collar has threads fastenable to threads on a port on the housing that comprises the second opening. (xii) The assembly of (i) wherein the housing further comprises a guide that connects the first opening to the second opening, with the insert being passable through the first opening and the guide, with the fastener fastening the insert to the housing with at least a portion of the semipermeable membrane extending through the second opening and the lumen in fluid communication with the interior. (xiii) The assembly of (i) further comprising a tube affixed to a port that comprises the first opening or the second opening. 
     Other embodiments are (xiv) An implantable medical device that provides for fluid collection from a patient by osmotic pressure from trapped osmotic solutes contained within a semipermeable membrane that allows passage of native fluids from the patient across the membrane for removal of the fluid from the device, the device comprising an implantable reservoir comprising trapped osmotic solutes in fluid communication with a lumen at least partially bounded by a semipermeable membrane for flow of fluid from the patient across the membrane into the device, with the device having only one egress for the trapped osmotic solutes, with a port connected to the reservoir comprising said egress. (xv) The device of (xiv) wherein the port is a percutaneous or transcutaneous access port. (xvi) The device of (xiv) further comprising a filter in the port or a collar on the port. (xvii) The device of (xiv) wherein the reservoir interior is the lumen and the reservoir comprises the semipermeable membrane. (xviii) The device of (xiv) wherein a catheter attached to the reservoir comprises the lumen and the semipermeable membrane. 
     Other embodiments are (xix) A medical device that provides for fluid collection from a patient by osmotic pressure from trapped osmotic solutes contained within a semipermeable membrane that allows passage of native fluids from the patient across the membrane for removal of the fluid from the device, the device comprising an impermeable container containing trapped osmotic solutes in an aqueous solvent and an implant that also comprises the trapped osmotic solutes, the implant comprising a lumen at least partially bounded by a semipermeable membrane for flow of fluid from the patient across the membrane into the device, with the trapped osmotic solutes having a molecular weight greater than a molecular weight cut off of the semipermeable membrane. (xx) The device of (xix) further comprising a transcutaneous access port in the fluid connection between the implant and the reservoir. (xxi) The device of (xix) wherein the access port is the only egress for the trapped osmotic solutes. (xxii) The device of (xix) further comprising a filter in the port or a collar on the port. (xxiii) The device of (xix) wherein the reservoir interior is the lumen and the reservoir comprises the semipermeable membrane. (xxiv) The device of (xix) wherein the implant comprises a catheter that comprises the lumen and the semipermeable membrane. (xxv) The device of (xix) wherein the trapped osmotic solutes have a concentration to produce an osmotic pressure of at least 1.5 psi. (xxvi) A medical system for collection of a fluids comprising a tube with one opening with a wall of the tube comprising a semipermeable membrane. 
     Other embodiments are, e.g., (xxvii) A physiological fluid collection medical system comprising an external reservoir and an internally implantable container that has a lumen at least partially bounded by a semipermeable membrane having a molecular weight cut-off, with the lumen being in fluidly communication with the reservoir to contain trapped osmotic solutes that have a molecular weight greater than the molecular weight cut-off; or (xxviii) A physiological fluid collection medical system comprising an internally implantable container that is in fluid communication with a lumen at least partially bounded by a semipermeable membrane having a molecular weight cut-off to contain trapped osmotic solutes that have a molecular weight greater than the molecular weight cut-off, with the container comprising a percutaneous access port; or (xxix) A physiological fluid collection medical system comprising an insert and an internally implantable container that comprises a port having an opening that leads to an interior of the container, with the insert comprising a lumen at least partially bounded by a semipermeable membrane having a molecular weight cut-off to contain trapped osmotic solutes that have a molecular weight greater than the molecular weight cut-off, wherein the insert is passable through the port and disposable in the container in fluid communication with the container; or (xxx) A fluid collection system comprising a catheter or a needle and an insert that comprises a collar having a bore that opens into a lumen at least partially bounded by a semipermeable membrane to contain trapped osmotic solutes to remove fluids from the patient, with the membrane being joined to the collar, wherein the insert passes at least partially into the catheter or needle and the collar is securable to the catheter or needle; or (xxxi) A method of withdrawing fluid from a patient comprising implanting a device comprising trapped osmotic solutes in a lumen at least partially bounded by a semipermeable membrane to remove fluids from the patient; or (xxxii) A method of treating a wound comprising implanting a fluid collection device that comprises a semipermeable membrane and trapped osmotic solutes in the patient at or near the wound (for instance, in a tissue under an ulcer); or (xxxiii) A method of collecting fluids from a patient comprising placement of a fluid collection device that comprises a semipermeable membrane that at least partially bounds a lumen containing trapped osmotic solutes in the patient, with the lumen being in fluid communication with a transcutaneous port or percutaneous port, wherein the semipermeable membrane has a molecular weight cut-off that is no more than the molecular weight of the trapped osmotic solutes. 
     Other embodiments are one or more of (i) to (xxxiii) in combination with one or more features as follows: (xxxiv) wherein the trapped osmotic solutes are in aqueous solution; (xxxv) wherein the trapped osmotic solute concentration is more than about 4 millimolar; (xxxvi) wherein the trapped osmotic solute is in aqueous solution and has a molecular weight between about 500 and about 40,000; (xxxvii) The collection system of claim  31  wherein the molecular weight cut off is between about 1000 and about 50,000; wherein the container is a tube with one egress for the trapped osmotic solutes, with the egress being in fluid communication with the reservoir; (xxxviii) wherein the external reservoir is a rigid container with a volume of at least 50 ml or at least 200 ml or 100 ml to 5000 ml; (xxxix) wherein the implantable container (or tube or catheter or reservoir) has a volume of between about 55 and about 500 ml (xl) wherein connection of the external reservoir and the implantable container comprises a transcutaneous port that is reversibly connectable to the external reservoir; (xli) wherein the implantable container is an internal catheter that has one egress for the trapped solutes, with the egress being connected to an internally implanted reservoir that is in fluid communication with the lumen and the external reservoir (xlii) wherein the internally implanted reservoir comprises a semipermeable membrane for passage of fluids across the membrane into the reservoir; (xliii) comprising a tube connected to the (optionally internally implanted) reservoir for redirection of fluids out of the internal reservoir; (xliv) wherein the access port (or other port) comprises a self-sealing septum for sealing after puncture by a needle and/or a guard for preventing passage of a needle through the port; (xlv) wherein the lumen is the interior of the container and a wall of the container comprises the semipermeable membrane; (xlvi) wherein the trapped osmotic solutes are in aqueous solution in the lumen; (xlvii) wherein the molecular weight cut off is between about 1000 and about 50,000; (xlviii) wherein the container has a volume of about 55 to about 2000 ml and is made of an elastic biocompatible material impermeable to fluids; (xlix) wherein the implantable container comprises a seat to receive the insert; (1) wherein the seat is located on the port; (li) wherein the catheter comprises two portions that fit together; (lii) wherein the collar comprises threads that cooperate with threads on the catheter or needle; (liii) wherein the catheter or needle wall has a plurality of holes; (xliv) wherein the collar passes fully into the catheter or needle and seats therein; (lv) wherein the collar has threads that engage the catheter or needle without passing into an interior of the catheter or needle; (lvi) The system of claim  50  comprising the needle, with the needle sidewall comprising a plurality of openings (lvii) wherein the device comprises an external reservoir and the membrane is implanted, with the lumen being in fluid communication with the external reservoir, with osmotic pressure in the lumen and reservoir drawing physiological fluid from the patient across the membrane into the lumen and reservoir; (lviii) wherein the external reservoir is placed higher than the implanted membrane such that fluid collected from the patient flows against gravity into the reservoir (lix) wherein the fluid is withdrawn to treat edema; (lx) wherein the edema is upper limb edema resultant from breast cancer surgery; (lxi) wherein the edema results from ascites or congestive heart failure; (lxii) wherein the device is at least partially implanted in a peritoneal space and the fluid is withdrawn from the peritoneal space; (lxiii) wherein the osmotic solutes are present at a concentration to produce a predetermined osmotic pressure of between 1 and 100,000 Torr; (lxiv) wherein the trapped osmotic solutes have an average molecular weight in a range from about 500 to about 100,000; (lxv) wherein the trapped osmotic solutes are polymers; (lxvi) wherein the trapped osmotic solutes are not beads, and/or are not particles; (lxvii) placing a portion of the device that comprises the lumen into a tissue of the patient, wherein the tissue is a peritoneal space, in an arm, in a leg, or at or near a lymph node that collects lung fluids; (lxviii) wherein the port is placed in the patient and the portion of the medical device comprises the lumen is thereafter passed through the port into the patient; (lxix) wherein the port is part of a cage or reservoir and an insert that comprises the lumen in passed through the port and secured to the cage or reservoir; and (lxx) wherein the medical device that comprises the lumen is a catheter. 
     Embodiments include kits. The kits are collections of components designed to cooperate with each other. The kit may be housed in a single package (e.g., box, pouch, shipment box) or delivered as a collection of packages. The kit may have instructions for use of the component or components. Accordingly, an embodiment described herein may be provided as a kit and instructions for the same may also be included. 
     All patents, patent applications, and publications herein are hereby incorporated by reference herein to the extent they do not contradict what is explicitly disclosed herein. The invention has been described in terms of certain embodiments having a variety of features. The features may be mixed-and-matched to make further embodiments as guided by the need to make a functional device.