SELF-GUIDING, MULTIFUNCTIONAL VISCERAL CATHETER

Abstract: The present invention is a multifunctional visceral catheter (1) having a self-guiding system in the form of one or more sensor systems (7, 14, 7', 14', 6, 12) which are sensitive to a predetermined analyte having a specific relationship to an organ associated with a given visceral venous system, such that values of the analyte within the visceral venous system are substantially different from values of the analyte outside the visceral venous system, e.g., galactose in the hepatic venous system or creatinine in the renal venous system.

Description: SELF-GUIDING. MULTIFUNCTIONAL VISCERAL CATHETER 1. Technical Field The invention relates to a multifunctional visceral catheter which is substantially self-guiding, i.e., which may be positioned in a visceral venous system without the need for bedside fluoroscopy or other x-ray devices. The self-guiding system of the catheter comprises sensor system(s) which are sensitive to a predetermined analyte or metabolite having a specific relationship to an organ associated with a given visceral venous system, such that values of the analyte within the visceral venous system are substantially different from systemic values of the analyte outside the visceral venous system. When the catheter is properly positioned, such as in the hepatic or renal vein, for example, signals received from the sensor system(s) will reflect a sudden, substantial difference in concentration values of the given analyte so as to readily confirm proper positioning. The catheter according to the invention is also capable of performing various other functions, including: continuous monitoring of the oxygen saturation in the hepatic or renal venous blood; measuring absolute hepatic or renal blood flow using a tracer clearance technique; and direct sampling of venous blood, such as hepatic or renal venous blood, for the ex vivo measurement of metabolite concentrations. 2. Background Art Known methods of diagnosing liver and/or kidney dysfunction, and for assessing associated physiological parameters typically require catheterization of the hepatic or renal venous systems. A principal disadvantage associated with known techniques for catheterizing the hepatic and renal venous systems is that bedside fluoroscopy or other x-ray devices are required in order to properly position the catheter. For example, while a thermodilution catheter has been developed for renal blood flow deteπnination which might be applicable to general clinical use, the need for fluoroscopic assistance in positioning such catheter is a critical shortcoming. See M. Brenner, G. L. Schaer, D. L. Mallory, et al, "Detection of renal blood flow abnormalities in septic and critically ill patients using a newly designed indwelling thermodilution renal vein catheter", Chest, Vol. 98, pp. 170-79 (1990). The invention overcomes this major shortcoming by providing a visceral catheter which is effectively self-guiding, i.e., which permits positioning of the catheter without the use of bedside fluoroscopy or other x-ray devices. In addition, the catheter of the invention permits continuous monitoring of the oxygen saturation in the hepatic or renal venous blood. Heretofore, there has been no known technique for readily assessing individual organ function or oxygenation. Instead, central mixed venous oxygen saturation has commonly been used as an index of global body oxygenation. However, studies have shown that a marked reduction in hepatic venous oxygen saturation frequently exists in critically ill patients. See, e.g., Michael S. Dahn, M. Patricia Lange, Robert F. Wilson, Lloyd A. Jacobs, and Robert A. Mitchell, "Hepatic blood flow and splanchnic oxygen consumption measurements in clinical sepsis," Surgery, Vol. 107, No. 3, pp. 295-301 (March 1990). This condition goes undetected when only global body oxygenation is assessed, leaving the physician unaware of a condition which could otherwise be therapeutically addressed. To overcome this problem, the catheter of the invention is capable of continuously monitoring regional oxygenation. Once the catheter is placed in a major hepatic vessel, hepatic function can be assessed in a more direct fashion than by conventional means such as by monitoring serum bilirubin or liver enzymes. The catheter of the invention also permits convenient, direct monitoring of the renal venous system, so that endogenous creatinine clearance and other renal functional indicators can be critically assessed. Further, if inulin and/or para-aminohypurate are available for intravenous infusion, glomerular filtration rate and renal blood flow can be assessed. 3. Disclosure of Invention The invention provides a visceral catheter comprising a catheter body provided with means for guiding the catheter to a position in which a portion of the catheter body is disposed within a predetermined visceral venous system. The catheter body comprises a main axial portion extending from the proximal end thereof, and an angled distal end portion extending from the main axial portion at a predetermined angle. The guiding means comprises first sensor means for detecting values of a predetermined analyte and for outputting signals related thereto, the first sensor means being disposed on a first portion of the main catheter body which in an operative position remains in a vessel outside the visceral venous system; and second sensor means for detecting values of the predetermined analyte and for outputting signals related thereto, the second sensor means being disposed on the angled distal end portion of the catheter body which in an operative position is positioned within the visceral venous system. The analyte has a specific relationship to the organ associated with the predetermined visceral venous system such that values of the analyte within the visceral venous system are substantially different from systemic values of the analyte outside the visceral venous system. The first and second sensor means are selectively connected to detector means for comparing the signals from the first and second sensor means and for alerting a user to a substantial difference between the signals. In a preferred embodiment, the first and second sensor means each comprises a fiberoptic biochemical sensor means, thus avoiding any direct electrical connection to the patient or potential electrical interference problems, enhancing detection capabilities, and reducing the size and/or expense of components. Further, there may be provided third fiberoptic sensor means for monitoring the oxygen saturation of blood in the visceral venous system, disposed substantially at the distal end of the catheter body. The catheter further includes means for measuring blood flow in the visceral venous system, comprising the first and second fiberoptic sensor means. An integral operating unit is provided which comprises illuminating means for transmitting light to all three fiberoptic sensor means, a microprocessor, and program memory programmed for computing concentration values of the predetermined analyte and for storing at least one equation for calculating blood flow values on the basis of concentration values. The microprocessor receives signals from the first and second fiberoptic sensor means and utilizes the program memory to calculate concentration values of the predetermined analyte based on the signals from the first and second sensor means, and to calculate the blood flow values utilizing the stored equation(s) and the concentration values. In an alternative construction of the catheter of the invention, the first and second sensor means each comprises an electrochemical sensing system including an electrode with a hydratable membrane containing a reagent which detects values of the predetermined analyte. Regardless of the type of sensor means employed, the invention further contemplates a single sensor construction in which a sensor is provided only on the angled distal end portion of the catheter, with proper positioning being confirmed by a substantial difference in analyte concentration as detected by the single sensor as it is moved from a vessel outside the predetermined venous system to an operable position within the venous system. It is an object of the invention to provide a visceral catheter which may be readily positioned within the hepatic or renal venous system by virtue of a novel self-guiding sensor arrangement which utilizes the difference in concentration of a given analyte within the visceral venous system, as opposed to outside that venous system, to readily confirm proper positioning of the catheter. A further object of the invention is to provide a self-guiding visceral catheter comprising means for continuously monitoring the oxygen saturation of blood in a desired visceral venous system, the monitoring means taking the form of a fiberoptic system. Another object of the invention is to provide a visceral catheter having the capability of measuring absolute hepatic or renal blood flow using a tracer clearance technique, based on outputs from the same sensor systems which form part of the self- guiding system of the catheter. The above and further objects, details and advantages of the invention will become apparent from the following detailed description, when read in conjunction with the accompanying drawings. 4. Brief Description of Drawings Figure 1 is a schematic view of a fiberoptic sensor embodiment of the catheter according to the invention. Figure 2 is a view taken along line 2-2 in Figure 1. Figure 3 is a view taken along line 3-3 of Figure 1. Figure 4 is a cut-away view of the distal end of the catheter, provided with a preferred fiberoptic sensor. Figure 5 is a cut-away, enlarged view of the fiberoptic sensor of Figure 4. Figure 6 is a cut-away view of the distal end of the catheter, provided with a fiberoptic sensor. Figure 7 is a cut-away view of a portion of the catheter of Figure 1, depicting various parts of the fiberoptic systems. Figure 8 is a cut-away view of the distal end of the catheter, showing an optical fiber of a fiberoptic system in an alternative embodiment. Figure 9 is a cut-away, enlarged view of an optical fiber and optode-type sensor according to another embodiment. Figure 10 shows a box diagram of an Analyzer Unit for operating the various elements of the catheter of Figure 1. Figure 11 is a schematic view of an alternative electrochemical sensor construction of the catheter according to the invention. Figure 12 is a cut-away view of the distal end of the catheter shown in Figure 11. Figure 13 is a cut-away view of an intermediate portion of the catheter of Figure 11. Figure 14 shows a box diagram of a detector for operating the various elements of the catheter of Figure 11. 5. Detailed Description and Best Mode of Carrying Out the Invention With reference to Figure 1, the self-guiding, multifunctional visceral catheter 1 according to a first embodiment of the invention comprises a main catheter body having a proximal end 1A and a distal end IB. The catheter 1 may comprise, for example, a 7F polyvinyl chloride diagnostic catheter which is designed for passage through an introducer system via the transfemoral venous route. However, other suitable catheters may alternatively be employed. The distal end portion of catheter 1 is preferably bent at an angle to facilitate spontaneous engagement of the distal end of the catheter with a desired vein during positioning, as described below. In the Figure 1 embodiment, the portion of catheter 1 including distal end IB is disposed at an acute angle of substantially 65° relative to the main axial portion of the catheter. It is contemplated that such angle may be varied as necessary and may range, for example, from approximately 20° to 160°, depending upon the particular application. With reference to Figures 1-3, catheter 1 is substantially hollow along its length, with the distal end portion provided with side vents 5 for the catheter lumen. Extending along the inside surface of catheter 1 are optical fibers 6 and 7 which are preferably retained in position by being embedded within the polyvinyl chloride or other material from which catheter 1 is fabricated. Optical fibers 6 and 7 each form part of respective fiberoptic sensor systems in accordance with the invention, as described below. Also provided within catheter 1, and extending along the entire length from proximal end 1A to distal end IB, is an optical fiber 8. Preferably, optical fiber 8 is also retained in position along the inside surface of catheter 1 by being embedded within the polyvinyl chloride or other material from which catheter 1 is fabricated. Optical fiber 8 is used for monitoring oxygen/hemoglobin saturation, as described below. As shown in Figure 3, optical fibers 6 and 7 may desirably, but not necessarily, be positioned substantially next to each other so as to extend along an inside surface portion of catheter 1 which is substantially opposite optical fiber 8. Optical fiber 6 extends from proximal end 1A of catheter 1 to a fiberoptic sensor 12 disposed on the main axial portion of catheter 1 (e.g., approximately 15 cm from the distal catheter bend), while optical fiber 7 extends from proximal end 1A to a fiberoptic biochemical sensor 14 - 8 - disposed on the angled distal end portion of the catheter. The proximal ends of optical fibers 6 and 7 are adapted to be connected with an Analyzer Unit as described below. Also provided at proximal end 1A of catheter 1 is a catheter hub 9. The two fiberoptic biochemical sensor systems in accordance with the invention comprise the optical fiber 6 and biochemical sensor 12 on the one hand, and the optical fiber 7 and biochemical sensor 14 on the other, together with the Analyzer Unit with which optical fibers 6 and 7 are connected. In one embodiment, the two sensor systems each comprise a substrate optode such as shown in Figure 9. Although only optical fiber 7 and sensor 14 of the distal sensor system are shown in Figure 9, it will be understood that the proximal sensor system including optical fiber 6 and sensor 12 is of substantially the same construction. For a general discussion of fiberoptic sensors used in medical applications, see, for example, J. S. Schultz, "Medical Applications of Fiberoptic Sensors", Medical Instrumentation, Vol. 19, pp. 158-63 (1985). For a discussion of the characteristics of substrate optode systems see, for example, N. Uwira, N. Opitz and D. W. Lubbers, "Influence of enzyme concentration and thickness of the enzyme layer on the calibration curve of the continuously measuring glucose optode", Adv. Exp. Med. Biol, Vol. 169, pp. 913-21 (1984); and K. P. Volkl, N. Opitz, and D. W. Lubbers, 'Temperature dependence of enzyme optodes as exemplified by the glucose optode", Adv. Exp. Med. Biol, Vol. 222, pp. 199-204 (1984). As shown in Figure 7, the optical fiber 7 is comprised of a core 7A surrounded by a suitable sheath or clad 7B. Provided at the distal end of optical fiber 7 is the biochemical sensor 14 comprised of biochemical sensor material 14A encased within a semipermeable membrane 14B. By way of example, the membrane 14B may comprise a Cuperphan membrane (Cuperphan, Enkar, Germany). While the sensor material 14A may take various forms, where the catheter is to be positioned in the hepatic venous system the sensor is adapted to detect analytes specific to the liver, such as plasma galactose. In one embodiment, galactose oxidase and luminol are applied to the optical fiber tip within the Cupeφhan membrane. Galactose is freely diffusible into the tip via the Cupeφhan membrane. When galactose is detected in the plasma, the galactose oxidase in the sensor material liberates hydrogen peroxide which then reacts with luminol to generate fluorescence according to the following scheme: galactose oxidase Galactose -I- O2 ► product -I- H2O2 peroxidase H2O2+ luminol ► H2O + luminol + fluorescence The Analyzer Unit to which the proximal ends of optical fibers 6 and 7 are connected comprises all necessary fiberoptic system components such as at least one light source, detection means, a microprocessor, and the like, as shown in Figure 10. The light source transmits excitation light through optical fibers 6, 7 to excite fluorescence of the optodes. The returning fluorescent signals, which vary with the relative concentration of galactose (or other plasma substrate), are received by the detector and are measured and compared with each other. The user is then alerted to a substantial difference in the respective fluorescent signals received from sensors 12 and 14 by means of a visual display and/or an audio signal. Use of catheter 1 as a hepatic catheter will now be described. As an initial procedure, an intravenous galactose infusion is initiated in a patient. This may entail, for example, the infusion of a priming bolus (e.g., 50 to 100 ml) of 5% to 7% galactose, followed by a continuous infusion at 100 ml/hour until a steady-state galactose concentration is reached. Once the galactose infusion has been initiated, the catheter 1 may be advanced transfemorally through the venous system. As the distal tip IB reaches the hepatic venous system, it will spontaneously engage the major hepatic veins, i.e., it will spontaneously advance into the hepatic vein when the tip is in proximity thereto. Thus, the distal sensor 14 will be disposed within the hepatic venous system, while the proximal sensor 12 will remain in a vessel outside the hepatic venous system, i.e., in the inferior vena cava, in the operable position of catheter 1. It is known that the extraction fraction of galactose across the splanchnic bed is greater than 90% in normal control subjects and 75% in critically ill septic patients. See Michael S. Dahn, M. Patricia Lange, Robert F. Wilson, Lloyd A. Jacobs, and Robert A. Mitchell, "Hepatic blood flow and splanchnic oxygen consumption measurements in clinical sepsis," Surgery, Vol. 107, pp. 295-301 (1990). This large gradient of galactose will be readily detected by a comparison of the fluorescent signals from the sensors 12 and 14. The hepatic venous sensor, i.e., the distal sensor 14, will detect a low concentration of galactose compared to that detected by proximal sensor 12 which remains in the inferior vena cava and thus measures systemic, or pre-hepatic galactose levels. It will thus be understood that the self-guiding system of catheter 1 permits positioning of the catheter in the hepatic venous system without any need for bedside fluoroscopy or other x-ray devices. By virtue of the shape of catheter 1, the angled distal end IB will spontaneously advance into the hepatic vein when the tip is in proximity thereto. This positioning of the catheter within the hepatic vein is then readily and immediately confirmed by the large difference in galactose concentrations as reflected by the fluorescent signals received from the two fiberoptic sensor systems. In one preferred embodiment of a hepatic catheter according to the invention, the fiberoptic biochemical sensor systems 6, 7 each take the form of a plasma galactose sensitive fiber such has shown in Figures 4 and 5. Although only the distal sensor system including optical fiber with tip 14' is shown in Figure 5, it will be understood that the proximal sensor system of this embodiment, including optical fiber 6 and sensor 12, is of substantially the same construction. Further, it will be understood that, similar to the foregoing embodiment, during use of this embodiment an intravenous galactose infusion is administered during the catheter passage phase. The light-conducting optical fiber T has disposed at its distal tip (i.e., at distal end IB of the catheter) an optode or hollow fiber membrane tip 14' which is semipermeable to small molecular weight analytes such as galactose. A specific lectin is immobilized on the inner surface of tip 14', which serves as a carbohydrate receptor (see, e.g., the Schultz article mentioned above). The lectin is selective for individual carbohydrates, depending upon the specific lectin used, analogous to a typical receptor-ligand interaction. In other words, the lectin serves as a specific receptor for a carbohydrate ligand which can reversibly interact with the immobilized lectin. While numerous lectins exist which can be selected to interact specifically with various carbohydrates, one example is the plant lectin Ricinus communis agglutinin, which is a specific receptor for galactose. Although drawbacks exist for the specific lectin Ricinus communis agglutinin, its use exemplifies lectin-based sensor systems suitable for use as the fiberoptic biochemical sensor systems in the catheter of the invention. As shown in Figure 5 (where L = Lectin, D = Galactosyl-dextran, and F = Flourescein), fluorescein and galactose may be conjugated to dextran to form a fluorescein (FITC) labeled galactosyl-dextran. Interaction of the galactosyl-dextran with a suitable lectin, such as Ricinus communis agglutinin, results in an alteration in fluorescence characteristics of this molecule. Where the labeled galactosyl-dextran is contained within hollow tip 14', its use as a detector system is based on the following relationship: Galactose + RC agglutinin - hollow fiber — -i- (free) (inner surface) galactose - RC agglutinin - hollow fiber (bound) FITC - galactosyl-dextran + galactose - RC agglutinin - hollow fiber (free) (bound) FITC - galactosyl-dextran - RC agglutinin - hollow fiber + galactose (bound) (free) Free plasma galactose will gain access to fiberoptic tip 14' by diffusion and will compete with the FITC galactosyl-dextran binding to the lectin. By virtue of the degree of competition between ambient galactose and the FITC galactosyl-dextran contained in tip 14', different concentrations of plasma galactose can be detected. Thus, when concentrations of galactose are varied, different intensities of fluorescence will be detected by the fiberoptic sensor system. A catheter provided with the sensor system 7', 14' will thus undergo changes in fluorescence response as it is advanced from a high galactose concentration system, i.e., the inferior vena cava, to a low galactose concentration system, i.e., the hepatic venous system, thus defining the novel self-guiding feature according to the invention. It is contemplated that while various lectins sensitive to a galactosyl-dextran conjugate may be suitable for use in sensor system 7', 14', the specific lectin used will be based upon different characteristics including sensitivity to plasma galactose and toxicity to the host. - 13 - In an alternative hepatic catheter construction according to the invention, the biochemical sensor material of sensors 12 and 14 may comprise galactose oxidase mixed with an alternative fluorescent agent, such as pyrene butyric acid. Similar to the manner described above, galactose detected in the blood compartment reacts with the galactose oxidase to produce hydrogen peroxide. The biochemical sensor material in the optode tip also includes catalase, which converts hydrogen peroxide to oxygen. The oxygen in turn quenches the fluorescence emitted by the pyrene butyric acid, thereby serving as a detection mechanism. The scheme is as follows: galactose oxidase Galactose ► product + H2O2 catalase H2O2 ► H2O + 1/2 O2 O2 quenches pyrene butyric acid fluorescence The degree of fluorescence quenching is dependent upon the concentration of galactose detected in either the vena cava or the hepatic vein. A comparison of the returning fluorescent signals from sensors 12 and 14 will thus permit ready positioning of the catheter tip within the hepatic vein. With the dual sensor embodiments of the invention as described above, because distal sensor 14 (or 14') is ultimately positioned in the hepatic venous system while proximal sensor 12 remains in the vena cava, simultaneous monitoring of the vena cava and hepatic venous analyte concentration gradient is attained, which may be used in determining liver blood flow measurement. Notwithstanding, the catheter 1 may alternatively be provided with only a single sensor system 7, 14 (or 7', 14') on the angled distal end portion of the catheter, while the proximal sensor system (6, 12) is eliminated. In such a modification, only the concentration of the predetermined analyte (e.g., galactose) within the visceral venous system of interest will be sensed, and correct positioning of the distal end of catheter 1 will be confirmed on the basis of a substantial decrease in the predetermined analyte as detected by the single sensor. In other words, when the distal end of catheter 1 enters the visceral venous system, the signals sent by sensor system 7, 14 or 7', 14' will reflect a sudden, substantial difference in concentration of the given analyte, to which the user may be alerted by a visual and/or audio signal. The invention further contemplates use of a simplified fiberoptic system to measure light at the catheter tip at a predetermined wavelength, as shown in Figure 8. An optical fiber 16 may take the form of a fiberoptic filament bundle extending from the proximal end 1A of catheter 1 to the distal tip IB, and having a core diameter of substantially 100 μ . Optical fiber 16 forms part of a simple reflectance spectrophotometric system, with a portion of the fibers in the filament bundle functioning as light transmission elements and the remaining fibers functioning as receiving elements for reflected and refracted light. The predetermined wavelength is selected to coincide with the absoφtion or fluorescence characteristics of an analyte which is selectively cleared from the blood by the liver, such as indocyanine green ("ICG") dye. By transmitting light along optical fiber 16 at a wavelength of 805 nanometers, which is the peak absorbance of ICG dye and the isosbestic point of hemoglobin, the reflection of differing intensities of light will correspond to the relative concentration of ICG dye in the vena cava as opposed to that in the hepatic venous system. Once the distal end of catheter 1 is advanced from the vena cava into the hepatic venous system, the fiberoptic system will measure a sudden change in fluorescence or absorbance intensity to which the user may be alerted by an audio and/or visual signal. For use in the renal venous system, the construction of catheter 1 is substantially the same as described above except that the fiberoptic biochemical sensor(s) are sensitive to a predetermined analyte or metabolite which is specific to the kidney, such as creatinine. By way of example, the sensor(s) may be formed with suitable biochemical sensor materials so as to generate fluorescence in reaction to the diffusion of creatinine into the sensor tip. The creatinine sensing fiberoptic system will detect a large difference between the creatinine concentration in the renal vein (sensor system 7, 14) and systemic creatinine concentration in the inferior vena cava (sensor system 6, 12). It is known, for example, that substantially 90% of creatinine is extracted across the renovascular circuit. The creatinine concentration detected by sensor system 7, 14 will thus be much lower than that detected by sensor system 6, 12 in the inferior vena cava. The sensor material to be employed in such an optode-type sensor sensitive to creatinine may be adapted from known membrane bound electrode systems in which hydrogen peroxide is liberated, as in the following scheme: creatinine amidohydrolase Creatinine > > >■■»■> » » < creatine creatine amidohydrolase creatine » ■> > »• ■ »■» » > * » » sarcosine + urea sarcosine oxidase sarcosine -I- O2 > * » ■ > > > >-> » > > glycine + formaldehyde + H2O2 The liberated hydrogen peroxide then reacts with a suitable fluorescent agent incoφorated in the sensor material to generate fluorescence in a manner similar to the galactose-sensitive optode described above. As with the hepatic catheter, the renal catheter may comprise only the single sensor system 7, 14 on the angled distal end portion of the catheter. When the distal end of catheter 1 enters the renal vein, the signals sent by sensor system 7, 14 will reflect a sudden, substantial change in concentration of the predetermined analyte, and the user would be alerted by means of a visual and/or audio signal. While the fiberoptic sensor systems of the invention have been described as being sensitive to either galactose for liver applications, or creatinine for kidney applications, it will be understood that the sensor systems are not limited to these particular analytes, and may alternatively be sensitive to other analytes or metabolites having a specific relationship to the organ associated with the given visceral venous system such that values of the analyte within the venous system are substantially different from systemic values outside of same, i.e., where there is a substantial depletion or enrichment of the analyte across the vascular circuit of interest. Other analytes which are known as being organ specific, and which could substitute for galactose or creatinine as analytes, include ammonia, urea, and lactate, all of which are normal constituents of blood. A blood concentration gradient of these analytes exists across the hepatic (lactate, urea, ammonia) and renal (urea, ammonia) venous systems. Known optical fiber systems for detecting urea are disclosed in Wolfbeis, O.S. and Li, H., Fluorescence optical urea biosensor with an ammonium optrode as transducer, Biosensors & Bioelectronics, 8: 161-166, 1993; and Sansubrino, A. and Mascini, M., Development of an optical fibre sensor for ammonia, urea, urease and IgG, Biosensors & Bioelectronics, 9: 207-216, 1994. As also disclosed in these publications, ammonia is detectable with a similar system. A known optical fiber system for detecting lactate is disclosed in Roda, A., et al, Microdialysis and luminescent probe: analytical and clinical aspects, Biosensors & Bioelectronics, 6: 21-29, 1991. The catheter 1, in addition to being self-guiding, is capable of performing a number of other functions. Once the catheter 1 is positioned in the hepatic or renal venous system, direct samples of hepatic or renal venous blood may be taken via catheter 1 tor the ex vivo measurement of metabolite concentrations. The catheter 1 is also capable of measuring absolute hepatic or renal blood flow using a tracer clearance technique. For example, if a known infusion rate of galactose is provided (e.g., 100 ml/hour), the data from the sensor systems can be used to calculate hepatic blood flow using a galactose clearance technique, such as described in the aforesaid publication by Dahn et al which is incoφorated herein by reference thereto. To this end, the Analyzer Unit shown in detail in Figure 10 includes program storage memory for storing equation(s) which permit the microprocessor to calculate galactose concentration values on the basis of signals received from the fiberoptic sensor systems, with data being stored in data storage memory and retrievable by the user via a display. Data inputs to be made by the user, such as the galactose infusion rate, may be made via a keypad. By way of example, the following equation can be used to measure hepatic blood flow ("HBF): Galactose infusion rate HBF = SS (EF) where SS is the net steady-state blood galactose concentration, and EF is the extraction fraction for galactose across the splanchnic bed. Similarly, the intravenous infusion of inulin and/or para-aminohypurate permits the assessment of glomerular filtration rate and renal blood flow with catheter 1. Further, once catheter 1 is positioned in any major hepatic or renal venous vessel, the oxygen saturation in the hepatic or renal venous blood can be continuously monitored via a fiberoptic system including optical fiber 8. The optical fiber 8 may comprise a fiberoptic filament bundle forming part of an available simple reflectance spectrophotometric system, such as, for example, the system sold under the trademark "OPTICATΗ" by Oximetrix, Inc. of Mountain View, California. In such system, a portion - 18 - of the filaments in the optical fiber function as fiberoptic transmission elements, while the remaining filaments function as receiving elements for reflected and refracted light. The differential wavelength absoφtion characteristics of hemoglobin in the oxygenated vs. deoxygenated state permit assessment of blood oxygenation based upon light reflected into the receiving filaments. The relative proportion of oxygenated vs. deoxygenated reflected light is electronically processed by the Analyzer Unit to inteφret the fraction of oxygen saturation of the hemoglobin in vivo. See John M. Sperinde and Kathi M. Senelly, "The Oximetrix* Opticath* Oximetry System: Theory and Development", Technical Bulletin, Oximetrix, Inc., Mountain View, California. Alternatively, the fiberoptic system comprising optical fiber 8 may be of the type available from Puritan-Bennett Coφoration of Carlsbad California (Model PB3300 Intra- Arterial Blood Gas Monitoring System). The fiberoptic element is coated with a fluorescent dye at the distal end portion. The fluorescence intensity of the dye is related to the ambient oxygen concentration at the catheter tip, so that the reflected fluorescence intensity can be electronically inteφreted by processing means in the Analyzer Unit to estimate in vivo oxygen concentration. See Terry Lumsden, William R. Marshall, George Divers and Samuel D. Riccitelli, "The PB 3300 intraarterial blood gas monitoring system", Journal of Clinical Monitoring, Vol. 10, pp. 59-66 (1994). It will be understood, however, that the fiberoptic system for monitoring oxygen saturation as employed in catheter 1 may alternatively comprise any suitable fiberoptic system. For example, optical fiber 8 may be replaced by an oxygen optode sensor system similar to the optode-type sensor systems 6, 12 and 7, 14 described above, thus affording the advantage of a common technology for the entire optical system of the catheter. It is further contemplated that, if desired, the catheter 1 may be provided in a simplified - 19 - version without the optical fiber 8. The invention contemplates that the Analyzer Unit shown in Figure 10 serves as a single common operating unit for all the components of catheter 1, regardless of which types of fiberoptic sensors are used in constructing the catheter. The Analyzer Unit comprises, preferably in a single compact case, all necessary operating system components including fiberoptic light source(s); fiberoptic signal detector(s); fiberoptic lenses, mirrors, and/or filters, if necessary; a microprocessor with associated data storage and program storage memory; a keypad for user input; a visual display; audio alarm means; and/or any other required components for operating the various elements of catheter 1. The microprocessor and program storage memory preferably function as a centralized information processing unit. An alternative construction of the catheter of the invention, in which electrochemical sensor systems are employed instead of fiberoptic sensor systems, will now be described with reference to Figures 11-14. The construction of catheter 1' shown in Figure 11 is similar to that described above with respect to Figure 1, including optical fiber 8 for monitoring oxygen saturation. Extending along the inside surface of catheter 1' are electrical conductors in the form of two copper wires 26, 27 which, like optical fiber 8, are retained in position by being embedded within the polyvinyl chloride or other material of catheter 1, as described above. Wires 26, 27 may desirably be positioned substantially next to each other and opposite optical fiber 8, in much the same manner as the optical fibers shown in Figures 2 and 3. Wire 26 extends from proximal end 1A of catheter 1' to a first sensor electrode system 30, 31, while wire 27 extends from proximal end 1A to a second sensor electrode system 35, 36 disposed on the angled distal end portion of the catheter. The proximal ends of wires 26, 27 are provided with electrical couplers 26A, 27A for connection with a differential Wheatstone bridge type detector 40 as described below. The first and second sensor systems 30, 31 and 35, 36 each comprises an electrochemical sensing system which is sensitive to a predetermined analyte. The first sensor system, disposed on the main axial portion of catheter 1, includes a platinum electrode 30 with a hydratable membrane 31 sealed thereover, the membrane containing immobilized reagents or enzymes on its inner surface. Likewise, the second sensor system disposed near the distal end of catheter 1' includes a platinum electrode 35 with a hydratable membrane 36 containing immobilized reagents or enzymes on its inner surface. Where the catheter 1' is to be positioned in the hepatic venous system, the membranes 31, 36 are adapted to electrochemically detect analytes specific to the liver. In a preferred embodiment, the specific analyte to be detected is plasma galactose and the membranes 31, 36 comprise galactose oxidase membranes. One membrane bound system which may be adapted for use as the sensor systems of a hepatic self-guiding catheter according to the invention is available from Yellow Springs Instruments of Yellow Springs, Ohio. The system is based upon a hydrogen peroxide electrode, having a galactose oxidase membrane for the electrochemical detection of galactose, as follows: galactose oxidase galactose -I- O2 -» ■ » > H2O2+ products platinum electrode H2O2+ H + + e " > 2 H2O Galactose oxidase in the membrane thus generates hydrogen peroxide from plasma galactose, with the hydrogen peroxide being detected amperometrically in an oxidation- reduction reaction. As noted above, the electrical couplers 26A, 27A at the proximal ends of wires 26, 27 are connected to the differential Wheatstone bridge type detector 20 (Figures 11 and 14) which compares the polarographic signal from sensor system 30, 31 vs. that from sensor system 35, 36 and alerts the user, via a visual display and/or an audio signal, when the signals are substantially different. Where the catheter 1' is to be positioned in the renal venous system, the first and second sensor systems are sensitive to analytes specific to the kidney. In a preferred embodiment, the specific analyte to be detected is creatinine and the membranes 31, 36 comprise creatinine membranes. One membrane bound system which may be adapted for use as the electrode systems of a renal catheter according to the invention is Kodak Ektachem Chemistry film for the detection of creatinine, as follows: creatinine amidohydrolase Creatinine » > » » > > > creatine creatine amidohydrolase creatine » > > > ■ » > > > > > sarcosine + urea sarcosine oxidase sarcosine + O2 glycine -I- formaldehyde + H2O2 platinum electrode H2O2+ H + + e " ■- H2O The critical feature of the above-described analyte detection membranes of catheter 1' is that they sense analytes or metabolites which are removed from the vascular circuit of interest to a high degree, i.e., in the liver, galactose; and in the kidney, creatinine. The first sensor system 30, 31 will sense the systemic metabolite concentration, while the second or distal sensor system 35, 36 will sense the concentration of the same metabolite in the organ of interest, i.e., the liver or the kidney. The use of catheter 1' as a hepatic catheter is similar to that as described above with respect to catheter 1, including administering a galactose infusion in the patient. As with catheter 1, by virtue of the angled shape of catheter 1' the angled distal end IB will spontaneously advance into the hepatic vein when the tip is in proximity to it, and proper positioning within the hepatic vein is readily and immediately confirmed by the substantial difference in galactose concentrations detected by the two electrochemical sensor systems. Where catheter 1' is used in a renal application, the creatinine sensing electrochemical systems will likewise detect a large difference between the creatinine concentration in the renal vein (sensor system 35, 36) and systemic creatinine concentration in the inferior vena cava (sensor system 30, 31). As with the fiberoptic sensors described above with respect to catheter 1, the electrochemical sensor systems of catheter 1' are not limited to galactose and creatinine as the predetermined analytes to be sensed. The electrochemical sensor systems may alternatively be sensitive to other analytes or metabolites having a specific relationship to the organ associated with the given visceral venous system such that values of the analyte within the venous system are substantially different from systemic values outside of same. Exemplary alternative analytes include lactate, urea, and glutamine. As known, lactate is normally cleared from the hepatic circulation, whereas urea and glutamine are discharged into the hepatic venous blood by the liver. As also known, urea and glutamine are both cleared by the kidney. Known immobilized enzyme systems for the potentiometric assay of lactate, urea, and glutamine, in a manner comparable to the assay of galactose described above, are disclosed in the following: for lactate, Meyerhoff, Biosensors and Bioelectronics, 8: 409, 1993; for glutamine, Moser, I., Biosensors and Bioelectronics, 10: 527, 1995; and for urea, Gardies, F., Anal Chim Acta, 231: 305, 1990. The catheter 1', in addition to being self-guiding, can perform all the assessment and monitoring functions described above with respect to catheter 1, including direct sampling of hepatic or renal venous blood, and measuring absolute hepatic or renal blood flow. To this end, detector 40 shown in Figure 14, similar to the Analyzer Unit in Figure 10, may preferably include a microprocessor, program storage memory with appropriate stored equation(s), and data storage memory. Also like catheter 1, once catheter 1' is positioned in a major hepatic or renal venous vessel, oxygen saturation in the hepatic or renal venous blood can be continuously monitored via a fiber optic system comprising optical fiber 8 and the fiberoptic monitor shown in Figure 11, which includes necessary fiberoptic system components including an illumination source, detection means, signal processing means, etc. If desired, however, catheter 1' may be provided without optical fiber 8 and associated fiberoptic system components. It is further contemplated that catheter 1', similar to catheter 1, may include a self- guiding system comprising only a single sensor electrode system 35, 36 on the angled distal end portion of the catheter, while sensor system 30, 31 is eliminated. In such a modification, only the concentration of the predetermined analyte (e.g., galactose or creatinine) within the visceral venous system of interest will be sensed, and correct positioning of the distal end of catheter 1 will be confirmed on the basis of a substantial change in concentration of the analyte, in much the same manner as described above with respect to the single-sensor embodiment of catheter 1. While there have been described above what are at present considered to be the preferred embodiments of the invention, it will be understood that various modifications may be made therein without departing from the spirit and scope of the invention. The present embodiments are therefore to be considered in all respects as illustrative, and not restrictive. The scope of the invention is indicated by the appended claims rather than by the foregoing description.

Claims: CLAIMS 1. A viscera] catheter, comprising: a main catheter body having a proximal end and a distal end; means for guiding said catheter to an operable position in which a portion of said main body is disposed within a predetermined visceral venous system, said guiding means comprising: first sensor means for detecting values of a predetermined analyte in a vessel disposed outside said visceral venous system in said operable position of said catheter and for outputting signals related thereto, said first sensor means being disposed on a first portion of said main catheter body which remains in said vessel outside said visceral venous system in said operable position of said catheter; second sensor means for detecting values of said predetermined analyte within said visceral venous system in said operable position of said catheter and for outputting signals related thereto, said second sensor means being disposed on a second portion of said main catheter body which is positioned within said visceral venous system in said operable position of said catheter; said main catheter body comprising a main axial portion extending from said proximal end and an angled distal end portion extending from said main axial portion, said second portion of said catheter body being disposed on said angled distal end portion of said catheter body; said predetermined analyte having a specific relationship to an organ associated with said predetermined visceral venous system such that values of said analyte within said visceral venous system are substantially different from systemic values of said analyte outside said visceral venous system; and said first and second sensor means being selectively connected to detector means for comparing said signals from said first and second sensor means and for alerting a user to a substantial difference between said signals. 2. A visceral catheter according to claim 1, wherein: said first sensor means comprises first fiberoptic sensor means and said second sensor means comprises second fiberoptic sensor means. 3. A visceral catheter according to claim 2, wherein: said first portion of said catheter body is disposed on said main axial portion of said catheter body; said first fiberoptic sensor means includes an optical fiber which extends along said catheter body from said proximal end thereof to a part of said main axial portion of said catheter body; and said second fiberoptic sensor means includes an optical fiber which extends along said catheter body from said proximal end thereof to said angled distal end portion of said catheter body. 4. A visceral catheter according to claim 3, wherein: said first fiberoptic sensor means further comprises an optode provided at an end of said optical fiber disposed at said part of said main axial portion; said second fiberoptic sensor means further comprises an optode provided at the distal end of said optical fiber; each of said optodes comprises biochemical sensor material provided within a semipermeable membrane; said predetermined visceral venous system comprises the hepatic venous system; said predetermined analyte comprises galactose; and said biochemical sensor material generates signals which vary according to detected values of galactose. 5. A visceral catheter according to claim 4, wherein: said biochemical sensor material includes a fluorescein labelled galactosyl-dextran, and a lectin. 6. A visceral catheter according to claim 4, wherein: said biochemical sensor material includes galactose oxidase. 7. A visceral catheter according to claim 3, wherein: each said optical fiber forms part of a simple reflectance spectrophotometric system; and illuminating means are provided for transmitting light to said optical fibers at a predetermined wavelength which corresponds to the absoφtion characteristics of said predetermined analyte. 8. A visceral catheter according to claim 3, wherein: said catheter body is substantially hollow; and each said optical fiber is embedded in an inner surface of said catheter body. 9. A visceral catheter according to claim 1, wherein: said catheter further comprises means for monitoring the oxygen saturation of blood in said visceral venous system; and said oxygen saturation monitoring means comprises an optical fiber extending along said catheter substantially from said proximal end to said distal end of said catheter body. 10. A visceral catheter according to claim 9, wherein: said oxygen saturation monitoring means comprises a simple reflectance spectrophotometric system. 11. A visceral catheter according to claim 10, wherein: said oxygen saturation monitoring means further comprises an oxygen optode provided at a distal end of said optical fiber of said monitoring means. - 28 - 12. A visceral catheter according to claim 2, further comprising: means for measuring blood flow in said visceral venous system, said blood flow measuring means comprising said first and second fiberoptic sensor means; an integral operating unit for operating said first and second fiberoptic sensor means and said blood flow measuring means, said integral operating unit including said detector means; said integral operating unit further comprising a microprocessor and program memory, wherein: said program memory is programmed for computing concentration values of said predetermined analyte, and stores at least one equation for calculating blood flow values on the basis of said concentration values; and said microprocessor receives said signals from said first and second fiberoptic sensor means and utilizes said program memory to calculate concentration values of said predetermined analyte based on said signals from said first and second fiberoptic sensor means, and to calculate said blood flow values utilizing said at least one stored equation and said concentration values. 13. A visceral catheter according to claim 1, wherein: said angled distal end portion extends from said main axial portion at an acute angle; and said first portion of said catheter body is disposed on said main axial portion of said catheter body. 14. A visceral catheter according to claim 13, wherein: said angled distal end portion extends from said main axial portion at an angle of substantially 65°. 15. A viscera] catheter according to claim 1, wherein: said first and second sensor means each comprises an electrochemical sensing system including an electrode with a hydratable membrane containing a reagent which detects values of said predetermined analyte. 16. A visceral catheter according to claim 15, wherein: said predetermined visceral venous system comprises the hepatic venous system; said predetermined analyte comprises galactose; and said hydratable membrane of each said first and second sensor means contains galactose oxidase. 17. A visceral catheter according to claim 15, wherein: said predetermined visceral venous system comprises the renal venous system; said predetermined analyte comprises creatinine; and said hydratable membrane of each said first and second sensor means contains creatinine amidohydrolase. 18. A visceral catheter according to claim 15, wherein: said catheter further comprises means for measuring blood flow in said visceral venous system, said blood flow measuring means comprising said first and second sensor means, and said detector means; said detector means comprising a microprocessor and program memory, wherein: said program memory is programmed for computing concentration values of said predetermined analyte, and stores at least one equation for calculating blood flow values on the basis of said concentration values; and said microprocessor receives said signals from said first and second sensor means and utilizes said program memory to calculate concentration values of said predetermined analyte based on said signals from said first and second sensor means, and to calculate said blood flow values utilizing said at least one stored equation and said concentration values. 19. A visceral catheter, comprising: a catheter body; sensor means for detecting values of a predetermined analyte both within and outside a predetermined visceral venous system and for outputting signals related thereto, said sensor means being disposed on a portion of said main catheter body which, in an operable position of said catheter, is positioned within said predetermined visceral venous system; said sensor means being selectively connected to detector means for receiving and processing signals from said sensor means; said predetermined analyte comprising an analyte other than oxygen which has a specific relationship to an organ associated with said predetermined visceral venous system such that values of said analyte within said visceral venous system are substantially different from systemic values of said analyte outside said visceral venous system; and said detector means processes said signals from said sensor system and alerts a user to a substantial difference in said values of said analyte when said sensor means is disposed within said predetermined venous system in said operable position of said catheter. 20. A visceral catheter according to claim 19, wherein: said sensor means comprises fiberoptic sensor means. 21. A visceral catheter according to claim 20, wherein: said catheter body comprises a main axial portion including a proximal end of said catheter body, and an angled distal end portion extending from said main axial portion at an angle; said portion of said catheter body which is positioned within said predetermined venous system in said operable position of said catheter comprises said angled distal end portion of said catheter body; said fiberoptic sensor system comprises: an optical fiber extending along said catheter body from said proximal end thereof to said angled distal end portion of said catheter body; and a light source operatively cooperating with a proximal end portion of said optical fiber so as to transmit light to said optical fiber. 22. A visceral catheter according to claim 20, wherein: said predetermined visceral venous system comprises the hepatic venous system; said predetermined analyte comprises galactose; said fiberoptic sensor system further comprises an optode provided at a distal end of said optical fiber, said optode comprising biochemical sensor material provided within a semipermeable membrane; and said biochemical sensor material generates fluorescent signals which vary according to detected values of galactose. 23. A visceral catheter according to claim 22, wherein: said biochemical sensor material includes a lectin. 24. A visceral catheter according to claim 22, wherein: said biochemical sensor material includes galactose oxidase. 25. A visceral catheter according to claim 21, wherein: said optical fiber forms part of a simple reflectance spectrophotometric system; and said light source transmits light to said optical fiber at a predetermined wavelength which corresponds to absoφtion characteristics of said predetermined analyte. 26. A visceral catheter according to claim 20, wherein: said main catheter body comprises a distal end and a proximal end, with a main axial portion extending from said proximal end and an angled distal end portion extending from said main axial portion at an acute angle; and said sensor means is disposed on said angled distal end portion of said catheter body. 27. A visceral catheter according to claim 26, wherein: said angled distal end portion extends from said main axial portion at an angle of substantially 65°. 28. A visceral catheter according to claim 20, wherein: said sensor means comprises an electrochemical sensing system including an electrode with a hydratable membrane containing a reagent which detects values of said predetermined analyte.

Inventors: DAHN MICHAEL S, LANGE M PATRICIA, DAHN, MICHAEL, S., LANGE, M., PATRICIA
Applicants: LANGE M PATRICIA, LANGE, M., PATRICIA
Application year: 1995
Main classification: A61B5
IPC codes: A61B5, A61M25