Abstract:
The present technology relates generally to a method and device for closing percutaneous punctures, and more particularly to a multi-lumen tamper for such a device. A closure device for sealing a percutaneous puncture in a wall of a body passageway is disclosed, the closure device including a plug configured to engage a surface of the puncture; a toggle configured to engage an internal surface of the body passageway; an elongate filament configured to associate the plug with the toggle; a locking member configured to engage the plug; and a tamper comprising at least two lumens, wherein a first lumen of the at least two lumens is configured to deliver a pharmaceutical agent to the plug.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. application Ser. No. 13/946,398, filed Jul. 19, 2013, which claims the benefit of U.S. Provisional Patent Application No. 61/673,570, filed Jul. 19, 2012. The content of each application in the paragraph is hereby incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present technology relates generally to a method and device for closing percutaneous punctures, and more particularly to a multi-lumen tamper for such a device. 
       BACKGROUND 
       [0003]    Percutaneous access of the vascular system for vascular device delivery is a common medical procedure. Typically this involves using a hollow needle to puncture a vessel, then introducing an introducer sheath to open the puncture site for the introduction of catheters and wire guides for navigation through the vascular system to facilitate delivery. For example, in many cases, vascular access requires introduction of catheters and wire guides through the femoral artery. Once the procedure is completed, the devices are removed from the patient and pressure is applied to the puncture site to stop the bleeding. Thereafter, the puncture may be sealed using a closure device. 
         [0004]    Closure devices generally consist of three basic sealing components: a toggle (or anchor) member, a sealing member (or plug), and a filament (or suture). To lock the components together within the puncture, a locking member may be used. To facilitate sealing and locking of the closure device components within and around the puncture, a tamper may be used. Embodiments of the present technology are directed to closing percutaneous punctures using a closure device with a multi-lumen tamper. 
       SUMMARY 
       [0005]    According to one aspect there is a closure device for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: a plug configured to engage a surface of the puncture; a toggle configured to engage an internal surface of the body passageway; an elongate filament configured to associate the plug with the toggle; a locking member configured to engage the plug; and a tamper comprising at least two lumen, wherein a first lumen of the at least two lumen is configured to deliver a pharmaceutical agent to the plug. 
         [0006]    According to another aspect, there is a drug delivery kit, comprising: a closure device, for sealing a percutaneous puncture in a wall of a body passageway, the closure device comprising: a guidewire passing through at least a portion of the closure device; a tamper associated with the guidewire, wherein the tamper comprises at least two lumen; and a drug releasably carried in at least one of the tamper lumen. 
         [0007]    According to another aspect, there is a deployment instrument for deploying a closure device for sealing a percutaneous puncture in a wall of a body passageway, the deployment instrument comprising: the closure device comprising a tamper, wherein the tamper comprises at least two lumen; a carrier device, wherein the carrier device is configured to hold the closure device in a pre-deployment state. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]    Embodiments of the present technology are described herein with reference to the attached drawing sheets in which: 
           [0009]      FIG. 1  is a schematic view of a closure device and deployment device, according to embodiments of the present technology. 
           [0010]      FIGS. 2-10  show schematic views of a closure device during the process of closing a percutaneous puncture in an artery wall, according to embodiments of the present technology. 
           [0011]      FIG. 11  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent or other substance to a puncture site, according to embodiments of the present technology. 
           [0012]      FIG. 12  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent or other substance to a puncture site with a guidewire channel, according to embodiments of the present technology. 
           [0013]      FIG. 13  shows a three-lumen tamper configured to deliver a pharmaceutical agent or other substances to the puncture site, including a plug, according to embodiments of the present technology. 
           [0014]      FIG. 14  shows a three-lumen tamper configured to deliver a pharmaceutical agent or other substances to the puncture site via a lumen and an extension tube, according to embodiments of the present technology. 
           [0015]      FIG. 15  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent or other substance to the puncture site with an entry hole on the side of the tamper, according to embodiments of the present technology. 
           [0016]      FIG. 16  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent or other substance to the puncture site with an entry hole on the side of the tamper via a lumen and an extension tube, according to embodiments of the present technology. 
           [0017]      FIG. 17  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent or other substance to the puncture site with an entry hole on the side of the tamper via a lumen and a drug delivery member, according to embodiments of the present technology. 
       
    
    
     DETAILED DESCRIPTION 
       [0018]    Aspects and embodiments of the present technology are directed to a method and device for closing percutaneous punctures, and more particularly to a multi-lumen tamper tube for such a device. Such devices and methods are used to close a relatively large puncture, or wound, of a body lumen, such as, for example, a femoral artery. Such a large puncture may exist as a result of balloon aortic valvuloplasty (BAV) for the treatment of aortic valve disease, a percutaneous aortic valve replacement (PAVR) procedure for the treatment of abdominal aorta disease or the like (e.g. abdominal aortic aneurysm repair, or AAA), a trans-catheter placement of stent valves for the replacement of damaged or diseased aortic valves (trans-catheter aortic valve implantation, TAVI), or any other similar related procedure (collectively herein, the “related procedures”). The multi-lumen tamper tube may be used for the precise delivery of drugs, such as thrombin, to the puncture site. 
         [0019]    Aspects of the disclosed technology are described below with reference to a particular embodiment configured to close a percutaneous puncture in an artery of a patient. However, it should be appreciated that embodiments of the present technology may be implemented in other body lumen, including other types of vessels. Furthermore, aspects of the disclosed multi-lumen tamper are described below with reference to particular closure and deployment devices for closing percutaneous punctures. However, it should be appreciated that embodiments of the present technology may be implemented in other various closure devices. 
         [0020]    As used herein, the term “distal” when referred to the end of an element of the present technology will refer to the end closest to, or configured to enter a puncture in, an artery of the patient, where the “proximal” end refers to the opposite end, farthest away from the artery. 
         [0021]      FIG. 1  is a schematic view of a closure device  150  and deployment device  151 , according to embodiments of the present technology. Prior to deployment of closure device  150 , the contents of closure device  150  fit within deployment instrument  110  of deployment device  151 . After deployment device  151  is inserted into the punctured artery of the patient, closure device  150  is deployed from the deployment device  151  to close the puncture.  FIG. 1  shows closure device  150  in a fully deployed state. 
         [0022]    Closure device  150  includes, among other things, a toggle  115 , plug (e.g. collagen pad)  117 , tamper  120  and tensioning cartridge  121 . As shown in  FIG. 1 , toggle  115 , plug  117 , tamper  120  and tensioning cartridge  121  are each associated with guidewire  20 . Guidewire  20  feeds through openings in toggle  115  and plug  117 , and through lumen in tamper  120  and tensioning cartridge  121 . Guidewire  20  serves to facilitate placement of the closure device elements around the vessel puncture during deployment of the closure device. The guidewire may also be a guidewire lumen, or in other words a guidewire with a lumen running through the guidewire along the longitudinal axis of the guidewire. The lumen of the guidewire lumen may receive another guidewire, a pharmaceutical agent or other substance, or anything else configured to feed through such a lumen. The elements of closure device  150 , including toggle  115 , plug  117 , tamper  120 , tensioning cartridge  121 , and others, may be held within a release tube (not shown) or other means that is held within deployment instrument  110 . The procedure of the elements of closure device  150  being held within deployment instrument  110  and released from deployment instrument  110  to close a puncture in an artery will be discussed further with respect to  FIGS. 5-7 . 
         [0023]    The toggle  115  may be an elongate, low-profile member which is arranged to be seated inside the artery against the artery wall contiguous with the puncture. Toggle  115  may be constructed of a polylactic-coglycolic acid or other synthetic absorbable polymer that degrades in the presence of water into naturally occurring metabolites (e.g., water and CO2). In an embodiment, the toggle  30  is a monolithic structure formed by a bio-absorbable polymer. However, a toggle may also include any other structure that is configured to be seated inside the artery against the artery wall contiguous with the puncture. 
         [0024]    The plug  117  comprises, for example, a strip of compressible, resorbable, collagen foam. In an embodiment, the plug  117  is a collagen pad made of a fibrous collagen mix of insoluble and soluble collagen that is cross linked for strength. In an embodiment, the collagen may be obtained from the connective tissue of animals. The collagen may be purified from the subdermal layer of cowhide. Plug, or collagen,  117  expands in the presence of blood within the puncture tract. 
         [0025]    Closure device  150  also includes elongate filament  118 . Like guidewire  20 , filament  118  may also be associated with toggle  115 , plug  117 , tamper  120  and tensioning cartridge  121  such that filament  118  feeds through openings in toggle  115  and plug  117 , and through the lumen in tamper  120  and tensioning cartridge  121 . Elongate filament  118  is, for example, a resorbable suture that is used to couple toggle  115  and plug  117  to each other and to portions of the artery to close the puncture. Filament  118  may be formed into a loop as shown in  FIG. 1 . Slideable knot  123  is formed from two portions of filament  118  being tied together to create such a loop. Filament  118  may be, for example, a braided multifilament size 2-0 PGA suture, but can also be made from any synthetic absorbable plastic material that degrades over time. 
         [0026]    Closure device  150  also includes locking member  119 . As shown in  FIG. 1 , filament  118  feeds through an opening/lumen in locking member  119 . Locking member  119  is associated with filament  118  such that locking member  119  is frictionally engaged with filament  118 . In other words, locking member  119  remains in place on filament  118  when no force is placed on the locking member, and only overcomes its frictional engagement with filament  118  in response to an application of force on the locking member  119 . The locking member  119  comprises, for example, a cylindrical piece of resorbable iron and/or stainless steel. The locking member  119  may be crimped in a manner to provide the frictional engagement/resistance to movement along the filament  118 . However, the lock may not be present, and instead, the filament is looped and/or suturing is utilized to hold the relative locations of the elements of the closure device (e.g., plug  30  and toggle  30 ). 
         [0027]    Embodiments of the present technology will now be described with respect to exemplary large bore procedures that include the referenced closure and deployment devices. In order to perform any of the related procedures, the user gains percutaneous access to, for example, the femoral artery, causing a puncture in the artery. To gain percutaneous access to the artery, the Seldinger technique may be used. For example, a hollow bore needle (not shown) is inserted into the artery. A guidewire is advanced through the hollow needle shaft and into the femoral artery a sufficient distance to allow removal of the needle without the guidewire pulling out of the vessel. Removing the needle leaves the guidewire in place, with a portion thereof extending into the artery. The guidewire, extending from outside the patient into the femoral artery, provides for an entry means for other medical devices. Therefore, once the guidewire is positioned in the vessel of the patient, catheters, or introducers, of gradually increasing diameters are advanced over the guidewire and through he puncture into the artery to further open the puncture site. Then, an introducer/procedure sheath set, i.e. an introducer inside an access tube or sheath, is provided via the guidewire such that the sheath runs through the artery puncture and, once positioned, provides for sizable access to the vessel interior from outside the body. 
         [0028]    After the relevant procedure is completed, the puncture in the artery created by the bore needle during percutaneous access of the artery may be closed. An efficient method for large bore puncture closure that minimizes blood loss is desirable. For example, closure device  150  may be used to seal the puncture.  FIGS. 2-10  show schematic views of closure device  150  during the process of closing a percutaneous puncture in an artery wall. 
         [0029]    To deliver closure device  150  to the puncture so that the closure device  150  may close the puncture, the introducer/procedure sheath set is replaced by a closure sheath set. For example, as shown in  FIG. 2 , closure sheath  100  is provided into artery  55  such that shaft  102  of sheath  100  runs through the artery puncture  90 , providing access to the inside of artery  55 . Procedure sheath is exchanged for the closure sheath by removing procedure sheath from the patient, leaving the guidewire in place, and feeding the closure sheath  100  over guidewire  20  into artery  55  through puncture  90 . Closure sheath  100  remains partially within artery  55 , partially within puncture  90 , and partially outside artery  55 , as shown in  FIG. 2 . 
         [0030]    In order to seal a percutaneous puncture in an artery such as puncture  90 , the deployment device  151 , which contains closure device  150  within the hollow inside portion (not shown) of deployment device  151 , gains access to the artery through the puncture. Deployment device  151  gains access to the artery via sheath  100 , as shown in  FIG. 3 . Sheath  100  includes a hub  101  and a shaft  102 . Sheath hub  101  is connected to sheath shaft  102  on one end of hub  101 , and is configured to receive deployment instrument  151  at its other end. Sheath hub  101  is specifically designed to interface with the deployment instrument body  111  (also, for example, the handle of the deployment instrument). In  FIG. 3 , deployment instrument body  111  is shown fully inserted into sheath  100  and attached (for example, snapped into) sheath hub  101 . 
         [0031]    After deployment instrument  151 , and therefore closure device  150 , is in a desired location within artery  55 , the user may release closure device  150  from deployment instrument  151 .  FIG. 3  shows the beginning of the process of releasing closure device  150  from deployment instrument  151 . Shown protruding out of the distal end (the end within artery  55 ) of shaft  102  is a portion of closure device  150 , including toggle  115  and release tube  113 . As shown in  FIG. 5 , closure device  150  also includes delivery tube  116 . Delivery tube  116  has a smaller diameter than release tube  113  such that release tube  113  can slide over delivery tube  116  as shown in  FIG. 5 . Toggle  115  is held within delivery tube  116  until released into artery  55 . 
         [0032]    Before toggle  115  is released further from release tube  113 , the entire device (including sheath  100 , closure device  150 , etc.) is gradually withdrawn from artery  55  until radiographic marker  114 , which is located on release tube  113 , aligns with external radiographic marker  75 , as shown in  FIG. 4 . Radiographic marker  75  is located on the outside wall of artery  55  (e.g., on tissue  70  adjacent to puncture  90 ). This action places the toggle  115 , as shown, in near proximity of the puncture  90 . Release tube  113  is physically connected to release knob  112 , whereby a pulling motion on the release knob  112  in a direction away from artery  55  moves the release tube  113  in the same direction. This pulling motion releases the toggle  115  out of release tube  113  and delivery tube  116  such that the toggle has an orientation substantially parallel with the longitudinal axis of vessel  55 , as shown in  FIG. 5 . Given the proximity of the toggle  115  in relation to the puncture  90 , further withdrawal of the combined assembly serves to move the toggle  115  into position on the inside surface of the vessel  55  at the puncture site  90 , as shown in  FIG. 6 . 
         [0033]    As the user further withdraws the closure device and connected sheath, the components within the delivery tube  116  emerge.  FIG. 6  shows closure device  150 , including toggle  115 , plug  117 , tamper  120 , locking member  119 , filament  118  and tensioning cartridge  121 , fully withdrawn from deployment instrument  151  (not shown). As noted, toggle  115  and plug  117  are connected by a filament  118 . In one embodiment, plug  117 , toggle  115  and filament  118  are arranged in a pulley-like fashion. Therefore, pulling on tensioning cartridge  121  in a direction away from artery  55  (similar to the direction that release knob  113  was pulled to release the closure device elements) causes tension in filament  118  that moves toggle  115  fully into position against the inside wall of vessel  55  at puncture  90  such that toggle  115  covers puncture  90 . Furthermore, the tension in filament  118  also pulls plug  117  into puncture  90 , and causes plug  117  to fill out substantially the rest of the space within puncture  90 , as shown in  FIG. 7 . As noted, after plug  117  is in contact with blood or other fluids within puncture  90 , plug  117  will expand to fill out the rest of puncture tract  90 . 
         [0034]    As noted, locking member  119  is associated with filament  118  such that locking member  119  is frictionally engaged with filament  118 . In other words, locking member  119  remains in place on filament  118  when no force is placed on the locking member, and only overcomes its frictional engagement with filament  118  in response to an application of force on the locking member  119 . After the user has pulled the tensioning cartridge  121  to cause tension in filament  118  and to cause plug  117  to enter puncture  90 , the user advances tamper  120  along guidewire  20  and filament  118 , as shown in  FIG. 10 , such that tamper  120  contacts locking member  119  and advances locking member  119  until locking member  119  contacts plug  117 , as shown in  FIG. 7 . As also shown in  FIG. 7 , plug  117  folds over the top of and inside puncture  90 . For example, as shown in  FIG. 7 , tamper  120  may push a portion or all of plug  117  below the outside surface of tissue/skin  70 . Furthermore, tamper  120  may be inserted less than 1 cm into puncture  90 , or may be inserted much greater distances (e.g. 3-6 cm, or more) into the puncture. 
         [0035]    Locking member  119 , together with the plug  117  and toggle  115 , effect a seal of the puncture  90 . As shown in  FIGS. 8 and 9 , tension is maintained on the tensioning cartridge  121  throughout the deployment of the plug  117  and toggle  115 . After advancement of locking member  119  by the tamper tube  120  and folding/compaction of plug  117 , guidewire  20  may be removed from the patient as shown in  FIG. 8 . Tension is still held on the tension cartridge  121 , and the user may re-compress plug  117  as necessary to confirm a proper seal of puncture  90 . After locking member  119  has secured plug in place and guidewire  20  has been removed, filament  118  may be cut below tamper  120  to remove the remaining filament  118 , tamper  120  and tensioning cartridge  121  from the puncture site, as shown in  FIG. 9 . Remaining portions of closure device  150 , including toggle  115  and plug  117 , and a portion of filament  118 , will resorb into the body of the patient over time (as may locking member  119 , depending on the material making up locking member  119 ). 
         [0036]    As noted, tamper  120  includes lumen that guidewire  20  and filament  118  feed through. Tamper  120  may include, for example, two lumens, three lumens, or more than three lumens. Referring back to  FIG. 1 , tamper  120  is shown as including three lumens, at least one lumen to receive guidewire  20  and at least one lumen to receive filament  118 . The third lumen may be used to facilitate the delivery of pharmaceutical agents, such as thrombin, or other substances to the puncture. If tamper  120  includes less than three lumens, for example, either guidewire  20  or filament  118  may share the same lumen as a pharmaceutical agent. 
         [0037]      FIG. 11  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent (i.e. drugs) or other substances to the puncture site, according to embodiments of the present technology. Tamper  120  includes lumen  28 , through which guidewire  20  feeds, lumen  29 , through which filament  118  feeds, and third lumen  30 , which includes entry hole  35  into which a substance may be delivered. Third lumen  30  includes entry hole  35  located at the end of third lumen  30 , and at the end of tamper  120 , which may be at the distal end of tamper  120 . It should be appreciated that the end of tamper  120  may be in a configuration other than flat (slanted, ridged, etc.). Furthermore, it should be appreciated that tamper  120  itself may be in a configuration other than an elongate cylindrical structure (rectangular box, shorter non-elongate cylinder, etc.). Third lumen  30  also includes release hole  36  located at the end of third lumen  30 , and at the end of tamper  120 , which may be closest to the artery wall. However, in certain embodiments, tamper  120  may be reversed such that hole  36  may be used as the entry point for substance delivery and hole  35  may be used as the release point for substance delivery. 
         [0038]    The three (or more) lumens of tamper  120  may be any size or shape as long as the size of the lumen as a whole do not compromise the structural stability of tamper  120 . For example, although lumen  28 ,  29  and  30  are shown in  FIG. 11  as having a cylindrical shape, the lumen may be of a variety of different shapes. Furthermore, the lumen may have a larger diameter than the diameters shown in  FIG. 11 . For example, one or more of the lumens may have diameters stretching closer to the outside edge of tamper  120 , and/or stretching closer to the other lumen. However, as noted, the lumen should not have diameters such that the structural stability of tamper  120  is compromised. For example, if one or more of the tamper lumen were wide enough, then a user holding the tamper and, for example, applying force on the tamper with the user&#39;s fingers, may damage tamper  120  by applying that force. On the other hand, the three lumens should be large enough to allow for the unrestricted movement of guidewire  20 , suture  118  and/or pharmaceutical agent  40  through the lumen within tamper  120  (unless, for example, a certain level of restriction/friction/tension is desired). 
         [0039]    Furthermore, one or more of lumen  28 ,  29  and  30  may be located at the edge of tamper  120  such that the lumen is an elongate channel and includes an opening where the lumen is accessible from the exterior of tamper  120 , as shown in  FIG. 12 . However, it may not be beneficial to the user for the user&#39;s fingers to touch the contents of the channel  31 , such as guidewire  20 , filament  118 , or agent  40 . Therefore, the channel may be configured in such a way (skinny in width, small opening, etc.) that prevents the fingers of the user from penetrating the lumen. Furthermore, tamper  120  may include bridges  32  attached to the body of the tamper that allow for the user to touch portions of the channel&#39;s surface area, but without penetrating the internal portions of channel  31 . The bridges may also have further utility in that they may cause the guidewire, suture, or agent to be “trapped” or otherwise retained within the channel (if, for example, the configuration of the channel does not already have that utility). 
         [0040]    As noted, tamper  120  contacts locking member  119  and advances locking member  119  until locking member  119  contacts plug  117 , as shown in  FIGS. 7 and 8 . Since the distal end of tamper  120  contacts locking member  119 , the holes in that end of tamper  120  should not be large enough such that locking member  119  (or plug  117 ) may be pushed into the lumen in tamper  120  connected to that hole. This size requirement for release hole  36 , for example, is therefore dependent on the size of the proximal end of locking member  119  that is used in the relevant embodiment of closure device  150 . 
         [0041]    In some embodiments, it may be beneficial for one or more of the lumen, such as the lumen configured to deliver a pharmaceutical agent, to have a diameter as large as possible so that it may carry the largest amount of pharmaceutical agent as possible as one time for delivery to the puncture site. For example, in one embodiment of tamper  120 , the walls between lumen  30  and the other lumen may be very thin so as to only prevent pharmaceutical agent  40  from exiting lumen  30  before reaching release hole  36 . However, the walls between the lumen should not be so thin such that, either guidewire  20  or suture  118  may puncture one or more of the walls. Furthermore, the drug delivery lumen may have a specifically chosen size such that a drug may be delivered at a certain predetermined rate. 
         [0042]      FIG. 13  shows a three-lumen tamper  120  configured to deliver a pharmaceutical agent or other substances to the puncture site, including plug  117 , according to embodiments of the present technology. More specifically,  FIG. 13  shows the flow of the pharmaceutical agent, or other substance, through lumen  30 , as shown by arrow  40 , and into plug  117 , which is at least partially condensed into puncture  90 , as shown by arrows  41 . Tamper  120  is fed over guidewire  20  because guidewire  20  allows for the guided motion of tamper towards and away from the puncture site when desired by the user. In other words, guidewire  20  prevents the user from having to balance tamper  120  on locking member  119  and/or plug  117  in the lateral direction (the direction perpendicular to a longitudinal axis going through tamper  120  from the distal end of the tamper to the proximal end). Third lumen  30  allows for a similar guided path for a pharmaceutical agent or other substance to follow through tamper  120 , as well as a guided (predetermined) delivery point of release hole  36 . If no guidewire is used in closure device  150 , elongate filament  118  may serve the same purpose as guidewire  20 , namely to provide for a guided path for the pharmaceutical agent or other substance to be delivered to the puncture/plug. In other words, because lumen  30  is substantially parallel to lumen  28  and lumen  29 , a substance deposited into lumen  30  will travel in the same direction as guidewire  20  and/or filament  118 , allowing the user to control the location of deposit of the substance through release hole  36  based on the location of guidewire  20  and/or filament  118 . It should be appreciated that even if two or more of lumen  28 ,  29  or  30  are not parallel but are close to being parallel, such an embodiment was contemplated by the inventors. Lumen  30  allows for the user to deliver a pharmaceutical agent or another substance to a specific desired location within the surgical site, such as onto plug  117  or elsewhere. This goal of delivery of a pharmaceutical agent or another substance to a specific desired location within the surgical site is achieved if the user understands the physical relationship between the pharmaceutical delivery lumen and the other lumen. 
         [0043]    The pharmaceutical agent  40  deposited into lumen  30  via entry hole  35  may include any of many different drugs such as, for example, thrombin. Punctures/ruptures in arterial walls trigger the clotting cascade, a complex series of signals and protein activations that ultimately result in a clot to help close the puncture in the artery wall. The key factor in the clotting cascade is thrombin. Thrombin is a protease that, for example, activates platelets to form an initial “plug” of the puncture and conversion of fibrinogen to fibrin. Fibrin is responsible for forming a more permanent seal of the puncture, and polymerizes to form a linked structure. Thrombin also activates Factor XIII to Factor XIIIa, which strengthens the bonds between the fibrin monomers in the linked structure, making the initial clot more permanent. Therefore, the inventors have discovered that accurate delivery of extra thrombin to the puncture site of a catheter procedure shortens the time to hemostasis. 
         [0044]      FIG. 14  shows a three-lumen tamper  120  configured to deliver a pharmaceutical agent or other substances to the puncture site via lumen  30  and extension tube  60 , according to embodiments of the present technology. Extension tube  60  is connected and sealed to entry hole  35  of lumen  30 . Extension tube  60  allows for modified access to lumen  30 . For example, extension tube  60  may allow for the user to insert a pharmaceutical agent or other substance into lumen  30  from outside the patient&#39;s artery, or from outside the patient all together. Extension tube  60  is shown in  FIG. 14  as having a cylindrical, bent shape. However, extension tube  60  may have a variety of shapes and lengths, and may vary in shape and/or length throughout its structure. 
         [0045]      FIG. 15  shows a three-lumen tamper tube configured to deliver a pharmaceutical agent (i.e. drugs) or other substances to the puncture site with an entry hole on the side of tamper  120 , according to embodiments of the present technology. While  FIG. 11  included an embodiment of tamper  120  such that entry hole  35  is located at the end of tamper  120 , entry hole  35  may also be placed on the side of tamper  120 , as shown by side entry  15  in  FIG. 15 . Furthermore, tamper  120  may include an entry hole on any other portion of tamper  120  where the entry hole connects to lumen  30  to deliver inserted agents to the user&#39;s desired location. Placement of an entry hole at a variety of different portions of tamper tube  120  allows for the user to choose the location easiest for delivering the desired substance based on the user&#39;s desired delivery device. Furthermore, tamper  120 , and more specifically one or more lumen of tamper tube  120 , may include more than one access hole (such as entry hole  35  or side entry  15 ). 
         [0046]    Pharmaceutical agent  40  or other substance may be deposited into lumen  30  in a variety of different ways. For example, agent  40  may be deposited into lumen  30  using extended port  65 , as shown in  FIG. 16 . A drug delivery member, such as a syringe, may be connected to the end of extended port  65  to deposit pharmaceutical agent into lumen  30  via extended port  65 . Furthermore, a drug delivery member, such as syringe  135 , may be connected directly to entry hole  15  without the use of extended port  65 , as shown in  FIG. 17 . Extended port  65  is connected to entry hole  15 , and may be sealed via seal  16  such that pharmaceutical agent deposited into hole  15  via port  65  is not leaked from the connection between port  65  and hole  15 . The syringe or other deposit mechanism may be connected to tamper  120  in a variety of different ways, including a variety of different locations based on the location of the entry hole. For example, as noted, extension port  65  may be connected to an extension such as extension tube  60 , or to any other mechanism that allows for the pharmaceutical agent or other substance to be safely deposited into lumen  30 . 
         [0047]    Furthermore, the pharmaceutical agent may be delivered via lumen  30 , for example, at any time during the large bore closure procedure. For example, a pharmaceutical agent may be delivered to the puncture site before plug  117  has been condensed, after plug  117  has been partially condensed, after plug  117  has been fully condensed, or after plug  117  has expanded to fill out the rest of puncture  90 . 
         [0048]    The technology described and claimed herein is not to be limited in scope by the specific preferred embodiments herein disclosed, since these embodiments are intended as illustrations, and not limitations, of several aspects of the technology. Any equivalent embodiments are intended to be within the scope of this technology. Indeed, various modifications of the technology in addition to those shown and described herein will become apparent to those skilled in the art from the foregoing description. Such modifications are also intended to fall within the scope of the appended claims.