Abstract:
A clamp ( 110 ) for releasably clamping a catheter, including a body having a first portion ( 112 ), a second portion ( 122 ), and a hinge ( 132 ) connecting the first portion and the second portion, such that the first portion is disposed to face the second portion. The first portion ( 112 ) includes a tab ( 134 ) extending distal from the hinge ( 132 ) and wherein the second portion ( 122 ) includes a locking means ( 146 ) for releasably locking the tab ( 134 ) to the second portion ( 122 ). A method of releasably clamping a plurality of catheter lumens ( 100,102 ) during catheter insertion and a method of locating a catheter insertion distance based on the location of the clamp are also disclosed.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]     The present application is a Divisional Application of U.S. patent application Ser. No. 10/775,988 filed Feb. 9, 2004, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/447,150, filed Feb. 13, 2003. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention relates to a clamp for positioning a catheter in place during insertion into a patient.  
       BACKGROUND OF THE INVENTION  
       [0003]     Catheters for the introduction or removal of fluids may be located in various venous locations and cavities throughout the body of a patient for the introduction of fluids to the body or removal of fluids from the body. Such catheterization may be performed by using a single catheter assembly having multiple lumens. A typical example of a multiple lumen catheter assembly is a dual lumen catheter assembly in which one lumen introduces fluids and one lumen removes fluids. Catheterization may also be performed by using separate, single lumen catheters inserted into an area to be catheterized. Examples of such multiple catheter assemblies are TESIO® catheters sold by Medical Components, Inc. of Harleysville, Pa.  
         [0004]     Generally, to insert any catheter in a blood vessel, the vessel is identified by aspiration with a long hollow needle in accordance with the Seldinger technique. When blood enters a syringe attached to the needle, indicating that the vessel has been found, a thin guidewire is then introduced, typically through a syringe needle or other introducer device, into the interior of the vessel. The introducer device is then removed, leaving the end portion of the guidewire that has been inserted into the vessel within the vessel and the opposing end of the guidewire projecting beyond the surface of the skin of the patient.  
         [0005]     At this point, several options are available to a physician for catheter placement. The simplest is to pass a catheter assembly into the vessel directly over the guidewire. The guidewire is then removed, leaving the catheter assembly in position within the vessel. However, this technique is only possible in cases where the catheter assembly is of a relatively small diameter, made of a stiff material and not significantly larger than the guidewire. For example, this technique may be used to insert small diameter dual lumen catheters into a patient. If the catheter assembly to be inserted is significantly larger than the guidewire, a dilator device is first passed over the guidewire to enlarge the hole. The dilator is then removed, and the catheter assembly is then passed over the guidewire into the vessel. The guidewire is then removed.  
         [0006]     In the case of an individual, singe-lumen catheter typically used in multiple catheter assemblies (e.g., a TESIO® catheter assembly), a physician may use an introducer sheath. If a TESIO® catheter assembly is used for hemodialysis, for example, each catheter is inserted in two separate veins, such as femoral veins. Alternatively, each catheter may be inserted in two different locations of the same vein, such as the internal jugular vein. The introducer sheath is simply a large, stiff thin-walled tube which serves as a temporary conduit for the permanent catheter which is being placed. The introducer sheath is positioned by placing a dilator device inside of the introducer sheath and passing both the dilator and the introducer sheath together into the vessel over a guidewire. The guidewire, left in the vessel after its insertion as described above, and the dilator are then removed, leaving the thin-walled introducer sheath in place. The catheter is placed into the vessel through the introducer sheath. After the catheter is inserted into the vessel, the sheath is then torn from around the catheter and removed. Preferably, the catheter is inserted into the patient&#39;s vessel a predetermined distance, depending on the size of the patient and the physician&#39;s preference.  
         [0007]     Typically, one catheter in the assembly, the venous catheter, is inserted farther into the patient than the other catheter in the assembly, the arterial catheter, to provide better blood circulation through the catheter assembly. Each of the catheters in the assembly is typically subcutaneously secured within the patient&#39;s body by a cuff located in a subcutaneous tunnel, or by otherwise externally affixing the catheter to the body.  
         [0008]     The TESIO® catheter assembly may also be inserted in accordance with the technique described in U.S. Pat. No. 5,624,413 through a single insertion point using a sheath into the vessel. The TESIO® catheter assembly, once inserted in the vessel, is then tunnelled separately through the patient in two subcutaneous tunnels leading to outside the body of the patient, where the external, proximal portions of the catheter preferably are secured. After tunneling, clamps and luer locks are secured to the proximal end of each catheter in the assembly for connection to an external device, such as a hemodialysis machine.  
         [0009]     One problem experienced by physicians while inserting the TESIO® catheter assembly occurs after the catheter assembly is inserted into the vessel, is that occasionally, while subcutaneously tunneling the catheter assembly through the body of the patient, the distal end of one or both catheters in the assembly may be pulled away from the predetermined location in which the physician initially inserted the catheter. Such a situation could reduce the effectiveness of the hemodialysis process. It would be beneficial to provide a mechanism by which the individual catheters in the catheter assembly are secured relative to each other, and in which the physician can determine whether the placement of the catheters in the vessel has changed after the catheter is inserted into the vessel.  
       BRIEF SUMMARY OF THE INVENTION  
       [0010]     Briefly, the present invention provides a clamp comprising a body having a first portion, a second portion, and a hinge connecting the first portion and the second portion, such that the first portion is disposable to face against the second portion when clamping around and to either one catheter lumen or a side-by-side pair of catheter lumens proximate to the hinge. The first portion includes a tab extending distal from the hinge and wherein the second portion includes a locking means for releasably locking the tab to the second portion.  
         [0011]     Additionally, the present invention provides a method of releasably clamping a catheter assembly. The method comprises inserting a distal end of a first catheter lumen into a patient at an insertion site; inserting a distal end of a second catheter lumen into the patient proximal to the first catheter lumen; releasably clamping the first and second catheter lumens proximate to the insertion site; subcutaneously tunneling a proximal end of each of the first and second catheter lumens; installing catheter locking devices on the proximal ends of each of the first and second catheter lumens; and later releasing the catheter clamp when desired.  
         [0012]     Further, the present invention provides a method of relocating a catheter insertion distance in a patient. The method comprises inserting a distal end of a first catheter lumen into a patient; inserting a distal end of a second catheter lumen into the patient proximal to the first catheter lumen; releasably clamping the first and second catheter lumens at a predetermined location with a catheter clamp; subcutaneously tunneling a proximal end of each of the first and second catheter lumens; determining whether the distal ends of the first and second catheter lumens have been dislodged by comparing the location of the catheter clamp to the predetermined location; moving the catheter clamp to the predetermined position; and later releasing the catheter clamp when desired. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]     The accompanying drawings, which are incorporated herein and constitute part of this specification, illustrate the presently preferred embodiments of the invention, and, together with the general description given above and the detailed description given below, serve to explain the features of the invention. In the drawings:  
         [0014]      FIG. 1  is a perspective view of a catheter clamp according to a first embodiment of the present invention.  
         [0015]      FIG. 1A  is a perspective view of a second embodiment of a catheter clamp.  
         [0016]      FIG. 2  is an enlarged sectional view of the catheter clamp taken along lines  2 - 2  of  FIG. 1 .  
         [0017]      FIG. 3  is a perspective view of the catheter clamp of  FIG. 1 , with a pair of catheter lumens, in an open position.  
         [0018]      FIG. 4  is a perspective view of the catheter clamp of  FIG. 1 , with a pair of catheter lumens, in a closed position.  
         [0019]      FIG. 5  is a flow chart showing the steps to ensure that desired catheter placement location is maintained during catheter tunneling.  
         [0020]      FIG. 6  is a perspective view of a catheter clamp according to a third embodiment of the present invention.  
         [0021]      FIG. 7  is a perspective view of the catheter clamp of  FIG. 6 , with a pair of catheter lumens, in a closed position.  
         [0022]      FIG. 8  is a perspective view of a catheter clamp according to a fourth embodiment of the present invention.  
         [0023]      FIG. 9  is a perspective view of a catheter clamp according to a fifth embodiment of the present invention.  
         [0024]      FIG. 10  is a perspective view of the catheter clamp of  FIG. 9 , with a pair of catheter lumens, in a closed position. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0025]     In the drawings, like numerals indicate like elements throughout. Certain terminology is used herein for convenience only and is not to be taken as a limitation on the present invention. The terminology includes the words above specifically mentioned, derivatives thereof, and words of similar import. The following describes preferred embodiments of the invention. However, it should be understood based on this disclosure, that the invention is not limited by the preferred embodiments described herein.  
         [0026]     Referring to  FIGS. 1 and 2 , a catheter clamp  110  according to a first embodiment of the present invention is shown. While the clamp  110  is preferably used to clamp a catheter, those skilled in the art will recognize that the clamp  110  may be used to clamp other catheters. The clamp  110  is preferably a unitary construction made from a polymer, such as, for example polypropylene, although those skilled in the art will recognize that other suitable materials may be used. The clamp  110  may be fabricated by injection molding or other known process.  
         [0027]     The clamp  110  is preferably a generally elongated strip comprised of a first portion  112  having a free end  114  and a connected end  116 . A top face  118  extends between the free end  114  and the connected end  116 . Optionally, the top face  118  may include at least one longitudinal rib  119  extending outwardly therefrom, or two such ribs as shown. A bottom face  120 , disposed away from the top face  118 , also extends between the free end  114  and the connected end  116 . The clamp  110  is further comprised of a second portion  122  having a free end  124  and a connected end  126 . A top face  128  extends between the free end  124  and the connected end  126 . Optionally, the top face  128  may include at least one longitudinal rib  129  extending outwardly therefrom. Preferably, the at least one longitudinal rib  129  is offset from the at least one longitudinal rib  119  on the first portion  112 . A bottom face  130 , disposed away from the top face  128 , also extends between the free end  124  and the connected end  126 . The second portion  122  also preferably includes a gripping ring  138  disposed at the free end  124 . The gripping ring  138  facilitates gripping the clamp  110  by the inserting physician during catheter insertion.  
         [0028]     A hinge  132 , preferably a living hinge, connects the connected end  116  of the first portion  112  to the connected end  126  of the second portion  122 . The hinge  132  is disposed to allow the first portion  112  to rotate about the hinge  132  so that the top face  118  of the first portion  112  is able to engage the top face  128  of the second portion  122 .  
         [0029]     The free end  114  of the first portion  112  includes a free end portion or narrow elongate tab  134  that extends away from the hinge  132 . The first portion  112  also includes a recessed portion  136  disposed on the top face  118  proximate to the connected end  116 . The second portion  122  includes a recessed portion  142  disposed on the top face  128  proximate to the connected end  126 .  
         [0030]     The top face  128  of the second portion  122  also includes a lock  146  that secures the tab  134  when the first portion  112  is pivoted about the hinge  132  so that the top face  118  of the first portion  112  engages the top face  128  of the second portion  122 .  FIG. 2  shows a sectional view of the lock  146 . The lock  146  is comprised of a guide  148  that extends generally orthogonally from the top face  128  of the second portion  122  and a cantilevered portion  150  that also extends generally orthogonally from the top face  128  of the second portion  122 , with a longitudinal channel  152  separating the guide  148  and the cantilevered portion  150 . The cantilevered portion  150  is disposed on a ledge  139  that extends away from the second portion  122 . The ledge  139  is connected to the second portion  122  by a recessed portion  140 . The recessed portion  140  is a flexible section that allows the ledge to be biased about the recessed portion  140  to permit pivoting of the cantilevered portion  150  away from the guide  148 , thus allowing the tab  134  to be disposed within the channel  152  to releasably lock the free end  114  of the first portion to the second portion  122 .  
         [0031]     The cantilevered portion  150  includes a beveled face  156  that guides the tab  134  toward the guide  148  and into the channel  152 . The cantilevered portion  150  also includes a latching ledge  158  that extends partially over and partially into the channel  52 . The latching ledge  158  extends toward the guide  148  and into the channel  152  sufficiently so that the channel  152  is narrower than the tab  134  at the latching ledge  158 .  
         [0032]     The second portion  122  also preferably includes a weakened portion  141  disposed between the free end  124  and the lock  146 . The weakened portion  141 , shown in  FIG. 1  as a generally transverse “V-shaped” cutout or groove, allows the free end  124  to flex relative to the remaining part of the second portion  122  to provide the inserting physician with some flexibility in gripping and maneuvering the clamp  110 .  
         [0033]     An alternate embodiment of a clamp  110 ′, shown in  FIG. 1A , shows a clamp similar to the clamp  110 , but with a weakened portion  141 ′ as a narrowed part of the second portion  122 ′ to provide the desired flexibility. Other features of the clamp  110 ′ are preferably the same or similar to corresponding features in the clamp  110 .  
         [0034]     Operation of the clamp  110  is illustrated in  FIGS. 3 and 4 , with reference to the sectional view of  FIG. 2 . Operation of the clamp  110 ′ is identical to operation of the clamp  110  and needs not be discussed. At least one, and preferably two catheters  100 ,  102  are disposed within the recessed portion  142 . The first portion  112  is pivoted about the hinge  132  toward the second portion  122  so that the top face  118  of the first portion  112  faces the top face  128  of the second portion  122  and traversing the catheter lumens  100 , 102 . The tab  134  engages the beveled face  156  of the cantilevered portion  150 , wherein the tab  134  is guided into the channel  152 . Since the channel  152  is narrower than the tab  134  at the latching ledge  158 , the cantilevered portion  150  bends about the recessed portion  140  away from the channel  152 , the recessed portion defining a flexible section. As the tab  134  clears the latching ledge  158 , the cantilevered portion  150  snaps back to its original position, locking the tab  134  in the channel  152  between the latching ledge  158  and the top face  128  of the second portion  122  and latches atop a side edge of tab  134 .  
         [0035]     The ribs  119 ,  129  engage the catheters  100 ,  102  to securely retain the catheters  100 ,  102  within the clamp  110  and secured against longitudinal movement relative to each other. Optionally, the ribs  119 ,  129  may compress the catheters  100 ,  102  sufficiently to occlude the catheters  100 ,  102 , preventing blood loss from the patient through the catheters  100 ,  102 , or preventing an air embolism from being aspirated into the patient through the catheter  100 ,  102 . However, those skilled in the art will recognize that, even if the ribs  119 ,  129  are omitted, the clamp  110 , when in the closed position, may sufficiently prevent blood loss and/or air embolism.  
         [0036]     The clamp  110  provides the ability for the implanting physician to ensure that the catheters  100 ,  102  are not dislodged from the patient&#39;s blood vessel during tunneling. Referring to the flow chart of  FIG. 5 , prior to insertion of the catheters  100 ,  102 , the physician determines how far into the patient&#39;s blood vessel that the catheters  100 ,  102  are to be inserted in order to optimize blood circulation through the catheters  100 ,  102 . Occasionally, during the tunneling procedure, the catheters  100 ,  102  may be inadvertently pulled from their desired location, reducing the efficiency of the catheters  100 ,  102 .  
         [0037]     To minimize such problem, after the catheters  100 ,  102  are inserted into the patient, but before the proximal ends of the catheters  100 ,  102  are subcutaneously tunneled, the clamp  110  may be repositioned along the length of the catheters  100 ,  102 , such as where the catheters  100 ,  102  enter the patient&#39;s skin. After the physician forms the tunnel and pulls the proximal ends of the catheters  100 ,  102  through the tunnel, the physician needs merely to see if the clamp  110  is still positioned at the entrance of the catheters  100 ,  102  into the patient. If the clamp  110  has been moved away from that location, the physician knows that the catheters  100 ,  102  have been longitudinally translated during tunneling, and that the catheters  100 ,  102  must be readjusted in the blood vessel. While holding the catheters  100 ,  102 , the physician moves the clamp  110  back against the entrance of the catheters  100 ,  102  into the patient&#39;s skin. The physician may remove the clamp  110  from the catheters  100 ,  102  after the proximal ends of the catheters  100 ,  102  are otherwise clamped off. To remove the clamp  110 , the ledge  139  is depressed so that the ledge  139  pivots about the recessed portion  140 . The cantilevered portion  150  is disposed away from the guide  148 , allowing the first portion  112  to pivot about the hinge  132 , and allowing the tab  134  to be removed from the channel  152 , releasing the first and second catheters  100 ,  102  from the clamp  110 .  
         [0038]     An alternative embodiment of the present invention is a catheter clamp  210  as shown in  FIGS. 6 and 7 . The clamp  210  is comprised of a first portion  212  having a free end  214  and a connected end  216 . A top face  218  extends between the free end  214  and the connected end  216 . The top face  218  includes a recessed portion  236 . Optionally, the top face  218  may include at least one longitudinal rib  219  extending outwardly therefrom. An outside face  220 , disposed away from the top face  218 , also extends between the free end  214  and the connected end  216 . The clamp  210  is further comprised of a second portion  222  having a free end  224  and a connected end  226 . A top face  228  extends between the free end  224  and the connected end  226 . The top face  228  includes a recessed portion  242 . Optionally, the top face  228  may include at least one longitudinal rib  229  extending outwardly therefrom. Preferably, the at least one longitudinal rib  229  is offset from the at least one longitudinal rib  219  on the first portion  212 . An outside face  230 , disposed away from the top face  228 , also extends between the free end  224  and the connected end  226 . The second portion  222  also preferably includes a gripping ring  238  disposed at the free end  224 . The gripping ring  238  facilitates gripping the clamp  210  by the inserting physician during catheter insertion.  
         [0039]     A hinge  232 , preferably a living hinge, connects the connected end  216  of the first portion  212  to the connected end  226  of the second portion  222 . The hinge  232  is disposed to allow the first portion  212  to rotate about the hinge  232  so that the top face  218  of the first portion  212  is able to generally face the top face  228  of the second portion  222 .  
         [0040]     The first portion  212  includes a free end portion having a slot  234  that extends longitudinally between the free end  214  and the connecting end  216 . The second portion  222  also includes a vertically projecting tab or lock  246  that engages the slot  234  when the first portion  212  is pivoted about the hinge  232  so that the top face  218  of the first portion  212  faces the top face  228  of the second portion  222 . The lock  246  is comprised of a locking member  250  having a rounded top and that extends generally obliquely from the top face  228  of the second portion  222 . A cantilevered portion  252  extends away from the locking member  250  toward the free end  224  of the second portion  222  and includes a ledge that latches atop an edge of slot  234 . Between the ledge and the rounded top the surface of the cantilevered portion is shown to be beveled.  
         [0041]     In operation, catheters  100 ,  102  are disposed on the top face  228  of the second portion  222 , within the recessed portion  242 , as shown in  FIG. 7 . The first portion  212  is pivoted about the hinge  232  so that the slot  234  is disposed toward the lock  246 . The oblique disposition of the locking member  250  with respect to the second portion  222  biases the locking member  250  toward the hinge  232 , allowing the tab  234  to pass under the cantilevered portion  252 . After the slot  234  clears the cantilevered portion  252 , the biasing member  250  returns to its prebiased position, and the free end  214  of the first portion  212  is locked under the cantilevered portion  252 , as seen in  FIG. 7 .  
         [0042]     The ribs  219 ,  229  engage the catheters  100 ,  102  to securely retain the catheters  100 ,  102  within the clamp  210 . Optionally, the ribs  219 ,  229  may compress the catheters  100 ,  102  sufficiently to occlude the catheters  100 ,  102 , preventing blood loss from the patient through the catheters  100 ,  102 , or preventing an air embolism from being aspirated into the patient through the catheter  100 ,  102 . However, those skilled in the art will recognize that, even if the ribs  219 ,  229  are omitted, the clamp  210 , when in the closed position, may sufficiently prevent blood loss and/or air embolism.  
         [0043]     To unlock the clamp  210 , the user places a thumb or finger on the top of the cantilevered portion  252  and biases the locking member  250  toward the hinge  232 . The cantilevered portion  252  clears the free end  214  of the first portion  212 , allowing the first portion  212  to pivot about the hinge  232 , opening the clamp  210  and releasing the catheters  100 ,  102 . The clamp  210  may also be used to practice the method of relocating a catheter insertion distance in a patient illustrated above with clamp  110 .  
         [0044]     An alternate embodiment of a clamp  310  is shown in  FIG. 8 . The clamp  310  is similar to the clamp  210 , with the exception that the clamp  310  includes generally rounded recessed portions  319 ,  329  instead of the generally flat recessed portions  236 ,  242  shown in the clamp  210  of  FIG. 6 . Each generally rounded recessed portion  319 ,  329  may include at least one longitudinally extending rib  320 ,  330 , respectively. Additionally, the clamp  310  includes a narrowed neck  323  of the second portion  322  which allows for flexibility of the clamp  310  relative to the gripping ring  338  to facilitate use by the inserting physician. Operation of the clamp  310  is preferably similar to the operation of the clamp  210  as described above.  
         [0045]     Another embodiment of a clamp  410  is shown in  FIG. 9 . The clamp  410  is preferably a generally elongated strip comprised of a first portion  412  having a free end portion  414  concluding in a free end edge, and a connected end  416 . A top face  418  extends between the free end  414  and the connected end  416 . Optionally, the top face  418  may include at least one longitudinal rib  419  extending outwardly therefrom. A bottom face  420 , disposed away from the top face  418 , also extends between the free end  414  and the connected end  416 . The clamp  410  is further comprised of a second portion  422  having a free end  424  and a connected end  426 . A top face  428  extends between the free end  424  and the connected end  426 . Optionally, the top face  428  may include at least one longitudinal rib  429  extending outwardly therefrom. Preferably, the at least one longitudinal rib  429  is offset from the at least one longitudinal rib  419  on the first portion  412 . A bottom face  430 , disposed away from the top face  428 , also extends between the free end  424  and the connected end  426 . The second portion  422  also preferably includes a gripping ring  438  disposed at the free end  424 . The gripping ring  438  facilitates gripping the clamp  410  by the inserting physician during catheter insertion.  
         [0046]     A hinge  432 , preferably a living hinge, connects the connected end  416  of the first portion  412  to the connected end  426  of the second portion  422 . The hinge  432  is disposed to allow the first portion  412  to rotate about the hinge  432  so that the top face  418  of the first portion  412  is able to engage the top face  428  of the second portion  422 .  
         [0047]     The free end  414  of the first portion  412  includes a vertical projection  434  that extends away from the top face  418 . The first portion  412  also includes a recessed portion  436  disposed on the top face  418  proximate to the connected end  416 . The second portion  422  includes slot  441  complementary to vertical projection  434  of first portion  412 , and also a recessed portion  442  disposed on the top face  428  proximate to the connected end  426 .  
         [0048]     The top face  428  of the second portion  422  also includes a vertically projecting tab or lock  446  that secures the transverse end edge of free end  414  of the first portion  412  when the first portion  412  is pivoted about the hinge  432  so that the top face  418  of the first portion  412  engages the top face  428  of the second portion  422 . The lock  446  includes a cantilevered portion  448  that extends away from the top face  438  and toward the free end  424  of the second portion  422 . The lock  446  also includes a ledge  450  that extends toward the connected end  426  of the second portion  422 , and locks atop a transverse end edge of free end  414 . The free end  414  of the first portion  412  may optionally include a recess  452  along the bottom face  420  that is engageable with the tab  450  when the clamp  410  is in a closed position.  
         [0049]     Operation of the clamp  410  is illustrated in  FIG. 10 . At least one, and preferably two catheters  100 ,  102  are disposed within the recessed portion  442 . The first portion  412  is pivoted about the hinge  432  toward the second portion  422  so that the top face  418  of the first portion  412  faces the top face  428  of the second portion  422 . The cantilevered portion  448  is biased toward the top face  428  of the second portion  422  and the free end  414  of the first portion is disposed under the tab  450 . Generally simultaneously, the tab  434  engages the slot  441  to lock the top face  418  of the first portion  412  and the top face  438  of the second portion  422  together. The cantilevered portion  448  is released, securing the free end  414  of the first portion  412  under the tab  450 .  
         [0050]     The ribs  419 ,  429  engage the catheters  100 ,  102  to securely retain the catheters  100 ,  102  within the clamp  410 . Optionally, the ribs  419 ,  429  may compress the catheters  100 ,  102  sufficiently to occlude the catheters  100 ,  102 , preventing blood loss from the patient through the catheters  100 ,  102 , or preventing an air embolism from being aspirated into the patient through the catheter  100 ,  102 . However, those skilled in the art will recognize that, even if the ribs  419 ,  429  are omitted, the clamp  410 , when in the closed position, may sufficiently prevent blood loss and/or air embolism.  
         [0051]     To release the clamp  410 , the cantilevered portion  448  is biased toward the top face  428  of the second portion  422 , releasing the free end  414  of the first portion  412 . The first portion  412  is pivoted about the hinge  432 , releasing the catheters  100 ,  102  from the clamp  410 . The clamp  410  may also be used to practice the method of relocating a catheter insertion distance in a patient illustrated above with clamp  110 .  
         [0052]     It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but it is intended to cover modifications within the spirit and scope of the present invention as defined by the appended claims.