Abstract:
An apparatus for controllably intermixing two or more components in a sterile, closed environment to produce a flowable substance and then for expelling the flowable substance from the apparatus at a precisely controlled rate. The apparatus is particularly useful for medical applications and includes a dispenser portion with its own stored energy element provided in the form of an elastomeric membrane and a coupling mechanism for coupling a drug vial to the dispenser portion for controlled mixing a medicament contained within the drug vial with a diluent stored within the dispenser portion of the apparatus via a sterile pathway.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to fluid mixing and delivery systems. More particularly, the invention concerns an apparatus for intermixing selected medicaments to form a flowable substance and for then infusing the substance into a patient at a precisely controlled rate. 
     2. Discussion of the Invention 
     Medicament delivering systems that can separately store and then controllably intermix a selected medicament with a diluent for infusion into a patient at a controlled rate have come into wide use. In the prior art systems the diluent is generally packaged in flexible plastic containers having administration ports for connection to an administration set which delivers the container contents from the container to the patient. The drug is often packaged in a separate, closed container and is mixed with the diluent shortly before infusion of the medicament in the patient. 
     Drugs are typically packaged separately from the diluent for a number of reasons. One important reason is that certain drugs do not retain their efficacy when mixed with a diluent and, therefore, the mixture cannot be stored for any appreciable length of time. Another reason is that many drug manufacturers do not produce medical fluids in containers for intravenous delivery. As a general rule, drugs are packaged in powder form in small, closed containers, or vials, for later mixing with a suitable diluent. In many instances it is necessary to mix the drug with the diluent immediately prior to delivery to the patient to insure that the drug will not separate from the diluent prior to or during infusion. 
     Infusion of medicaments is most often accomplished in a hospital environment and the nurse, doctor or other medical personnel mixes the drug and diluent shortly before administration of the drug to the patient. This mixing step can be time consuming and hazardous, as for example, when toxic drugs are used. Additionally, many of the prior art mixing devices are crude and imprecise making accurate, sterile and thorough mixing of the drug and the diluent difficult, time consuming and not well suited for use in the home environment. 
     Several types of closed drug delivery systems are presently in use. These systems typically comprise a flexible container such as a plastic bag to which a drug vial can be coupled. The flexible container usually contains a liquid diluent and often includes a frangible member that allows fluid passage only when broken. When the drug vial is coupled with the flexible container, the stopper of the drug vial is pierced and the frangible member ruptured so as to allow sterile communication between the drug vial and the liquid diluent contents of the flexible container. Mixing of the drug with the diluent is accomplished by manipulating the flexible container. Exemplary of prior art systems of the aforementioned character are those disclosed in U.S. Pat. No. 4,583,971 issued to Bocquet, et al. and in U.S. Pat. No. 4,606,734 issued to Larkin. 
     Another prior art closed delivery and mixing system is disclosed in U.S. Pat. No. 4,458,733 issued to Lyons. The Lyons apparatus includes a compressible chamber with a liquid component therein, the compressible chamber including gas-trapping and reservoir compartments in open communication. The gas trapping compartment can be connected to a container such as a drug vial having a mixing component therein. After a pathway between the vial and the gas trapping compartment is opened, mixing is accomplished through manipulation of the compressible chamber. 
     Another very successful prior art, dual container system is described in U.S. Pat. Nos. 4,614,267 issued to Larkin and 4,614,515 issued to Tripp and Larkin. In this system, a flexible diluent container includes a tubular port which provides means for securing thereto a stoppered medicament vial as well as a stopper removal means. The stopper removal means includes an engagement element, or extractor, which is attached to a removable cover and seals the inner end of the port. In use, as the vial is advanced into the tubular port, the vial stopper moves into engagement with the extractor which grips the stopper enabling it to be pulled from the vial as the cover is pulled from the port. Once the stopper has been removed from the vial, the contents of the vial can be dumped into the diluent in the bag and mixed therewith through manipulation of the bag. 
     The prior art devices of the character described in the preceding paragraphs typically use the traditional gravity flow method for infusion of the medicament mixture into the patient. Such a method is cumbersome, imprecise and typically requires bed confinement of the patient. Also, the flexible bag must be maintained in a substantially elevated position and periodic monitoring of the apparatus by the nurse or doctor is required to detect malfunctions of the infusion apparatus. 
     The apparatus of the present invention overcomes the drawbacks of the prior art by totally eliminating the need for a flexible bag, the cumbersome manipulative mixing of the medicaments using the flexible bag and the undesirable gravity infusion method which is typically followed when the flexible bag is used. As will be described in the paragraphs which follow, the apparatus of the present invention makes use of recently developed gas permeable elastomeric films and similar materials, which, in cooperation with a plate-like base define a fluid chamber that initially contains the first component, such as a diluent. Adjacent the base and in communication with the fluid chamber is a sterile coupling means for operably interconnecting a container such as a drug vial containing the second component. To enable controlled, sterile intermixing of the first and second components, the apparatus includes flow control means for controlling the flow of fluid through internal passageways which interconnect the fluid chamber and the drug vial. 
     The apparatus of the present invention is small, compact, easy to use and inexpensive to manufacture. The apparatus provides a sterile, closed delivery system which can readily be used by ambulatory patients and in home care envorinment. Connector elements are provided on the housing of the device which permits the apparatus to be conveniently affixed to the patient&#39;s clothing or to be strapped to the patients body. 
     The apparatus of the invention can be used with minimal professional assistance in an alternate health care environment, such as the home. By way of example, devices of the invention can be used for intermixing numerous medicaments with suitable diluents and for the continuous infusion of medicament mixtures such as antibiotics, analgesics, hormonal, anticoagulants, clot dissolvers, immuno suppressants, and like medicinal agents. Similarly, the apparatus can be used for I-V chemotherapy and can accurately deliver fluids to the patient in precisely the correct quantities and at extended microinfusion rates over time. 
     SUMMARY OF THE INVENTION 
     It is an object of the present invention to provide a compact, lightweight, low-profile apparatus for controllably intermixing two or more components in a closed environment to produce a flowable substance and then for expelling the flowable substance at a precisely controlled rate. More particularly, it is an object of the invention to provide such an apparatus for medical applications which can be used in either a home care or hospital environment for the precise mixing and infusion of diluents and selected medicaments to an ambulatory patient at controlled rates over extended periods of time. 
     It is another object of the invention to provide an apparatus of the aforementioned character which includes a dispenser portion with its own stored energy means and coupling means for operably interconnecting a drug vial to the dispenser portion for controlled mixing of the medicament within the drug vial with a diluent stored within the dispenser portion via a sterile pathway. 
     Another object of the invention is to provide an apparatus of the class described which permits extremely accurate fluid mixing and delivering, and one which is highly reliable and easy to use by lay persons in a non-hospital environment. 
     Another object of the invention is to provide an apparatus which includes an internal fluid reservoir storage chamber that can be factory prefilled with a diluent or one which can readily be filled in the field shortly prior to use. 
     Another object of the invention is to provide an apparatus of the character described in the preceding paragraph in which the reservoir is provided with an elastomeric energy source that can be subjected to gamma sterilizaton and extended thermal sterilization temperatures without degradation of integrity and performance. 
     Another object of the invention is to provide an apparatus in which intermixed fluids can be delivered to the patient either at a fixed rate or at precisely metered variable rates and one which is operational in all attitudes and altitudes. 
     Still another object of the invention is to provide an apparatus of the class described which includes means for securely interlocking the drug vial with the dispenser portion of the apparatus. 
     Yet another object of the invention is to provide an apparatus as described in the preceding paragraph which is provided with means for attaching the apparatus to the clothing of the patient or to the patients body. 
     A further object of the invention is to provide a low profile, fluid delivery device of laminate construction which can be manufactured inexpensively in large volume by automated machinery. 
     Another object of the invention is to provide a device of the character described in which fluid is dispelled from the apparatus through a cooperating infusion set by a thin, distendable membrane cooperatively associated with a thin, plate-like base. 
     Another object of the invention is to provide an apparatus of the aforementioned character in which the distendable membrane can be a single elastomeric film, a laminate contruction or a composite that is permeable to gases at least in one direction, whereby gases within the intermixed fluids can be released from the fluid chamber and not injected into the patient. 
     Yet another object of the invention is to provide an apparatus of the class described in which a thin, planar filter element is disposed within the fluid chamber for filtering the reservoir outflow to the patient. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a generally perspective view of one form of the drug delivery system of the present invention. 
     FIG. 2 is an exploded perspective view of the device shown in FIG. 1. 
     FIG. 3 is a top plan view of the apparatus shown in FIG. 1 partly broken away to show internal construction. 
     FIG. 4 is a cross-sectional view taken along lines 4--4 of FIG. 3. 
     FIG. 5 is a cross-sectional view taken along lines 5--5 of FIG. 3. 
     FIG. 6 is an enlarged cross-sectional view of the lower right hand portion of the apparatus as viewed in FIG. 3 illustrating construction of the shut-off and metering valve of the apparatus. 
     FIG. 7 is an enlarged cross-sectional view taken along lines 7--7 of FIG. 3. 
     FIG. 8 is a fragmentary cross-sectional view illustrating the first step involved in interconnecting the drug vial with the device of the invention. 
     FIG. 9 is an enlarged fragmentary view illustrating the check valve of the apparatus in a closed position. 
     FIG. 10 is a cross-sectional view similar to FIG. 8 illustrating the second step in the interconnection of the drug vial with the device of the invention. 
     FIG. 11 is a cross-sectional view similar to FIG. 10 illustrating the next step in the interconnection of the drug vial with the apparatus and showing the intermixing of fluids contained within the infusion portion of the device with the medicament contained within the vial which has been interconnected with the infusion portion of the device. 
     FIG. 12 is a cross-sectional view similar to FIG. 11 but illustrating the further step of transferring the intermixed fluids contained within the drug vial to the reservoir of the infusion portion of the device of the invention. 
     FIG. 13 is a cross-sectional view taken along lines 13--13 of FIG. 12. 
     FIG. 14 is an enlarged fragmentary view partly in cross-section illustrating the construction of the valving mechanism of the drug vial. 
     FIG. 15 is a fragmentary cross-sectional view similar to FIG. 10 but showing an alternate embodiment of a drug vial usable with the apparatus of the invention. 
     FIG. 16 is a fragmentary cross-sectional view similar to FIG. 11 and illustrating the intermixing of fluids contained within the infusion portion of the device with the medicament contained within the second form of the drug vial shown in FIG. 15. 
     FIG. 17 is a generally perspective view of another alternate form of the apparatus of the invention. 
     FIG. 18 is fragmentary plan view of the apparatus shown in FIG. 17 partly broken away to show internal construction of the infusion portion of the apparatus prior to the coupling therewith of another form of the drug container or vial. 
     FIG. 19 is an enlarged cross-sectional view illustrating the initial step in mating the drug container shown in FIG. 18 with the infusion portion of the device. 
     FIG. 20 is a cross-sectional view similar to FIG. 11 showing the intermixing of the diluent contained within the infusion portion of the device with the medicament contained within this latest form of drug vial. 
     FIG. 21 is a cross-sectional view similar to FIG. 12 showing the transfer step wherein the intermixed fluids are transferred from the drug vial to the reservior of the infusion portion of the device. 
     FIG. 22 is a fragmentary cross-sectional view taken along lines 22--22 of FIG. 21 showing the means for interlocking the drug vial with the infusion portion of the device. 
     FIG. 23 is a rear perspective view of still another embodiment of the invention. 
     FIG. 24 is a generally perspective front view of the apparatus of the embodiment shown in FIG. 23. 
     FIG. 25 is a generally perspective, exploded view of the apparatus of this latest form of the invention. 
     FIG. 26 is a bottom view of the apparatus. 
     FIG. 27 is a cross-sectional view taken along lines 27--27 of FIG. 26. 
     FIG. 28 is a cross-sectional view taken along lines 28--28 of FIG. 26. 
     FIG. 29 is a cross-sectional view illustrating the initial step in the coupling of the drug container with the infusion portion of the device. 
     FIG. 30 is a cross-sectional view similar to FIG. 11 showing the intermixing of the diluent contained within the infusion portion of the device with the medicament contained within the drug vial. 
     FIG. 31 is a cross-sectional view showing the transfer step wherein the intermixed fluids are transferred to the reservoir of the infusion portion of the device. 
     FIG. 32 is a cross-sectional view taken along lines 32--32 of FIG. 30. 
     FIG. 33 is a cross-sectional view taken along lines 33--33 of FIG. 32. 
     FIG. 34 is a plan view partly broken away to show internal construction of this last form of closed drug delivery apparatus of the present invention. 
     FIG. 35 is a fragmentary cross-sectional view taken along lines 35--35 of FIG. 34. 
     FIG. 36 is a side view, partly in cross-section of the drug vial of this last embodiment of the invention. 
     FIG. 37 is a cross-sectional view illustrating the drug vial coupled with the delivery portion of the device to accomplish the initial mixing step. 
     FIG. 38 is a cross-sectional view showing the transfer of the intermixed fluids within the drug vial to the reservior of the infusion portion of the device. 
    
    
     DESCRIPTION OF THE INVENTION 
     Referring to the drawings and particularly to FIGS. 1 and 2, the apparatus of one form of the the present invention, generally designated by the numeral 12, is used for intermixing a first component contained within a separate container, such as a drug vial 14, with a second component contained within a storage reservoir disposed internally of the infusion portion of the apparatus to form an injectable fluid and then for infusing the fluid into a patient at a controlled rate. In this first embodiment of the invention, shown in FIGS. 1 through 11, the apparatus comprises a housing 16 having a first cylindrical portion 18 and a second infusion device portion 20. 
     As best seen by referring to FIG. 2, first portion 18 includes coupling means for operably coupling container 14 with the infusion portion of the device. Second portion 20 of housing 16, the construction of which will be described in greater detail hereinafter, comprises the infusion device portion of the apparatus and includes a base assembly 21 having a generally planner, plate-like base 22. Base 22 includes a fluid inlet 24 and a fluid outlet 26 which are in communication via a multi-legged fluid passageway 28. Fluid passageway 28 includes a first transversely extending leg 28a which is in communication with fluid inlet 24, a second, spaced-apart transversely extending leg 28b and a pair of longitudinally extending legs, or conduits, 28c which interconnect legs 28a and 28b. Transversely extending leg 28b is in communication with fluid outlet 26 in the manner shown in FIG. 2. 
     Turning also to FIGS. 4 and 5, the apparatus of this form of the invention further includes a distendable membrane 30 constructed of an elastic material. Membrane 30 is adapted to overlay base 22 and cooperate therewith to define one or more duluent storage reservoirs, or chambers 32. Membrane 30 is distendable by fluid introduced under pressure into chamber 32 through a sealable inlet port 33 provided in base 22. The elastic character of membrane 30 is such that the membrane, after being distended has a tendency to return to its original less distended configuration. This causes the fluid to flow outwardly of the apparatus through fluid outlet 26 upon opening the flow control means of the invention. The details of construction of both the flow control means and of membrane 30 will be discussed in the paragraphs which follow. 
     Disposed intermediate distendable membrane 30 and the upper planner surface 22a of base 22 is means for creating an ullage within chamber 32. This means is here provided in the form of a pair of spaced apart outwardly extending protuberances 34. Each of the protruberances 34 is provided with a longitudinally extending first passageway or conduit 36. When the apparatus is assembled in the manner illustrated in FIGS. 4 and 5, passageways 36 are superimposed directly over spaced-apart fluid conduits 28c and the membrane engaging means, shown here as protruberances 34, extend upwardly into fluid chambers 32 defining ullage therewith. In operation of the device, as distendable membrane 30 attempts to return to its less distended configuration, it will move toward engagement with the upper surfaces of protruberances 34 and, in so doing, will efficiently force the fluid contained within chambers 32 into conduits 28c through passageways 36 (FIG. 5). The configuration of protruberances 34 ensure that substantially all of the fluid within chambers 32 will be controllably dispelled therefrom as the membrane returns toward its original planar configuration. 
     Superimposed over distendable membrane 30 is a porous plastic, free venting, structural filler member 40. As best seen by referring to FIG. 5, member 40 is provided with a pair of longitudinally extending, concave channels 42 having interior walls 43 against which membrane 30 initially engages when it is outwardly distended by fluid flowing from an inlet 33 provided in base assembly 21 into chambers 32 under pressure. 
     Superimposed over and sealably enclosing base 22 and member 40 is a cover means shown here as a hard plastic cover 44. Cover 44 includes a first portion 44a which comprises the upper segment of cylindrical portion 18 of housing 16 (FIG. 2). As will be described further hereinafter, cylindrical portion 18 houses the coupling means of the apparatus, which includes first flow control means, for operably coupling the drug vial with the infusion portion of the device. Cover 44 also includes gas venting means here provided as a plurality of apertures 46 formed within the upper wall of cover member 44. When distendable membrane 30 is constructed of a gas permeable material, gas venting means, including apertures 46, permit any gases contained within the fluids introduced into chambers 32 to pass through the gas permeable membrane, through filler 40 and to atmosphere through the gas venting means. A medicament label 48, which may also be permeable to gases, covers vent apertures 46. Forming still another part of cover assembly 44 is a removable belt clip 50 provided with a dovetailed mortise 52 adapted to be slidably receivable over an up-standing mating tenon 54 formed on the upper surface of cover member 44. 
     Base assembly 21 also includes an outlet port 56 which is normally closed, by a removable cover member 58. Outlet port 56 is in communication with fluid outlet 26 via a conduit 57. Outlet port 56 is also in communication with a transversely extending passageway 60 which terminates at its outer end in an opening 62 (FIG. 2). Receivable within opening 62 is an outlet flow control means shown here as a shut-off and fluid metering means 63 which comprises a needle valve of standard construction having an elongated valve stem or member 64 which is closely receivable within passageway 60 (FIGS. 2 and 6). Provided at one end of stem 64 is a control knob 66. Provided at the opposite end is a tapered portion 68 adapted to cooperate with a valve seat 69 provided on base 22 for either substantially blocking or for controllably restricting the flow of fluid outwardly of the device through conduit 57 and outlet port 56. As best seen in FIG. 6, passageway 60 is internally threaded to threadably receive external threads 70 formed on stem 64. With this construction, by rotating control knob 66, valve member 64 can be moved axially of passageway 60 to controllably move tapered portion 68 of the valve relative to passageway 57 and into engagement with valve seat 69 so as to control fluid flow through passageway 57. An 0 ring 67 is provided to seal stem 64 relative to passageway 60. 
     Turning now to FIG. 8, the construction of the container, or drug vial portion 14 of the apparatus of the present invention, is there illustrated. In this form of the invention, the container includes second flow control means for controlling the flow of fluid into and out of an internal chamber 75 of a vial 76, Closely received over vial 79 is a plastic cover, or overpackage 78 which is provided with vial interlocking means shown here as a pair of spaced apart, circumferentially extending safety interlocks 80 and 82, the purpose of which will presently be described. Each of the circumferentially extending interlocks 80 and 82 is provided with a radially outwardly extending flat surface 83 which is adapted to lockably engage one of a pair of spaced apart annular stops 18a and 18b provided internally of cylindrical portion 18 (see also FIG. 2). Annular stops 18a and 18b comprise novel stop means which are adapted to interengage the vial interlocking means provided on the drug vial assembly to prevent removal of the drug vial from cylindrical portion 18 after it has been introduced and mated therewith. 
     The second flow control means of this first form of the invention comprises a plunger 86 which is substantially sealably receivable within vial 76. Vial 76 is movable relative to plunger between a first position shown in FIGS. 8 and 10 and a second position shown in FIG. 11 and from the second position to a third position shown in FIG. 12. Plunger 86 is generally cylindrical in shape having a skirt portion 86a adapted to substantially sealably engage the inner walls of vial 76. Plunger 86 also includes fir st connector means, or interengagement means, shown here as threads 86b, for interconnection with the coupling means of the apparatus. Disposed within a central passageway 86c formed interiorly of the plunger is a plunger valve means here provided as a valve assembly 88. Referring also to FIG. 14, valve assembly 88 includes a cylindrically-shaped central portion 90 closed at one end by a disk-shaped member 92. Fluid passageways 94 are provided through the cylindrical wall of central portion 90 proximate member 92, which member is preferably integrally formed with portion 90. Provided at the opposite end of central portion 90 is an annular shaped member 96. 
     As best seen in FIGS. 8 and 10, plunger 86 is provided with a central portion 87 which includes spaced-apart, radially, inwardly extending seats or shoulders 100 and 102. When the valve assembly 88 is in the closed position shown in FIG. 8, the periphery of member 92 is substantially sealably seated against shoulder 100 and annular portion 96 is spaced apart from shoulder 102. On the other hand, when the valve is in the open position shown in FIG. 10, the periphery of member 92 is spaced apart from shoulder 100 and annular portion 96 of the valve member is in engagement with shoulder 102. If desired, central portion 90 can be constructed to provide support to a stem 106 as stem 106 moves axially of the central body portion. With the valve in the open position shown in FIG. 10, fluid can flow from the central passageway 103 of the valve through radially extending passageways 94 and into the vial in the manner indicated by the arrows of FIG. 10. 
     Valve assembly 88 is moved from the closed position into the open position by operating means, here comprising a plunger stem portion 106 which is integrally formed with disk-shaped member 92 and, as shown in FIGS. 8 and 14, extends axially of valve passageway 103. As will be presently described, the operating means functions to operate the first and second control means of the invention, including valve assembly 88, for controlling the flow of fluid into and out of drug vial 14. 
     Before discussing the mode of operation of the operating means, the previously identified coupling means for coupling the container 14 with portion 18 of the housing will be discussed. As best seen by referring to FIGS. 2, 3, and 8, the coupling means here comprises a sterile coupling assembly 110 which is supported centrally of cylindrical housing portion 18 by a rigid coupling support 111 which extends transversely of housing portion 18. Coupling assembly 110 comprises an outer cylindrical portion 112 having second connector means or internal threads 113 and a co-axially aligned, inner cylindrical portion 114. Inner portion 114 is held rigidly in position within outer portion 112 by means of a circular shaped end wall 116 (FIG. 8). As best seen by also referring to FIG. 2, end wall 116 is closely received within a recess or socket 118 formed in coupling support 111. Also forming a part of coupling support 111, is a radially extending connector element 120 having an internal fluid passageway 122 which is adapted to communicate with inlet 24 of base 22 when support 111 is positioned within cylindrical portion 18 in the manner shown in FIGS. 3 and 8. Passageway 122 communicates with a passageway 124 which is defined by the interior walls of cylindrical portion 114. A smaller diameter fluid passageway 126 joins passageway 124 at a value seat defining, tapered wall portion 128 (FIG. 8). 
     Turning also to FIG. 9, a coupling valve means, generally designated by the numeral 136, which also forms a part of the coupling means of the present invention, is reciprocally movable within passageway 124 and functions to control the flow of fluid through passageway 126 in a manner presently to be described. As indicated in FIGS. 8 and 9, coupling valve means 136 includes a valve element 137 having a body portion 138 and a coupling stem portion 140. At the junction of portions 138 and 140 is a tapered wall 142 which is adapted to substantially sealably engage the valve seat defined by tapered wall portion 128 when the valve is in the closed configuration shown in FIG. 8. When the apparatus of the invention is in a storage mode, the open end of coupling 110 is closed by a removable sealing cap 130 which is provided with a pull tab 132 for use in removing the cap from the sterile coupling (FIG. 2). 
     In operating the apparatus of the invention, the drug vial closure cap 146 (FIG. 2) is first removed from the drug vial 14. This done the closure cap 130, which closes the passageway of the sterile closure element 110, is removed and the open end of the drug vial 14 is inserted through open end 148 of cylindrical portion 18 (FIG. 8). As the drug vial 14 is received within open end 148, locking member 80 on the overpackage will slip past stop member 18a on cylindrical portion 18 and threads 86b will move into mating engagement with threads 113 provided on coupler member 112. Rotation of the drug vial in a clockwise direction will cause the plunger to couple with coupling member 112 in the manner shown in FIG. 10. As the parts are coupled together, stem 106 of the container valve will engage stem 140 of valve means 136 simultaneously axially moving both valve member 137 of the first flow control means and valve member 92 of the second flow control means into the open position shown in FIG. 10. With the valves of the flow control means in this position, distendable membrane 30 will cause the fluid contained within chambers 32 to flow under pressure past the valve seat 128 into fluid passageway 126 of the coupler means and then into passageway 103 of the container valve means. The fluid under pressure will next flow through radially extending passageways 94 of the container valve and rapidly into the interior of container 76 in the manner shown by the arrows in FIG. 10. This rush of fluid under pressure into the drug vial initiates the mixing or reconstitution process. 
     As illustrated in FIG. 11, the fluid flowing into the drug vial will mix with the medicament M contained within the vial in the manner shown to form a flowable substance comprising a mixture of the liquid which was stored within chambers 32 and the medicament M which was stored within the drug vial. It is important to note that, as the fluid under pressure rushes into the drug vial, the drug vial will move outwardly into the position shown in FIG. 11 wherein surface 83 of the vial locking means or locking member 80 provided on the plastic overpackage will engage first stop means or member 18a provided interiorly of cylindrical housing portion 18. It is to be noted that in this position, the plunger 86 has travelled from an intermediate position within vial 76, as shown in FIG. 8, to an outward position shown in FIG. 11 wherein plunger 76 is located proximate the open mouth of the glass container 76. Contained air, if any, within vial 76 assists in the turbulent mixing process. 
     The reconstituted mixture, the medicament M stored within container 14, and residual air if any is next transferred back into the infusion device reservoir by exerting an inward pressure on the drug vial in the direction of the arrow 150 of FIG. 12. As the drug vial 14 is reinserted into cylindrical portion 18, the reconstituted mixture contained in the drug vial is directed through radial passageways 94, of the drug vial valve into passageway 103 of the valve, into passage 126, passed valve seat 128 and into passageway 124 of the coupling means. The fluid will then flow into chambers 32 via passageways 122 and 28 (FIG. 5). Entrained air, if any, will vent to atmosphere through gas permeable elastomeric membrane 30 by the permeation transport process. As illustrated in FIG. 13, the interior wall of inner cylindrical member 114 of the coupling means is provided with a plurality of circumferentially spaced fluid passageways 152 to facilitate flow of fluid to and from the chambers 32 provided within the drug infusion portion of the apparatus. 
     It is to be observed from FIG. 12 that continued inward pressure exerted on the drug vial 14 will cause locking member 80 provided on overpackage 78 to slip past and lockably engage second stop member 18b provided internally of cylindrical chamber 18. Similarly locking member 82 will slip past first stop member 18a of cylindrical portion 18 and lock against locking member 18a. With the parts of the apparatus in the configuration shown in FIG. 12, the drug vial 14 is non-removably locked in position within cylindrical chamber 18 of housing 16. 
     The flow of the reconstituted mixture of the first and second components contained within the vial 14 into chambers 32 due to the telescopic movement of the drug vial into cylindrical portion 18 will urge the partially distended membrane 30 into the distended configuration shown in FIG. 5. Once distended, membrane 30 will continuously exert a pressure on the now fully intermixed fluid contained within chambers 32 so that upon the removal of cap 58 and the opening of needle valve 64, the newly reconstituted drug and diluent comprising the combined intermixed fluid components will be infused into the patient at a controllable rate through any suitable interconnection means such as an infusion needle connected to the conduit shown in dotted lines in FIG. 1 and designated by the numeral 154. As previously discussed, the rate of infusion of the liquid from the apparatus of the invention into the patient can be precisely controlled through the manipulation of the needle valve 64. 
     Contributing to the superior performance of the apparatus of the invention are the several state-of-the art materials used in the construction of the apparatus. These materials markedly contribute to the reliability, accuracy and manufacturability of the apparatus. Before discussing the alternate forms of the invention shown in the drawings, a brief review of the materials used in constructing the apparatus of the invention is in order. 
     With respect to the base 22 and cover 44, a wide variety of materials can be used, including; metals, rubber or plastics that are compatible with the liquids they contact. Examples of such materials are stainless steel, aluminum, latex rubber, butyl rubber, nitrile rubber, polyisiprene, styrene-butadiene copolymer, silicones, polyolefins such as polypropylene and polyethylene, polyesters, polyurethane, polyamides and polycarbonates. 
     Considering next the elastic distendable membrane 30, this important component can be manufactured from several alternate materials including rubbers, plastics and other thermoplastic elastomers. These include latex rubber, polyisoprene (natural rubber), butyl rubber, nitrile rubber, polyurethanes, Ethylene-Butadiene-Styrene Copolymers, Silicone modified Polyurethanes, fluorocarbon elastomers, fluorosilicones, fluoralkoxyphosphazene ploymers and other polymer multicomponent systems including copolymers (random, alternating, block, graft, crosslink and starblock), mechanical poly-blends and interpenetrating polymer networks. 
     Examples of materials found particularly well suited for this application include; silicone polymers (polysiloxanes) and high performance silicone elastomers made from high molecular weight polymers with appropriate fillers added. These materials are castable into thin film membrances and have high permeability (which allows maximum transport of vapor and gas), high bond and tear strength and excellent low temperature flexibility and radiation resistance. Additionally, silicone elastomers retain their properties over a wide range of temperature (-80° to 200° C.) are stable at high temperatures, and exhibit tensile strengths up to 2,000 lb./in 2  elongation up to 600%. 
     Further, silicone (polyorganosiloxanes) are thermally stable, hydrophobic organometallic polymers with the lowest P--P interaction (of all commercially available polymers. This fact coupled with the flexibility of the backbone results in a low Tg (-80° C.) and an amorphous rubbery structure for the high MW (polydimethylsiloxanes). Silicone rubber membranes are considerable more permeable to gases than membranes of any other polymer. Depending on the medicinal fluid used and the filling of the storage mode, which will determine the desired mass transport characteristics of the membrane (permeability and selectivity), other materials of choice include polyurethane-polysiloxane copolymers, blends and IPN&#39;s. By example, polydimethylsiloxane (PDMS) and polyurethane (PU) multicomponent IPN containing 10%-20% weight of PU shows enhanced initial modulus relative to that of PDMS itself. 
     Interpenetrating polymer networks (IPNS) are unique blends of cross-linked polymers containing essentially no covalent bonds, or grafts between them. True IPNS are also homogeneous mixtures mixtures of component polymers. Further examples of an additional candidate materials would be a polyurethane-polysiloxane (IPN) bilaminated with a polyparaxylene or alternately bilamination of polydimethylsiloxane (PDMS) and polyparaxylene. Coextruded laminates of this type can be selected according to the desired gas permeability for vapor and O 2 , N 2  and CO 2  diffusion and their specific selectivity requirements as well as for direction of gas migration when appropriately layered. Additionally, interfacial surface layers of various materials of on the order of 5 to 20 angstroms thick can be provided on the membrane to establish a biocompatible interface without substantially effecting the membrane permeation rate. 
     With respect to the structural filter 40, many types of porous plastic materials can be used. In certain embodiments of the invention, this component can be produced from one of several polymer groups. The plastic structure of this component typically contains an intricate network of open celled omni directional pores. The pores can be made in average sizes for 0.8 micron to 2,000 micron and, gives the porous plastic a unique combination of venting and structural strength. Further, the material is strong, lightweight, has a high degree of chemical resistance and, depending on the particular configuration of the apparatus, can be flexible. The degree of hardness can range from soft, resilient or rigid, and depending on the specific micro diameter range desired, the following polymers can be employed: Polypropylene(PP), Ultra high molecular weight polyethylene (UHMW PE), High density polyethylene (HDPE), Polyvinylidene Fluoride (PVDF), Ethylene-vinyl acetate (EVA), Styrene Acrylonitrile (SAN), Polytetrafluoroethylene (PTFF). 
     An alternate material for use in constructing the cover 40 and base 22 so as to serve as a non-permeable gas barrier, is a material sold by B-P Chemicals International of Cleveland, Ohio, under the name and style &#34;Barex&#34;. This material, is a clear rubber modified Acrylonitrile Copolymer which has wide application in the packaging industry because of its superior gas barrier, chemical resistance and extrusion (thermoforming) and injection molding capabilities. Structures using this or similar barrier materials can be manufactured in either monolayer or coextrusion (with such other materials as polyethylene, polypropylene, polystyrene and other modified styrenes). Combinations of different materials can be used to enhance the desired physical properties of the thermoformed part. 
     Turning now to FIGS. 15 and 16, a second embodiment of the present invention is there shown. In this form of the invention, the first and second portions of the housing, and the infusion device portion of the apparatus are identical in construction and operation to those of the first embodiment just described and like numbers are used to identify like components. However, the container assembly, generally designated in FIGS. 15 and 16 by the numeral 200, is somewhat different. 
     Container assembly 200 comprises a glass vial 202 having a chamber 204 for containing a medicament M. A plastic cover or overpackage 206 is closely received over vial 202 and includes first and second locking members 208 and 210 which are identical to locking members 80 and 82 as previously described. Housed within vial 202 is the second flow control means of this form of the invention for controlling the flow of fluid into and out of chamber 204. Here the second flow control means comprises a plunger 212 substantially sealably received within vial 202. Plunger 212 is of generally similar construction to plunger 86 being cylindrical in shape and having a skirt portion 214 adapted to substantially sealably engage the inner wall, of vial 202. Plunger 212 also includes similar connector means shown here as threads 216 for interconnection with threads 113 provided on coupling number 112. 
     In this second form of the invention, however, plunger 212 has an internal passageway 218 which is normally blocked by a transversely extending, frangible or pierceable diaphragm 220. A first valve means, here provided as a valve assembly 222, is disposed within passageway 218 and, in cooperation with diaphragm 220, controls fluid flow through passageway 218. Plunger 212 includes an inwardly extending flange 224 against which a flange 226 provided on valve assembly 222 normally seats (FIG. 15). Valve assembly 222 also includes a stem 228, which, in this form of the invention, comprises a part of the operating means for operating the coupling valve and the plunger valve. A fluid passageway 230 surrounds stem 228. Stem 228 is integrally formed with the plunger body which terminates in a point 232. As indicated in FIG. 15, when valve assembly 222 is in the normal position shown in FIG. 15, point 232 is in engagement with diaphragm 220. 
     In operating the apparatus of this second form of the invention, when plunger 214 is threadably connected to coupler member 112 in the manner shown in FIG. 16, valve assembly 222 will be moved to the right by stem 140 of the coupling valve 136 and diaphragm 220 will be ruptured. At the same time, valve 136 will be axially moved into the open position permitting the fluid contained within the reservoir of the delivery portion of the device to flow through passageways 230 into chamber 204 of the vial 202 and to mix with the medicament M. The fluid under pressure flowing from the reservoir of the delivery portion of the device forces the container assembly outwardly to the position shown in FIG. 16 with locking member 208 engaging stop member 18a provided on the first portion 18 of housing 16. After this reconstitution process, the reconstituted fluid is forced into the reservoir of the delivering portion of the device in the manner previously described by pushing the container assembly to the left as shown in FIG. 16 and into a locked position similar to that shown in FIG. 12 and earlier described. 
     Turning now to FIGS. 17 through 22, still another form of the invention is there illustrated. The infusion device portion of this embodiment of the invention is substantially identical in construction and operation to that of the first two forms of the invention, and like numerals are used to identify like component parts. However, the coupling portion of the device is slightly different, as is the construction of the drug vial assembly identified here by the numeral 300. 
     The infusion device portion of this third embodiment of the invention also includes a base assembly 21 having a generally planner base 22. Base 22 has a fluid inlet 24 and a fluid outlet 26 (not shown) which are in communication via a multi-legged fluid passageway 28. As before, fluid passageway 28 includes a first transversely extending leg 28a which is in communication with fluid inlet 24, a second, spaced-apart, transversely-extending leg 28b (not shown) and a pair of longitudinally extending legs, or conduits, 28c which interconnect legs 28a and 28b. Transversely extending leg 28b is in communication with fluid outlet 26 in the manner shown in FIG. 2. 
     The apparatus of this form of the invention also includes a distendable membrane 30 constructed of an elastic material. Membrane 30 is adapted to fit over base 22 in the manner previously described and cooperates therewith to define one or more diluent storage reservoirs, or chambers 32 of the character shown in FIG. 5. Membrane 30 is distendable by fluid introduced under pressure into chambers 32 through a sealable inlet port 33 provided in base 22 (FIG. 18). As in the previously described embodiments, the elastic character of membrane 30 is such that the membrane, after being distended has a tendency to return to its original less distended configuration. This causes the fluid to flow outwardly of the apparatus through the fluid outlet port upon opening the flow control means of the invention. 
     Disposed intermediate distendable membrane 30 and the upper planner surface 22a of base 22 is means for creating an ullage within chambers 32. This means is once again provided in the form of a pair of spaced-apart, outwardly extending protuberances 34. Each of the protruberances 34 is provided with a longitudinally extending first passageway or conduit 36. When the apparatus is assembled in the manner illustrated in FIGS. 4 and 5, passageways 36 are superimposed directly over spaced-apart fluid conduits 28c and membrane engaging means, shown here as protruberances 34, extend upwardly into fluid chambers 32 defining ullage therewithin. The operation of the distendable membrane 30 to efficiently force the fluid contained within chambers 32 outwardly of the device through outlet 56 is as previously described. The construction and operation of the outlet flow control means, or shut off and fluid metering means 63 is also as previously described. 
     Superimposed over distendable membrane 30 is a porous plastic, free venting, structural filler member 40 (not shown in FIG. 17), which, in turn, is covered by a cover 44 of the character previously described. 
     The first portion of the housing, designated in FIG. 17 by the numeral 302, is of a slightly different construction than first housing portion 18. Rather than being provided with stop members 18a and 18b of the character shown in FIG. 2, first housing portion 302 is here provided with internal threads 304, the purpose of which will presently be described. Portion 302 is also provided with container locking means shown here as resilient ratchet teeth 306 which interface and interlock with mating ratchet teeth 308 provided on the drug vial container assembly. 
     The coupling means of this third form of the invention is substantially identical to the coupling means of the earlier described embodiments and comprises a sterile coupling assembly 110 which is supported centrally of cylindrical housing portion 302 by a rigid coupling support 111 which extends transversely of housing portion 302. Coupling assembly 110 comprises an outer cylindrical portion 112 having internal threads 113 (FIG. 19) and a coaxially aligned inner cylindrical portion 114. As before, inner portion 114 is rigidly held in position within outer portion 112 by means of a circular shaped end wall 116 (FIG. 19). As best seen by also referring to FIG. 19, end wall 116 is closely received within a recess or socket 118 formed in coupling support 111. Also forming a part of coupling support 111, is a radially extending connector element 120 having an internal fluid passageway 122 which is adapted to communicate with inlet 24 of base 22 when support 111 is positioned within cylindrical portion 302 in the manner shown in FIGS. 17 and 18. 
     Turning to FIG. 19, passageway 122 communicates with a passageway 124 which is defined by the interior walls of cylindrical portion 114. A smaller diameter fluid passageway 126 joins passage 124 at a valve seat defining tapered wall portion 128. A valve means, generally designed by the numeral 136, which is of the character previously described, is reciprocally movable within passageway 124 and functions to control the flow of fluid through passage 126 in a manner presently to be described. As indicated in FIGS. 8 and 9, valve means 136 includes a valve element 137 having a body portion 138 and a stem portion 140. At the junction of portions 138 and 140 is a tapered wall 142 which is adapted to substantially sealably engage the valve seat defined by tapered wall portion 128 when the valve is in the closed configuration shown in FIG. 19. When the apparatus of the invention is in a storage mode, the open end of coupling 112 is preferably closed by a removable sealing cap 130 of the character shown in FIG. 1. 
     In this form of the invention shown in FIGS. 17 through 21, container assembly 300 includes second flow control means for controlling the flow of fluid into and out of an internal chamber 309 of a glass vial 310 (FIG. 19) which contains the medicament M. The second flow control means of this form of the invention is similar in construction and operation to that previously described and includes a plunger 86 which is substantially sealably receivable within vial 310. Plunger 86 also includes connector means, shown as threads 86b, for interconnection with the coupling means of the apparatus. As before, valve assembly 88 controls fluid flow through passageway 86c formed within plunger 86 and is operated by operating means of the character previously described. However, as seen in FIGS. 19 and 20 plunger 86 includes circumferentially extending, annular channel portions 89 and 91 which substantially sealably engage members 92 and 96 respectively of member 90. 
     Glass vial 310 is enclosed in a multi-part cover, or overpackage 312 which surrounds vial 310 and includes the previously identified, circumferentially extending ratchet teeth 308. Provided proximate the open end of cover 312 are external threads 314 which are adapted to mate with internal threads 304 provided within cylindrical portion 302 of the apparatus housing. Vial 310 (FIG. 18) is closed by a tear-away removable closure cap such as 311 which is integrally formed with the forward part 312f of overpackage 312. 
     In operating the apparatus of this third form of the invention, vial closure cap 311 is first removed from the drug vial assembly 300. This done closure member 130, which closes the passageway of the sterile closure element 110, is also removed and the open end of the drug vial assembly 300 is inserted into open end 148 of cylindrical portion 302 (FIG. 19). As the drug vial 310 is received within open end 148, threads 314 will move toward a first internal thread 304a provided within cylindrical portion 302 (FIG. 19). Simultaneously threads 86b will move toward mating engagement with threads 113 provided on coupler member 112. Rotation of the drug vial in a clockwise direction will cause threads 314 to mate with first internal thread 304a and will cause threads 86b on plunger 86 to mate with threads 113 on coupling member 112 in the manner shown in FIG. 20. Teeth 308 provided on overpackage 312 will also move to a location proximate ratchet teeth 306. As the plunger couples with member 112, stem 106 of the container valve will engage stem 140 of valve means 136 simultaneously moving both valve member 137 of the first flow control means and valve member 92 of the second flow control means into the open position shown in FIG. 20. With the valves of the flow control means in this open position, distendable membrane 30 will cause the fluid contained within chambers 32 to flow under pressure past the valve seat 128 into fluid passageway 126 of the coupler means and then into passageway 103 of the container valve means. The fluid under pressure will next flow through radially extending passageways 94 of the container valve and rapidly into the interior 309 of the glass container 310 in the manner shown by the arrows in FIG. 20. This flow of fluid under pressure into the drug vial initiates the mixing or reconstitution process. 
     As depicted by the arrows in FIG. 20, the fluid flowing into the drug vial will thoroughly mix with the medicament M contained within the vial in the manner shown to form a drug active flowable substance comprising a mixture of the diluent stored within chambers 32 and the medicament M which was stored within the drug vial. 
     After the medicament M is mixed with the diluent, the drug vial assembly is once again rotated in a clockwise direction. During this further rotation, threads 314 on the drug vial will move through a circumferentially extending space 316 provided within cylindrical portion 302. As shown in FIG. 20, space 316 functions as a dwell space and is located intermediate first thread 304a and threads 304. Continued clockwise rotation of the drug vial assembly will cause threads 314 to mate with threads 304 moving the drug vial assembly from the position shown in FIG. 20 to the seated position shown in FIG. 21. Ratchet teeth 308 on the overpackage will also mate with resilient ratchet teeth 306 provided within housing portion 302. As best seen in FIG. 22, ratchet teeth 306 are constructed so that they are yieldably deformable in a manner to permit the drug vial assembly to be freely rotated in a clockwise direction, but are designed to engage teeth 308 in the manner shown in FIG. 22 to preclude block counter-clockwise rotation of the vial assembly. With this construction, once the drug vial assembly is mated with cylindrical housing portion 302 it cannot be easily removed. 
     Movement of the drug vial assembly into the position shown in FIG. 21 causes the reconstituted mixture to be transferred back into the infusion device via passageways 94, 103, 126, 124, 122 and 28 for introduction into chamber 30 and further mixing with the diluent and for later infusion into the patient in the manner previously described. 
     A label covering the peripheral surface of overpackage 312 and joining the forward and rear portions 312f and 312r, can be provided with indicia in the form of numbers, color codes, or the like, to indicate the interconnection, reconstitution and transfer location function of the vial assembly with respect to cylindrical housing 302. Such indicia are useful in training lay persons in the operation of the apparatus. 
     Referring to FIGS. 23 through 33, another embodiment of the invention is there illustrated. This fourth form of the invention is quite different in overall appearance, but similarly includes a drug vial or container assembly of identical construction and operation to that of container assembly 300 of the third form of the invention. Accordingly, like numerals are used in FIGS. 23 through 33 to identify like container assembly component parts. The coupling members of the coupling means of the present form of the invention are also identical to those previously described in connection with FIGS. 17 through 22. However, the cylindrically shaped first portion of the apparatus housing which houses the coupling means, here identified by the numeral 400, is of slightly different construction, as is the second housing portion that houses the infusion portion of the device. The device of this fourth form of the invention is generally larger than the devices of the earlier described embodiment and is designed to dispense larger volumes of medicaments. 
     Turning particularly to FIGS. 23, 24 and 25, the second or infusion portion, generally designated by the numeral 402, comprises a base assembly 404 which includes a curved base member 406 having front and back surfaces 408 and 410. The central portion 407 of base member 406 is provided with a multiplicity of small, crossing fluid flow micro-channels 412 which communicate with a longitudinally extending, central collection fluid passageway 414 having spaced-apart portions 413 and 416 (FIG. 29). The function of these channels and parts will be described presently. The side portions 418 of base member 406 are provided with spaced-apart apertures 420 which can be used to grip the device during handling or can accept straps for use in connecting the device to the patients body. 
     A thin, generally planar distendable elastomeric membrane, or member, 430 is termally bound and cooperates with central portion 407 of base 406 to form a chamber 432 (FIG. 27). Member 430 is distendable out of plane in the manner shown in FIG. 27 by the introduction of fluid into the chamber under pressure. As the distendable member 430 is distended by fluid pressure, internal stresses are formed in the member which continuously urge it to return to its original less distended configuration. 
     Forming an important aspect of this latest form of the apparatus of the invention is the provision of filter means which is disposed internally of chamber 432 for filtering fluids flowing from chamber 432 into fluid passageways 412 formed in base member 406. The filter means also functions as an interfacial bubble trap. In the embodiment of the invention hereshown, the filter means is provided in the form of a thin, micro-porous film laminate or composite membrane 434 which is fitted over the front surface 408 of base 406 in the manner shown in FIG. 27. Front surface 408 provides support means for filter 434. Membrane 434 can be constructed from a wide variety of filtering materials of a character well understood by those skilled in the art, including Cellouous Acetate, Polytetraflouroethylene, Polypropylene, Polyvinylidene Fluoride and Polyurethane/Polyethylene Composite. 
     Superimposed over distendable membrane 430 is a porous plastic, free venting, structural filler member 436. As best seen by referring to FIG. 27, member 436 is provided with a centrally disposed, longitudinally extending, concave channel 438 having an interior wall 440 against which membrane 430 initially engages when it is maximally, outwardly distended by fluid flowing into chamber 432 under pressure. Member 436 can be constructed of the same materials as previously described in connection with member 40. 
     Extending over and sealably enclosing member 436 is a cover means shown here as a hard plastic cover 442. Cover 442 includes gas venting means here provided as a plurality of apertures 444 formed within the upper wall of the cover member. When distendable member 430 is constructed of a material of high gas permeability, gas venting means, including apertures 444, permit gases contained within the fluids, if any, then introduced into chamber 432 to pass through the gas permeable membrane, through filler 436 and to atmosphere through the gas venting means. A medicament label 446 having a removable portion, covers vent apertures 444. In certain applications, the cover and base can be constructed of similar materials of the character previously described. 
     Base assembly 404 also includes an outlet or delivery port 448, which is normally closed, by a removable cover member 450. Outlet port 448 is in communication with fluid passageway 414 and an outlet 417 via a conduit 452 (FIG. 28). Outlet port 448 and passageway 452 are also in communication with a transversely extending passageway 454 formed in base 406 which terminates at its outer end in an opening 456 (FIG. 28). Receivable within opening 456 (FIG. 23) is an outlet flow control means shown here as is a shut-off and fluid metering means of the character previously discussed herein and identified in FIGS. 2 and 6 by the numeral 63. In the manner previously described, needle valve means 63 functions to either substantially close or to controllably restrict the flow of fluid outwardly of the device through passageway 414 and outlet port 448. As seen in FIG. 28, passageway 454 is internally threaded to threadably receive external threads 458 formed on a stem 460. With this construction, by rotating a control knob 462 attached to stem 460, the valve member can be moved axially of passageway 454 to controllably move tapered portion 464 provided on stem 460 proximate its inner end relative to passageway 454 and into engagement with a valve seat 464a provided in base 406 (FIG. 28). An O-ring 463 is provided to seal stem 460 relative to passageway 454. Alternatively to, or in conjunction with, the needle valve, passageway 452 can be initially sealed by an internal structural septum 465 (FIG. 23) which can be pierced by an IV administration set piercing spike. This type of recipient port a septum structure is well known in the art. 
     Turning to FIGS. 23 and 29, the construction of the container assembly 300 can be seen to be of similar construction to that shown in FIGS. 17 through 22. The container assembly, the details of construction of which will not be repeated here, is receivable within cylindrical housing portion 400 and the plunger 86 is initially mated with the coupling member 112 in the manner previously described (See also FIGS. 32 and 33). In this latest form of the invention, cylindrical portion 400 is integrally connected to the back or concave surface 410 of base member 406 by means of a connector flange 470 (FIG. 23). Portion 400 also includes a transversing extending base wall 471 having a socket 473 which supports coupling member 112 in a manner best seen in FIG. 30. Base wall 471 is provided with a passageway 477 which communicates with passageway 124 of coupling member 114 and with passageway 414 of base 402 via port 415. Similarly, an outlet passageway housing 472 and a needle valve housing 474 extend angularly outwardly from back surface 410 (FIGS. 26 and 28). It is to be noted that the front surface 408 of base member 406 is provided with an upstanding mounting boss 475 which surrounds port 415 and to which filter 434 is bonded. Filter 434 is provided with an aperture 434a which peripherally receives boss 475 so that fluid can flow freely through port 415 between channel 414 and chamber 432. (FIG. 25). 
     In operating the apparatus of this fourth form of the invention, the device is held by one of the side portions 418 and, with the vial closure cap and the cap which closes the passageway of the sterile coupling element 110, removed, the open end of the drug vial assembly 300 is inserted into open end 401 of cylindrical portion 400 (FIG. 23). As best seen by referring to FIGS. 29 and 30, as the drug vial 310 is received within open end 401, threads 314 will move toward a first internal thread 403a provided within cylindrical portion 400. Simultaneously threads 86b will move toward mating engagement with threads 113 provided on coupler member 112. Rotation of the drug vial in a clockwise direction will cause threads 314 to mate with first internal thread 403a and will cause threads 86b on plunger 86 to mate with threads 113 on coupling member 112 in the manner shown in FIG. 30. Teeth 308 provided on overpackage 312 will also move to a location proximate ratchet teeth 405 provided on cylindrical housing portion 400. As the plunger couples with member 112, stem 106 of the container valve will engage stem 140 of valve means 136 simultaneously moving both valve member 137 of the coupling flow control means and valve member 92 of the container flow control means into the open position shown in FIGS. 30 and 33. With the valves of the flow control means in this open position, distendable membrane 430 will cause the fluid contained within chamber 432 to flow under pressure through port 415 (FIGS. 25 and 30) into passageway 477, into passageway 124, past the valve seat 128 into fluid passageway 126 of the coupler means and then into passageway 103 of the container valve means. The fluid under pressure will next flow through radially extending passageways 94 of the container valve and rapidly into the interior 309 of the glass container 310 in the manner shown by the arrows in FIG. 30. This flow of fluid under pressure into the drug vial initiates the mixing or reconstitution process. 
     As depicted by the arrows in FIG. 30, the fluid flowing into the drug vial will thoroughly mix with the medicament M contained within the vial in the manner shown to form a flowable substance of drug active concentrate comprising a mixture of the diluent stored within chamber 432 and the medicament M which was stored within the drug vial. 
     After the medicament M is mixed with the diluent, the drug vial assembly is once again rotated in a clockwise direction in the manner shown in FIG. 31. During this further rotation, the vial will move through a circumferentially extending space 479 provided within cylindrical portion 400. As before, space 479 functions as a dwell space and is located intermediate first thread 403a and threads 403. Dwell space 479 provides momentary residence time allowing system back-filling and drug reconstitution. Continued clockwise rotation of the drug vial assembly will cause threads 314 to mate with threads 403 moving the drug vial assembly from the position shown in FIG. 30 to the position shown in FIG. 31. Ratchet teeth 308 on the overpackage will also mate with resilient ratchet teeth 405 provided within housing portion 400 so as to substantially lock the vial in position within housing portion 400. 
     Continued movement of the drug vial assembly into the final position shown in FIG. 31 causes the reconstituted mixture to be substantially transferred back into chamber 432 of the infusion device via passageways 94, 103, 126, 124, 477 and 414 and through port 415 for later controlled infusion of the reconstituted drug active medicament into the patient via the filter 434 and the multiplicity of fluid collection passageways 412, into passageway 414 through port 417 and outwardly of the device through passageway 452 and outlet 448. As previously discussed, the rate of flow fluid through outlet 448 is controlled by the needle valve means 63. 
     Once again, a label covering the peripheral surface of overpackage 312 is preferably provided with indicia in the form of numbers, color codes or the like to indicate the interconnection, reconstitution and transfer functions of the vial assembly with respect to cylindrical housing 400. 
     Turning to FIGS. 34 through 38, the final embodiment of the present invention is shown. This final embodiment is similar in many respects to the embodiment of FIGS. 23 through 33 and like numbers are used to identify like component parts. More particularly, the infusion container portion of the device along with coupling members 112 and 114 are identical to those previously described as is the coupling valve means 136 and the operating means. However, the cylindrical housing portion 500, while mounted on the back surface 410 of the base 406, is of a slightly different construction s is the drug vial assembly 502. The details of construction of these different elements and the method of opration of this last form of the invention will be described in the paragraphs which follow. 
     Turning first to FIGS. 34 and 35, the base assembly can be seen to be quite similar to that shown in FIG. 35 having a curved base member 406 provided with a multiplicity of flow micro-channels 412 which communicate with a central passageway 414 having spaced-apart portions 413 and 416. Side portion 418 having apertures 420 are as previously described. The apparatus also includes a distendable elastic membrane 430 and filter means 434 which function as before. Turning to FIG. 36, the drug vial or container assembly 502 of this form of the invention, includes second flow control means for controlling the flow of fluid into and out of an internal chamber 509 of a vial 510 which contains the medicament M. The second flow control means of this form of the invention is identical in construction and operation to that previously described and includes a lower durometer plunger 86 which is substantially sealably receivable within vial 510. Plunger 86 also includes connector means, shown as threads 86b, for interconnection with the coupling means of the apparatus. As before, valve assembly 88 controls fluid flow through flow passageways formed within plunger 86 and is operated by operating means of the character previously described. 
     Vial 510 is enclosed in a multi-part cover, or overpackage member 512 which surrounds vial 510. Overpackage member 512 is, in turn, telescopically received within a collar 512a which includes system interlock stops 511. Provided proximate the lower end of collar 512a are external threads 514 which are adapted to mate with internal threads 504 provided within cylindrical portion 503 of the apparatus housing. Vial 510 is closed by an integral tear-off type closure such as 508 (FIG. 36). Collar 512a is also provided with circumferentially spaced finger grips 507, the purpose of which will presently be described. Overpackage member 512 includes locking means for locking the cover assembly to the cylindrical portion 502. This locking means is here provided in the form of an annular member 515 located proximate the lower end of member 512. 
     Turning to FIG. 37, cylindrical portion 503 of the housing of this latest form of the invention has an enlarged diameter mouth 517 which is adapted to receive stops 511 and which defines a radially extending annular surface 519 against which stops 511 engage. Longitudinally spaced part from surface 519 is a circumferentially extending, inwardly protruding annular stop member 521 which, in a manner presently to be described, is adapted at the completion of the cycle, to lockably engage annular member 515 provided on overpackage member 512. 
     In operating the apparatus of this final form of the invention, vial closure 508 is first removed form the drug vial assembly 502. This done, the open end of the drug vial assembly 502 is inserted into sterile mouth 517 of cylindrical portion 503 (FIG. 37). Using finger grips 507 for control, threads 514 are threadably mated with internal threads 504 provided within cylindrical portion 503. Vial assembly 502 is then pushed forward to move threads 86b on plunger 86 into proximity with threads 113 provided on coupler member 112. Further rotation of the drug vial in a clockwise direction, using grips 507, will then cause threads 86b on plunger 86 to mate with threads 113 on coupling member 112 in the manner shown in FIG. 37. As the plunger couples with member 112, stem 106 of the container valve will engage stem 140 of valve means 136 simultaneously axially moving both valve element 137 of the first flow control means and valve member 88 of the second flow control means into the open position shown in FIG. 37. With the valves of the flow control means in this open position, distendable elastic membrane 30 will cause the fluid contained within chamber 432 to flow under pressure through port 415, into passageway 477, into passageway 124, past the valve seat 128 into fluid passageway 126 of the coupler means and then into passageway 103 of the container valve means. The fluid under pressure will next flow through radially extending passageways 94 of the container valve and rapidly into the interior of the container 510 in the manner shown by the arrows in FIG. 37. This flow of fluid under pressure into the drug vial initiates the mixing or reconstitution process and causes the container assembly to move outwardly (upwardly as shown in FIG. 37). 
     Subsequent movement of the drug vial assembly inwardly in the direction of arrow 523 and into the all forward and locked position shown in FIG. 38 causes the reconstituted mixture to be substantially transferred back into the reservoir infusion device via passageway 94, 103, 126, 124, 477 and 414 and through port 415 for later infusion into the patient in the manner previously described via filter 434 and passageways 412 and 414 and through recipient port outlet 448. 
     In all forms of the invention previously described, the plunger of the container valve is preferably constructed from a rubber or silicon material. The valve member which reciprocates within the plunger is preferably constructed of higher durometer rubber or silicon, or from glass or plastic materials such as polypropylene, polycarbonate, polystyrene, ABS, PTFE or high density teflon or nylon. Similarly, valve member 137 is preferably constructed from silicon rubber, rubber, flexible PVC, polyurethane, PTFE, or fluorsilicon elastomers. 
     Having now described the invention in detail in accordance with the requirements of the patent statutes, those skilled in this art will have no difficulty in making changes and modifications in the individual parts or their relative assembly in order to meet specific requirements or conditions. Such changes and modifications may be made without departing from the scope and spirit of the invention, as set forth in the following claims.