# Patent

## Title
Large-volume bolus patient controlled drug administration device with lock-out

## Abstract

A patient controlled liquid drug administration device providing either or both of a continuous flow of a liquid drug, as well as successive boluses thereof, to be self-administered by a patient while allowing delivery of only full bolus volumes. The device includes a reciprocating pump defining a closed internal reservoir having a fixed first wall, and a second, flexible wall that is axially movable in relation to the fixed wall between reservoir-full and reservoir-empty positions. A lock is connected to a push button that activates a plunger of the pump. The lock has a first position preventing the push button from being depressed when the push button is in an extended position and the plunger is in a reservoir-empty position and a second position permitting the push button to be depressed when the push button is in an extended position and the plunger is in a reservoir-full position.

## Background
RELATED APPLICATION
The present application is a Divisional Application of U.S. application Ser. No. 14/051,911, filed Oct. 11, 2013, issued as U.S. Pat. No. 9,061,100, on Jun. 23, 2015.


FIELD OF THE INVENTION
The present invention relates to medical devices in general, and in particular, to a patient controlled device for the self-administration of drugs, such as analgesics, and the like.
BACKGROUND
The treatment of pain symptoms, e.g., post-operative pain or pain resulting from disease or injury, frequently entails the subcutaneous and/or intravenous (“IV”) infusion of a liquid analgesic and/or anesthetic drug into the patient, e.g., by one or more hypodermic injections thereof. When pain is more chronic, it may be preferable to catheterize the patient intravenously, e.g., with a hypodermic needle, and infuse the drug through the catheter continuously at a low, or “basal,” rate of flow using, e.g., an “IV drip” or an electromechanical pump having an adjustably low flow rate.
Many patients who exhibit chronic pain symptoms also experience periodic episodes in which the pain level is perceived as much more acute, indicating a need for a temporarily greater infusion rate of the drug. One solution is to adjust the flow rate of the infusion apparatus. However, this requires the presence and intervention of a trained health care professional, as the patient typically lacks the training, skill and/or physical ability to make such an adjustment of the infusion device.
There have been a number of proposals for a “Patient Controlled Analgesic,” or “PCA,” drug administration device that would enable a patient to self-administer a drug intravenously without intervention by a health care professional at, e.g., the onset of an acute pain episode, that is not only simple and effortless to operate, but is also failsafe in use, i.e., one that precludes the possibility of a self-administered drug overdose. Examples of such PCA devices can be found in U.S. Pat. No. 5,084,021 to B. Baldwin; U.S. Pat. No. 5,891,102 to K. Hiejima et al.; and U.S. Pat. No. 6,213,981 to K. Hiejima et al.
These devices all have in common the provision of a reciprocating pump in which the patient manually effects a “compression” stroke of the pump by depressing a plunger of the pump, thereby expressing a measured bolus of a liquid drug to the patient intravenously, after which a compression spring and/or a pressurized source of the drug returns the plunger to its initial position, thereby effecting a refill, or “intake,” stroke of the pump. The rate at which the pump refills, and hence, the rate at which the patient may self-administer the drug, is limited by a flow restrictor placed at the inlet of the pump. A reverse flow of fluids from the patient to the pump may be effected by a check valve disposed at the outlet of the pump.
These PCA devices afford only a partial solution to the problem of a patient controlled drug administration device because they present certain drawbacks. For example, some require that the patient continuously exert a force on the plunger throughout the compression stroke of the pump, which may take several seconds or even minutes to complete, and some patients may not be physically capable of such a prolonged exertion. Others require that the patient push a first button down on the pump to effect the compression stroke, then push a second button on the pump to initiate the intake stroke, which may also be of prolonged duration, after the compression stroke is complete, which requires that the patient monitor the position of the plunger to know when to push the second button. An additional drawback shared by all is that they require an extended period of time, and require a careful manipulation of the device by a health care professional, to “prime” the device before use, i.e., to replace any air in the device with the liquid drug, since the administration of any air bubbles to the patient could form a dangerous embolism in the patient.
Another PCA device is described in U.S. Pat. No. 6,936,035 to Rake et al. That device can administer either or both of a continuous and a bolus infusion of a liquid drug to a patient, in which the bolus doses can be safely self-administered by the patient by quickly depressing a single button, to effect the compression stroke of the pump, and which thereafter automatically initiates the intake stroke of the pump when the compression stroke is completed, and further, one which can be rapidly primed for use without skilled manipulation of the device. Improvements to this PCA device are described in U.S. Pat. No. 8,308,688 to Valle et al. which includes a clamp system that can avoid the potential for bolus refill during bolus delivery. Such a condition is undesirable because it may allow delivery of more liquid drug to a patient over a defined period of time than the predetermined volume of successive boluses. The clamp system helps avoid the potential for liquid drug delivery through the pump after bolus delivery but before an intake stroke of the pump occurs. While that improvement addresses the problem of over-delivery or over-dose of a liquid drug to a patient, a significant problem still exists in that a patient may still deliver successive partial bolus volumes of a liquid drug by successively activating of the pump. For certain liquid drugs, such successive partial bolus delivery can significantly reduce the effectiveness of the liquid drug because the physician may prescribe the concentration and bolus volume to deliver a specific amount of the liquid drug in one dose. Accordingly, there is still an unmet need for a PCA device that prevents delivery of successive partial bolus volumes of a liquid drug. There is a need for a PCA device that permits the patient activation of a reciprocating pump only after the reservoir is filled so that only the full volume of the bolus of liquid drub can be delivered.
BRIEF SUMMARY OF THE INVENTION
In accordance with one aspect of the present invention, a PCA device is provided that enables either or both of a continuous flow of a liquid drug, as well as successive, large-volume boluses thereof, to be self-administered to and by a patient while allowing delivery of only full bolus volumes.
Generally speaking, the patient self-administers a single bolus of the drug by a quick push of a button that effects an extended-duration output stroke of a pump, so that the patient is not required to push the button down continuously during the output stroke, and the intake stroke of the pump is automatically achieved at the end of the compression stroke by the device itself, without need for further monitoring or action by the patient.
The device of the invention includes an elongated housing having an axial cavity extending through it with a reciprocating pump mounted at a bottom end thereof. The pump defines a closed internal reservoir and includes a first wall, or seat, that is fixed in the cavity, and a second, flexible wall that is axially movable in the cavity in relation to the fixed wall between reservoir-full and reservoir-empty positions. The pump includes an inlet port that is connectable to a source of a pressurized liquid drug by an inlet conduit, and an outlet port subcutaneously connectable to the patient by an outlet conduit, both conduits extending out the bottom end of the housing. In one preferred embodiment, the inlet and outlet ports of the pump are arranged on the device such that, in a selected priming orientation of the device, the outlet port is disposed higher than the inlet port for rapid priming of the device.
According to an aspect of the invention, a clamp is rotatably mounted in the cavity to move between a closed position constricting the outlet conduit of the pump, thereby preventing the flow of the liquid drug through the conduit, and consequently, the flow of the drug from the pump, and an open position disengaged from the outlet conduit, thereby allowing the flow of the drug from the pump. The clamp is resiliently biased toward its closed position by a spring.
An elongated plunger is situated in the cavity above the pump for axial movement between raised and lowered positions and has a lower end contacting the movable wall of the pump. An elongated push button is also situated in the cavity above the plunger for axial movement between extended and depressed positions. The push button includes a detent in it for latching the button in its depressed position, and a ledge that engages the inlet clamp and moves it to its closed position when the button is moved to its depressed position. This action simultaneously rotates the outlet clamp clockwise and moves it to its open position. In one exemplary embodiment of the device, the push button includes an axial bore in a lower end portion thereof in which an upper portion of the plunger is coaxially disposed for relative axial sliding movement. A compression spring is axially disposed between the plunger and the button.
A lock has a first position that prevents the button from being depressed when the button is in its extended position and the plunger is in the reservoir-empty position. The lock also has a second position that allows the button to be depressed when the button is in its extended position and the plunger is in the reservoir-full position. In an aspect of the invention, the lock is pivotably connected to the housing. The plunger defines a protrusion on its outer surface, and the plunger-actuating button includes a lock detent such that the lock detent engages the lock at its first position to prevent the button from being depressed and the protrusion engages a portion of the lock at its second position to disengage the lock from the lock detent to allow the button to be depressed. Desirably, the lock is biased to engage the lock detent until the bias force is overcome by the engagement of the protrusion of the plunger with a portion of the lock.
A spring catch mounted in the cavity of the housing resiliently engages the detent in the button when the button is moved to its depressed position, and holds the button there against the upward urging of the compression spring, until a catch release on the plunger disengages the spring catch from the detent in the button when the plunger is moved to its lowered position.
An optional bypass conduit can be provided in the device or external to the device that connects the inlet conduit upstream of the pump to the outlet conduit downstream of the clamp, so that a continuous, or basal, flow of the liquid drug can be administered to the patient independently of pump or patient activity. An orifice may be inserted in the inlet conduit of the pump to regulate the rate of flow of the liquid drug into the pump, and hence, the rate at which the patient can safely self-administer the drug. Additionally, an orifice may be inserted in the bypass conduit for regulating the rate of basal flow of the liquid drug to the patient. In an embodiment of the invention, an orifice may be inserted in the inlet conduit external to the device to regulate the rate of flow of the liquid drug into the device and, more particularly, the pump, thereby regulating the rate at which the patient can safely self-administer the drug. Additionally, an orifice may be inserted in the external bypass conduit to regulate the rate of basal flow of the liquid drug to the patient.
In an aspect of the PCA, the device is provided with a removable priming tab that extends through a side wall of the housing and engages the outlet clamp such that the outlet clamp is held in its open position regardless of the position of the button. The priming tab enables the device to be primed rapidly and effortlessly by placing the device in the selected priming orientation, and connecting the inlet conduit to a source of pressurized liquid drug. After the device is primed and ready for use, the priming tab is simply removed and discarded.
According to an aspect of the invention, the clamp may be in the form of a clamp system that avoids bolus refill during bolus delivery which may cause more liquid drug to be administered than the predetermined volume of the bolus. The clamp system also avoids continued delivery of the liquid drug to and through the pump after bolus delivery but before an intake stroke of the pump occurs. This avoids delivery of more liquid drug to a patient over a defined period of time than the predetermined volume of successive boluses. This is particularly advantageous in embodiments utilizing a bypass conduit delivering a continuous flow of the liquid drug to the patient. In other words, the clamp system is configured for respectively closing and opening an outlet of the pump and for respectively opening and closing an inlet of the pump. The clamp system may be, for example, a single dual-direction clamp or two separate clamps.
The two separate clamps may be in the form of an outlet clamp and an inlet clamp. For example, an outlet clamp is rotatably mounted in the cavity to move between a closed position constricting the outlet conduit of the pump, thereby preventing the flow of the liquid drug through the conduit, and hence, the flow of the drug from the pump, and an open position disengaged from the outlet conduit, thereby allowing the flow of the drug from the pump. The clamp is resiliently biased toward its closed position by a spring. An inlet clamp is mounted in the cavity to move between a closed position constricting the inlet conduit and thereby preventing the flow of liquid through it, and an open position disengaged from the inlet conduit, thereby allowing the flow of liquid through it.
The single dual-direction clamp may be mounted in the cavity to move between: (i) a first position constricting the outlet conduit thereby preventing the flow of liquid through it and simultaneously disengaged from the inlet conduit thereby allowing the flow of liquid through it; and (ii) a second position disengaged from the outlet conduit thereby allowing the flow of liquid through it and simultaneously constricting the inlet conduit thereby preventing the flow of liquid through it, the clamp being biased toward its first position.
The present invention also encompasses a device for dispensing fluid to a patient which includes: (i) a first reservoir configured to provide a source of fluid under pressure; (ii) a bolus flow path for the delivery of a bolus dose of fluid; (iii) a large volume bolus delivery system in fluid communication with the bolus flow path and configured to receive fluid from the first reservoir, the bolus delivery system being configured to elastically expand to pressurize fluid, store the pressurized fluid and dispense the pressurized fluid while avoiding bolus refill during bolus delivery or after bolus delivery but before it is enabled to elastically expand in a subsequent delivery cycle; and (iv) a patient operable actuator to release fluid from the bolus delivery system, the actuator being configured such that it can be actuated only when the bolus delivery system contains the pre-determined volume of fluid (e.g., the full bolus volume), does not require effort to force the fluid out of the bolus reservoir and that, when actuated by the patient, fluid is permitted to flow out of the bolus reservoir to the patient without further action by the patient. The large volume bolus delivery system is desirably the PCA device described above.
The device for dispensing fluid to a patient may further include a continuous flow path from the source providing a continuous and substantially constant flow rate of fluid. The continuous flow path and the bolus flow path are in fluid communication with the source of fluid (i.e., the first reservoir). The device may further include a flow regulator which sets the flow rate through the continuous flow path into the patient and the continuous flow path and bolus flow path may desirably converge into a single path downstream from the flow regulator. The device may also include a flow regulator which sets the flow rate of fluid through the bolus flow path.
In an aspect of the invention, the flow regulator may be an adjustable flow regulator. For example, the flow regulator may be a valve including a dial to permit adjustment of a flow rate through the flow regulator. Such an adjustable flow regulator may include a display configured to indicate a flow rate of fluid through the flow regulator. The adjustable flow regulator desirably permits adjustment of the flow rate. As a non-limiting example, the flow rate may be adjusted to a rate within a range of from about 1 to about 14 cubic centimeters per hour. Desirably, the flow rate may be from about 1 to about 7 or from about 2 to about 14 cubic centimeters per hour.
A better understanding of the above and many other features and advantages of the novel PCA device may be obtained from a consideration of the detailed description of the invention below, particularly if such consideration is made in conjunction with the appended drawings.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an elevation view of an exemplary patient controlled liquid drug administration device in accordance with the present invention.
FIG. 2 is a top and side perspective view of the device.
FIG. 3 is a partial exploded perspective view of a plunger, reciprocating pump, clamp, outlet conduit, outlet loop, inlet conduit and inlet loop of the device, wherein the clamp is shown in a first position thereof and in constricting engagement with the outlet conduit and disengaged from the inlet conduit.
FIG. 4 is a cross-sectional side view of the device revealed by a section taken in FIG. 3 along the lines 4-4 therein, and showing the inlet conduit, the outlet conduit, the inlet port and the outlet port of the pump.
FIG. 5 is a cross-sectional side view of the device revealed by a section taken in FIG. 3 along the lines 5-5 therein, and showing the inlet conduit 32 and the outlet conduit 34.
FIG. 6 is a cross-sectional side view of the device revealed by a section taken in FIG. 1 along the lines 4-4 therein, and showing the relative positions of the elements of the device at a point just before an output stroke of the pump is commenced, wherein a push button, the plunger and a movable wall of the pump are shown in respective extended, raised and reservoir-full positions thereof, wherein a lock is shown in its second position allowing the push-button to be depressed, and wherein a priming tab of the device is shown extending through an aperture in a side wall of a housing of the device and holding the clamp in its second position thereof.
FIG. 7 is a cross-sectional side view of the device similar to that of FIG. 6, except showing the relative positions of the elements of the device at a point about midway through the output stroke of the pump, and wherein the button of the device is shown latched in a depressed position thereof.
FIG. 8 is a cross-sectional side view of the device similar to those of FIGS. 6 and 7, except showing the relative positions of the elements of the device just after the output stroke of the pump is completed, wherein the plunger and movable wall of the pump are shown in respective lowered and reservoir-empty positions thereof, wherein the button of the device is shown having automatically returned to the extended position thereof, and wherein a lock is shown in its first position preventing the push-button from being depressed.
FIG. 9 is a inboard elevation view of the device similar to that of FIG. 6, with a part of the housing, pump, plunger and button of the device removed to reveal the clamp and a portion of the outlet conduit thereof (but without the inlet conduit or bracket), and wherein the priming tab is shown holding the clamp in its second position and disengaged from the outlet conduit.
FIG. 10 is a partial cross-section and inboard side elevation view of the device similar to that of FIG. 9, wherein the button is shown latched in its depressed position and a clamp shield is shown removed from the device to reveal a ledge on the button engaging the clamp and holding it in its second position disengaged from the outlet conduit and in constricting engagement with the inlet conduit.
FIG. 11 is an inboard elevation view of the device similar to that of FIG. 9, showing the button removed and a spring biasing the clamp into its first position in constricting engagement with the outlet conduit and disengaged with the inlet conduit.
FIG. 12A is a partial cross-section and side elevation view showing a detail of an exemplary device highlighting an exemplary lock in its first position.
FIG. 12B is a side view showing a detail of an exemplary lock.
FIG. 13 is a partial cross-section and side elevation view showing a detail of an exemplary device highlighting an exemplary lock in its second position.
FIG. 14 is partial cross-section and side elevation view showing a detail of an exemplary device highlighting an exemplary lock in its second position.
FIG. 15 is an exploded perspective inboard elevation view of a portion of the device.
FIG. 16 is a schematic view of an embodiment of the present invention illustrating an exemplary device for dispensing fluid to a patient which includes a large volume bolus delivery system configured to elastically expand to pressurize fluid, store the pressurized fluid and dispense the pressurized fluid while avoiding bolus refill during bolus delivery or after bolus delivery but before it is enabled to elastically expand in a subsequent delivery cycle.



DETAILED DESCRIPTION OF THE INVENTION
An exemplary improved large volume bolus patient controlled liquid drug administration device 10 (also referred to as a “PCA” or “LVPCA”) in accordance with the present invention is illustrated in the elevation view of FIG. 1. The device 10 is composed of an elongated housing 12 having respective open top and bottom ends 14 and 16 and, as generally illustrated in, e.g., FIG. 9, an axial cavity 18 extending through it. In the particular exemplary embodiment illustrated in the figures, the housing is injection molded from a rugged plastic material, and includes two clam-shell side walls 12A and 12B that are coupled together, e.g., with an ultrasonic weld, along a medial plane extending through the device.
As shown in the cross-sectional views of FIGS. 6-8, a reciprocating pump 20 is mounted on the ribs in the cavity 18 of the housing 12 and/or at the bottom end 16 thereof. The pump defines a closed reservoir 22 for a liquid drug, and includes a first wall, or seat, 24 that is fixed in the cavity against movement, and a second, flexible wall 26 that is axially movable in the cavity with respect to the fixed wall between a reservoir-full position (see FIG. 6), and a reservoir-empty position (see FIG. 8).
The pump 20 includes an inlet port 28 and an outlet port 30. One end of an inlet conduit 32 (and respective inlet loop 35B) is connected to the inlet port and the other end is connectable, e.g., by means of a Luer fitting (not illustrated), to a source of a pressurized liquid drug (not illustrated), which may be an infusion pump (e.g., a mechanical infusion pump, an electromechanical infusion pump or the like (not illustrated)). The outlet port is subcutaneously connectable to a patient (e.g., by a hypodermic needle, catheter or the like (not illustrated)) by an outlet conduit 34 (and respective outlet loop 35A). In an embodiment, the inlet and outlet conduits comprise clear, flexible surgical tubing, and extend out the bottom end 16 of the housing 12 through a protective, flexible grommet 36.
As illustrated in the cross sectional view of FIGS. 10 and 11, a clamp 38 is rotatably mounted in the cavity 18 to move between a closed position constricting the outlet conduit 34 of the pump, thereby preventing the flow of the liquid drug through the conduit, and consequently, the flow of the drug from the pump, and an open position disengaged from the outlet conduit, thereby allowing the flow of the drug from the pump. The clamp is resiliently biased toward its closed position by a spring.
Referring again to the cross-sectional views of FIGS. 6-8, an elongated plunger 48 is situated in the cavity 18 of the housing 12 above the pump 20 for axial movement between a raised position (see FIG. 6, and a lowered position (see FIG. 8). The plunger has a lower end 48A (see also FIG. 3) that contacts the movable wall 26 of the pump, and which has a shape that conforms to the internal shape of the fixed wall, or seat, 24 thereof. It may be seen that, if the clamp 38 is in its first position, a downward force exerted on the plunger will cause the plunger to move down from the raised position (see FIG. 6), and thereby push the movable wall of the pump toward the fixed wall thereof (see FIG. 7), until the movable wall conformably seats against the fixed wall (see FIG. 8), thereby executing an output stroke of the pump and expelling a bolus of liquid drug from the reservoir 22 of the pump to the patient. During this output stroke, a second wedge-shaped jaw 42B may constrict the inlet conduit 32 against a bracket 90 so that no liquid drug can enter the reservoir.
The plunger 48 is pushed down by the patient indirectly through the agency of an elongated push button 50 that is situated in the cavity 18 of the housing 12 above the plunger for axial movement between an extended position (see FIGS. 6 and 8) and a depressed position (see FIG. 7), as well as a compression spring 52 that is axially disposed between the plunger and the button. In the particular exemplary embodiment illustrated in the figures, the button includes an axial bore extending through a lower end thereof, and an upper portion of the plunger is coaxially disposed in the bore for relative sliding axial movement therein, thereby enclosing or surrounding the compression spring and resulting in a more compact device 10.
The button 50 includes a detent 54 for latching the button in the depressed position, and a ledge 56 that engages the clamp 38 and moves it to its second position when the button is moved to its depressed position, as illustrated in FIG. 10. When the button (shown in cross-section) is pushed to its depressed position, the ledge 56 of the button engages an extension 58 on the lever arm of the clamp and rotates it to its second position, thereby disengaging the first wedge-shaped jaw 42A enabling outflow from the pump 20 through the outlet conduit 34 and optionally further engaging the second wedge-shaped jaw 42B to constrict the inlet conduit 32 so that no liquid drug can enter the reservoir, as described above. Simultaneously, the latching detent engages a resilient spring catch 60 mounted in the cavity 18 in an over-center latching engagement, which holds the button in its depressed position and against the upward force of the compression spring 52.
Movement of the button 50 to its depressed position also compresses the compression spring 52 against the plunger 48 (see FIG. 7), resulting in a corresponding downward movement of the plunger against the movable wall 26 of the pump 20 and a corresponding output stroke of the pump, as described above. Thus, a single, quick depression of the button to its depressed position by the patient results in a subsequent full output stroke of the pump that is typically of an extended duration, due to the flow resistance in the device between the pump and the patient. However, since the button latches in the depressed position, as above, it is unnecessary for the patient to exert a continuous force on the button for the entire duration of the stroke.
To enable the button 50 to return automatically to its extended position at the end of the output stroke of the pump 20 (see FIG. 8), a scoop-like catch release 62 is provided on the plunger 48 that catches an end of the spring catch 60 and detaches it from the latching detent 54 in the button when the plunger reaches its lowered position. When the button returns to its extended position, the compression in the compression spring 52 is relaxed, and simultaneously, the clamp 38 is released to return to its first position, thereby initiating an intake stroke of the pump, as described above. Thus, the intake stroke of the pump is achieved automatically, and no activity or monitoring of the device 10 is required on the part of the patient.
Control of the input and output stroke of the pump improves the ease of use and aids in patient activation of the pump. The clamp system is desirably configured to avoid the potential for bolus refill during bolus delivery and over-delivery or over-dose of a liquid drug to a patient. However, to properly address the problem of successive partial bolus volumes of a liquid drug by successively activating of the pump, a different feature is required. The present invention utilizes a lock 100 that permits the patient activation of a reciprocating pump only after the reservoir is filled so that only the full volume of the bolus of liquid drub drugs can be delivered. The lock 100 has a first position that prevents the button from being depressed when the button is in its extended position and the plunger is in the reservoir-empty position. The lock also has a second position that allows the button to be depressed when the button is in its extended position and the plunger is in the reservoir-full position.
Referring to FIGS. 8 and 12A, there is illustrated an exemplary lock 100. The lock includes an arm 102 has a proximal portion 104 and a distal portion 106. The lock 100 may be pivotably connected to the housing 12 by any suitable hinge or pivot 108. Referring briefly to FIG. 12B, the proximal portion 104 of the lock arm 102 has projection 110 that projects generally perpendicularly from the lock arm 102. The projection 110 desirably forms a sloping or angled intersection 112 with the lock arm 102. For example, the intersection may have a compound chamfered edge (shown in FIG. 12B) or plain chamfered edge. Alternatively and/or additionally, the intersection may have a curved edge that forms a generally concave profile. The purpose of this configuration of the proximal portion 104 of the lock arm 102 is to translate force applied from a projection 116 on an outer surface of “S” the plunger 48 as the plunger moves axially to its extended position into radial movement of the distal portion 106 of the lock arm 102. As illustrated in FIGS. 8 and 12A, the lock 100 is shown in its first position “P1”. The radial movement of the distal portion 106 of the lock arm 102 swings the lock from its first position “P1” to its second position “P2” which is illustrated in FIG. 6 and FIG. 13. In the first position “P1” of the lock 100, the distal portion 106 of the lock arm 102 engages with a lock detent 120 defined in a portion of the button 50. In the second position “P2” of the lock 100, the distal portion 106 of the lock arm 102 is disengaged from the lock detent 120 thereby permitting axial movement of the button 50. As can be seen from FIGS. 6 and 13, the button 50 is in an extended position that can be depressed. FIGS. 7 and 14 illustrate the distal portion 106 of the lock arm 102 as it is situated after the button 50 is depressed and the resilient spring catch 60 is engaged with the latching detent 54 to hold the button 50 in position to compress the spring 52 against the plunger.
As seen in FIGS. 6-8, the lock 100 is located in the cavity 18 defined by the housing 12 so it is not accessible by the patient using the device. The plunger 48 defines a protrusion 116 on its outer surface. The positions of the plunger and the protrusion engage and disengage the lock. For example, in FIGS. 6 and 13 the reservoir 22 is in a reservoir-full, elastically expanded condition causing movement the plunger to its extended position. In this position, the protrusion engages the projection 110 on the lock arm 102 and causes the distal portion 106 of the lock arm to disengage from the lock detent 120 on the button 50. That is, the lock 100 is in its second position“P2”. Referring to FIGS. 7 and 13, the button 50 is depressed thereby compressing the spring 52 and gradually moving the plunger 48 to deliver the full bolus volume. In this configuration, the distal portion 106 of the lock arm 102 remains disengaged from the lock detent 120 without contact between the protrusion 116 and the projection 110 of the lock arm 102 because the button 50 is held in the depressed condition by the resilient spring catch 60 engaged with the latching detent 54. That is, the lock 100 is in its second position“P2”. It is contemplated that the lock may be pivotably connected to the button and may engage a lock detent located in the housing.
Referring now to FIG. 8, after delivery of the bolus the scoop-like catch release 62 on the plunger 48 catches an end of the spring catch 60 and detaches it from the latching detent 54 in the button when the plunger reaches its lowered position. This allows the button 50 to return to its extended position, relaxing the compression in the compression spring 52 thereby initiating an intake stroke of the pump, as described above. Where a separate inlet clamp or a single “dual-direction” clamp (both as generally described below) is used to constrict the inlet conduit during bolus delivery, this movement of the button 50 also simultaneously releases the clamp to disengage from the inlet conduit thereby allowing the liquid drug to flow through it. When the button 50 reaches its extended position while the plunger 48 is in the “reservoir-empty” condition, the distal portion 106 of the lock arm 102 engages with the lock detent 120. Desirably, the lock 100 is biased to engage the lock detent 120 until the bias force is overcome by the engagement of the protrusion of the plunger with a portion of the lock. In this manner, the lock prevents the button from being depressed when the button is in its extended position and the plunger is a position other than a reservoir-full position. The biasing force can be provided by a spring, foam element, elastic element or the like.
According to an aspect of the present invention, the combination of the inlet clamp to constrict the inlet and the lock to prevent activation of pump until the full bolus volume is available for delivery serves to address the problems of the over-delivery or overdose of liquid as well as the problem of successive partial bolus delivery which can significantly reduce the effectiveness of the liquid drug because the physician may prescribe the concentration and bolus volume to deliver a specific amount of the liquid drug in one dose. In another aspect, the present invention provides a lock or lock system 100 operatively responsive to movement of the plunger 48 between a selected position thereof, the lock 100 being connected to the housing 12 and having a first position “P1” that prevents the push button 50 from being depressed when the push button 50 is in an extended position and the plunger 48 is in an reservoir-empty position and a second position “P2” that permits allows the push button 50 to be depressed when the push button 50 is in an extended position and the plunger 48 is in an reservoir-full position.
A clamp system in the form of a single clamp 38 may be mounted in the cavity 18 to move between (i) a first position constricting the outlet conduit (see FIG. 11) thereby preventing the flow of liquid through it and simultaneously disengaged from the inlet conduit 32 thereby allowing the flow of liquid through it; and (ii) a second position disengaged from the outlet conduit (see FIG. 10), thereby allowing the flow of liquid through it and simultaneously constricting the inlet conduit 32 thereby preventing the flow of liquid through it, the clamp being biased toward its first position. For ease of illustration, the lock 100 is not illustrated in FIGS. 10 and 11. The single clamp 38 may be referred to as a “dual-direction” clamp in that it is configured to constrict a conduit at either of its first or second positions. Details of an exemplary dual-direction clamp are described in U.S. Pat. No. 8,308,688, issued Nov. 13, 2012 to Valle, et al. for “Large-Volume Bolus Patient Controlled Drug Administration Device”, which is hereby incorporated by reference. A spring 40 resiliently biases the clamp toward its first position. In the first position, it may be seen that the clamp 38 constricts the outlet conduit 34 blocking the outflow of the pump 20 while the clamp is disengaged from the inlet conduit 32 so that the reservoir 22 takes in, or refills with, the pressurized liquid drug through the inlet port 28 of the pump. In the second position, the clamp 38 disengages from the outlet conduit 34 enabling the pump to expel the contents of the reservoir through the outlet port 30 of the pump while the clamp 38 constricts the inlet conduit 32 such that the reservoir 22 is unable to take in, or refill with, the pressurized liquid drug through the inlet port 28 of the pump.
When a single clamp 38 is used (i.e., a dual-direction clamp), the clamp 38 includes a lever arm that is rotatably mounted on a side wall of the housing 12 (desirably housing 12B as illustrated in FIG. 10) for movement between its first and second positions (see FIGS. 10 and 11). Alternatively, the device 10 may employ a clamp system in the form of two separate clamps or components, each including a blade or other feature that can close its associated tube. More particularly, the device may employ an outlet clamp that is movably (e.g., rotatably) mounted in the cavity 18. The outlet clamp may be mounted on a stem extending from the housing 12 so that it is configured to move between a closed position constricting the outlet conduit of the pump, thereby preventing the flow of the liquid drug through the conduit, and hence, the flow of the drug from the pump, and an open position disengaged from the outlet conduit, thereby allowing the flow of the drug from the pump. In addition, the device may further employ an inlet clamp that is movably (e.g., rotatably) mounted in the cavity 18. The inlet clamp may be mounted on the stem extending from the housing 12 or it may be mounted on a support projecting from the outlet clamp and other mounting configurations are contemplated. The inlet clamp is mounted so that it is configured to move between an open position disengaged from the inlet conduit, thereby allowing the flow of the liquid drug into the pump and a closed position constricting the inlet conduit of the pump, thereby preventing the flow of the liquid drug through the inlet conduit and into the pump. Details of an exemplary two-component clamp system having separate inlet and outlet clamps are further described in U.S. Pat. No. 8,308,688, issued Nov. 13, 2012 to Valle, et al. for “Large-Volume Bolus Patient Controlled Drug Administration Device”, which is hereby incorporated by reference.
The PCA device 10 can be primed for use in a procedure that is both rapid and simple. As illustrated in FIGS. 6-8, the respective inlet and outlet ports 28 and 30 of the pump 20 are arranged on the device such that, in a selected, resting orientation of the device, the outlet port is disposed higher than the inlet port, so that any air bubbles in the liquid drug in the reservoir 22 are directed toward the outlet port by gravity. This is accomplished by simply laying the device 10 on its side on, e.g., a table, such that the outlet port is higher than the inlet port. The legend, “THIS SIDE UP FOR PRIMING,” can be applied to the upstanding side as an aid to the practitioner. Details about an exemplary priming feature are further described in U.S. Pat. No. 8,308,688, issued Nov. 13, 2012 to Valle, et al. for “Large-Volume Bolus Patient Controlled Drug Administration Device”, which is hereby incorporated by reference.
Thus, the device can be manufactured, stored and supplied with the priming tab 66 inserted in place (see FIG. 1, 6 or 9). The device is then primed rapidly and with a minimum of manipulation of the device by: 1) removing the device from any sterile packaging; 2) moving the push button 50 to its depressed position; 3) placing the device on a surface or holding it in the selected priming orientation; and, 4) connecting a distal end of the inlet conduit 32 to a source of pressurized liquid drug. The liquid drug quickly fills the inlet conduit and the minimized volume of the reservoir 22 of the pump 20, and pushes any air therein ahead of it and out of the elevated outlet port 30 and the outlet conduit 34. After the device is primed, the priming tab 66 is simply removed and discarded, whereupon the button returns to its extended position, the clamp moves to its first position and closes the outlet conduit (or the outlet clamp moves to its closed position and closes the outlet conduit), and reservoir begins to fill with an initial bolus of the drug. A tubing clamp 73 of a known type (see FIG. 2) can be provided on the outlet conduit to control the flow of the liquid drug through the device during the priming operation.
Additionally, as illustrated in FIGS. 4 and 6-8, the device can also be made capable of administering a continuous, basal flow of the drug independently of patient control by the provision of a bypass conduit 74 on the pump 20 which has a first end connected to the inlet conduit 32 upstream of the pump and an opposite second end connected to the outlet conduit 34 downstream of the clamp 38. The flow of the liquid drug through the bypass conduit 74 bypasses the reservoir 22 of the pump and is thus administered directly to the patient through the outlet conduit. A flow restrictor 76, e.g., a glass orifice, can be provided in the bypass conduit for regulating the rate of basal or continuous flow of the liquid drug to the patient.
Additionally, or alternatively, a second flow restrictor can be provided in an inlet loop of the inlet conduit 32 of the pump 20 for regulating the rate at which the liquid drug refills the pump, and therefore, the maximum rate at which the patient can self-administer successive boluses of the drug, thereby precluding the possibility of a self-administered overdose thereof.
As will by now be evident to those of skill in this art, many variations and modifications are possible in the materials and methods of the PCA device 10 of the present invention without departing from its essence and scope.
For example, as illustrated a badge-type clip connected to a lead or a resilient clip 80 (see, for example, FIG. 1) can be provided on the housing of the device so that the device can be conveniently attached to an article of the patient's clothing or bed clothes. Alternatively and/or additionally, an extension clip or “badge clip” attached to a lead may be provided on the housing for greater versatility and options for orientation and attachment. Referring briefly to FIG. 2, an indicator 82 can be provided on the plunger 48, and a corresponding window 84 can be formed in the housing 12 of the device through which the indicator may be seen, such that the axial position of the plunger relative to its raised (reservoir-full) and lowered (reservoir-empty) positions can be easily visualized through the housing.
Referring now to FIG. 16, the present invention also encompasses a device 300 for dispensing fluid to a patient which includes a first reservoir 302 that serves as a pressurized fluid source or pump that holds medicinal fluid, such as local anesthetics (referred to hereinafter as a “pump”) and that is configured to provide a source of fluid under pressure. The pump 302 forces the medicinal fluid through a conduit 304. The conduit 304 splits into a continuous or primary flow path 306 and into a controlled bolus flow path 308 for delivery into a wound site nerve bundle or the blood stream of a patient P.
The pump 302 preferably accommodates about from 100 to 500 ml of fluid under 10-15 psi. The pump 302 has an inner core 316 surrounded by an elastomeric chamber 318 within a housing 320. The core 316 preferably has an inlet port 321 to fill the pump and an outlet port 322 in fluid communication with the tubing 304. The elastomeric chamber 318 is preferably constructed from a resilient material which may comprise a variety of elastomeric compositions, well known in the art, including vulcanized synthetic polyisoprenes, natural latex, natural rubber, synthetic rubber or silicone rubber. Fluid is held under pressure within the elastomeric chamber 318 and flows from the elastomeric chamber 318 through an outlet port 322 into the conduit 304 at a controlled and predictable rate. Alternatively, conduit 304 may be sized to serve as a flow restrictor. Exemplary pumps are described in U.S. Pat. No. 5,254,481 which is hereby incorporated by reference. A variety of other conventional pumps may be used, so long as they can impart the desired pressure on the fluid. For example, the pumps described in U.S. Pat. Nos. 5,080,652 and 5,105,983, which are hereby incorporated by reference may also be used, as well as other suitable electronic or mechanical pumps offered by other manufacturers as will be understood by those of skill in the art.
A large volume bolus delivery system 310 accumulates a large quantity of fluid from the bolus flow path 308 from the first reservoir 302, and holds the fluid under pressure until the bolus dose is triggered by a patient operable actuator 312 for release into the patient P. The large volume bolus delivery system 310 is configured to receive a pre-determined volume of fluid (i.e., the full bolus volume), the bolus delivery system being configured to elastically expand to pressurize the pre-determined volume of fluid, store the pressurized pre-determined volume of fluid and dispense the pressurized the pre-determined volume of fluid while avoiding bolus refill during bolus delivery or after bolus delivery but before it is enabled to elastically expand in a subsequent delivery cycle. The actuator 312 is configured such that it can be actuated only when the bolus delivery system contains the pre-determined volume of fluid, does not require effort to force the fluid out of the bolus reservoir and that, when actuated by the patient, fluid is permitted to flow out of the bolus reservoir to the patient without further action by the patient. The large volume bolus delivery system 310 is desirably the PCA device described above.
Downstream from large volume bolus delivery system 310, the continuous flow path 306 and the bolus dose flow path 308 converge into a single flow path 314 to the patient P. An optional clamp 324 is positioned in the flow path 306 downstream from the conduit 304. The clamp 324 can compress the flow path 306 such that fluid flow from the pump 302 is occluded. Such occlusion is advantageous for the transportation and preparation of the fluid delivery device and method as described herein. An exemplary clamp 324 is also described in U.S. Pat. No. 6,350,253, which is hereby incorporated by reference. However, a variety of other conventional clamps known in the industry may be used to occlude the flow of fluid from the pump 302 through the flow path 306 such as compression clamps, C clamps, roller clamps, and the like.
An optional filter 326 downstream of the clamp 324 separates the fluid from contaminates and other undesired particles that may be found within the fluid. The filter 326 also preferably eliminates air from the fluid path 306. One such filter 326 is described in U.S. Pat. No. 6,350,253, which is hereby incorporated by reference. Other suitable filters recognized in the industry may be used to capture undesired particles and/or remove air from the system.
An optional flow regulator 328 is positioned in the continuous flow path 306. The flow regulator 328 sets the continuous and substantially constant flow rate of fluid from the pump 302 to the patient P via tubing 306. The flow rate may be adjusted to a rate within a range of from about 1 to about 14 cubic centimeters per hour. Desirably, the flow rate may be from about 1 to about 7 or from about 2 to about 14 cubic centimeters per hour. The flow regulator 328 may be manually adjustable, if desired, and provided with a dial, switch or lever with an adjustable flow rate control display of from about 1 to about 14 cubic centimeters per hour. For example, the flow rate may be from about 1 to about 7 or from about 2 to about 14 cubic centimeters of fluid per hour. Alternatively, a constant flow regulator which may not be adjusted can be employed. For example, an optional first flow regulating orifice such as a first glass tube 360 may be employed in the primary or continuous flow path 306 and/or an optional second flow regulating orifice such as a second glass tube 362 may be employed in the bolus flow path 308
The particular arrangement of the clamp 324, filter 326 and flow regulator 328 herein described is merely exemplary. These elements, if present, may be arranged in any order as will be easily understood by those skilled in the art. For example, the first glass tube 360 and the second glass tube 362 may be located downstream of the respective filters 326 and 334.
Still referring to FIG. 23, an optional clamp 332 and an optional filter 334 may be positioned in the flow path 308 downstream from the conduit 304. The clamp 332 can compress the flow path 308 such that fluid flow from the pump 302 is occluded. Such occlusion is advantageous for the transportation and preparation of the fluid delivery device and method as described herein.
The release-rate of the bolus dose to the patient P is controlled by the decompression of the elastomeric bolus reservoir 310, by the pressure gradient at the valve 312, and the diameter of the catheter 330. Advantageously, the patient P does not have to provide pressure to force fluid out of the large volume bolus delivery system 310 into the narrower bolus flow path 308. Rather, the patient P can turn the stopcock or release the push button to administer the bolus dose. If the patient P activates the bolus valve 312 prior to the time the bolus reservoir 310 has filled to its capacity, the patient P receives less than the full amount of the bolus dose. In effect, this prevents the patient P from self-administering more than the maximum desired amount of fluid per the time specified as a large volume bolus dose.
In light of the foregoing examples, the scope of the present invention should not be limited to that of the particular embodiments described and illustrated herein, as these are merely exemplary in nature. Rather, the scope of the present invention should be commensurate with that of the claims appended hereafter and their functional equivalents.

## Claims

1. A device for dispensing fluid to a patient comprising:
a first reservoir configured to provide a source of fluid under pressure;
a bolus flow path for the delivery of a bolus dose of fluid;
a large volume bolus delivery system in fluid communication with the bolus flow path and configured to receive a pre-determined volume of fluid from the first reservoir, the bolus delivery system being configured to elastically expand to pressurize the pre-determined volume of fluid, store the pressurized pre-determined volume of fluid and dispense the pressurized pre-determined volume of fluid while avoiding bolus refill during bolus delivery or after bolus delivery but before it is enabled to elastically expand in a subsequent delivery cycle; and
a patient operable actuator actuated by pressing from an extended position to a depressed locked position to release fluid from the bolus delivery system, the actuator being configured such that once held in the depressed locked position, it does not require further effort to force the fluid out of the bolus reservoir by the patient, wherein the fluid is automatically forced out of the bolus reservoir to the patient while the actuator is in the depressed locked position; and
a lock configured with the patient operable actuator in a manner so as to automatically move to a locked position upon automatic subsequent release of the patient operable actuator from the depressed locked position to the extended position upon emptying the bolus reservoir and to automatically disengage from the locked position when the bolus reservoir is refilled so that the patient operable actuator is actuated only when the bolus delivery system contains the predetermined volume of fluid.

2. The device of claim 1, including a continuous flow path from the source providing a continuous and substantially constant flow rate of fluid, and wherein the continuous flow path and bolus flow path are in fluid communication with the source of fluid.

3. The device of claim 2, including a flow regulator which sets the flow rate through the continuous flow path into the patient.

4. The device of claim 3, wherein the continuous flow path and bolus flow path converge into a single path downstream from the flow regulator.

5. The actuator of claim 3, wherein the flow regulator comprises an adjustable flow regulator.

6. The device of claim 5, wherein the flow regulator includes a dial to permit adjustment of a flow rate through the flow regulator.

7. The device of claim 6, wherein the flow regulator includes a display configured to indicate a flow rate of fluid through the flow regulator.

8. The device of claim 7, wherein the adjustable flow regulator permits adjustment of the flow rate from about 1 to about 5 cubic centimeters of fluid per hour.