Abstract:
Hemostatic clip cartridge having a plurality of individual compartments for holding preformed hemostatic clips. Each individual compartment progressively increases in width from the centerline of the cartridge. Flexible retaining fingers extend into each individual compartment and secure the hemostatic clip to a pedestal. Harvesting the hemostatic clip from that particular individual compartment by a clip applicator moves at least one of the retaining fingers from a first position to a post-harvest position. Subsequent removal of the clip applicator with the harvested hemostatic clip from that particular individual compartment leaves at least one of the retaining fingers in the post-harvest position different from the first position so that the post-harvest position of the at least one of the retaining fingers indicates that the particular individual compartment has been accessed by the clip applicator.

Description:
This application is a Continuation-in-Part of and claims priority to U.S. patent application Ser. No. 12/002,201 filed Dec. 14, 2007 for Hemostatic Clip Cartridge. 
    
    
     BACKGROUND 
     1. Field of the Disclosure 
     This disclosure relates generally to hemostatic clips used to ligate or clamp blood vessels during surgical procedures and more particularly, to a cartridge for securely retaining a plurality of preformed hemostatic clips prior to the withdrawal of the clips by a clip applicator. Even more particularly, the disclosure relates to a cartridge where the cartridge has a feature that is altered by the clip loading into the applicator process resulting in a pronounced visible indicator that the applicator has been inserted and removed from the individual compartment. 
     2. Related Art 
     Hemostatic clips are a well known practice and have been used in surgery for over 75 years in the strangulation of blood vessels and other fluid ducts. The clips are permanently implanted in the body and are typically formed in a “V” or “U” shape as described in Wood—U.S. Pat. Nos. 3,326,216 and 3,363,628. Regardless of shape, the basic clip has two legs originating from a central apex. 
     In a prior art cartridge, Peiffer—U.S. Pat. Nos. 4,936,447 and 4,972,949, a plurality of clips is retained in place on a center, fixed pedestal by flexible retaining fingers pressing against the exterior surface of the clips legs. The use of flexible fingers was advantageous in that it provided an effective way of securing the clip and allowed the user to load clips into the applicator using a single hand. The use of retaining fingers to secure the clip results in a portion of the clip being obscured by the retaining fingers and the user can not easily determine if a clip is present in the individual compartment. Clip detection is further impeded by the use of flexible fingers that return to their original location after a clip is removed by an applicator and the small size of the clips used to ligate vessels. Clip detection is further impeded by the individual compartment design which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. The prior art does not provide for a pronounced cartridge feature change resulting from the clip loading into the applicator process. Absence of a pronounced cartridge feature change creates a user nuisance as the user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. Failure to confirm clip presence could result in user nuisance due to wasted time as the user attempts to pick up a clip from an empty individual compartment, a worse scenario of the user believing they had picked-up and retracted a clip only to notice it missing at time of application, thus delaying the procedure while the user searches for the “lost” clip in the patient which they will never find, or the worst scenario of causing patent injury where the user, who erroneously thinks they have picked up a clip, closes an empty applicator on a vessel resulting in an unplanned severance of the vessel. To compensate for the lack of a pronounced cartridge feature change, the prior art provided for such a cartridge wherein the base is made of a light colored material and the retaining fingers are made of a dark colored material to help facilitate detection of empty individual compartments. 
     In Reimels—U.S. Pat. No. 3,713,533, a plurality of “V” shaped clips is retained in place on a center, fixed pedestal by placing the ends of the clips under the shoulder of housing. The use of the housing was advantageous in that it provided an effective way of securing the clip and it allowed the ability for the user to load clips into the applicator using a single hand. Using the clip ends to secure the clip does not result in a pronounced cartridge feature change as part of the clip loading into the applicator process and the user can not easily determine if a clip is present in the slot due to the small size of the clips. Clip detection is further impeded by the individual compartment design which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. Absence of a pronounced cartridge feature change creates a user nuisance as the user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. 
     In Wood—U.S. Pat. No. 3,326,216, a plurality of clips is retained by press fitting the clip over a rigid, fixed pedestal with the resulting friction force on the internal surface of the clip securing the clip to the cartridge. Although the complete clip exterior is exposed, the small size of the clip does not provide an easily detectable method to determine if a clip had been previously removed and no pronounced cartridge feature change occurs as part of the clip loading into the applicator process. The user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. Clip detection is further impeded by the individual compartment design which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. 
     In other prior art such as Carroll et al. —U.S. Pat. No. 4,076,120, Samuels et al.—U.S. Pat. No. 4,146,130, Raczkowski et al. —U.S. Pat. No. 4,212,390, Samuels—U.S. Pat. No. 4,696,396, Kulp—U.S. Pat. No. 4,961,499, Appleby—U.S. Pat. No. 5,908,430, and Esposito et al. —U.S. Pat. No. 6,044,971, a plurality of clips is held in place by the legs, face or top of the clip contacting features formed into the clip compartment walls The use of a clip compartment wall feature to secure the clip impedes clip detection by adding an additional feature to the individual compartment which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. In all cases, no pronounced cartridge feature change occurs as part of the clip loading into the applicator process and the user can not easily determine if a clip is present in the slot due to the small size of the clip. Absence of a pronounced cartridge feature change creates a user nuisance as the user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. 
     In Jewusiak et al.—U.S. Pat. No. 4,294,355, a plurality of clips is held in place by a film secured by a cover plate to hold clips in place. This film is weakened along the centerline of the clips. As the applicator is inserted into an individual compartment, it ruptures the film so the clip can be removed. A film or tape covering to secure clips is also present in Samuels et al.—U.S. Pat. No. 4,146,130. The use of film/tape may create a cartridge feature change as part of the clip loading into the applicator process, but without a feature to lock the ruptured film/tape in a new location the inherit memory of film/tape may result in the film/tape returning to its original location thus obscuring the individual compartment and making it difficult to detect an empty individual compartment. The prior art does not provide for a locking feature. Clip detection is further impeded by the individual compartment design which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. The use of film/tape creates other concerns. In a later patent, Samuels—U.S. Pat. No. 4,696,396, by the same inventor as U.S. Pat. No. 4,146,130, the inventor describes a problem with tape. According to this second patent the tape described in the first patent may stick to the clip when the clip is being removed. Additionally, the use of film/tape may generate particulate as part of the rupture process increasing the potential of placing film/tape particulate in the patient. 
     In Mericle—U.S. Pat. No. 4,361,229, a plurality of plastic clips with bosses is held in place by fingers on the side of the cartridge that engage the clip bosses and operates in principle very similar to Peiffer—U.S. Pat. No. 4,936,447. The use of retaining fingers to secure the clip results in a portion of the clip being obscured by the retaining fingers and the user can not easily determine if a clip is present in the individual compartment. Clip detection is further complicated by the use of flexible fingers that return to their original location after a clip is removed by an applicator. Clip detection is further impeded by the individual compartment design which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. The prior art does not provide for a pronounced cartridge feature change resulting from the clip loading into the applicator process and the small size of the clips. The user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. 
     In Malec et al.—U.S. Pat. No. 5,279,416, a plurality of clips is held in place by a retaining member which engages the clip ends and secures the clip in the cartridge When the applicator engages the clip, the retaining member is displaced creating a cartridge feature change. The use of individual retaining members (i.e. one per clip) creates a complex multiple piece cartridge design and increases manufacturing cost. The cartridge feature change is not pronounced as it occurs in the bottom of the individual compartment which is purposely narrow to control applicator position and alignment with the clip during the clip loading into the applicator process. The user can not easily determine if a clip is present in the slot due to the small size of the clips used to ligate vessels. The user must closely inspect the cartridge prior to loading a clip and ensure a clip is present in the individual compartment. 
     It is thus apparent that there is a need in the art for an improved system for transporting and supplying preformed hemostatic clips, specifically a system where the hemostatic clip cartridge has a pronounced feature change created by the clip loading into the applicator process. This pronounced feature change allowing the user to easily determine that the applicator has been previously inserted into the individual compartment thus removing the need for the user to closely inspect the cartridge for clip presence in the individual compartment. 
     SUMMARY 
     Aspects of the teachings contained within this disclosure are addressed in the claims submitted with this application upon filing. Rather than adding redundant restatements of the contents of the claims, these claims should be considered incorporated by reference into this summary. 
     Improvements to the prior art may be realized with a hemostatic clip cartridge having a plurality of individual compartments, each of which will hold one hemostatic clip. In one implementation of teachings of the present disclosure, each individual compartment is dimensioned from the center out so as to progressively increase in width providing a pair of compartment side walls to control clip position, a pair of compartment side walls to align the applicator with the hemostatic clip during the clip loading into the applicator process, and a pair of compartment side walls with locking tabs creating a compartment significantly larger than the applicator to maximize visual detection when the locking tabs prevent the retaining fingers from returning to their original location after the clip loading into the applicator process. Each individual compartment has a center, fixed pedestal to position the hemostatic clip. 
     Each hemostatic clip is held in place by two retaining fingers that extend into the individual compartment and contact the hemostatic clip securing it to the pedestal. These retaining fingers are made of a flexible material that allows the applicator to move the retaining fingers as the applicator enters the individual compartment to pick up a hemostatic clip. The retaining fingers flex past the locking tabs during the clip loading into the applicator process yet have sufficient thickness and interference to prevent the retaining fingers from returning to their original position when the applicator is retracted. 
     Because the interference between the retaining finger and the locking tabs is minimized, only a small amount of force is required to place the applicator over a clip, thus a clip can be placed into an applicator (sometimes worded as “harvested”) with one hand, yet tactile feedback is provided to the user. 
     This summary is meant to provide an introduction to the concepts that are disclosed within the specification without being an exhaustive list of the many teachings and variations upon those teachings that are provided in the extended discussion within this disclosure. Thus, the contents of this summary should not be used to limit the scope of the claims that follow. 
     Other systems, methods, features, and advantages of the disclosed teachings will be or will become apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional systems, methods, features and advantages be included within the scope of and be protected by the accompanying claims. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       The various teachings of this disclosure may be better understood with reference to the following figures. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles to be conveyed. Moreover, in the figures, like reference numerals designate corresponding parts throughout the different views. 
       The above and other objects, features, and advantages of the various conveyed teachings will be better understood by reading the following more particular description presented in conjunction with the following drawings, wherein: 
         FIG. 1  shows a perspective view of the cartridge with an applicator inserted therein; 
         FIG. 2A  is a side view of a prior art clip that may be used with a hemostatic clip cartridge using teachings of the present disclosure; 
         FIG. 2B  is a section view of a prior art clip shown in  FIG. 2A  taken through the line A-A of  FIG. 2A ; 
         FIG. 3  is a top view of the base component; 
         FIG. 4  is a side view of the base component; 
         FIG. 5A  is a top view of the clip retaining component; 
         FIG. 5B  is a detail from  FIG. 5A  showing an enlarged top view of a retaining finger; 
         FIG. 6  is an end view of the clip retaining component; 
         FIG. 7A ,  FIG. 7B  and  FIG. 7C  show a section view of the retaining fingers  20  with respect to the locking tabs  58  before, during and after applicator insertion; 
         FIG. 8  is a top view of the cartridge showing clips contained therein; 
         FIG. 9  is a section side view of the cartridge, taken through the line B-B of  FIG. 8 , showing the clip retaining component and clips assembled onto the base component; 
         FIG. 10  is a section end view of the cartridge, taken through the line A-A of  FIG. 8 , showing a clip being retained by the retaining fingers; 
         FIG. 11  is a section end view of the cartridge, taken through the line A-A of  FIG. 8 , showing an applicator positioned before insertion into the cartridge; 
         FIG. 12  is a section end view of the cartridge, taken through the line A-A of  FIG. 8 , showing an applicator fully inserted into the cartridge; 
         FIG. 13  is a section end view of the cartridge, taken through the line A-A of  FIG. 8 , showing the retaining fingers positioned below the locking tabs after an applicator has been fully inserted into and removed from the cartridge; 
         FIG. 14  is a top view of a Peiffer type hemostatic clip holder with one hemostatic clip removed; 
         FIG. 15  is a top view of a hemostatic clip cartridge made in accordance with teachings of the present disclosure, the hemostatic clip cartridge with one hemostatic clip removed; 
         FIGS. 16A and 16B  show a cross section of a prior art Peiffer type hemostatic clip holder before and after the removal of a hemostatic clip; 
         FIGS. 17A and 17B  show a cross section of a hemostatic clip cartridge as shown in  FIG. 15  before and after the removal of a hemostatic clip; and 
         FIG. 18  is a section end view of an alternative implementation of a cartridge showing an applicator fully inserted into the cartridge and depressing retaining fingers below platform tabs  74 , the view in  FIG. 18  showing the contrast with this implementation and the one shown in  FIG. 12  showing a section taken through the line A-A of  FIG. 8 . 
         FIG. 19A ,  FIG. 19B  and  FIG. 19C  show a section view of the retaining fingers  20  with respect to the wedge walls  59  before, during and after applicator insertion; 
     
    
    
     DETAILED DESCRIPTION 
     The following description is of the best presently contemplated mode of carrying out the teachings of the present disclosure. This description is not to be taken in a limiting sense but is made merely for the purpose of describing the general principles to one of ordinary skill in the art. The scope of the patent protection should be determined by referencing the appended claims. 
       FIG. 1  shows a perspective view of the cartridge with an applicator positioned over a clip in one of the individual compartments. Referring now to  FIG. 1 , a cartridge  10  (also called a hemostatic clip cartridge) is shown having a base component  12 . Formed into the base component  12  is a plurality of individual compartments  14 , separated by compartment walls  46 . Each of the individual compartments  14  will hold one hemostatic clip  30 . Each individual compartment  14  has three sub-compartments established by different width dimensions (as shown in  FIG. 3 ). The centered clip sub-compartment  52  is dimensioned to control clip location. An applier sub-compartment  54  is positioned on each side of the clip sub-compartment and is dimensioned to control and align the applicator  16  with the hemostatic clip  30  during the clip loading into the applicator process. The locking sub-compartment  56  is positioned on each side of the applier sub-compartment  54  and is dimensioned to include locking tabs (discussed below) and creating a sub-compartment  56  significantly larger than the applier sub-compartment  54  to maximize visual detection when the locking tabs prevent the retaining fingers  20  from returning to their original location after the clip loading into the applicator process (as will be described in detail below). The hemostatic clips  30  are held on the cartridge  10  by a plurality of retaining fingers  20 , which are attached to a rim  22 . The cartridge  10  has two retaining fingers  20  for each individual compartment  14 , one located on each side of the individual compartment  14 . 
     In operation, the applicator  16  is positioned over an individual compartment  14  and inserted downward into the individual compartment  14 . As the applicator jaws  18  move downward, the retaining fingers  20  in the individual compartment  14  rotate down into the individual compartment  14  and away from the legs of the hemostatic clip  30 . This is illustrated in  FIG. 11  and  FIG. 12  by the pair of retaining fingers  20  being pressed downward by the applicator jaws  18 . The retaining fingers  20  are below the applicator jaws  18  and rotate away from the clip as the applicator jaws  18  are fully inserted into the individual compartment  14 . 
     Visible in  FIG. 1  are a set of grooves  70  on side wall  48 D. Not visible in  FIG. 1  but visible in  FIG. 3  are a set of grooves  70  on the outside face of opposite side wall  48 B. These sets of grooves  70  provide a textured surface to make the hemostatic clip cartridge  10  easier to hold while wearing gloves (especially if the gloves are wet from other activities related to the surgical procedure). 
       FIGS. 2A and 2B  show a side view and an end view, respectively, of a prior art clip, described generally in Wood—U.S. Pat. No. 3,363,628, which is suitable for use with the present hemostatic clip cartridge and the Peiffer &#39;447 hemostatic clip holder. Other clips are also suitable for use with the present disclosure, for example plastic clips having a retaining hook or snap closure will also work with the present disclosure. One of skill in the art will recognize that a hemostatic clip having outer dimensions that are different from the hemostatic clip used in the figures of the present disclosure might impact the dimensions of a hemostatic clip cartridge intended to hold and dispense such clips. However, a hemostatic clip cartridge sized to work with a different size of hemostatic clips could implement the teachings of the present disclosure. 
       FIG. 2A  shows a side view of the hemostatic clip  30  which is formed by a central bend  32  creating two legs, each with a leg bend  36 . 
       FIG. 2B  shows an section view of the clip  30 . The hemostatic clip occlusive surface  34  has a pair of rounded sections separated by a groove. The outside edge of the clip is generally triangular in shape, having a peak  38  to fit in the applicator. 
       FIG. 3  shows a top view of the base component  12  of the hemostatic clip cartridge  10  as shown in  FIG. 1 . Referring now to  FIG. 3  the individual compartment  14  has three sub-compartments established by different width dimensions. The centered clip sub-compartment  52  is dimensioned to control clip location. An applier sub-compartment  54  is positioned on each side of the clip sub-compartment  52  and is dimensioned to control and align the applicator jaws  18  with the hemostatic clip  30  during the clip loading into the applicator process. The locking sub-compartment  56  is positioned on each side of the applier sub-component  54  and is dimensioned to include locking tabs (discussed below) and creating a locking sub-compartment  56  significantly larger than the applier sub-compartment  54  to maximize visual detection when the locking tabs prevent the retaining fingers  20  from returning to their original location after the clip loading into the applicator process. The base component  12  shown in  FIG. 3  is generally rectangular in shape, and is typically molded from rigid material that can be sterilized for surgical use. The hemostatic clip cartridges  10  may be intended for a single cycle of loading with hemostatic clip  10  and then use. The hemostatic clips  30  may be loaded into the hemostatic clip cartridge  10  before the loaded cartridge is sterilized. 
     Alignment posts  40  may be used to center and attach the clip retaining component  60  (see  FIG. 5 ). The clip sub-compartment  52  within each individual compartment  14  contains a pair of centering protrusions  44 A and  44 B to help center the clip (not shown) within the clip sub-compartment  52 . The centering protrusions  44 A and  44 B are attached to the compartment walls  46  of the individual compartment  14  and also to a pedestal  50  (centering protrusions are best seen in  FIG. 4 ). 
     Side walls  48 B and  48 D serve to protect the retaining fingers  20  from being prematurely depressed and create a pocket into which the clip retaining component  60  ( FIG. 5A ) is placed.  FIG. 4  has side wall  48 D removed but the two ends of side wall  48 B are visible. Side walls  48 B and  48 D are also visible in  FIG. 1 . 
     Locking tabs  58  are positioned and toleranced to allow passage of the retaining finger  20  ( FIG. 7B ) during applicator jaw  18  ( FIG. 1 ) insertion into individual compartment  14 , but do not allow the retaining fingers  20  ( FIG. 7C ) to return to their original positions when the applicator is retracted. As noted below in relations to the discussion of  FIG. 7B , the retaining finger  20  may be designed to include retaining finger wings  68  that flex when forced downward between the locking tabs  58 . For precision, locking tabs  58  may be called compartment locking tabs  58 . 
       FIG. 4  shows a side view of the base component  12 . Referring now to  FIG. 4 , the base component  12  is shown, having the side wall  48 B partially visible in this view as it is on the far side of the base component  12 . The pedestal  50  is shown extending down through each individual compartment  14 . The centering protrusions  44 A and  44 B extend down into the each individual compartment  14  below the top of the pedestal  50 . The locking tabs  58  are positioned to allow passage of the retaining fingers  20  ( FIG. 7B ) during applicator insertion into pocket, but not allow the retaining fingers  20  ( FIG. 7C ) to return to their original position (above the locking tabs  58 ) when the applicator is retracted. 
       FIG. 5A  shows a top view of the clip retaining component  60  as implemented for use with the teachings of the present disclosure. Referring now to  FIG. 5A , the clip retaining component  60  has a rim  22  and a plurality of retaining fingers  20  with retaining finger wings  68 . The clip retaining component  60  is typically molded from flexible material that can be sterilized for surgical use. The rim  22  has one pair of retaining fingers  20  for each individual compartment  14  in the base component  12  ( FIG. 1 ). A pair of horizontal support members  62 A and  62 B provides structural support for the rim  22  so that the rim  22  does not bend easily during the manufacturing process. Four post holes  64  are of a size, shape and location to allow them to mate with the alignment posts  40  of the base component  12  ( FIG. 3 ). During the assembly process, the hemostatic clips  30  ( FIG. 1 ) are placed in the individual compartments  14  ( FIG. 3 ), and then the clip retaining component  60  is placed over the hemostatic clips  30  ( FIG. 1 ), and the post holes  64  are aligned with the alignment posts  40  ( FIG. 3 ). The clip retaining component  60  is then permanently attached to the base component  12  ( FIG. 3 ) by reforming the alignments posts  40  ( FIG. 3 ) to make the ends of the alignment posts larger than the post holes  64 . 
       FIG. 5B  shows an enlarged view of the distal portion of a retaining finger  20 . Referring now to  FIG. 5B , the retaining fingers  20  contain two locking wings  68  which are dimensioned to flex and pass through the interference created with the locking tabs  58  ( FIG. 7B ) during applicator insertion into individual compartment  14 , but not allow the retaining finger  20  to return to original position upon applicator retraction ( FIG. 7C ). 
       FIG. 6  shows an end view of the clip retaining component  60 . This figure illustrates the retaining finger bend  66  in the retaining fingers  20  which allows the retaining fingers  20  to slope downward toward the hemostatic clip  30  ( FIG. 1 ). The retaining fingers could also be designed to be substantially horizontal after the retaining finger bend  66  rather than having a visibly downward slope.] 
       FIG. 7A ,  FIG. 7B  and  FIG. 7C  show a section view of the retaining fingers  20  with respect to the locking tabs  58  prior to, during and after applicator insertion (applicator is represented by the general element number  16  rather than using the applicator jaw element number  18 ). Referring now to  FIG. 7A , prior to applicator  16  insertion, the retaining fingers  20  are located above the locking tabs  58  ( FIG. 7A ). The thickness of the retaining finger wings  68  is dimensioned relative to retaining finger material characteristics to allow the retaining finger  20  to flex and pass through the interference created with the locking tabs  58  during applicator  16  insertion as shown in  FIG. 7B , but not allow retaining fingers  20  to return to original position upon applicator  16  retraction as shown in  FIG. 7C . 
     The retaining finger wings  68  can be thought of as finger locking tabs that extend outward from the longitudinal centerline of the retaining finger  20  but have in this implementation a reduced material thickness relative to the longitudinal centerline of the retaining finger  20  in order to make it easier for that portion of the retaining finger to flex past the locking tabs  58 . 
       FIG. 8  shows a top view of the cartridge  10 , and  FIG. 9  shows a side sectional view taken through the line B-B of  FIG. 8 . Referring now to  FIGS. 8 and 9 , the base component  12  is shown with individual compartments  14 , each of which contains a hemostatic clip  30 . The clip retaining component  60  is attached to the base component  12 , and each of the retaining fingers  20  are positioned over a side of a hemostatic clip  30 .  FIG. 8  illustrates the end of the retaining finger  20  contacting the hemostatic clip  30  to hold the hemostatic clip  30  in place. 
       FIG. 10  shows an end section view of the cartridge  10 , taken through the line A-A of  FIG. 8 . Referring now to  FIG. 10 , the retaining fingers  20  are shown to be located above the locking tabs  58 . 
       FIG. 11  shows an end section view of the cartridge  10 , taken through the line A-A of  FIG. 8 . Referring now to  FIG. 11 , the applicator jaws  18  are being moved downward to be placed over a hemostatic clip  30  and the retaining fingers  20  are still positioned above the locking tabs  58  (as shown in  FIG. 7A ). 
       FIG. 12  shows an end section view of the cartridge  10 , taken through the line A-A of  FIG. 8 . Referring now to  FIG. 12 , the applicator jaws  18  are fully in place over the hemostatic clip  30 . The downward applicator force provided by the user to insert the applicator jaws  18  into the cartridge and over the hemostatic clip  30  pushes the retaining finger  20  past the locking tabs  58  (as shown in  FIG. 7C ). Also visible in  FIG. 12  are alignment post  40  and retaining finger wing  68 . 
       FIG. 13  shows an end section view of the cartridge  10 , taken through the line A-A of  FIG. 8 . Referring now to  FIG. 13 , the applicator jaws  18  have been inserted into the individual compartment  14 , picked up a hemostatic clip  30  and retracted so that the applicator jaws  18  are no longer in contact with the retaining fingers  20 . Upon applicator retraction the retaining fingers  20  attempt to return to their original, pre-applicator insertion position (as shown in  FIGS. 7A and 11 ), but are prevented from doing so by the locking tabs  58 . The retaining fingers  20  remain under the locking tabs  58  creating a pronounced, visible indicator that the applicator has been inserted into the individual compartment (visible indicator discussed below). The initial contact between the locking tab  58  and the retaining finger  20  created by the clip loading into an applicator process provides tactile feedback to the user that applicator insertion is in progress. In many implementations of the teachings of the present disclosure, the user will feel, and possibly even hear, the transition of the retaining finger wings  68  from flexed against the locking tabs  58  (as shown in  FIG. 7B ), to un-flexed but retained below the locking tabs  58  (as shown in  FIG. 7C ). 
     The teaching of having locking tabs  58  to prevent the retaining fingers  20  from returning to their original, pre-applicator insertion position is in direct contrast to the teaching of the Peiffer &#39;447 patent which teaches in Col 10 lines 24 to 33: 
     “The flexible clip retainer fingers  20  move freely out of the way of the applicator  16  during the process of transferring the clip from the cartridge into the jaws of the applicator, thus insuring a smooth release of the applicator from the cartridge with the use of only one hand and without the use of any additional devices, such as a base weight. Since the fingers are resilient and attempt to return to their relaxed state, they act as a spring to help eject the applicator  16  from the cartridge  10 .” 
     Thus, the teachings of the present disclosure teach 180 degrees away from purported advantages in Peiffer &#39;447 in order to provide a tactile indication to the user during the loading process that the applicator has been inserted sufficiently to press the retaining finger  20  past the locking tabs  58  and then providing a permanent and pronounced visual indicator by way of the latched retaining fingers  20  that indicates that the applicator has already acquired the clip from that individual compartment  14 . 
     To highlight the dramatic difference in the level of visual indication provided, take a quick look at both  FIG. 14  and  FIG. 15 . While black and white drawings lose the visual impact that is provided by selective use of contrasting colors, the difference between the  FIG. 14  and  FIG. 15  is striking. In each case, one of the six hemostatic clips  30  is removed from the container (Peiffer &#39;447 hemostatic clip holder  210  in  FIG. 14  and hemostatic clip cartridge  10  in  FIG. 15 ). Note that the difference is not attributed to scale as the two drawings have been sized to be approximately the same scale (as evident from the length of the hemostatic clips  30 ). 
     As noted above, the Peiffer retaining fingers are adapted to return to their original position after being moved by the applicator jaw  18  ( FIG. 1 ) during the process of loading a hemostatic clip  30  into the applicator  16  ( FIG. 1 ). Thus, the pair of retaining fingers  222  in individual compartment  224  after removal of the hemostatic clip  30  from individual compartment  224  look the same as the pair of retaining fingers  220  in individual compartment  226  which still has a hemostatic clip  30 . This results in very little visual difference between individual compartments with and without hemostatic clips  30 . The lack of a pronounced visual difference is a user nuisance as a surgeon that is using many hemostatic clips  30  in a surgical procedure cannot be expected to count the number of hemostatic clips used and remember how many individual compartments have been harvested. So as the surgeon moves focus from the patient&#39;s body to the hemostatic clip holder  210  to obtain another hemostatic clip  30 , it is desirable for the process of identifying which individual compartments have a hemostatic clip  30  to be as easy as possible. 
     In marked contrast, a hemostatic clip cartridge  10  in accordance with teachings of the present disclosure has a pronounced visual difference between the retained pair of retaining fingers  120  in individual compartment  114  after removal of the hemostatic clip as compared to adjacent individual compartment  116  that has the pair of retaining fingers  20  in the original position indicating to those glancing from afar that a hemostatic clip  30  has not yet been removed from individual compartment  116 . 
     If the process of assembly is well controlled, then it would be rare if ever that an individual compartment did not receive a hemostatic clip  30  during assembly so that the position of the retaining fingers  20  would be effectively an indication that a hemostatic clip  30  remains in the individual compartment  116  available for loading into an applicator  16  ( FIG. 1 ). Note that the visual indication is enhanced if the color or other aspects of the appearance of the applier sub-compartment  54  and the locking sub-compartment  56  are markedly different from the color and appearance of the retaining fingers  120 . In order to provide at least a muted indication of the potential impact of a different color, the exposed portion of the visible table viewed through the bottoms of individual compartment  114  in  FIG. 15  has been made dark. (As indicated in the cross section in  FIG. 9  and in other drawings, the bottom is not solid.) The amount of visible table in  FIG. 14  is so small that the drawing has not been made dark to show the small increase in the amount of table visible through the prior art hemostatic clip holder  210 . 
     Returning to a comparison of  FIG. 14  to  FIG. 15 , it can be seen that the increase in size between the hemostatic clip holder  210  and the hemostatic clip cartridge  10  in order to hold the same quantity of hemostatic clips  30  allows much larger compartments and larger retaining fingers ( 20  and  120 ). Notice that the width of the majority of each retaining finger ( 20  and  120 ) is several times wider than the width of the hemostatic clips  30 . In this context, the width of the hemostatic clip  30  is the dimension orthogonal to the long axis of the compartment. As shown in  FIG. 15 , the width of the majority of each retaining finger  120  may be significantly more than the width of the hemostatic clip  30 . This added width helps amplify the visual impact when retaining fingers are left in a position that indicates that the hemostatic clip  30  for that compartment has been harvested. 
     While the visual indication is increased if the width of the majority of the retaining finger is several times the width of the hemostatic clip, other narrower configurations such will provide some of the same type of visual indication. 
     An alternative way of describing the relationship of widths is to say that the hemostatic clip cartridge has a maximum width of the retaining finger that is more than 2.5 times the width of the centered clip-sub-compartment, (taking the widths orthogonal to the length of the individual compartment). 
     A comparison of  FIGS. 16 and 17  helps reinforce the differences between a hemostatic clip cartridge  10  made in accordance with teachings of the present disclosure.  FIG. 16A  shows a section of a Peiffer hemostatic clip holder  210  before the removal of the hemostatic clip  30  from individual compartment  224 . The distal ends of the pair of retaining fingers  222  are above the hemostatic clip  30 .  FIG. 16B  shows the same cross section after the removal of the hemostatic clip  30  by the insertion of the hemostatic clip into the applicator  16  (not shown here). Notice that the position of the pair of retaining figures  222  is essentially the same before and after the removal of the hemostatic clip  30  so the position of the pair of retaining fingers  222  cannot be part of the visual indication that the hemostatic clip  30  has been removed from a particular individual compartment  224 . 
     In contrast,  FIG. 17A  shows a section of a hemostatic clip cartridge  10  before the removal of the hemostatic clip  30  from individual compartment  114 . The distal ends of the pair of retaining fingers  120  are above the hemostatic clip  30 .  FIG. 17B  shows the same cross section after the removal of the hemostatic clip  30  by the insertion of the hemostatic clip into the applicator  16  (not shown here). Notice that the position of the pair of retaining figures  120  is markedly different before and after the removal of the hemostatic clip  30  so the position of the pair of retaining fingers  120  can play an important part of the visual indication that the hemostatic clip  30  has been removed from a particular individual compartment  114 . The aggregate effect is that the view from above will change with the removal of a hemostatic clip  30  to decrease the visible area of the retaining fingers  120  with a corresponding increase in the visible area of the exposed bottom of the individual compartment  114 . 
     Alternatives 
     One of ordinary skill in the art will appreciate that one general teaching of the present disclosure is that it is advantageous to have a cartridge for a set of hemostatic clips that changes the configuration of components within an individual compartment during the process of retrieving a hemostatic clip from that individual compartment to provide a non-subtle visual indication that the hemostatic clip has been harvested from that individual compartment. A specific set of components was described in great detail in the figures and associated text set forth above. One of ordinary skill in the art will recognize that other arrangements of components could be used to achieve this same end. A few of the possibilities are listed below to illustrate the point. 
     A designer could choose to add a feature (such as a slot, notch or groove) to the retaining fingers where each retaining finger contacts the locking tabs and allows the retaining finger to flex inward during applicator insertion and clear the locking tabs and then flex back to create an interference with the locking tab upon applicator removal so that the retaining finger is kept below the locking tabs. 
     A designer could choose to fabricate the retaining fingers out of a compliant material which would compress and pass past the locking tabs during applicator insertion of the applicator into the individual compartment but would then expand out to create an interference with the locking tab upon applicator removal to retain the retaining finger below the locking tab. 
     A designer could choose to fabricate the locking tabs out of a compliant material which would compress and allow the retaining finger to pass past the locking tabs during applicator insertion of the applicator into the individual compartment but the locking tabs would then expand out to create an interference with the retaining finger upon applicator removal to retain the retaining finger below the locking tab. 
     A designer could create flexible or hinged locking tabs that flex or otherwise move out of the way when the retaining finger as the retaining finger is forced down by applicator, but then returns to back to the original location after the retaining finger passes the interference point to create an interference for the retaining finger when the retaining finger attempts to return to the original location of the retaining finger. Again the net effect is that the retaining finger is held by the locking tabs in a position that is different from the original position to highlight the removal of the hemostatic clip from that particular individual compartment. 
     A designer could add a feature (such as a slot, notch or groove) or make other design modifications to the retaining finger so that the retaining finger is permanently deformed during the process of the applicator depressing the retaining finger during the harvesting of a hemostatic clip. If the permanent deformation is sufficient to preclude the return of the retaining finger to its original position, then the retaining finger may provide a significant visual indication that the hemostatic clip has been removed from that particular individual compartment even in the absence of locking tabs to hold the retaining finger. A designer may choose to use a combination of a permanent deformation of the retaining finger combined with interference from a locking tab to hold the retaining finger in a position after hemostatic clip harvest that is different than the position of the retaining finger before harvesting the hemostatic clip. 
     A designer would not have to implement symmetric locking tabs. For example, a designer could choose to add a single locking tab with a top feature (i.e. angle, slope, or cam) that extends into the individual compartment so that during applicator insertion the downward movement of the retaining finger deflects the retaining finger to an off-centered opening allowing the retaining finger to pass the locking tab. Upon applicator retraction, the bottom of the locking tab creates an interference with the retaining finger as the retaining finger moves back towards the centerline of the individual compartment. In the re-centered position, the retaining finger can not pass the single locking tab and lacks a force input to move the retaining finger off-center to get past the locking tab. 
     Any of the above-mentioned alternates could employ a “catch” feature on either the retaining finger, the locking tab or both to increase the retention characteristics of the interference created between the retaining finger and the locking tab. 
     Any of the above-mentioned alternates could employ one or multiple locking tabs. 
     While the designs discussed above implied that the sidewalls were rigid and did not flex or otherwise deform appreciably, a designer could rely on the side walls to flex or otherwise deform to allow the retaining finger to pass the locking tabs or could rely on the flexing or other form of elastic deformation of the side walls as a portion of the movement required to allow the retaining finger to get below the interference from the locking tabs. Another option is that the shape of at least one compartment locking tab deforms during the insertion of the clip applicator into that individual compartment to harvest the hemostatic clip. 
     While the implementations described above use an interaction between the retaining finger wings (element  68  in  FIG. 5B ) and the locking tabs protruding from the side walls, other interactions could be used to retain the retaining finger in a post-harvest position. 
       FIG. 18  shows a cartridge  104  via an analogous cross section to that shown in  FIG. 12  in order to facilitate comparison with  FIG. 12 . In  FIG. 18 , the distal ends of the retaining fingers  20  are moved downward in the cartridge  104  by the downward movement of the applicator jaws  18  as the applicator jaws  18  are inserted to harvest a hemostatic clip  30 . The downward applicator force provided by the user to insert the applicator jaws  18  into the cartridge and over the hemostatic clip  30  pushes the retaining finger  20  past the platform tabs  74 . After the applicator jaws  18  are removed from the cartridge  104  along with the harvested hemostatic clip  30 , the depressed retaining fingers  20  cannot resume their pre-harvesting position as platform tabs  74  prevent the return to the pre-harvesting position. 
     While having each of the pair of retaining fingers  20  engage with a platform tab  74  to retain the retaining finger in a post-harvest position would give more visual impact than having merely one of the pair of retaining fingers  20  be so retained, one could implement teachings of the present disclosure by having only one of the two retaining fingers  20  retained. 
     In many implementations using platform tabs  74  the extent of the interference between the platform tab  74  and the at least one retaining finger  20  will cause a discernable bump as the at least one retaining finger  20  passes beyond the one or more platform tabs  74  to provide feedback to the user that the applicator jaws  18  are fully inserted and thus the hemostatic clip  30  should be engaged with the applicator jaws  18  and the at least one retaining finger  20  will be retained in the post-harvest position. 
     The various implementations illustrated or discussed above have pushed retaining fingers  20  beyond a point and the hemostatic clip cartridge has one or more features that prevent at least some of the retaining fingers from returning to their pre-harvest position. Thus, while the retaining finger  20  is free to move downward, it is restrained from moving back to the pre-harvest position. An alternative is that as the distal ends of the retaining fingers  20  are moved downward in the cartridge  104  by the downward movement of the applicator jaws  18  as the applicator jaws  18  are inserted to harvest a hemostatic clip  30 . The downward applicator force provided by the user to insert the applicator jaws  18  into the cartridge and over the hemostatic clip  30  pushes the retaining finger  20  to become wedged into a locked position by an engagement with the hemostatic clip cartridge  104 . After the applicator jaws  18  are removed from the cartridge  104  along with the harvested hemostatic clip  30 , the depressed retaining fingers  20  cannot resume their pre-harvesting position as one or more of the retaining fingers are wedged into the hemostatic clip cartridge. 
       FIGS. 19A ,  19 B and  19 C show a section view of the retaining fingers  20  with respect to the wedge walls  59  prior to, during and after applicator insertion (applicator is represented by the general element number  16  rather than using the applicator jaw element number  18 ). An example of the wedge concept is the use of compartment walls (wedge walls  59 ) that are not parallel with one another but slant inward so that the spacing between the walls decreases as the retaining finger  20  is moved downward until the spacing between the wedge walls  59  is less than the full width of the retaining finger  20 . Further downward motion of the retaining finger  20  imposes a friction fit between the retaining finger  20  and the wedge walls  59 . 
     While the examples given above implied that the base component ( FIG. 1  element  12 ) is placed on a substantially horizontal surface and the applicator jaws ( FIG. 1  element  18 ) move downward to harvest the hemostatic clip and leave the retaining finger ( FIG. 1 , element  20 ) in a depressed orientation relative to the starting orientation, this set of consistent orientation clues is meant to facilitate the provision of the teachings of the present disclosure and not to serve as a limitation. One of skill in the art will recognize that for example, if the hemostatic clip cartridge  10  using locking tabs was mounted on a vertical surface—that the same movements could be termed outward or away rather than down without changing the nature of the teaching. For an additional example, in an implementation using locking tabs, if for some reason the hemostatic clip cartridge was mounted on a horizontal surface above the surgeon, the applicator jaws would force the retaining fingers upward and they would be retained in an upward position above the locking tabs. 
     A designer of skill in the art will select one or more materials for creating the various components described above based upon the suitability of the material to be machined or formed into a particular shape, the required mechanical qualities of the component including the ability to deform or resist deformation, the ability to accept coloring or other appearance altering treatments; the ability to withstand any chosen sterilization process (if any process is selected), and any other qualities important to the designer. 
     Teachings May be Used in Isolation or in Combination. 
     One of skill in the art will recognize that some of the alternative implementations set forth above are not universally mutually exclusive and that in some cases additional implementations can be created that employ aspects of two or more of the variations described above. Additional variations may be created by implementing some but not all of the teachings provided for a particular implementation provided above. Likewise, the present disclosure is not limited to the specific examples provided to promote understanding of the various teachings of the present disclosure. 
     Having thus described a presently preferred embodiment of the present disclosure, it will now be appreciated that the present disclosure has conveyed improvements over the prior art, and it will be understood by those skilled in the art that many changes in construction and widely differing embodiments and applications of the various teachings of the present disclosure will suggest themselves without departing from the spirit and scope of the present disclosure. The disclosures and the description herein are intended to be illustrative and are not in any sense limiting of the legal scope of protection sought. The legal limitations of the scope of the claimed invention are set forth in the claims that issue based upon this disclosure and extend to cover their legal equivalents. Those unfamiliar with the legal tests for equivalency should consult a person registered to practice before the patent authority which granted this patent such as the United States Patent and Trademark Office or its counterpart.