# Patent

## Title
Splitable tip catheter with bioresorbable adhesive

## Abstract

Splitable-tip catheters are disclosed with bioresorbable adhesive to provide spatial separation of distal tip elements during use. The invention can be particularly useful in hemodialysis applications where it is desirable to separate blood extraction and return lumens. The adhesive facilitates insertion of the distal end of the catheter as an assembly, e.g., into a blood vessel using a single guidewire, while the bioresorbable nature of the adhesive allows the tip elements to separate in vivo.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a divisional of U.S. patent application Ser. No. 10/874,298 filed on Jun. 9, 2004 now U.S. Pat. No. 8,992,454, and entitled “Splitable Tip Catheter With Bioresorbable Adhesive,” which is hereby incorporated by reference in its entirety.


FIELD OF THE INVENTION
The present invention generally relates to catheters and preferably to multi-lumen catheters used for vascular access.
BACKGROUND OF THE INVENTION
Multi-lumen catheters and, in particular split-tip catheters, are desirable for various treatment applications such as hemodialysis where fluid extraction and infusion occur simultaneously. Hemodialysis is the separation of metabolic waste products and water from the blood by diffusion through a semipermeable membrane. Typically, a hemodialysis unit is connected to a patient's body by a catheter. The catheter's distal end is placed in a blood vessel and its proximal end is connected to a hemodialysis unit.
During hemodialysis, a patient's blood flows through a double lumen catheter to the hemodialysis unit which provides filtration and controls the flow of blood. A double lumen catheter has two lumens that independently allow fluid extraction and return. For example, one lumen can be used for removing blood from a patient for processing in the hemodialysis machine and the other lumen can be used for subsequently returning the processed blood back to the patient's circulatory system.
Parameters that can be varied to achieve adequate hemodialysis include blood flow rate, dialysis solution flow rate, dialyzer competency, and temperature. Generally, raising the blood flow rate increases dialyzer clearance of small molecular weight solutes. Consequently, higher blood flow rates have been used to improve dialysis clearance efficiency. However, conditions such as access recirculation decrease clearance. Access recirculation is the recirculation of treated blood back into the hemodialysis unit causing inadequate dialysis. This problem effectively reduces blood flow rates thereby diminishing the efficiency of the hemodialysis process causing the duration of the treatment needed for dialysis to increase. Access recirculation can be particularly of concern when using a double lumen catheter due to the close proximity of the intake and outflow ports at the distal tip of the catheter.
Various double lumen catheter designs have been suggested for the purpose of reducing access recirculation. The distal ends of intake and outflow lumens have been longitudinally spaced 20-30 mm apart to prevent recirculation. For example, Twardowski et al. U.S. Pat. No. 5,569,182 discloses that the lumen for return of blood back into the vein should terminate beyond the extraction lumen. The purpose of this is to prevent cleansed blood, exiting from the outlet point of the catheter, from re-entering the catheter's blood inlet point and returning to the dialysis machine. However, certain disadvantages have been noted by such large longitudinal spacing between the distal ends of the respective lumens. For example, blood flow stagnation in the region of the blood vessel between two widely separated tips can lead to clot formation.
In addition to longitudinal spacing of the distal openings of the lumens for blood extraction and return, others have suggested that the distal end of a multi-lumen catheter can be split such that the distal tips of the lumens can independently move in the blood vessel to optimize the fluid dynamics of the different functions (blood extraction and blood return).
In general, good catheter outcomes depend on proper positioning of the catheter in the blood vessel. Insertion complications include pneumothorax, hemothorax, and cardiac tamponade, as well as poor blood flow rates, poor clearances, and long-term complications such as catheter dysfunction and fibrin sheath formation. These complications are compounded by the use of double lumen catheters because of their size.
Additional difficulties can be encountered when split distal tips must be inserted into a blood vessel. Typical insertion techniques of conventional double lumen catheters require the use of a peel-away sheath over a guidewire. Frequently there is a preference to insert the catheters without the use of a peel-away sheath to eliminate the risk of an air embolism by the use of two guidewires, or alternatively, inserting the guidewire through the one lumen and threading it through the side hole channels of the other lumen thus utilizing one guidewire, referred to as the “weave technique”. Moreover, precise positioning of a multi-lumen catheter can be challenging because the exact placement of the tips can not be assured. An improperly positioned multi-lumen catheter can further result in sub-optimal functionality requiring intervention.
Thus, there remains a need for a multi-lumen catheter that addresses the problems of access recirculation yet retains the comparative ease of insertion of a single lumen catheter.
SUMMARY OF THE INVENTION
Splitable-tip catheters are disclosed having tip elements that are joined with biodegradable or biosoluble adhesive to facilitate insertion and yet provide spatial separation of distal tip elements during use. The invention can be particularly useful in hemodialysis applications where it is desirable to separate blood extraction and return lumens. The adhesive facilitates insertion of the distal end of the catheter as an assembly, e.g., into a blood vessel using a single guidewire, while the biodegradable or biosoluble nature of the adhesive allows the tip elements to separate in vivo. The term “bioresorbable” as used herein encompasses both biodegradable and biosoluble materials.
The biodegradable adhesive, applied to the contacting surfaces of the distal tips of the extraction and return lumens, can be formed from various polymer or copolymer compositions. Additionally, the adhesive can be composed such that the time in which the adhesive biodegrades or biodisolves can be in the range of about 1 second to 1 hour. More generally, the adhesives of the present invention can bio-resorb from about 1 second to about 7 days, or from about 1 second to about 1 day, or from about 1 second to about 1 hour, or from about 1 second to about 10 minutes, or from about 10 seconds to about 5 minutes. In another embodiment a splitable tip catheter is disclosed having distal fluid openings to accelerate dissolution. The biodegradable or biosoluble adhesive can be water soluble such that the introduction of saline or similar type fluid will dissolve the adhesive and facilitate the separation of the distal tip elements.
An embodiment of the present invention provides a multi-lumen catheter device for hemodialysis having an elongate catheter body with at least one blood extraction lumen and one blood return lumen extending longitudinally therethrough. The proximal end of the instrument can be adapted for coupling to a hemodialysis apparatus and the distal end terminates in separable distal tip portions adapted for insertion into a blood vessel. The distal end of the catheter includes a distal extraction tip portion for fluid coupling of the extraction lumen with the blood vessel and a distal return tip portion for fluid coupling of the return lumen with the blood vessel, such that biodegradable or biosoluble adhesive joins the distal tip portions together prior to insertion into the blood vessel and facilitates the separation of the distal tip portions from each other following insertion.
Another embodiment of the present invention provides a method for hemodialysis to include providing a multi-lumen catheter assembly with at least a blood extraction lumen and a blood return lumen extending longitudinally therethrough, each lumen having a proximal end adapted for coupling to a hemodialysis apparatus and a distal end terminating in separable distal tip portions for blood extraction and return where the tip portions are joined together by a biodegradable or biosoluble adhesive. The method further provides for inserting the distal end of the catheter assembly into a blood vessel and allowing the adhesive to degrade such that the distal tip portions separate from each other within the blood vessel.
Therefore, the present invention addresses current problems associated with conventional split-tip catheter insertion by joining the distal tips of a split-tip catheter with biodegradable or biosoluble adhesive. After insertion of the catheter into the patient, the biodegradable or biosoluble adhesive dissolves and the distal tips of the split-tip catheter are free to move and function like conventional split-tip, double lumen, triple lumen, or multi-lumen catheters.



BRIEF DESCRIPTION OF THE DRAWINGS
The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:
FIG. 1A is a schematic, perspective view of an embodiment of the present invention showing distal tip portions joined together;
FIG. 1B is a schematic, perspective view of an embodiment of the present invention showing distal tip portions separated from one another;
FIG. 1C is a schematic view of an embodiment of the present invention in use in the body of a patient;
FIG. 2A is a cross-section view of an embodiment of the present invention showing opposed “D” shaped lumens inside an outer sheath;
FIG. 2B is a cross-section view of an embodiment of the present invention showing unibody construction utilizing opposed “D” shaped lumens;
FIG. 2C is a cross-section view of an embodiment of the present invention showing yet another unibody construction;
FIG. 2D is a cross-section view of an embodiment of the present invention showing individual lumens inside an outer sheath;
FIG. 2E is a cross-section view of an embodiment of the present invention showing a unibody construction utilizing individual lumens;
FIG. 2F is a cross-section view of a variation of an embodiment of the present invention showing opposed “D” shaped lumens;
FIG. 2G is a cross-section view of an embodiment of the present invention showing three lumens;
FIG. 2H is a cross-section view of a variation of an embodiment of the present invention showing three lumens;
FIG. 2I is a cross-section view of a yet another variation of an embodiment of the present invention showing three lumens;
FIG. 3A is a schematic, perspective view of an embodiment of the present invention showing an adhesive application using spots of adhesive;
FIG. 3B is a schematic, perspective view of an embodiment of the present invention showing an adhesive application using regions of adhesive;
FIG. 4A is a cross-section view near the distal end of a catheter according to the present invention showing distal tip portions adhered to one another;
FIG. 4B is an distal cross-sectional view of another embodiment of the present invention showing alternative adhesive disposition;
FIG. 4C is a distal cross-sectional view of yet another adhesive design;
FIG. 5A is a schematic, perspective view of another embodiment of the present invention showing distal tip portions joined and wound about one another;
FIG. 5B is a schematic, perspective view of the embodiment of FIG. 5A with the distal tip portions shown in a separated state;
FIG. 5C is a schematic, perspective view of an embodiment of the present invention showing one lumen wound about another lumen;
FIG. 6A is a schematic, perspective view of an embodiment of the present invention showing fluid openings in the distal tip portions;
FIG. 6B is a schematic, perspective view of an embodiment of the present invention showing a design having an additional center lumen;
FIG. 6C is a cross-sectional view of an embodiment of the present invention showing a design having an additional center lumen;
FIG. 7A is a schematic, perspective view of an embodiment of the present invention showing distal tip portions adhered to one another in a shape memory configuration;
FIG. 7B is a schematic, perspective view of the embodiment in FIG. 7A showing distal tip portions that are separated; and
FIG. 8 is schematic, perspective view of an embodiment of the present invention showing distal tip portions in an alternate shape memory configuration.



DETAILED DESCRIPTION OF THE INVENTION
As used herein, the term “bioresorbable” refers to materials that are biodegradable or biosoluble such that they degrade or break down by mechanical degradation upon interaction with a physiological environment into components that are metabolizable or excretable over a period of time.
The present invention includes various embodiments of a multi-lumen catheter for hemodialysis and methods of use. As shown in FIGS. 1A and 1B, one embodiment of catheter 10 includes an elongate body 20 having proximal and distal end 11 and 12, and at least one blood extraction lumen 30 and at least one blood return lumen 40 extending longitudinally therethrough. Each lumen 30, 40 has a proximal end 30′, 40′ adapted to direct fluid to, or couple directly with, a hemodialysis apparatus (not shown), and a distal end 31, 41 for insertion into a blood vessel. Distal extraction and return tip portions 32, 42 of each lumen 30, 40 include a distal end opening 33, 43 formed therein to provide for simultaneous flow of blood in opposite directions during hemodialysis. The distal extraction and return tip portions 32, 42 are joined by bioresorbable adhesive 90 prior to being inserted into a blood vessel such that after insertion, the bioresorbable adhesive degrades sufficiently to allow the distal extraction and return tip portions of each lumen 30, 40 to separate from one another.
FIGS. 1A and 1B illustrate an outer sheath 50 which covers and encloses the lumens 30, 40. The outer sheath 50 can be any shape and size and can be made of the same material as the lumens 30, 40 or other material compatible with insertion into a blood vessel. As illustrated in the embodiment shown in FIGS. 1A and 1B, the outer sheath 50 terminates proximal to the distal ends 31, 41 of the lumens 30, 40 such that the distal extraction and return tip portions 32, 42 of each lumen can separate from one another after being inserted into a blood vessel. FIG. 2A shows a cross-section 2-2 of one embodiment of an outer sheath 50. The outer sheath 50 can be any thickness and can have varying inner and outer shapes as well as varying inner and outer dimensions.
FIG. 2B illustrates another embodiment showing a cross-section of an elongate body 20 having unibody construction 500 which incorporates the blood extraction and blood return lumens 308, 408 in a single elongate body 20. The unibody catheter can be constructed such that sheath material 500′ separates the lumens 308, 408. The amount of sheath material around each lumen 308, 408 and in-between each lumen can vary but preferably allows for blood extraction and blood return in accordance with hemodialysis. Separating the sheath material in-between both lumens 308, 408 along a vertical axis y at one end of the unibody construction can separate the lumens from one another into distinct distal portions. A variety of methods known to one skilled in the art can be used to separate the material such as for example cutting or scoring.
In another embodiment of the present invention the elongate body 20 can be formed such that the blood extraction and blood return lumens 30 and 40 (or 300 and 400) are non-circular to increase the areas of their outer surfaces 350, 450 that are in contact as shown, for example, in cross-section in FIGS 4A and 6C. Here, the distal extraction and return tip portions 320, 420 of each lumen can have bioresorbable adhesive on all or any part of their facing surfaces 350, 450. As shown in FIG. 3A and 3B, the facing surfaces can be joined by spots 91 as well as regions 94 of adhesive (further described below). The configuration of the lumens in this embodiment allows the lumens, as joined, to resemble a single, circular lumen prior to insertion. After insertion of the distal extraction and return tip portions (e.g., tip portions 32 and 42 or tip portions 325 and 425), into a blood vessel, the bioresorbable adhesive 90 can dissolve allowing the tip portions to separate and facilitate hemodialysis.
The lumens 30, 40 can have a variety of cross-sectional shapes and sizes but preferably, as shown in the embodiments in FIGS. 1B, 2A, 2B, 2F, 3A, 3B, 4A, 4C, 6B, 6C, 7A, and 7B, the lumens are “D” shaped. Alternately, each of the lumens 30, 40 can have a cross-sectional shape, size, or area that can be distinct from the other, as shown, for example, in FIGS. 2C, 2G, and 2H. FIG. 2A is a cross-section view of an embodiment of the present invention showing opposed “D” shaped lumens inside an outer sheath. FIG. 2B is a cross-section view of an embodiment of the present invention showing unibody construction utilizing opposed “D” shaped lumens. FIG. 2C is a cross-section view of an embodiment of the present invention showing yet another unibody construction. FIG. 2D is a cross-section view of an embodiment of the present invention showing individual lumens inside an outer sheath. FIG. 2E is a cross-section view of an embodiment of the present invention showing a unibody construction utilizing individual lumens. FIG. 2F is a cross-section view of a variation of an embodiment of the present invention showing opposed “D” shaped lumens. FIG. 2G is a cross-section view of an embodiment of the present invention showing three lumens. FIG. 2H is a cross-section view of a variation of an embodiment of the present invention showing three lumens. FIG. 2I is a cross-section view of a yet another variation of an embodiment of the present invention showing three lumens. The lumens 30, 40 can be made of any material consistent with materials presently known for catheters including any material which allows the distal tip portions 32, 42 of the lumens to be flexible and facilitate hemodialysis.
The distal extraction and return tip portions 32, 42 of each lumen 30, 40 include distal end openings 33, 43 formed thereon for the extraction or return of blood or other bodily fluids. The openings are preferably sized to allow the carrying of blood to and from the hemodialysis unit. The distal extraction and return tip portions 32, 42 can be the same length or, as shown in FIGS. 1A and 1B, can be different lengths. As shown, the distal extraction tip portion 32 of the blood extraction lumen 30 terminates proximal to the distal return tip portion 42 of the blood return lumen 40. However, in another embodiment, the distal return tip portion 42 of the blood return lumen 40 can terminate proximal to the distal extraction tip portion 32 of the blood extraction lumen 30. The longitudinal distance d between the distal extraction and return tip portions 32, 42 of each lumen 30, 40 can vary but preferably allows for performing blood extraction and blood return in accordance with hemodialysis. Prior to the distal end 11 of the catheter being inserted into a blood vessel, the distal extraction and return tip portions 32, 42 of the lumens 30, 40 are joined to one another with bioresorbable adhesive 90. After insertion into the blood vessel, bioresorbable adhesive 90 facilitates the separation of the distal extraction and return tip portions 32, 42 of the lumens 30, 40.
The bioresorbable adhesive 90 used to join the distal extraction and return tip portions, 32, 42 of the lumens 30, 40 to one another can be a composition selected from the group of polymers consisting of polylactides, polyglycolides, polylactones, polyorthoesters, polyanhydrides, and copolymers and combinations thereof. In general, bioresorbable adhesives have bonding elements and degradable elements. The degradable elements can have the components of polylactide, polyglycolide and polylactones (polycaprolactone). The bonding elements can have hydrogen bonding strength (polyvinyl alcohol, polysaccharides) or can be able to polymerize as a single component (cyanoacrylates) or as two componets (epoxy compound plus amino compounds, or radical (light) initiators of acrylate compounds).
Proteins, sugars, and starch can also be used as an adhesive. By way of non-limiting example, antithrombotic agents such as heparin and hirudin, citrate, antithrombin-heparin complex, and albumin heparin complex as well as anti-infective agents such as chlorohexidine, silver, antibiotics, and antiseptic agents may be added to the adhesive.
In an embodiment of the present invention, polymers which can be useful include polyurethane, generally described as a copolymer of polyethylene glycol with polylactide or polyglycolide end capped with methacrylates. Another embodiment can include a two component composition, one component preferably including a low molecular weight polyurethane end capped with methacrylates, and the other component preferably including polylactide, polyglycolide, or polycaprolactone end capped with methacrylate.
In another embodiment of the present invention, one or more components can be used from styrene, methyl methacrylate, methyl acrylate, ethylene dimethacrylate, ethylene diacrylate, acrylamide, diurethane dimethacrylate, polyisoprenegraft-maleic acid monomethyl ester, azobis(cyanovaleric acid), azobiscyclohexanecarbonitrile, azobisisobutyronitrile, benzoyl peroxide, iron (II) sulfate, polyvinyl alcohol, dextran, polysaccharide, epichlorohydrin, ethylenediamine, diaminocyclohexane, diamino propane, copolymers with polylactide and polyethylene oxide as the blocks and acrylate, methacrylate as the end groups, cyanoacrylates, ethyl-2cyanoacrylate, propyl-2-cyanoacrylates, pentyl-2-cyanoacrylate, hexyl-2-cyanoacrylate, and octyl-2-cyanoacrylate, ammonium persulfate and/or polyethylene glycol methacrylate when water, organic solvent such as dichloromethane, chloroform, tetrahydrofuran, acetone, petroleum ether, acetyl acetate, dimethylformamide, or the mixture thereof, is combined with the aforementioned solvents.
As shown in FIGS. 1A, 3A, and 3B, bioresorbable adhesive can be applied along a facing surface 35, 45 of either, or both, distal extraction and return tip portions 32, 42 of the lumens 30, 40 to facilitate the joining of the lumens along their longitudinal length l prior to insertion of the distal end 11 of the catheter 10 into a blood vessel. (As used throughout, “catheter 10” refers to the various embodiments of the present invention.) FIG. 1A shows bioresorbable adhesive 90 applied along a longitudinal length l of the distal extraction and return tip portions 32, 42 of each lumen 30, 40. However, the bioresorbable adhesive 90 need not be applied along the entire length of the facing surfaces 35, 45 of each lumen 30, 40 but is preferably applied such that the adhesive facilitates the joining of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 prior to insertion into a blood vessel and allows the distal extraction and return tip portions of the lumens to separate after insertion.
In the embodiments described herein, the bioresorbable adhesive 90 preferably dissolves after insertion into a blood vessel to provide separation of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 in a time period ranging from 1 minute to 1 hour. This range can be controlled by using different compositions of the bioresorbable adhesive 90 as well as by the amount of adhesive applied to join the distal extraction and return tip portions 32, 42 of the lumens 30, 40 together. In another embodiment with opposed distal fluid openings 80 (further described below), the bioresorbable adhesive 90 can be water soluble such that the introduction of saline or similar type fluid will effectuate the separation of the distal extraction and return tip portions 32, 42 of the lumens 30, 40. In this instance, the adhesive will not dissolve until a time after the introduction of the soluble solution into the lumens 30, 40.
As shown in another embodiment in FIG. 3A, the bioresorbable adhesive can also be applied to the facing surfaces of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 in form as discrete spots 91. The spots 91 of bioresorbable adhesive 90 can be applied continuously along the entire longitudinal length l of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 or selectively in an assortment of areas thereof. Preferably, the bioresorbable adhesive 90 is applied such that the spots 91 of adhesive facilitate the joining of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 prior to insertion into a blood vessel and allow the distal extraction and return tip portions of the lumens to separate after insertion. The spots 91 of bioresorbable adhesive 90 can vary in number and size in order to facilitate the joining of the tip portions of the lumens.
FIG. 3B shows yet another embodiment of the application of the bioresorbable adhesive 90 in the form of discrete regions 94. Discrete regions 94, like the spots 91 stated above, of bioresorbable adhesive 90 can be applied to the facing surfaces of the distal extraction and return tip portions 32, 42 of the lumens 30, 40. The discrete regions 94 of bioresorbable adhesive 90 can also be different lengths and can be applied in addition to discrete spots 91 of adhesive such that the adhesive facilitates the joining of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 prior to insertion into a blood vessel and allows the distal extraction and return tip portions of the lumens to separate after insertion.
FIGS. 4A-4C show cross-sections of the distal extraction and return tip portions 32, 42 of the lumens 30, 40 detailing alternate embodiments of the bioresorbable adhesive 90 application. FIG. 4A shows bioresorbable adhesive 90 applied at the contact point 70 of the facing surfaces 350, 450 of the lumens 30, 40. FIG. 4B shows another embodiment of an application of the bioresorbable adhesive 90 such that the adhesive, as applied, joins non-contacting surfaces 36, 46 of the distal extraction and return tip portions 32, 42 of the lumens 30, 40. FIG. 4C shows a variation on the embodiment shown in FIG. 4A where the bioresorbable adhesive 90 surrounds the distal extraction and return tip portions 32, 42 of the lumens 30, 40 forming a continuous cross-section of adhesive coating notwithstanding the distal extraction and return tip portions of the lumens extending therethrough. As stated above, the bioresorbable adhesive 90 need not be applied along the entire length of the distal extraction and return tip portions 32, 42 of each lumen 30, 40 but is preferably applied such that the adhesive facilitates the joining of the distal extraction and return tip portions of the blood extraction and blood return lumens prior to insertion into a blood vessel and allows the distal extraction and return tip portions of the lumens to separate after insertion. It should be noted that because the lumens 30, 40 can be various shapes, as stated above, the bioresorbable adhesive 90 need not be applied to all of the contact area along length l of the facing surfaces 35, 45 of each lumen 30, 40, as shown in FIG. 1A. As shown in FIGS. 3A and 3B, the bioresorbable adhesive 90 can be applied as a region 94, spot 91, or other shape, to a section of the contact area and need only be applied to facilitate the joining function.
FIG. 5A illustrates another embodiment of the present invention. As shown, the lumens 30, 40 are twisted about, or otherwise wrapped, around one another. The wrapped lumens can be twisted about one another such that there are non-contact areas, along the longitudinal length l of the distal extraction and return tip portions of each lumen 30, 40 as shown in FIG. 5A. In FIG. 5B, the distal tip elements are shown in a separated state. The distal extraction and return tip portions of each lumen 30, 40 can wrap around one another any number of times, as well as wrap such that one lumen 30 is wound around the other lumen 40 as shown in FIG. 5C, or vice versa. In FIG. 5A, bioresorbable adhesive 90 can be applied where the distal extraction and return tip portions of the lumens 30, 40 contact one another. As stated above, the bioresorbable adhesive 90 can be applied in discrete spots or regions where the distal extraction and return tip portion surfaces contact one another. However, the bioresorbable adhesive need not be applied to all contact points of the twisted lumens 30, 40 so long as the joining of the distal extraction and return tip portions of the lumens 30, 40 can be facilitated. The various compositions and methods of application of the bioresorbable adhesive 90 application previously described above can also be used with the twisted embodiment catheter design as well.
In another embodiment of the present invention, FIG. 6A shows distal fluid openings 80, in formed in the distal extraction tip portion 32 of lumen 30. It should be understood from the drawings that in the embodiment shown, the distal fluid openings 80 can either be in addition to, or in place of, the distal end opening 33 located on the distal extraction tip portion 32 of lumen 30. The distal fluid openings 80 can be any shape and size and can be located in a variety of places on lumen 30 as illustrated. However, FIG. 6A shows the distal fluid openings 80 located on facing (contacting) surface 35 of the distal extraction tip portion 32 of lumen 30. In this embodiment, the distal fluid openings 80 can be filled or covered with fluid activated bioresorbable adhesive 900 and joined to lumen 40 along its facing surface 45. After insertion of the catheter into a blood vessel, saline or similar type fluid can be introduced into lumen 30 at its proximal end 30′ such that the fluid travels through the lumen to the distal fluid openings 80 and dissolves the fluid activated bioresorbable adhesive 900 thereby separating the distal extraction and return tip portions 32, 42 along their longitudinal length l to facilitate hemodialysis. Bioresorbable adhesive 90 can also be applied to the contact surfaces 35, 45 of each lumen as previously described above in addition to the distal fluid openings 80 being filled or covered with fluid activated bioresorbable adhesive 900.
FIG. 6B shows yet another embodiment in which the catheter 10 can be designed to facilitate separation of its distal tips 325, 425 after insertion into a blood vessel. Catheter 10 can include a center lumen 60 extending in-between lumens 300, 400 from a proximal end 120 to a separation point 62 and can be used to carry saline or a similar type fluid. At the separation point 62, the center lumen splits into two center lumen halves 63′, 64′ each half located in a facing surface 350, 450 of each lumen 300, 400. The center lumen 60 can be made of a variety of cross-sectional shapes but is preferably circular. As shown, the center lumen halves 63′, 64′ terminate proximal to the distal ends 310, 410 of lumens 300, 400. It should be noted that a mirrored portion of center lumen half 64′ is located in the facing surface 450 of distal return tip 425. The proximal end of center lumen 60, which is out of view in FIG. 6B, can extend at the proximal end 120 of catheter 10 anywhere outside the patient so long as the center lumen 60 can be accessible for saline fluid introduction. As shown in FIG. 6C, the center lumen 60 and the center lumen halves 63′, 64′ are not in fluid communication with either of the lumens 300, 400. Distal extraction and return tip portions 325, 425 can have fluid activated bioresorbable adhesive 900 applied anywhere within center lumen halves 63′, 64′ distal of a center lumen gap. The adhesive 900 can also be applied at or beyond a center lumen half end, to facilitate separation of the distal tip portions 325, 425. The center lumen gap, of any desirable length, should remain free of fluid activated bioresorbable adhesive 900 and in fluid communication with a blood vessel in order to allow any extraneous saline or similar type fluid to be displaced between the facing surfaces 350, 450 and into the bloodstream during the dissolving process.
In this embodiment, the catheter 10 is inserted into a patient and saline or other type fluid can be introduced into the center lumen 60 at its proximal end which dissolves the fluid activated bioresorbable adhesive 900 applied at or beyond center lumen gap. Once separated, the distal tip portions 325, 425 can facilitate blood extraction and blood return in accordance with hemodialysis through distal end openings of lumens 300, 400.
In FIGS. 7A and 7B, another embodiment of the present invention is shown in which one or both of the lumens 30, 40 can be made of a shape memory material such that after insertion of the distal end 11 of the device into a blood vessel, and upon the bioresorbable adhesive 90 dissolving, the lumens, and more preferably the distal extraction and return tip portions 32, 42 thereof, can separate to a pre-adhesive position. The distal extraction and return tip portions 32, 42 of the lumens 30, 40 can be made of polymer material or other material as needed or combined to facilitate the shape memory in the described embodiment. FIGS. 7A and 7B illustrate the lumens 30, 40 in this configuration. The distal extraction and return tip portions 32, 42 of each lumen 30, 40 are joined with bioresorbable adhesive 90 prior to insertion into a blood vessel. A memory gap 93 can be located between the lumens and distal of the outer sheath 50. The memory gap can be any length and width but preferably allows for a configuration such that the lumens 30, 40 are not pinched after joining. As shown, each lumen 30, 40 exits the outer sheath 50 in a non-parallel, diverging direction. The relative angle α at which the lumens 30, 40 exit the outer sheath 50 can vary. Bioresorbable adhesive 90 can be applied, in any manner described herein, to join the lumens 30, 40 distal of the memory gap 93. FIG. 7B shows the lumens 30, 40 in roughly a “pre-adhesive” configuration as well as in an “after insertion into a blood vessel” configuration. It should be noted that the lumens 30, 40 illustrated in FIG. 7B, can separate more or less, after being inserted into a blood vessel, as compared to their pre-adhesive state.
In another embodiment, the distal extraction and return tip portions 32, 42 of each of the lumens 30, 40 can be pre-formed to exit the outer sheath 50 in a substantially parallel direction and then angularly diverge from one another, at a location distal from the outer sheath, upon the degradation of the bioresorbable adhesive 90, as shown in FIG. 8. The distal extraction and return tip portions 32, 42 of each lumen 30, 40 shown in FIG. 8, exit the outer sheath 50 in a distal direction and are substantially parallel relative to one another. As the bioresorbable adhesive 90, applied in any manner described herein, dissolves, the distal extraction and return tip portions 32, 42 of the lumens 30, 40 substantially separate and angularly diverge from one another along a longitudinal axis b. Distal extraction and return tip portions 32, 42 of each lumen 30, 40 can be pre-formed from polymer or similar type polymer materials to effectuate this divergence. As further shown in FIG. 7, the distal extraction and return tip portions 32, 42 can re-converge toward each other if desired or can continue diverging as shown in FIG. 6B.
In use, a catheter 10 is provided having distal extraction and return tip portions 32, 42 which are joined to one another using any of the bioresorbable adhesive applications described throughout this specification. The proximal end 12 of the catheter 10 can be attached to a hemodialysis apparatus using various attachment means known to one skilled in the art. The distal end 11 of the catheter 10 can be inserted into a blood vessel wherein the bioresorbable adhesive 90 is allowed to dissolve in a time in the range of 1 minute to 1 hour, such that the distal extraction and return tip portions 32, 42 of the blood extraction lumen 30 and the blood return lumen 40 separate from each other within the blood vessel. Blood extraction and blood return can be subsequently commenced through each lumen 30, 40 according to hemodialysis methods and practices.
Accordingly, the embodiments of the present invention are not limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.

## Claims

1. A multi-lumen catheter device for hemodialysis, comprising:
an elongate catheter body with at least a blood extraction lumen and a blood return lumen extending longitudinally therethrough, having a proximal end adapted for coupling to a hemodialysis apparatus, and having a distal end terminating in separable distal tip portions adapted for insertion in a blood vessel, the distal end further comprising:
a distal extraction tip portion for fluidic coupling of the blood extraction lumen with the blood vessel;
a distal return tip portion for fluidic coupling of the blood return lumen with the blood vessel;
at least one gap between the distal extraction tip portion and the distal return tip portion that facilitates the entry of fluid between the distal tip portions; and
a bioresorbable adhesive located between the separable distal tip portions distal to the at least one gap, the adhesive configured to join the distal tip portions together for insertion into the blood vessel while maintaining the at least one gap between the distal tip portions, the bioresorbable adhesive dissolvable in blood of the blood vessel, thereby facilitating separation of the distal tip portions from each other following insertion.

2. The device of claim 1, wherein the blood extraction and blood return lumens are independent of each other to provide simultaneous flow of blood in opposite directions during hemodialysis.

3. The device of claim 1, wherein the bioresorbable adhesive comprises a hydrophilic polymer.

4. The device of claim 1, wherein the bioresorbable adhesive comprises a water-soluble composition.

5. The device of claim 1, wherein the bioresorbable adhesive degrades in blood to provide separation of the distal tip portions from each other in less than an hour.

6. The device of claim 1, wherein the bioresorbable adhesive degrades in blood in a time period ranging from about 1 second to about 7 days.

7. The device of claim 1, wherein the bioresorbable adhesive degrades in blood in a time period ranging from about 1 second to about 1 day.

8. The device of claim 1, wherein the bioresorbable adhesive degrades in blood in a time period ranging from about 1 second to about 1 hour.

9. The device of claim 1, wherein the bioresorbable adhesive comprises a composition selected from a group consisting of polylactides, polyglycolides, polylactones, polyorthoesters, polyanhydrides, and copolymers thereof.

10. The device of claim 1, wherein the bioresorbable adhesive comprises a protein, a sugar, and a starch.

11. The device of claim 1, wherein the bioresorbable adhesive comprises an antithrombotic, an anti-septic, or an anti-stenotic agent.

12. The device of claim 1, wherein the distal tip portions are of different lengths.

13. The device of claim 1, wherein the blood extraction and blood return lumens have different cross-sectional areas.

14. The device of claim 1, wherein at least one of the distal tip portions has a plurality of openings for fluid flow.

15. The device of claim 1, wherein the elongate catheter body has an unibody construction with the blood extraction lumen and the blood return lumen incorporated therein.

16. The device of claim 1, wherein the blood extraction and the blood return lumens are separate tubular elements and partially joined by an outer sheath.

17. The device of claim 1, wherein the bioresorbable adhesive covers at least a portion of an outer surface of each distal tip portion.

18. The device of claim 1, wherein the bioresorbable adhesive applied to a surface of each distal tip portion forms a continuous linear bond.

19. The device of claim 1, wherein the bioresorbable adhesive applied to a surface of each distal tip portion forms discrete spots.

20. The device of claim 1, wherein at least one distal tip portion comprises a shape memory material.

21. The device of claim 20, wherein the shape memory material is configured to facilitate an angular separation of the distal tip portions from each other to a pre-adhesive position following dissolution of the bioresorbable adhesive.

22. The device of claim 1, wherein at least one of the distal tip portions is coiled about another of the distal tip portions.

23. The device of claim 1, wherein the elongate catheter body contains an additional lumen for fluid administration or sampling.

24. The device of claim 1, wherein the bioresorbable adhesive comprises a bonding element and a degradable element.

25. The device of claim 1, further comprising a third lumen extending longitudinally along a length of the device from the proximal end to a separation point between the distal tip portions, wherein the third lumen is designed such that fluid administered through the third lumen is directed from the third lumen at the bioresorbable adhesive located between the separable distal tip portions to facilitate the dissolution of the bioresorbable adhesive and separation of the distal tip portions.