FLUID DELIVERY DEVICE WITH BOLUS INJECTION SITE

Abstract: This invention is an apparatus (10) for accurately infusing fluids into a patient at specific rates over an extended period of time. The apparatus (10) is of a low profile, laminate or layered construction having a stored energy source in the form of a distended membrane (28), which in cooperation with the base (12) of the apparatus (10), defines one or more fluid reservoirs (20), each having a fluid inlet (22) and a fluid outlet (32). The apparatus further includes a novel conformable ullage made of yielding materials which uniquely conform to the shape of the elastomeric membrane (28) as the membrane (28) returns to its less distended configuration. This arrangement will satisfy even the most stringent medicament delivery tolerance requirements, and will elegantly overcome the limitations of materials selection encountered in devices embodying solely a rigid ullage construction. Additionally, in one form of the invention, the apparatus includes a novel fill assembly (302) for controllably filling the reservoirs of the device in the field.

Description: Fluid Delivery Device with Bolus Injection Site Background of The Invention This is a Continuation-In-Part application of co-pending U.S. Serial No. 08/541.184. filed October 1 1. 1995. Field of The Invention The present invention relates generally to fluid delivery devices. More particularly, the invention concerns an improved fluid delivery apparatus for precise delivery over time of medicinal liquids to an ambulatory patient, the device including a bolus injection site for bolus delivery of medicinal liquids as from time to time may be required. Discussion of The Invention A number of different types of liquid dispensers for dispensing medicaments to ambulatory patients have been suggested. Many of the devices seek either to improve or to replace the traditional hypodermic syringe which has been the standard for delivery of liquid medicaments such as insulin solution. Those patients that require frequent injections of the same or different amounts of medicament, find the use of the hypodermic syringe both inconvenient and unpleasant. Further, for each injection, it is necessary to first draw the injection dose into the syringe, then check the dose and. after making certain that all air has been expelled from the syringe, finally, inject the dose. This cumbersome and tedious procedure creates an unacceptable probability of debilitating complications, particularly for the elderly and the infirm. One example of the urgent need for an improved liquid delivery device for ambulatory patients can be found in the stringent therapeutic regimens used by insulin-dependent diabetics. The therapeutic objective for diabetics is to consistenth' maintain blood glucose levels within a normal range much as the normalh functioning pancreas would do secreting a ver\ low level of extremely fast-acting insulin at a basal rate into the blood stream throughout the da\ and night. Consider the normal individual who doesn ' t have diabetes. A normal individual * s cells require energy throughout the day just to maintain a basal metabolic rate This energy is supphed to the cells by glucose that is transported from the bloodstream to the cells by insulin When food is consumed, the blood glucose level rises and the pancreas responds by releasing a surge of fast-acting insulin. To mimic this natural process with indiv idual injections, the individual would have to administer minuscule amounts of fast-actmg insulin every few minutes throughout the da\ and night. Conventional therapy usually involves injecting, separate]} , or in combination, fast-acting and slower-acting insulin by syringe several times a day. often coinciding with meals The dose must be calculated based on glucose levels present in the blood Slower-acting insulin is usual!} administered in the morning and evening to take advantage of longer periods of lower level glucose uptake Fast-acting insulin is usually iniected prior to meals If the dosage of fast-acting insulin is off. the bolus administered may lead to acute levels of either glucose or insulin resulting in complications, including unconsciousness or coma Over time, high concentrations of glucose in the blood can also lead to a variety of chronic health problems, such as vision loss. kidne\ failure, heart disease, nerve damage, and amputations A recent!} completed study sponsored by the National Institutes of Health (NIH ) investigated the effects of different therapeutic regimens on the health outcomes of insulin-dependent diabetics This study revealed some distinct advantages in the adoption of certain therapeutic legimens Intensive therap\ that im h ed intensive blood glucose monitoring and moie lrequent administration of insulin conventional means, toi example. πnges. throughout the saw dramatic decreases in the incidence of debilitating complications The NIH study also raises the question of practicality and patient adherence to an intensive therapy regimen. A bona fide improvement in insulin therapy management must focus on the facilitation of patient comfort and convenience as well as dosage and administration schemes. Basal rate delivery of insulin by means of a convenient and reliable delivery device over an extended period of time represents one means of improving insulin management. Basal rate delivery involves the delivery of very small volumes of fluid (for example. 0.3-3 mL. depending on body mass) over comparatively long periods of time (18-24) hours). As will be appreciated from the discussion which follows, the apparatus of the present invention is uniquely suited to provide precise fluid delivery management at a low cost in those cases where a variety of precise dosage schemes are of utmost importance. An additional important feature of the apparatus of the present invention is the provision of a bolus injection site which permits, in addition to the basa! rate, a bolus delivery of medication on an as-needed basis. For example, if the apparatus is being used for basal delivery of insulin over an extended period of time, should a bolus deliver} of medication be required to manage an anticipated increase in blood sugar, such a bolus delivery can be quickly and easily accomplished using the device ' s bolus injection site and eliminates the need for a direct subdermal injection at an alternate site on the individual ' s body. With regard to the prior art. one of the most versatile and unique fluid deliver apparatus developed in recent years is that developed by one of the present inventors and described in U. S. Patent 5.205.820. The component of this novel fluid delivery apparatus generally include: a base assembly, an elastomeric membrane serving as a stored energy means, fluid flow channels for filling and delivery, flow control means, a cover, and an ullage which comprises a part of the base assembh . The ullage in these devices is provided in the form of a semi-rigid structure having flow channels leading from the top of the structure through the base to inlet or outlet ports of the device. Since the inventions described herein represent improvements over those described in Patent No. 5.205.820. this patent is hereby incoφorated by reference as though fully set forth herein. In the rigid ullage configuration described in Patent No. 5.205.820. the stored energy means of the device must be superimposed over the ullage to form the fluid-containing reservoir from which fluids are expelled at a controlled rate by the elastomeric membrane of the stored energy means tending to return to a less distended configuration in the direction toward the ullage. With these constructions, the stored energy membrane is typical ly used at higher extensions over a significantly large portion of the pressure-deformation curve. For good performance, the elastomeric membrane materials selected for construction of the stored energy membrane must have good memory characteristics under conditions of extension: low stress relaxation; good resistance to chemical and radiological degradation: and appropriate gas permeation characteristics depending upon the end application to be made of the device. Once an elastomeric membrane material is chosen that will optimally meet the desired performance requirements, there still remain certain limitations to the level of refinement of the delivery tolerances that can be achieved using the rigid ullage configuration. These result primarily from the inability of the rigid ullage to conform to the changing geometry of the elastomeric membrane near the end of the delivery period. This nonconformity can lead to extended delivery rate tail-off and higher residual problems when extremely accurate deliver} is required. For example, when larger volumes of fluid are to be delivered, the tail-off volume represents a smaller portion of the fluid amount delivered and therefore exhibits must less effect on the total fluid deliver}' profile, but in very small dosages, the tail-off volume becomes a larger portion of the total volume. This sometimes places severe physical limits on the range of deliver} profiles that ma} easily be accommodated using the rigid ullage configuration. An additional penalt} inherent in rigid ullage construction is the high Z axis height of the ullage that will be required to maintain acceptable flow tail off delivery requirements As w ill be better appreciated from the discussion which follows, the apparatus of the present invention provides a unique and novel improvement for a disposable dispenser of simple but highh reliable construction that may be adapted to many applications of use A particularh important aspect of the improved apparatus is the incorporation of conformable ullages made ot } leldable materials which uniquely conform to the continuously changing geometr} of the stored energy membrane during the delivery cycle This nov el construction will satisfv even the most stringent delivery tolerance requirements and elegant!} overcomes the limitation ot materials selection Anothei useful liquid deliver} device is that described in U S Patent No 5.226.896 issued to Harris This device comprises a multidose syringe hav ing the same general appearance as a pen or mechanical pencil the device is specificalh adapted to provide for multiple measured injections of materials such as insulin or human growth hormones Still another type of liquid deliver} device is disclosed in U S Patent No 4.592.745 issued to Rex et al This device is. in principle, constructed as a rn podermic syringe, but differs in that it enables dispensing of a predetermined portion trom the available medicine and in that it dispenses ver\ accurate doses The present invention seeks to significanth improve over the prior art by providing a nov el fluid deliver} device having one or more fluid reservoirs which is low in profile, is compact, is eas} to use b} ambulator} patients, and is eminent!} capable of meeting the most stringent of fluid deliver} tolerance requirements Additionalh . the dev ice prov ides novel means Ioi accomplishing immediate bolus deliver} ot medication on an as-needed basis Summan of The Invention It is an object of the present invention to provide an apparatus having a self-contained stored energy membrane for expelling fluids at a precisely controlled rate which is of a compact, extremely low profile, laminate construction. More particularly, it is an object of the invention to provide such an apparatus which is of very low profile so that it can conveniently be used for the precise delivery of pharmacetitical fluids, such as insulin solution and the like, into an ambulatory patient at controlled rates over extended periods of time. It is another object of the invention to provide an apparatus of the aforementioned character which is highh' reliable and easy-to-use by lay persons in a non-hospital environment. It is another object of the invention to provide an apparatus as described in the preceding paragraphs which, can be used for both basal and bolus deliver} of fluids. In this re¬ gard, the apparatus includes a novel and unique bolus injection site which can be used to deliver bolus doses of medication as may be required. Another object of the invention is to provide an apparatus which embodies a conformable mass which defines an ullage within the reservoir of the device which will closely conform to the shape of the stored energy membrane thereby effectively avoiding extended flow delivery rate tail-off at the end of the fluid delivery period and thus precisely controls the time of delivery. A further object of the invention is to provide a low profile, fluid delivery device of laminate construction which can meet even the most stringent basal fluid delivery tolerance re¬ quirements and at the same time permit bolus delivery of medicaments to the patient as may be required. Another object of the invention is to provide an apparatus of the character described which, due to its unique construction, can be manufactured inexpensively in large v lume hv automated machinery. Other objects of the invention are set forth in L . S. Patent No. 5.205.820 w hich is incorporated herein by reference and still further objects will become apparent from the discus¬ sion which follows. Brief Description of the Drawings Figure 1 is a generally perspective, exploded view of one embodiment ofthe liquid delivery device of the present invention showing an ancillary syringe type device usable for bolus delivery of liquid medication via the bolus injection site of the device. Figure 2 is a top plan view of the invention shown in Figure 1 partly broken away to show internal construction. Figure 3 is a cross-sectional view taken along lines 3-3 Figure 2. Figure 4 is an enlarged cross-sectional view taken along lines 4-4 of Figure 2 Figure 5 is a greatly enlarged, cross-sectional view taken along lines 5-5 of Figure 2. Figure 6 is an enlarged, cross-sectional vie taken along lines 6-6 of Figure 2. Figure 7 is a greatly enlarged, fragmentary view of the liquid delivery port of the device and of the locking tabs for lockablv interconnecting a quick connect delivery fitting with the base of the device. Figure 8 is a generally perspective, exploded, view of the liquid deliver}' port of the device and of an infusion set usable with the device. Figure 9 is a cross-sectional view of the quick connect deliver}' fitting shown in Figure 8. Figure 9A is an end view of the quick connect fitting shown in Figure 9. Figure 10 is a greath enlarged cross-sectional view of the area designated as 10 m Figure 3 Figure 1 OA is a generally perspective, illustrative view showing one manner of filling the fluid reservoir of the device Figure 1 OB is a generally perspective, illustrative view showing the device of the invention attached to the patient and showing the patient engage in injecting a bolus dose of liquid medication Figure 1 1 is a generally perspective, exploded view of an alternate embodiment of the invention Figure 12 is a top view of the embodiment shown in Figure 1 1 partly broken awa} to show internal construction Figure 13 is a side elevational. parth cross-sectional view taken along lines 13-13 of Figure 12 Figuie 14 is a cross-sectional view taken along lines 14-14 of Figure 13 Figure 15 is a greath enlarged, fragmentar} . cross-sectional view of a portion of the base and cover of the device illustrating the manner in which the distendable membrane and the barrier membrane of tne dev ice are sealabh clamped between the base and cover Figure 16 is a fragmentar} . cross-sectional view of the flow control assembly of the dev ice which is positioned within the base Figure 17 is an enlarged, generally perspective view of the flow control assembh shown in Figure 16 Figure 18 is a front view of }et another form of the fluid deliver} dev ice of the inv ention parti} bioken awa} to shown internal construction Figuie 19 is a top v iew of the embodiment shown in Figure 18 paιth broken aw av to show internal construction Figuie 20 is a cross-sectional v iew taken along lines 20-20 ot Figure 19 Figure 21 is a cross-sectional view taken along lines 21 -21 of Figure 19 Figuie 21 A is a fragmentar} . cross-sectional view taken along lines 21A-21A of Figure 21 Figure 22 is a cross-sectional view taken along lines 22-22 of Figure 19 Figure 22A is a cross-sectional view similar to Figure 22 but showing the fluid being expelled from the fluid reservoir into the body subdermal tissue Figure 23 is a cross-sectional, exploded view of this latest embodiment of the inv ention Figuie 24 is an enlarged, generally perspective, exploded view of the bolus injection port of the device Figure 25 is a generally schematic view illustrating the various modes of operation of the apparatus of the invention Figure 26 is a generally perspective, exploded view of an alternate embodiment of the liquid delivery device of the present invention showing a dispensing and a fill assembly usable for filling the fluid reservoir of the dispensing assembl} Figure 27 is a generally perspective . exploded view ot one form of the fill assembl} of the present invention Figure 28 is an enlarged cross-sectional view of the fill assembh illustrated in Figure 27 as it appears in the assembled configuration Figuie 29 is an enlarged, cross-sectional v iew taken along lines 29-29 of Figure 28 Figui e 30 is a cross-sectional v iew similar to Figuie 28 but showing the appearance ot the component parts of the fill assemblv after the plunger ot the container has been telescopicalh mov ed trom a first to a second position Figure 31 is a generally perspective, exploded view of the apparatus of this latest form of the invention showing both the dispensing assembly and the fill assembly in an exploded configuration Figure 32 is a top plan view of the assembled apparatus of the invention shown in Figure 26 partlv broken away to show internal construction Figure 33 is a right-side view of the apparatus shown in Figure 32 Figure 34 is an enlarged, cross-sectional view taken along lines 34-34 of Figure 32 Figure 35 is an enlarged, cross-sectional view taken along lines 35-35 of Figure 32 Figure 36 is a view taken along lines 36-36 of Figure 35 Figure 37 is an enlarged, cross-sectional view taken along lines 37-37 of Figure 32 Figure 38 is an enlarged, cross-sectional view taken along lines 38-38 of Figure 32 Figure 39 is a greatly enlarged, fragmentar} view of the liquid delivery port of the dev ice and of the quick connect delivery fitting which is interconnectable w ith the base of the device Figure 40 is a cross-sectional view taken along hnes 40-40 of Figure 39 Figure 41 is an enlarged, generally perspective view of the quick connect deliver} fitting showing the locking tabs for lockablv interconnecting the fitting w ith the base of the de ice Description o the Inv ention Referring to the drawings and particularh to Figures 1 thiough 10. one form of the low pi filc fluid de v erv dev ice of the inv ention is theie shown and geneiallv designated b\ the numeral 1 The device comprises a base 12. having an upper surface 14 including a central convex portion 14a and a peripheral portion 14b circumscribing central portion 14a As best seen in Figures 1 and 4, base 12 is also provided with a lower surface 16 to which a patient interconnection means or adhesive pad assembly 18 is connected In a manner presenth to be described, pad assembh 18 functions to releasably interconnect the device to the patient so as to hold it secureh in place during the liquid delivery step A stored energy means cooperates with the upper surface 14 of base 12 to form a reservoir 20 having an mlet port 22 which is in communication with a flow passageway 24 which, in turn, communicates with a filling means shown here as a septum assembh 26 (Figures 2. 3. and 4) The stored energy means is here provided in the form of at least one distendable membrane 28 which is superimposed over base 12 Membrane 28 is distendable as a result of pressure imparted on the membrane by fluids "F" introduced into reservoir 20 through inlet port 22 (Figures 2 and 3) As membrane 28 is distended in the manner shown in Figure 3. internal stresses will be established, which stresses tend to move the membrane toward a less distended configuration and in a direction toward base 12 Membrane 28 can be constructed from a single membrane or from multiple membranes to form a laminate construction of the character shown in Figure 39 of Patent No 5. 279.558. which patent is incorporated herein bv reference Mem¬ brane 39 can be formed from a variety of elastomers of the character discussed in detail in Patent No 5.279.558 ( see columns 9 and 10 of the patent) Prov ided within the reservoir portion of the dev ice which includes fluid reservon 20 and the conv ex central portion ot the base, is ullage defining means tor prov iding ullage w ithin the reser on and tor engagement with membrane 28 as the membrane moves toward its less distended starting configuration in the manner sho n in Figure 4 The ullage defining means in the embodiment of the in ention shown in Figures 1 through 1 compnses the conv ex central portion 14a of base 12 and defines an engagement surface for engagement by the distendable membrane as the membrane returns to its less distended configuration. As the membrane returns toward this less distended configuration, fluid contained within the reservoir 20 will flow through a fluid passageway 21a formed in the convex central portion 21. the base, and thence uniformly outwardly of the reservoir through an outlet port 32. The fluid will then flow into a fluid outlet passageway 34 via flow control means, the character of which will presently be described. Superimposed over base 12 is a cover 40 which functions to sealably enclose membrane 28. A medicament and use label 41 is affixed to cover 40 in the manner shown in Figure 1 . Base 12 and cover 40 can be constructed from a number of different materials of the character described in Patent No. 5.279.558 (see columns 9 and 1 1 ). Referring particularly to Figures 1. 6. 8. and 9 in the present form ofthe invention. the infusion means for infusing medicinal fluids from reservoir 20 into the patient comprises a tapered outlet cavity 46 formed in base 12 (Figure 6) which sealably receives a quick connect delivery fitting 48 that comprises a part of the infusion means of the invention. Fitting 48 in¬ cludes a tapered inboard end portion 48a and a hexagonally shaped body portion 48b. A central bore 50 extends through portions 48a and 48b and communicates at its outboard end with a cannula 54 which also forms a part of the infusion means of the invention for infusing liquids into the patient. The inboard end of bore 50 communicates with fluid passageway 34 when fitting 48 is seated within cavity 46 in the manner shown in Figure 1. In order to releasably lock quick connect delivery fitting 48 in the fluid deliver} position within cavity 46 and in fluid communication with passageway 34. locking means shown here as resiliently deformable locking tabs 55 are prov ided on base 12 (Figure 7). Upon pushing inwardly on fitting 48. tabs 55 will separate so that tapered portion 48a of the fitting can be intro¬ duced into cav itv 46. As the fitting 48a seats within portion 46. the resilient!} deformable locking tabs will close about portion 48b and will engage shoulder 48c in the manner to lockablv interconnect the infusion means with the base. Filling reservoir 20 is accomplished by introducing fluid into the reservoir under pressure via fill means which here comprises a septum assembly 26 mounted in base 12 (Figure 4). Septum assembly 26 is of a similar construction to the bolus injection site of the invention. the nature of which will presently be described. More particularly, the septum assembly includes a pierceable septum 26a which is mounted within a tapered cavity 19 formed in base 12. Surrounding septum 26a is a generally circularly shaped guide channel 26b. Using a conven¬ tional syringe assembh'. fluid can be introduced into passageway 24 via a pierceable septum 26a which comprises a part of septum assembly 26. During this filling step, distendable membrane 28 is distended outwardlv' in the manner shown in Figures 3 and 10 and internal stresses are thereb} formed in the membrane which tend to urge it toward its less distended starting configuration. In a manner presently to be described. a mechanical injection pen can also be used to fill the fluid reservoir. During the fluid dispensing step, the distendable membrane will provide a constant fluid expelling pressure on the fluid contained within the reservoir throughout the fluid deliver} cycle, thereby providing precise delivery of liquid medicament over the prescribed deliver} period. In the manner discussed in Patent No. 5.279.558. distendable membrane 28 can be tailored to provide the desired fluid flow characteristics. (See for example Column 17 of the patent ) During the liquid delivery step, fluid will flow from reservoir 20. through outlet port 32. through the prev ious!} identified flow control means and then into outlet passageway 34 ( Figure 1 ) The flow control means, which further controls the fluid flow characteristics of the de ice, here comprises an assemblage 36 which is received in a cavitv 61 formed in base 12 and which is preferabh constructed from a plurality of stacked members 36a. 36b. and 36c. Member 36a is a porous member: member 36b is a rate control element: and member 36c is a porous supporting substrate. Member 36a is preferably constructed from a material comprising polysulfone sold by Gelman Sciences under the name and style of "SUPOR". Member 36c is preferabh' constructed from a porous polycarbonate material available from Corning Costar Corporation or from a material sold by DuPont under the name and style KAPTON which has been laser drilled or machined to provide appropriate flow orifices. Member 36c can be constructed from a porous polypropylene. After flowing through the flow control means, the liquid medicament will flow outwardly of the device via passageway 34 and the infusion means in the manner best seen in Figure 8. An important feature of the apparatus of the present invention comprises the previously mentioned bolus injection means which here comprises a bolus injection site mounted in cover 40 and base 12 and generally designated by the numeral 65. Referring particularly to Figures 1 and 5. this novel bolus injection means includes a tapered cavity 67 provided in base 12 within which a pierceable septum 70 is mounted. A peripheral groove, or guide channel. 72 is provided in cover 40 and surrounds septum 70. Septum 70 is accessible via an opening provided in cover 40 and channel 72 is specially designed to guidably receive a first skirt portion 74a of a novel adapter means or adapter assembl}' 74 which also comprises a part of the bolus injection means of the invention. Adapter assembly 74 includes a central bod}' portion 74b which supports a double-ended hollow needle 76. For purposes presently to be described. needle 76 has a pierceable point 76a at one end and a pierceable point 76b at the other end. A second internally threaded skirt portion 74c extends from central bod} portion 74b and surrounds end 76a of needle 76. Turning to Figure 1. it is to be noted that second skirt portion 74c is special!} designed lo be threadably interconnected with the threaded barrel portion "B" of a syringe shown here as a dose indicating injection pen "IP" of the character disclosed in U. S. Patent 5. 226.896 issued to Harris. While any type of conventional syringe assembly having an injection needle can be used to provide the bolus dose via septum 70. the apparatus of the present form of the invention is specially well suited for use with the Harris injection pen. For this reason, the Harris patent No. 5.226.896 is hereby incorporated by reference as through fully set forth herein. In accomplishing the bolus delivery using the Harris device, internally threaded second skirt 76c of the adapter assembly is first threadabl}' connected to barrel "B" of the Harris device. During this step, end 76a of the needle will pierce the septum of a medicament vial disposed within the device IP. Next, the adapter assembh' is mated with cover 40 by inserting first skirt 74a into groove.72 and then pressing inwardly on the pen to cause needle end 76b to pierce septum 70 This places the bore ofthe hollow needle in communication with the passage- wa\ 34 formed in base 12 and also in communication with bore 50 of fitting 48 of the infusion means. Operation of the injection pen "IP" in the manner described in U. S. Patent 5. 226.896 will then cause a bolus dose to enter the infusion means for delivery to the patient. With this highly novel construction, the patient can receive from liquid reservoir 20 a selected basal dose of insulin of. by way of example, one-half milliliter over a 24 hour period. Should the patient determine that the blood sugar level is unduly high, a bolus injection of a predetermined volume can quickly and easily be accomplished through use of the bolus injection means of the invention thereby appropriately supplementing the basal dose being delivered from the fluid reservoir 20. More particularly, by using either a conventional syringe or b} using the injection pen IP. a bolus dose can be introduced into fluid passageway 34 via septum 70 Because of the resistance to upstream flow offered by the rate control means, the bolus dose w ill flow through passage 34 toward the central bore 50 of quick connect fitting 48 and thence into deliv er} line 54 Interconnected with line 54 is a soft cannula assembly 80 (Figure 8). the operation of which is well understood by those skilled in the art. Once the soft cannula 80a has been introduced into the patient " s subdermal tissue "ST" in the manner shown in Figure 8. the cannula insertion assembly 82. which includes a trocar 82a can be removed, leaving the soft cannula 80a in position within the patient. Needle cannula interconnect 84a of the connector assembly 84 of the infusion set can then be inserted into assembly 80 and interconnect therewith using the conventional latch mechanism 85. Connector assembly 84 which also forms a part of the infusion means, when connected to assembly 80, places soft cannula 80a in fluid communication with reservoir 20 The infusion set of this form of the invention. which comprises line 54. connector assembh 84. and soft cannula assembly 80. is of a character well known in the art and is readih available from several commercial sources including Pharma-Plast International A/S of Lynge. Denmark Turning to Figure 10B. it is to be noted that the injection pen IP can effectively be used to provide the bolus dose delivery when the device of the invention is affixed to the patient " s bod} as. for example, a location proximate the patient ' s waist Due to the novel design of the skirt portion 74a of the adapter assembly 74. the injection pen can be easih mated with dev ice 10 b} simph inserting the skirt portion into the circular guide channel or groove 72 As illustrated in Figure 10A. the injection pen IP can also be conveniently used to fill the fluid reservoir of the device via filling septum 26a while being held in the user ' s hand In this case, skirt portion 74a is guidably received within guide channel 26b formed as a part of septum assembh 26 ( see also Figure 4) Referring next to Figures 1 1 through 17. still another form ot the fluid deliver} dev ice ot the in ention is there shown and general!} designated b} the numeral 90 As best seen bv reterπnL! to Figures 1 1 and 12. this latest embodiment of the invention is similar in some respects to that shown in Figures 1 through 10. Accordingly, like numbers are used to describe like components. However, this latest embodiment of the invention is unique in that it includes dual reservoirs which communicate with the infusion means of this latest embodiment of the invention. As best seen in Figures 12 and 13. the embodiment of the invention there shown compπses a base 92 having an upper surface 94 including a central portion 94a and a peripheral portion 94b circumscribing central portion 94a. Base 92 is also provided with a lower surface 96 Formed within base 92 is a fluid passageway 100 (Figure 12). which communicates with a tapered wall, cavit} 102 provided in base 92. which cavity sealably receives portion 104a of a quick connect deliver} fitting assembh 104 which is somewhat similar to fitting 48 as previoush described As before, the apparatus shown in Figures 1 1 through 17 includes stored energv means for forming, in conjunction with the base 92. a pair of reservoirs 106 and 108 having outlets 1 10 and 1 12 respectively (Figure 13) As best seen in Figure 13. outlet 1 10 is in communication with a first inlet passageway 1 14 leading to passagewa} 100. while outlet 1 12 is in communication with a second inlet passageway 1 16 leading to passagewa} 100 Filling of central or inner reservoir 106 is accomplished via fill means here comprising a first septum assembh 1 18 while filling of outer or toroidal reservoir 108 is accomplished via a second fill means or second septum assembh 120. Both septum assemblies include a pierceable septum 1 19 (Figure 14) which is pierceable by a needle of a conventional syringe As before, the stored energy means is provided in the form of at least one distendable membrane 122 which is superimposed over base 92. An ullage defining means is disposed within a central chamber 124 formed in a covei 126 for forming ullage within the chambei Similar!} an ullage defining means is disposed within a toroidal chamber 130 formed in cover 126 each of the central chambers for forming ullage within the toroidal chamber. The ullage means interact with membrane 122 which, after being distended, will tend to return to its less distended configuration. The ullage defining means of this latest embodiment of the invention comprises conformable masses 134 and 136 which uniqueh conform to the continuously changing shape of the distendable membrane as the membrane tends to return to its less distended configuration. The first conformable mass 134 is disposed within chamber 124. while the second conformable mass 136 is disposed within chamber 130. The ullage defining means, or flowable masses 134 and 136 are preferably constructed from materials such as gels, foams, fluids and soft elastomers. More particular!}', materials particularly well suited for constructing the conformable masses include oil. gaseous materials, various polymers and various viscous liquids. Additionally, those masses can be formed from sodium palmitate . sodium sterate and methyl cellulose. Where, as is here the case, the conformable ullage comprises a gel. a yieldable encapsulation barrier means or membrane 140 is used to encapsulate the conformable masses 134 and 136 between the distendable membrane and the barrier membrane. With this construction, the conformable ullages are located between the barrier membrane 140 and the distendable membrane 122. Barrier membrane 140 can be constructed from various materials including polyurethane. polypropylene, polyethylene and fluorosilicon. As indicated in Figure 15. the peripheral portion of the cover 126 is provided with a capture groove 142 and an adjacent tongue 144. Similarly, base 92 is provided with tongue 146 which mates with groove 142 as the cover moves into engagement with base 92. Base 92 is further provided w ith an upstanding membrane cutting means, or protuberance 147 which functions to cleanh cut the stored energy means and barrier membrane 140 upon cover 126 being brought into pressural engagement with base 92. With this construction, follow ing cutting of the membrane the cover can be sonically welded to the base in a manner well understood by those skilled in the art. ln using the apparatus of this latest form of the invention. central reservoir can be filled via septum assembly 1 18 and passagewa} 1 18a using a conventional fluid containing syringe assembly having needle adapted to penetrate septum 1 19 of septum assembly 1 18. Similarly, toroidal reservoir 108 can be filled via septum assembly 120 and passageway 120a using a second syringe assembly containing a second fluid either the same as or different from the first fluid used to fill chamber 106. Fluids flowing into the reservoirs are filtered by filter means shown in Figure 14 as filter elements 157. With the chambers filled, and the quick connect deliver} fitting assembly 104 connected to base 92. the device is in condition for the liquid deliver}' step. As seen in Figure 12. the quick connect delivery fitting assembly is of slightly different construction, as is the outlet port assembly of the device. More particularly, the outlet port housing 154. within which tapered portion 102 is formed. extends outwardly from the base and is provided with a circumferentially extending locking groove 156 which forms a part of the infusion set locking means of this form of the invention. Fitting assembly 104 also includes a pair of spaced-apart locking arms 158 which terminate at their inboard ends in hook-like extremities 158a which are receivable within groove 156. By pressing inwardly on the rearwardly extending portions 158b of arms 158. extremities 158a will pivot about a collar 158c carried by the fitting and will resiliently spread apart to permit their release from normal biased engagement with groove 156. As before, the base of the device is provided with a suitable adhesive to enable the device to be removably affixed to the patient ' s bod} such as to the arm or leg of the patient. Once the device is interconnected with the patient, it will be appreciated that the fluids contained w ithin first or central chamber 106 and within toroidal chamber 108 will be urged to flow through fluid passagewa} 100 as the stored energy means, or distendable membrane 122 tends to return to its less distended configuration As before, the conformable ullages contained within the reservoirs will closely conform to the changing geometr} of the stored energv means as the stored energy means moves toward base 92 The flow control means here comprises a pair of assemblies each being of the character shown in Figure 17 Each assembly is receivable within a cavity provided in the base More particularh . assemblage 160 is mounted within a cavity 162 provided in the central portion of the base while assembly 164 is mounted within a cavit} 166 provided in the peripheral portion of the base As shown in Figure 17. each assemblage 160 and 164 is of a laminate construction comprising filtering means for filtering the fluid flowing outwardlv of the reservoirs and rate con¬ trol means for controlling the rate of fluid flow from the reservoirs into passagewa} 100 Referring to Figure 17. it can be seen that the filter means comprises disk-like filter element 160a while the rate control element comprises a disk-like rate control element 160b A porous disk-like support substrate 160c provides support to elements 160a and 160b The assemblage comprising filter element 160a. rate control element 160b and porous substrate 160c is supported in base 92 in the manner shown in Figure 16 Filter element 160a can be constructed from a wide vaπet} of materials However, a material compπsing polysulfone sold bv Gelman Sciences under the name and style of SUPOR has proven satisfactory Rate control element 160b is preferabh constructed from a polycarbonate material having extreme!} small flow apertures ablativelv drilled b} an excimer laser ablation process Both the orifice size and unit distribution can be closeh controlled bv this process However, a number of other methods can also be used to construct this element Porous substrate 160c can similarh be constructed from v arious materials such as a |x>rous po propvlene available from Gelman Sciences The latest embodiment ot the inv ention also includes bolus injection means comprising a bolus injection site 65. which is identical in construction and operation to that previously described As before, the bolus injection means includes a pierceable septum 70 which is accessible through the cover of the device and also includes a guide channel 72 which permits easy mating of the previously described adapter assembly 74 As best seen in Figure 13, liquids introduced v ia septum 70 will flow into a passageway 100a which communicates with outlet passagewa} 100. thereby permitting delivery to the patient of bolus doses of medication v ia the infusion means of the device Referring to Figures 18 through 24. yet another form of the fluid delivery device of the inv ention is there shown and generally designated by the numeral 170 This latest form ot the inv ention is similar in many respects to that shown in Figures 1 through 10. but in this latest embodiment the infusion means is specially designed for subdermal infusion of selected medicaments The device here comprises a base 172. having an upper surface 174 including a central portion 174a and a peripheral portion 174b circumscribing central portion 174a As best seen in Figures 18 and 22. base 172 is also provided with a lower surface 176 to which a patient interconnection means or adhesive pad assembh 178 is connected As befoie. pad assembh 178 functions to releasabh interconnect the device to the patient so as to hold it secureh in place during the de veiv step As was the case with the earlier described embodiments of the invention, a stored energy means cooperates with the upper surface 174 of base 172 to form a reservoir 180 having an inlet port 182 which is m communication with a flow passagewa} 184 which in turn communicates ith a filling means shown here as a septum assembh 186 (Figures 18. 19. and 20) The stored energv means is here provided in the form of at least one distendable membrane 188 which is superimposed o er base 172 Membrane 188 is distendable as a Jesuit of pressure impaited on the membrane b} fluids "F" introduced into ieservoir 180 thi ugh inlet poit 182 (Figure 20). As membrane 188 is distended in the manner shown in Figure 20. internal stresses will be established, which stresses tend to move the membrane toward a less distended con¬ figuration and in a direction toward base 172. Membrane 188 is substantially identical to membrane 28 (Figure 3 ) and can be constructed from a single membrane or from multiple membranes to form a laminate construction. Provided within the reservoir of the device, which is defined by the upper surface 174 of the base and a concave surface of a cover means for covering the distendable membrane, is ullage defining means for providing ullage within the reservoir and for engagement with membrane 188 as the membrane moves toward its less distended starting configuration. The ullage defining means provided in this latest embodiment of the invention comprises a conformable mass 190 which is engageable by the distendable membrane as the membrane returns to its less distended configuration. Conformable mass 190 is of a character similar to the conformable masses that make up the ullage defining means of the form of the invention shown in Figures 1 1 through 17. As before, when the distendable membrane returns toward its distend¬ ed configuration, fluid contained within the reservoir 180 will flow uniform!} outwardly of the reservoir through an outlet port 192 and into a fluid outlet passagewa} 1 4 via flow control means generally designated by the numeral 196 (Figure 22A). Superimposed over base 172 is the cover means, shown here as a rigid cover 200. which functions, through the use of novel sealing means, to sealably enclose membrane 188. The sealing means here comprises a circular groove 175 formed in peripheral surface 174b of base 172 and a circular rim like protuberance 200a formed on the lower surface of cover 200. Protuberance 200a is receivable within groove 175 and functions to sealabh clamp distendable membrane 188 between the cover and the base in the manner shown in Figures 20 and 22. If desired. a medicament and use label 41 can be affixed to cov er 200 in the manner previous!} described and as shown in Figure 1 Once again, base 172 and covet 200 can be constructed from a aπet} ol materials of the character described m Patent No 5.279.558 Referring particularly to Figures 1 and 24. the infusion means of this latest form of the invention tor subdermal infusion of medicaments into the patient is of a highly novel construction More particularly, the infusion means here comprises a circuitous shaped hollow cannula 206 which is carried withm a circuitous channel 208. formed in the intermediate bod} portion 1721 of base 172 Cannula 206 includes a body portion 206a which is mounted within channel 208 and also includes an outlet end 206b. here provided in the form of a needle-like segment, which extends general!} perpendicularly downward from the lower surface of base 172 The circuitous bodv portion 206a. of the cannula. when mounted within channel 208. provides an extremeh strong and rigid structure that effectivel} prevents bending or breakage of the small diameter cannula So that outlet end 206b can easily penetrate the patient s skin and tissue "ST" for subdermal penetration (see Figure 22A). end 206b is provided with a sharp, pointed extremit} 206c (Figures 22 and 22A) To protect segments 206b and 206c ofthe cannula from damage, a protective cover assembh 210 surrounds these portions of the cannula At time of use. the skirt portion 210a of the protectiv e covei 210 can be readily separated from the base breaking it awa} along a serration line 21 1 formed between the skirt portion 210a and a disk like base portion 210b Skirt portion 210a is configured to receive a plug 21 Op which provides a sterile barrier and prevents prematuie fluid flow from end 206c of the cannula Base portion 210b is provided with an upstanding circumferentially extending nm 210c which is receivable within a cv lindπcallv shaped cav itv 214 pi ov ided in base 172 (see Figure 22 ) Disk-like base portion 210b is also receiv able within an apertuie 1 78a provided in pad assemblv 178 (Figure 23 ) Tilling of reservoir 180 is accomplished bv introducing fluid into the reservon under pressure v ia a septum assembly 186 which is mounted in base 172 (Figure 18) Using an appropriate syringe assembly having a needle "N". fluid can be introduced into passageway 184 via a pierceable septum 186a which comprises a part of septum assembly 186 During this filling step, a barπer means or barrier membrane 217 is distended outwardly against the conformable mass 190 controllably moving it along with a distendable membrane 188 toward cover 200 As the ullage defining means moves toward cover 200. distendable membrane 188 will engage surface 219 formed in cover 200. and the ullage defining means will uniqueh conform to surface 219 as well as to the varying shape of distendable membrane 188 As the distendable membrane moves toward suitace 21 any gases contained within the reservoir will be vented to atmosphere v ia vent means, shown here as a vent plug 221 Barπer membrane 217 can be constructed from the vaπous materials previously described When the fluid is dispensed from the device, the conformable ullage will permit the distendable membrane to provide a constant fluid expelling pressure on the fluid contained within the reserv oir throughout the fluid delivery cycle, thereby avoiding undesirable delivery rate tail oft at the end of the deliver} period This novel substantial!} linear performance permits the device to meet even the most stringent of delivery protocols During the delivery step, fluid will flow from reservoir 180. through outlet port 192. through the flow control means, and then, in a manner presently to be described, into cannula 206 The flow control means of this latest form ot the invention comprises an assemblage 224 which is received in a cavit} 225 formed in the high nov el fusion means of the present invention, the character of which will present!} be described Assemblage 224 compπses a first wafer 224a which functions as a filter means of the chaiacter prev louslv described Wafei 224b is preferabh constructed from a hv drogel rate control medium which, upon imbibing fluid, swells into a cav it} prov ided in the filtei Upon swelling into a known configuration, wafei 224b w ill function to prov ide a specific peimeabi tv thereby precise!} controlling the rate of fluid flow from the reservoir 180 Wafer 224c functions as a support substrate for the assemblage. Turning particularly to Figure 24. the novel infusion means of the present invention is there illustrated This infusion means includes the previous!} identified circuitous shaped cannula 206. the inlet end 206ι of which is connected to a hollow housing 226 that is mounted in base 172 in the manner best seen in Figure 21 Inlet end 206ι of the cannula communicates with a chamber 226a formed in housing 226 as does the outlet end 230a of a hollow tube 230 The inlet end 230b of tube 230 is connected to a second hollow housing 232 which is mounted in base 172 and within which the previously identified cav itv 225 is formed \\ ith this construction, tube 230 places the outlet 180a of reservoir 180 in fluid communication with chamber 226a of housing 226 and also in fluid communication with cannula 206 via an mlet port 234 which is disposed within chamber 226a Accordingh . fluid can flow from reservoir 180 into chamber 225 via the flow control means, then into tube 230 and finally into cannula 206 for subdermal delivery to the patient As before, an important feature of this latest form of the invention is the a bolus injection means which here forms a part of the infusion means of the invention and includes a bolus injection site which is accessible through cover 200 Referring particularly to Figures 21 and 24. it can be seen that this novel bolus injection means is similar to that prev lously described but includes the earlier identified hollow housing 226 within which a pierceable septum 236 is mounted in the manner shown in Figure 21 Septum 236 is held in place within cover 200 a retainei cap 237 A peripheral groove 238 surrounds retainer cap 237 and is specificalh designed to receive the first skirt portion 74a of the previoush described adapter means oi adaptei assembl} 74 Adapter assembl} 74 is of identical construction and operation to that described in connection with the embodiment ofthe invention shown in Figures 1 through 10 and serves to deliver a bolus dose of medicinal fluid into chamber 226a of hollow housing 226 and thence into cannula 206 via let 234. As before adapter assembly 74 is specially designed to be threadably interconnected with the dose indicating injection pen "IP" of the character disclosed in U. S. Patent 5.226.896 issued to Harris. With the highly novel construction of the device as described in the preceding paragraphs, the patient can continually receive a selected basal dose of liquid medication, such as insulin from reservoir 180. However, should the patient at any time determine that his or her blood sugar level is unduly high, a bolus injection of a predetermined volume can quickly and easily be administered through use of the novel bolus injection means of the invention and in this wa} appropriate!} supplement the basal dose being delivered from reservon 180 Turning finally to Figure 25. several fluid delivery regimens are there illustrated For example, at the upper portion of Figure 25. a very simple regimen is illustrated. Here a fluid deliver} device 250. having a fluid reservoir 252 with a volume V-l is used to accomplish delivery of a liquid medicament such as insulin. The medicament is delivered to the patient through an appropriate infusion means which includes a delivery line 253 and a flow rate control means designated as R-l Reservoir 252 can be filled using a filling means here shown as a septum assembh S- 1 Using this basic arrangement, medicinal liquids can be delivered to the patient at a fixed rate over time with the rate of delivery being governed by the character of the flow rate control means R-l . Referring next to the arrangement illustrated in the central portion of Figure 25. a fluid deliver} dev ice 254 having a fluid reservoir 252 with a volume V-l is there shown. As was the case w ith the prev ioush described arrangement, fluid can be delivered to the patient at a basal rate v ia deliver} line 255 and a flow rate control means designated as R- l Reservoir 252 can. once again, be filled a fill means shown here is a septum assembl} S-1 Howevei . forming an important part of this second delivery system is a bolus dose delivery means general]} designated as S-2 This bolus dose delivery means, which can be of the character illustrated and described in connection with the embodiment of the invention shown in Figures 1 through 10. uniquely enables the patient to administer a pre-determined bolus dose of liquid insulin as ma} be required Device 254 exemplifies the types of single reservoir devices of the invention illustrated in Figures 1 through 10 and in Figures 18 through 24 of the drawings. Turning to the last arrangement schematically illustrated in Figure 25. a deliver} device 256 is there provided Unlike delivery devices 250 and 254. device 256 includes dual fluid reservoirs 252 and 258. As before, reservoir 252 has a volume V-l . while second reservoir 258 has a v olume V-2 Reservoir 252 can be filled by septum assembly S-1 while reservoir 258 can be filled using a septum assembly S-2. Reservoir 252 communicates with the patient via a delivery line 257 and a first flow rate control means R-l . while reservoir 258 communicates with the patient via a delivery line 259 and a second flow rate control means designated as R-2. For reasons present!} to be described. this arrangement is ideally for delivering hquid medicaments such as insulin For example, during the day when a larger basal rate is required, insulin can be delivered to the patient via delivery line 261 with insulin flowing simultaneously from both reservoirs 252 and 258 The amount of fluid being delivered from each of the reservoirs is. of course, determined by the character of the flow rate control device which is interconnected with that reserv oir B} making the resistance offered to fluid flow from reservoir 258 greater than the resistance to fluid flow from reservoir 252. it is apparent that reservoir 252 w ill empty faster than w ill reserv oir 258 Accordingly, by correct!} selecting the flow rate control means R-l and R-2. reservon 252 w ill be emptv at the end of the da} . Howev er, because of the greater resistance ottered bv flow rale control means R-2. during the night insulin w ill continue to flow to the jiatient trom reserv on 258 but at a lesser rate than the da} time basal deliv ei v rate Once again by properly selecting the flow rate control means R-2. insulin can be delivered to the patient at a prescribed basal delivery rate from reservoir 258 throughout the entire nighttime hours. Thus a single dual reservoir fluid delivery device can be used to provide a precise basal delivery of insulin to the patient over an entire 24-hour period. An important additional feature of this last arrangement, is the provision of a bolus dose delivery means designated as S-3. This important bolus delivery means permits the patient to introduce into delivery line 261 via S-3 a bolus dose of insulin at any time the patient discovers that his or her blood sugar level is too high. As is apparent, this latest arrangement as shown in Figure 25. is exemplified by the dual reservoir embodiment of the invention which is illustrated in Figures 1 1 through 17 of the drawings. In summary, it is clear from a study of Figure 25 that each of the fluid deliverv regimens illustrated in Figure 25 and described in the preceding paragraphs can be accomplished using a selected one of the various embodiments of the invention disclosed in Figures 1 through 24 of the drawings. Referring next to Figures 26 through 41. yet another form of the apparatus of the present invention is there illustrated. The apparatus here comprises two main assemblies, name a fluid delivery assembly 300 (Figures 26 and 31 ) and a fill assembly 302 (Figure 27 through 30) which can be operably mated with the fluid delivery assembly in a manner present!} to be described. Fluid delivery assembly 300. the details of construction of which will presently be described. is similar in some respects to the fluid delivery devices previously described herein and includes a base 304 having an upper surface 306 including a central portion 306a and a peripheral portion 306b (Figure 31 ). As best seen by referring to Figures 27 through 30. the fill assembly portion 302 of the apparatus comprises a container subassembly 308. an adapter subassembly 31 . and a cover subassemblv 12. the character of which will presently be described. Container subassembly 308 includes a bod} portion 314. having a fluid chamber 316 for containing an injectable fluid "F" which is provided w ith first and second open ends 318 and 320 (Figures 28 and 30) First open end 320 is sealabh closed by closure means here provided in the form of a pierceable septum assembly 322 Septum assembly 322 is held securely in position bv clamping ring 324 As best seen in Figures 28 and 30. a plunger 326 is telescopicalh movable within chamber 316 of container subassembly 308 from a first location shown in Figure 28 where it is proximate open end 318 to a second position shown in Figure 30 where it is proximate open end 320 The v ial portion of the container subassembh can be constructed of various materials in¬ cluding glass and plastic Referring particularly to Figures 27 and 28. it can be seen that the adapter subassembh 310 comprises a hollow housing 330 having a first open end 332 and a second closed end 334 (Figure 30) Container subassembh 308 is telescopicalh receivable within open end 332 of housing 330 in the manner shown in Figure 28 so that the housing can be moved from the first extended position shown in Figure 28 to the vial encapsulation position shown in Figure 30 Forming an important part of the adapter subassembh is pusher means shown here as an elongated pusher rod 336 which functions to move plunger 326 within fluid chamber 316 from the first position shown in Figure 28 to the second position shown in Figure 30 In the form of the invention shown m the drawings, pusher rod 336 has a first end 336a interconnected with a closure wall 334 of housing 330 and an opposite end 336b which engages plunger 326 and causes telescopic movement of the plunger within chamber 316 of container subassembh 308 as housing 330 is moved from the extended position into the v ial encapsulating position shown in Figure 30 Λ best seen b} referring to Figures 27 and 29 the interioi wall 330a of housing " "• O is prov ided with circumferential!} spaced-apart protuberances 340 which engage and center container subassembly 308 within housing 330. Due to the small surface area presented by protuberances 340. there is little frictional resistance to the sliding movement of container subassembh 308 relative to housing 330 as the housing is moved from the extended position shown in Figure 28 into the vial encapsulating position shown in Figure 30. Referring particularly to Figure 27. it is to be noted that cover subassembly 312 of the fill assembly of the present form of the invention includes a spiral wound, frangible portion 342 having a first open end 342a for telescopically receiving body portion 314 of container subassembh 308 (Figure 28) and a second closed end 342b. Portion 342 initially circumscribes a major portion of container subassembly 308 in the manner best seen in Figure 28. An integral pull tab 344 is provided to permit the spiral wound, frangible portion to be pulled from container subassembly 308 so as to expose a substantia] portion of body 314. As best seen in Figures 27 and 28. a medicament label 346 circumscribes spiral wound portion 342 and serves to prevent accidental unwinding of the spiral portion from the container subassembly 308. However, upon pulling tab 344. the spiral portion will unwind and. in so doing, will tear medicament label 346 so that the spiral portion 342 of the covering as well as the cylindrical portion 348 which, also comprises a part of the cover assembly, can be slipped from the container subassembh 308 so as to expose to view septum assembly 322 (Figure 30). As shown in Figures 27 and 28. end 342b of cylindrical portion 348 of subassembh 312 is provided with venting apeπures 350 which are covered by a porous vent patch 352 which can be constructed from an}' suitable porous material that will permit air entrapped within the interior of cover subassembly 312 to be expelled to atmosphere as the subassembh is placed over container subassembh 308. Turning particularly to Figures 26 and 31 through 38. the fluid deliver}' assemb which defines upper surface 306 As was the case with the earlier described embodiments of the invention, a flexible barrier means, shown here as a barrier membrane 354. cooperates with the upper surface 306 of the base to form a reservoir 356 having an inlet/outlet port 358 which is in communication with flow passageway s 360 and 362 the latter of which, in turn communicates with a cannula 364. the purpose of which ill presently be described (See Figures 31 and 35) A stored energy means is here provided in the form of at least one distendable membrane 366 which is superimposed over barrier membrane 354 and base 304 Disposed between barrier membrane 354 and distendable membrane 366 is an ullage defining means shown here as a conformable mass 388 (Figure 35 ) Conformable mass 388 is of a character similar to the conformable masses that make up the ullage defining means of the form of the invention shown in Figures 1 1 through 17 and can comprise a gel or other deformable material Membrane 354 is distendable as a result of pressure imparted on the membrane by fluids "F" introduced into reservoir 356 through port 358 As membrane 354 is distended in the manner shown in Figure 35. it will act on the conformable ullage which will, in turn, act upon distendable membrane 366 causing internal stresses to be established, which stresses tend to move the membrane toward a less distended con¬ figuration and in a direction toward surface 306a of base 304 As before membrane 354 can be constructed from a single membrane or from multiple membranes to form a laminate When the distended membrane returns toward its less distended configuration, fluid contained within the reserv on 356 w ill flow uniform!} outward!} of the reservoir through passagewa} 360 and then into a fluid outlet chamber 390 (Figure 35) v ia flow control means generally designated the nuinei ! 392 Superimposed ov er the central portion 306a of the base is sealing means shown here as a sealing i mg 396 which functions to sealabh lntei connect membrane 366 with base 304 Ring 396 includes a circular groove 396a within which is received a circular rim like protuberance 400 formed on the upper surface of base 304 (Figure 35). Protuberance 400 is closely received within groove 396a and functions to sealably clamp distendable membrane 366 between the clamping rings and the base in the manner shown in Figures 35 and 38. As shown in these figures, the periphery 354a of barrier membrane 354 is sealably affixed to the base by any suitable means, such as adhesive or thermal bonding. Once again, base 304 and clamping ring 396 can be constructed from a variety of materials of the character described in Patent No. 5.279.558. A unique feature of the base assembly of this latest form of the invention comprises, along one side of base 304. an elongated receiving chamber 404 which is adapted to receive a portion of the fill assembly of the invention. Receiving chamber 404 is formed within a generally cylindrically shaped housing 406 which is integrally formed with one of marginal portions 306b of the base. As best seen in Figures 31. 32. and 34. the previously identified piercing cannula 364 extends into the inboard portion of receiving chamber 404 and functions to provide a fluid flo path between the fill assembly and the fluid reservoir 356. Turning particularly to Figures 31 and 35. the fluid delivery assembly 300 further includes a housing 407 having an internal chamber 409 within which the base assembly, including chamber 404. is received. An apertured end wall 407a substantially encapsulates the base assembly within chamber 409. End wall 407a includes an aperture 409a which is indexible with receiving chamber 404 when the base assembly is positioned within housing 407 in the manner shown in Figure 32. Housing 407 is also provided with an aperture 410 which aligns with an important feature of the invention, namelv a bolus injection means, the character of which will presently be described. In using the apparatus of this latest form of the invention. w ith the fill assembh in the filled configuration shown in Figure 28. the cover subassembh' is first removed from the container subassembly by pulling on pull-tab 344. This will cause the spiral portion 342 of the cover subassembly to tear away from the container subassembly so that it can be separated from the forwardly disposed portion 348. Once the spiral wound portion 342 is removed, cylindrical portion 348 can also be removed and discarded. Removal of the cover subassembly to expose the forward portion ofthe container subassembly and septum 322 readies the adapter subassembly for interconnection with the fluid delivery assembl}'. Prior to mating the adapter subassembly with the fluid delivery assembly, a closure plug 412 which forms a part of the cover subassembh' must be removed in the manner illustrated in Figure 26. This done, the container subassembly 308 can be telescopically inserted into receiving chamber 404 and pushed forwardly in the direction indicated by the arrow 314 in Figure 34. A force exerted in the direction of the arrow will cause the adapter subassembh- to move to the right as viewed in Figure 34 and will cause the piercing cannula 364 to pierce septum 322. Once a fluid flow path between fluid chamber 316 of the container subassembly 308 and the fluid reservoir 356 of the fluid delivery assembly is thus created, a continued movement of the adapter subassembly will cause pusher rod 336 to move plunger 326 forwardly of chamber 316 to a position shown in Figure 34. As plunger 326 is moved inwardly of chamber 316. the fluid "F" contained within the chamber will flow through open end 320. into passagewa}' 364a of the piercing cannula. into passageway 362 of base 304 and then into fluid reservoir 356 via passagewa}' 360. As the fluid under pressure flows into reservoir 356. barrier member 354 will be distended outwardly in the manner shown in Figure 35 and will deform the conformable ullage 388 and at the same time distend the distendable membrane 366 until it reaches the position show n in Figure 35. Gases contained in the volume between the cover and the distendable membrane w ill be vented to atmosphere v ia aperture 409a in end wall 407a. Ring 396. which 3 : is in clamping engagement with base 304, functions to capture and seal the distendable membrane relative to the base ln a similar manner, the periphery of the barrier member 354 is sealabh affixed to the base as b} adhesive or thermal bonding, so as to prevent leakage of fluid around the perimeter of the member Referring particularly to Figure 35. it is to be noted that inlet means shown here as an inlet 417 formed base 304 is provided to enable the introduction of gel which forms the conformable ullage 388 of this embodiment of the invention Inlet 417 communicates with a fluid passagewa} 419 which, in turn, communicates with the volume defined between the under surface of membrane 366 and the upper surface of barrier member 354 v ia an inlet port 419a Inlet 41 7 is sealabh closed b} a bonded plug 421 With the construction described m the preceding paragraphs and as shown in Figures 35 and 38. the conformable mass 388. which comprises the ullage defining means of the invention is in direct engagement with distendable membrane 366 which, after being distended, will tend to return to its less distended configuration It is to be noted that the shape of the conformable ullage ill continuousl} vary as the distendable membrane distends outwardly from the base during reservoir filling and then tends to return to its less distended configuration during fluid deliver} While the conformable ullage, or mass 388 is here constructed from a flowable gel. the conformable ullage can also be constructed from a number of materials such as various types of foams, fluids and soft elastomers In some instances, the conformable ullage may comprise an integral conforming mass In other instances, such as when a gel or fluid is used as the ullage medium, an encapsulation barπer member such as membei 354 must be used to encapsulate the gel oi fluid and to provide an appropriate interface to the fluid contained in the reservoir Mteinativ eh a separate pliable film can be used to encapsulate the ge! oi othei fluid medium Once reservoir 356 is filled with fluid from the container subassembly of the fill assembh . the fluid will remain in the reservoir until such time as an outlet flow path of the fluid deliver} assembh is opened Once this path is opened in a manner presently to be described, distendable membrane 366 will tend to return to its less distended configuration and will act upon the conformable ullage 388 and the bamer member 354 in a manner to cause fluid to flow from reservoir 356 outwardly through flow passageways 360 and 362 and then into chamber 390 via the flow control means 392 (Figure 35) Referring once again to Figures 31 and 34. it is to be noted that base portion 406 and adapter membei 330 include locking means for locking the adapter member 330 within receiving chamber 404 after the fill subassembly has been mated with the fluid delivery device These locking means are here provided in the form of a series of forwardlv and rearwardh disposed locking teeth 420 and 422 respectively formed on adapter 330 and a locking tab 424 formed on base portion 406 As indicated in Figure 34. these locking teeth are constructed so that they will slide under the flexible locking tab 424. which is provided proximate the entrance of receiving chamber 404. as the adapter subassembh is urged mwardh of receiving chamber 404 Howevei. once the adapter subassembly has reached the full} inserted position shown in Figure 34 wherein the fluid is transferred to reservoir 356. locking tab 424 will effectiveh prevent removal of the adapter subassembly from passageway 404 With this novel construction once reservoir 356 has been filled with the fluid contained in the container subassembh the adaptei subassemblv cannot be removed from the fluid delivery dev ice and therefore, cannot be reused thereb} prev enting system adulteration Also forming an important aspect of the present invention is the provision of v iew ing means foi v iewing the v olume of fluid contained within chambei 316 of the fluid contamei subassemblv 308 In the form of the inv ention shown in the draw ings this v iewing means takes the form of an elongated viewing window 428 which is provided in housing 330 (Figure 27) As indicated in Figure 27. the body portion 308 of the container subassembly is provided with a plurahty of longitudinally spaced-apart index lines, or marks 430. which can be v lewed through indow 428 Index lines 430 provide reference points for observing the volume of fluid remaining within the container subassembh A protuberance 330a formed on housing 330 in cooperation with channel 406a (Figures 31 and 38) functions to provide polarized orienta¬ tion of the subassembly as it is introduced into receiving chamber 404 Referring particularly to Figures 31. 40. and 41. in the present form of the inv ention the deliver} means for delivering medicinal fluids from reservoir 356 outwardly of the dev ice comprises a tapered outlet cavity 433 which is formed in base 304 and defines outlet chamber 390 Cav ity 433 is adapted to receive a quick connect deliver} fitting 435 that comprises a part of the delivery means of the invention Fitting 435 includes a tapered inboard end portion 435a and a body portion 435b A central bore 437 extends through portions 435a and 435b and communicates at its outboard end with a cannula 450 which also forms a part of the deliver} means of the invention for delivering fluids from the device When fitting 435 is seated within chamber 390. the inboard end of bore 437 communicates with the chamber and with a stub passagewa} 452 which houses a portion of the flow control means 392 In order to lock quick connect deliver} fitting 435 in the fluid deliver} position, locking means shown here as resiliently deformable locking tabs 454 are prov ided on the bod} portion of fitting 435 Tabs 454 lockabh engage a locking surface 455 provided on cover 407 ( Figuie 40) Upon pushing inwardh on fitting 435. tabs 454 will } ieldabh deform inwardly so that tapered poition 435a of the fitting can be introduced into chamber 390 As the fitting seats within the hambei . the resilient!} deformable locking tabs will spring outwardh and engage lockmg surface 455 in a manner to lockabh interconnect the delivery means with the cov er 407 During this fluid step, fluid will flow from reservoir 356 through passageway 360 through the prev louslv identified flow control means and then into outlet cannula 450 (Figure 35) The flow control means, which further controls the fluid flow characteristics of the device, here comprises an assemblage 392 which is preferably constructed from a plurality of components 392a. 392b. and 392c Member 392a is a porous member, member 392b is a rate control element, and member 392c is a porous supporting substrate Member 392a is preferabl} constructed from a material comprising polysulfone sold by Gelman Sciences under the name and sty le of "SUPOR" Member 392b is preferabh constructed from a porous polycarbonate material av ailable trom Corning Costar Corporation or from a material sold b} DuPont under the name and style KAPTON which has been laser drilled or machined to provide appropriate flow orifices Member 392c can be constructed from a porous polypropylene After flowing through the flow control means, the liquid medicament will flow outwardh of the device via deliver} cannula 450 An extremely important feature of the apparatus of this latest form of the present invention comprises the previoush mentioned bolus injection means which here comprises a bolus injection site mounted in base 304 and accessible through aperture 410 prov ided in cover 407 Referring particularly to Figures 31. 32. and 37 this novel bolus injection means includes a cav itv 460 provided in base 304 within which a pierceable septum assembl} 462 is mounted Assembh 462 includes a pierceable septum 464 and a retaining ring 466 Septum 464 is accessible v ia opening 410 provided in cover 407 and is specialh designed to accept a needle "V of a conv entional sv πnge (see Figure 37) Through use of a conv entional S} πnge a bolus dose can be conv eniently introduced into a fluid passagewa} 467 formed in base 304 v ia septum 464 The bolus dose will then flow through passage 452 and toward the central bore 437 of quick connect fitting via the flow control means. After passing through the flow control means, the bolus dose will flow into delivery cannula 450. With the highly novel construction of the device as described in the preceding paragraphs, the patient can continually receive a selected basal dose of liquid medication, such as insulin from reservoir 356. However, should the patient at any time determine that his or her blood sugar level is unduly high, a bolus injection of a predetermined volume can quickly and easily be administered through use of the novel bolus injection means of the invention and in this wa} appropriate!}' supplement the basal does being delivered from reservoir 356. Having now described the invention in detail in accordance with the requirements of the patent statutes, those skilled in this art will have no difficulty in making changes and modifications in the individual parts or their relative assembly in order to meet specific requirements or conditions. Such changes and modifications may be made without departing from the scope and spirit of the invention. as set forth in the following claims. 3 £

Claims: WE CLAIM 1. A fluid delivery apparatus comprising: (a) a fluid delivery assembly having an outlet for delivering fluid from the apparatus, said fluid delivery assembly including: (i) a base having a fluid passageway in communication with said outlet; (ii) a stored energy means comprising at least one distendable membrane cooperating with said base to define a fluid reservoir in communication with said fluid passageway of said base: and (iii) a cover assembly connected to said base, one of said cover assembh and said base having a receiving chamber interconnected with said fluid passagewa}': and (b) a fill assembly interconnected with said fluid delivery assembly for filling said reservoir, said fill assembly comprising: (i) a container assembly including: a. a container having a body portion, a fluid chamber, and first and second open ends: b. closure means for sealably closing said first end of said container: and c. a plunger telescopically movable within said container from a first location proximate said open end to a second spaced apart location: and (ii) an adapter assembly receivable within said receiving chamber, said adapter assembh comprising a hollow housing having a first open end for telescopically receiving a part of said bod} portion of said container of said container assembh and including a second end: (c ) delivery means for delivering fluid from said reserv oir outwardly of the device: and (d ) bolus injection means in communication with said delivery means for providing a bolus volume of fluid to said delivery means 2 A device as defined in Claim 1 in which said cover assemblv includes a cover connected to said base, said bolus injection means comprising an injection site formed in said base and accessible through said cover assembly 3 A dev ice as defined in Claim 1. including ullage defining means 4 A device as defined in Claim 1 further including a barrier member disposed between said base and said ullage defining means 5 A device as defined in Claim 1 further including flow control means for controlling fluid flow toward said deliver} means 6 A device as defined in Claim 5 in which said flow control means comprises a rate control element for controlling the rate of fluid flow outwardly of said device 7 A device as defined in Claim 6 in which said delivery means further comprises a quick connect fitting for interconnection with said cover assembly 8 A fluid delivery apparatus comprising (a) a fluid delivery assembly having an outlet for delivering fluid from the apparatus, said fluid delivery assembly including (l) a base having a fluid passageway in communication with said outlet of the apparatus. (π) a conformable mass ov erlaying said base for forming in conjunction theiew ith a leserv oir having a fluid port in communication with said fluid passagewa} (in ) a cov er connected to said base said base hav ing a receiv ing chamber interconnected w ith said fluid passagewa} ( iv ) a stored energy means foi exerting forces on said means defining a contoimable ullage said stored energy means compnsing at least one distendable membrane superimposed over said means defining a conformable ullage, said membrane being distendable by forces imparted thereon by said means defining a conformable ullage in response to fluids introduced into said reservoir, said forces establishing internal stresses within said distendable membrane, said stresses tending to return said distendable membrane toward a less distended configuration, and (v) bolus injection means comprising an injection site formed in said base and accessible through said cover for delivering a bolus dose of medication into said outlet. (b) a fill assembly interconnected with said fluid delivery assembly for filling said reservoir, said fill assembly comprising (i) a container assembly including. a. a container having a body portion, a fluid chamber, and first and second open ends: b. closure means for sealably closing said first end of said container, and c a plunger telescopically movable within said container from a first location proximate said open end to a second spaced apart location, and (ii) an adapter assembly receivable within said receiv ing chamber, said adapter assembly comprising a hollow housing having a first open end for telescopically receiving a part of said body portion of said container of said container assembly and including a second end. and (c) delivery means connected to said outlet of said fluid deliv er} assembly for delivering fluid from said reservoir outwardlv of the device 9 A dev ice as defined in Claim 8 further including a barπei membei disposed between said conformable mass and said base 10 \ dev ice as defined in Claim 8 in which said conformable mass comprises a gel that is substantially conformable to the continually changing geometr} of said distendable membrane as said membrane tends to move toward a less distended configuration 1 1 A dev ice as defined in Claim 8 in which said delivery means comprises a fluid deliver} administration line and a quick connect fitting for interconnecting said administration line with said cover assembly 12 A device as defined in Claim 8 including locking means for locking said adapter assembh within said receiving chamber 13 A dev ice as defined in Claim 8 in which said injection site comprises a pierceable septum mounted within a chamber formed in said base, said chamber being in communication with said fluid passageway 14 A device as defined in Claim 8 further including flow control means for controlling fluid flow toward said delivery means 15 A device as defined in Claim 13 in which said flow control means comprises a rate control element for controlling the rate of fluid flow outwardly of said device 16 A fluid delivery apparatus comprising (a) a fluid delivery assembly having an outlet for deliv ering fluid from the apparatus, said fluid delivery assembly including (0 a base having an upper surface, a lower surface, and a fluid passagewa} formed in said base intermediate said upper and lower surfaces, said fluid passagewa} being in communication with said outlet of the apparatus and having first and second ends (n) a conformable gel overlaying said base for forming in conjunction theiew ith a reserv on having a fluid port in communication w ith said second end ot said passagewa} formed in said base. ( in ) a cov er connected to said base, said base hav ing a receiv ing chamber mtei connected w ith said first end of said fluid passageway formed in said base (iv ) an elastomeric membrane for exerting forces on said gel. said elastomeric membrane being superimposed over said gel. said membrane being distendable b} forces imparted thereon by said gel in response to fluids introduced into said reservoir, said forces establishing internal stresses within said elastomeric membrane, said stresses tending to return said elastomeric membrane toward a less distended configuration, (v) bolus injection means comprising an injection site formed in said base and accessibly brought said cover for delivering a bolus dose of medication into said outlet, and (vi) flow control means for controlling fluid flow toward said outlet. (b) a fill assembh interconnected with said fluid delivery assembly for filling said reservoir, said fill assembl} comprising (1) a container assembh including a a container having a body portion, a fluid chamber, and first and second open ends. b closure means for sealabh closing said first end of said container, and c a plunger telescopicalh movable within said container from a first location proximate said open end to a second spaced apart location, and (n) an adapter assembly receivable ithin said receiv ing chamber, said adapter assemblv comprising a hollow housing hav ing a first open end for telescopicalh receiving a pait of said bod} portion of said container of said container assembly and including a second end. and (c ) deliver} means for delivering fluid from said reserv on outwardlv of the dev ice 1 " \ dev ice as defmed in Claim 16 in which said injection site is mounted within a chamber formed in said base, said chamber being in communication with said fluid passagewa} formed in said base. 18. A device as defined in Claim 16 further including a barrier member disposed between said base and said gel. 19. A device as defined in Claim 16 in which said flow control means comprises a rate control element for controlling the rate of fluid flow toward said outlet of said fluid delivery system. 20. A device as defined in Claim 16 further including locking means for locking said adapter assembh within said receiving chamber.

Inventors: BARBER STEVEN C, FENG WILLIAM W, KAZEMZADEH FARHAD, KLUCK WILLIAM J, KRIESEL MARSHALL S, KRIESEL MATTHEW B, BARBER, STEVEN, C., FENG, WILLIAM, W., KAZEMZADEH, FARHAD, KLUCK, WILLIAM, J., KRIESEL, MARSHALL, S., KRIESEL, MATTHEW, B.
Applicants: SCIENCE INC, SCIENCE INCORPORATED
Application year: 1996
Main classification: A61M37
IPC codes: A61M5, A61M31, A61M37