Patent Publication Number: US-2021177297-A1

Title: Distributed extravasation detection system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 14/241,171, filed on Mar. 11, 2014, which is the National Stage of International Patent Application No. PCT/US2012/052796, filed on Aug. 29, 2012, which claims the benefit of U.S. Provisional Patent Application No. 61/530,436, filed on Sep. 2, 2011, U.S. Provisional Patent Application No. 61/530,441, filed on Sep. 2, 2011, and U.S. Provisional Patent Application No. 61/530,454, filed on Sep. 2, 2011, each of which is incorporated by reference in its entirety. 
    
    
     TECHNICAL HELD 
     The present invention relates generally to the detection of fluids in tissue, and, more particularly, to apparatuses, systems and methods for detection of changed, elevated or abnormal fluid levels in tissue. 
     BACKGROUND ART 
     Changed, elevated or abnormal fluid levels in living tissue can result from a number of physiological conditions. For example, edema is an abnormal accumulation of watery fluid in the intercellular spaces of connective tissue. Edematous tissues are swollen and, when punctured, secrete a thin incoagulable fluid. Edema is most frequently a symptom of disease rather than a disease in itself, and it may have a number of causes, most of which can be traced back to gross variations in the physiological mechanisms that normally maintain a constant water balance in the cells, tissues, and blood. Among the causes may be diseases of the kidneys, heart, veins, or lymphatic system; malnutrition; or allergic reactions. 
     Moreover, bleeding (hemorrhage) can cause blood to collect and clot (hematoma). Hematomas can, for example, occur beneath the outermost of three membranes that cover the brain (meninges) as a result of a head injury. There are two types of cranial subdural hematomas. An acute subdural hematoma occurs soon after a severe head injury. A chronic subdural hematoma is a complication that may develop weeks after a head injury. Such a head injury may have been so minor that the patient does not remember it. An epidural hematoma is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. The inciting event often is a focused blow to the head. It is often difficult to detect hematomas, particularly when the hematoma occurs well after the time of an injury. 
     In addition to accumulation of body fluids, elevated fluid levels in tissue can arise as a result of introduction of a fluid into the body, for example, during an injection procedure. In that regard, in many medical diagnostic and therapeutic procedures, a physician or other person injects fluid into a patient&#39;s blood vessels. Moreover, in recent years, a number of injector-actuated syringes and powered injectors for pressurized injection of contrast medium in procedures such as angiography, computed tomography, ultrasound and NMR/MRI (Nuclear Magnetic Resonance/Magnetic Resonance Imaging) have been developed. 
     Extravasation or infiltration is the accidental infusion or leakage of an injection fluid such as a contrast medium or a therapeutic agent into tissue surrounding a blood vessel rather than into the blood vessel itself. Extravasation can be caused, for example, by rupture or dissection of fragile vasculature, valve disease, inappropriate needle placement, or patient movement resulting in the infusing needle being pulled from the intended vessel or causing the needle to be pushed through the wall of the vessel. High injection pressures and/or rates of some modem procedures can increase the risk of extravasation. In computed tomography, for example, contrast injection flow rates can be in the range of 0.1 to 10 ml/s. 
     Extravasation can cause serious injury to patients. In that regard, certain injection fluids such as contrast media or chemotherapy drugs can be toxic to tissue. It is, therefore, very important when performing fluid injections to detect extravasation as soon as possible and discontinue the injection upon detection. 
     In U.S. Pat. No. 7,122,012 to Bouton, et al., issued Oct. 17, 2006, which is hereby incorporated by reference in its entirety, a method was disclosed for detecting a change in the level of fluid in tissue in a first area of a body. Steps included applying electromagnetic energy, preferably in the frequency range of approximately 300 MHz to approximately 30 GHz, to a first volume of the body; measuring a resultant or returned signal; comparing the signal to a reference signal to determine if the fluid level in the tissue has changed. In one embodiment, the method detected changes in the level of fluid in tissue of a body by applying electromagnetic energy to a first volume of the body over a period of time; measuring a resultant signal or a signal returned from the tissue; and comparing the signal to a reference signal to determine if a level of fluid in the tissue has changed during the period of time. 
     DISCLOSURE OF INVENTION 
     The following presents a simplified summary in order to provide a basic understanding of some aspects of the disclosed aspects. 
     In accordance with one or more aspects and embodiments, and the corresponding disclosures thereof, various features of the invention are described in connection with detecting a change in the level of fluid in tissue of a body with an apparatus having a wireless link for remote monitoring. In particular, extravasation during a fluid injection or infiltration during fluid infusion into a body part is detected with the flexibility of being spaced away from a receiver that gives an indication to care givers. By using a wireless link, a patient, for example, can be mobile, especially for lower fluid rate infusions. Alternatively or in addition, multiple, patients can be collectively monitored, recorded, analyzed, etc., leveraging an institutional infrastructure. 
     Enabling this flexibility, an apparatus or integrated device is largely or entirely worn by the patient undergoing the injection or infusion. The device can be adjusted to vary a rate of detection and reporting. Thereby, power can be conserved and potentially the increased ambient noise from multiple integrated devices can be reduced without impairing timely detection of an extravasation or infiltration. 
     In one aspect, the present disclosure provides an apparatus for indicating a change in a level of fluid in tissue of a body. A detecting component transmits power into and receives power from a body portion, wherein a change in the received power that passes through the tissue is indicative of a change in the fluid level. A signal processing component generates an output signal based at least in part on the received signal. A wireless interface transmits, to a receiver, the output signal from the signal processing component. The apparatus advantageously further comprise a power supply that powers the detecting component and the wireless interface. 
     The apparatus may further comprise a conduit for providing fluid to the body. In various aspects and embodiments, a substrate may be provided to support one or more of the detecting component, the signal processing component, the wireless interface and the conduit. In some embodiments all of these components may be supported by the substrate. In other embodiments, the conduit may be positioned near the substrate but is not supported on the substrate. 
     A current received power level may be defined by only the received power when the transmitted power is fixed and there are no changes, except for fluid level, in the pathway from structure forming part of the detecting component that transmits the power into the body portion and structure forming part of the detecting component that receives the power passing through the body portion. Alternatively, when the transmitted power varies during a time period of interest, the current received power level may be defined as a ratio of the received power to the transmitted power, presuming good coupling of the detecting component to the tissue. A decrease in the received power level represents an increase in fluid level. 
     In some embodiments, the detecting component comprises a control component for intermittently causing power to be transmitted to the body portion. For instance, the control component can comprise an adjustment feature for setting a period between intermittent activations. 
     In some embodiments, the wireless interface intermittently reports the output signal. For instance, the signal processing component can receive a reference signal from the detecting component and compare the reference signal with a signal corresponding to the received power for generating the output signal. 
     In embodiments of the invention, a comparison component may be provided to receive a control input, set a baseline received power level based on the received power in response to the control input, compare a current received power level at a subsequent time with the baseline level to produce a comparison result, and generate the output signal based upon the comparison result. In some embodiments, a substrate is provided to support the detecting component and the wireless interface. For instance, the power supply may comprise a portable power supply supported by the substrate. 
     In some embodiments, the detecting component further transmits power and receives power comprising a Radio Frequency (RF) signal. For instance, the detecting component comprises an RF voltage controlled oscillator for sweeping a frequency range of greater than 1.5 GHz to approximately 10 GHz over a period of time. Alternatively or in addition, the detecting component further comprises a gain/phase measurement circuit. The detecting component may comprise a transmit antenna for transmitting power comprising a Radio Frequency (RF) signal and a receive antenna for receiving power comprising an RF signal. 
     In some embodiments, the detecting component further transmits power and receives power comprising an ultrasonic signal. 
     In further embodiments, the wireless interface comprises at least one of a personal area network interface, a Wi-Fi interface, and a cellular interface. For instance, the wireless interface can comprise the personal area network interface that interfaces to a cellular device for communicating with the receiver. 
     In a second aspect, a system is provided for indicating a change in a level of fluid in tissue of a body. The system may comprise the apparatus of any of the embodiments described in relation to the first aspect of the invention. In an embodiment of this aspect, the system may comprise a device/apparatus comprising a detecting component for transmitting power into and receiving power from the body portion, a signal processing component for generating an output signal based at least in part on the received power, and a wireless interface for transmitting the output signal from the signal processing component. Conveniently, the device/apparatus of this and the first aspect of the invention may be attachable to a body portion, in use. The system typically further comprises a power supply for powering the detecting component, the signal processing component and the wireless interface. The system may further comprise a remote apparatus comprising a receiver for receiving the output signal from the wireless interface. 
     In embodiments of the invention, the remote apparatus may further comprise a comparison component for receiving a control input, setting a baseline received power level based on a current received power level in response to the control input, comparing the current received power level at a subsequent time with the baseline level to produce a comparison result, and generating an indication of fluid level change based upon the comparison result. 
     In other embodiments, the device further comprises a comparison component for receiving a control input, setting a baseline current power level based on a current power level in response to the control input, comparing the current level at a subsequent time with the baseline level to produce a comparison result, and generating the output signal based upon the comparison result. 
     In a third aspect, the present invention provides a method for detecting a change in a level of fluid in tissue of a body. Conveniently, the method employs as apparatus and/or system according to the invention. A power waveform is transmitted into a body portion. Power is received from the body portion. A baseline received power level and a subsequent series of current received power levels are determined from the transmitted and received power. The current level is compared with the baseline level. A reporting rate is determined, comprising at least a first rate for reduced power consumption and a second rate for increased reporting. An output signal is transmitted at the reporting rate that is related to the current level to a receiver. 
     In some suitable embodiments, the method further provides for setting the reporting rate based upon a user setting. 
     To the accomplishment of the foregoing and related ends, one or more aspects comprise the features hereinafter fully described and particularly pointed out in the claims. The following description and the annexed drawings set forth in detail certain illustrative aspects and are indicative of but a few of the various ways in which the principles of the aspects may be employed. Other advantages and novel features will become apparent from the following detailed description when considered in conjunction with the drawings and the disclosed aspects are intended to include all such aspects and their equivalents. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The disclosed aspects will hereinafter be described in conjunction with the appended drawings, provided to illustrate and not to limit the disclosed aspects, wherein like designations denote like elements, and in which: 
         FIG. 1  is a schematic block diagram of a system for detecting a change in a fluid level in tissue, according to one aspect; 
         FIG. 2  is a flow diagram of a methodology for detecting a change in the fluid level of tissue with adjusted reporting rate, according to one aspect; 
         FIG. 3  is schematic block diagram of a system for detecting a change in a fluid level in tissue using a swept Radio Frequency (RF) power transmission, according to one aspect; and 
         FIG. 4  is a schematic block diagram of a system for detecting a change in a fluid level in tissue using an ultrasonic power transmission, according to one aspect. 
     
    
    
     MODES FOR CARRYING OUT THE INVENTION 
     A system and method enhance clinical effectiveness for monitoring for a change in a level of fluid in tissue by using a device attached to a body portion that wirelessly reports to a remote apparatus or receiver for indications of extravasation or infiltration. Adjusting an activation rate of fluid detection, reporting or both extends service life of the device. Embodiments of the device can include Radio Frequency (RF) transmission for changes in permittivity or ultrasonic measurements. Remote monitoring and indication leverages institutional monitoring systems to ensure that a state of extravasation or infiltration is addressed in a timely fashion. 
     Various aspects are now described with reference to the drawings. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of one or more aspects. It may be evident, however, that such aspect(s) may be practiced without these specific details. 
     In  FIG. 1 , a system  100  detects a change in a level of fluid in tissue of a body portion  102 . For example, at an initial time, such as before beginning a fluid injection or infusion, a device  104  having a detecting component  106  is attached to the body portion  102  for passing a selected waveform  108  (e.g., microwave, acoustic) as transmitted power that encounters a baseline level of fluid and tissue. A baseline received power level  112  corresponding to the baseline fluid level can be based upon an absolute measurement of received power  110  that has passed through body tissue or based upon a comparison of the received power  110  through body tissue with a reference signal  114  of the selected waveform  108 , such as for amplitude and/or phase information. At a subsequent time or series of times, the selected waveform  108  as received power  110 ′ through the body portion  102  is detected and a current received power level  116  corresponding to a current fluid level can be based upon an absolute measurement of the received power  110 ′ through the body tissue or a comparison of the received power through body tissue relative to the reference signal  114 . 
     A signal processing component  118  is coupled to the detecting component  106  for generating an output signal  120  for wireless transmission by a wireless interface  122  of the device  104 . A remote apparatus or receiver  124  that receives the output signal  120  can generate an alert via an indicator  125  if the output signal  120  contains an indication of certain states of the device  104  (e.g., inoperative, nominal, etc.) or body portion  102  (e.g., normal fluid level, increased fluid level, etc.). Thus, the output signal  120  is indicative of the received power  110 ,  110 ′ as detected by the detecting component  106 . 
     In one aspect, the output signal  120  can be representative of, or related to, an absolute measurement of the received power  110 ,  110 ′. Alternatively, the output signal  120  can be representative of, or related to, a relative measurement of the received power  110 ,  110 ′ as compared to the reference signal  114 . The output signal  120  at a specified time can be designated the baseline received power level  112  and subsequently can provide the current received power level  116  for signal processing by a comparison component  126  in the remote apparatus or receiver  124 . Tracking of the baseline level  112  and the current level  116  can be performed at the remote apparatus or receiver  124  for use by the comparison component  126 . Thus, in an exemplary aspect, the comparison component  126  of the remote apparatus or receiver  124  receives a control input  146  such as when the device  104  is initially activated so as to set a baseline received power level  112  corresponding to a baseline fluid level based on the current received power level  116  in response to receiving the control input  146 , compares the current received power level  116  corresponding to a current fluid level at a subsequent time with the baseline level  112  to produce a comparison result, and generates an indication of fluid level change based upon the comparison result. 
     Alternatively or in addition, the device  104  can incorporate additional signal processing capabilities, depicted as a local comparison component  128  of the signal processing component  118 . Thus, the output sianal  120  can comprise discrete values indicating a state of the device  104  (e.g., inoperative, nominal, etc.) or body portion  102  (e.g., normal, increased fluid level, etc.). These discrete values can be indicated on a local indicator  130 , wirelessly transmitted as an output signal  120  for indicating on indicator  125 , or both. Alternatively a range or continued set of values can be indicated or reported. 
     In another exemplary aspect, the local comparison component  128  of the device  104  receives a local control input, such as a manual input to define a baseline received power level corresponding to a baseline fluid level, or the control input  146  from the remote apparatus or receiver  124 . In response, the device  104  sets the baseline received power level  112  based on the current received power level  116  in response to the control input  146 , compares the current level  116  at a subsequent time with the baseline level  112  to produce a comparison result, and generates the output signal  120  based upon the comparison result. 
     In use, the received power  110 ′ used for the current received power level  116  can be essentially unchanged from the received power  110  used for the baseline received power level  112 . Qualities of the current level  116  can serve nonetheless as an affirmation that no state of extravasation or infiltration exists and that the device  104  is operating nominally. 
     In some instances, the received power  110 ′ can encounter an area  132  of a changed (e.g., increased) level of fluid. The area  132  can cause swelling and changes in transmission of the received power  110 ′, such as affecting ultrasonic and microwave transmission characteristics. Typically, an increase in fluid level in the area  132  results in a reduction in the amount of received power  110 ′ detected by the detection component  106 . If the transmitted power from the detecting component  106  is constant over the time of the period of interest, then the absolute measurement of the propagated power  110 ′ may define the current received power level  116 . If the transmitted power varies over the time of the period of interest, then the current level  116  should be based on a comparison of the propagated power  110 ′ to the reference signal  114 . Thereby, the current level  116  represents a change in the baseline received power level  112  corresponding to a baseline fluid level that can warrant an alert if the change in the current received power level  116  from the baseline level  112 , indicating a fluid level change, falls below a threshold, e.g., the current level  116  is equal to or less than 90% of the baseline level  112 . 
     In an exemplary aspect, the device  104  comprises an integrated assembly wherein a substrate  134  functions to attach the detecting component  106  to the body portion  102 , e.g., an outer surface of the body portion, as well as supporting other parts or the entirety of the device  104 , which can include a power supply  136  for powering the detecting component  106 , the signal processing component  118  and the wireless interface  122 . For example, the power supply  136  can be portable (e.g., rechargeable battery). In order to provide long-term reliability and reduced maintenance requirements, the wireless interface  122  can report at more than one rate, depicted as low rate  138  and high rate  140 , although it should be appreciated that a greater range of reporting could be provided and selected. It is also contemplated that a conduit (e.g., catheter, needle, etc.) may be mounted to the substrate  134  so as to provide fluid to a body portion from a fluid supply (e.g., infuser supply, contrast agent injector, IV drip, etc.). It is further contemplated that the fluid providing conduit may not be coupled to the substrate  134  but may be positioned near the substrate  134 . 
     Changing the frequency of activating the detecting component  106 , the wireless interface  122 , or both, between the high rate  140  and the low rate  138  mitigates power consumption. To that end, the detecting component  106  can comprise a control component  142  for intermittently causing power to be transmitted to the body portion  102 . For instance, the control component  142  can comprise a manual adjustment feature  144  for setting a period between intermittent activations, which may relate to a rate of injection or transfusion. In another exemplary aspect, the wireless interface  122  intermittently reports the output signal  120 , which rate may be adjustable as well. 
     By virtue of the foregoing, the device  104  comprises the detecting component  106  for transmitting power into and receiving received power  110 ,  110 ′ from the body portion  102  for sensing the current received power level  116 , the signal processing component  118  for generating the output signal  120  based at least in part on the received or detected power  110 ,  110 ′ , the wireless interface,  122  for transmitting the output signal  120  from the signal processing component  118 , and the power supply  136  for powering the detecting component  106 , the signal processing component  118  and the wireless interface  122 . The remote apparatus or receiver  124  receives the output signal  120  from the wireless interface  122 . 
     In another exemplary aspect, the detecting component  106  further transmits power and receives power comprising a Radio Frequency (RF) signal. For instance, the detecting component comprises an RF voltage controlled oscillator for sweeping a frequency range of greater than 1.5 GHz to approximately 10 GHz over a period of time. 
     Alternatively or in addition, the detecting component  106  further comprises a gain/phase measurement circuit. 
     In an additional exemplary aspect, the detecting component  106  further transmits power and receives power comprising an ultrasonic signal. 
     In a further exemplary aspect, the wireless interface  122  comprises at least one of a personal area network (PAN) interface, a Wi-Fi interface, and a cellular interface. For instance, the wireless interface  122  can comprise the PAN interface that interfaces to a cellular device for communicating with the remote apparatus or receiver  124 . 
     In  FIG. 2 , a method  200  provides for detecting a change in a level of fluid in tissue of a body. An power waveform is transmitted into a body portion (block  202 ). Power is received from the body portion (block  204 ). A baseline received power level and a subsequent series of current received power levels are determined from the received power (block  206 ). The current level is compared with the baseline level to determine a resultant value (block  208 ). A reporting rate is defined, comprising at least a first rate for reduced power consumption and a second rate for increased reporting (block  210 ). An output signal is transmitted at the reporting rate that is related to the current level to a receiver (block  212 ). 
     In an illustrative implementation, reducing power consumption by using a very low duty cycle for operation allows for a more economical device with a longer service life. With IV (intravenous) infiltrations, the fluid flow rate is typically low and therefore the infiltration of fluid leakage into the subcutaneous tissue outside of a vein is very slow as well. Therefore, by allowing a setting of intervals between performing one or more of quick sensor full-sweep operation, and wirelessly reporting can achieve performance benefits without degrading functionality. For example, it can be determined that a default or high rate of multiple times per second could be slowed to several times per minute. Multiple magnitudes of adjustability in a duty cycle could result in extremely low power consumption, extending the battery life of the device. 
     A nurse or technician may adjust, such as via the adjustment feature  144 , a rate of activation of the detecting component  106  in relation to a rate of fluid injection so as to minimize power consumption. For example, presuming X volume of accidentally injected fluid within a patient is considered unacceptable, e.g., 2 ml, and fluid is being or about to be injected into the patient at a desired rate of Y volume/time, e.g., 1 ml/hour, then a nurse or technician may use the following formula to define a time period between activation events of the detecting component  106 : 
       Time period between activation events of the detecting component  106 =[X volume of unacceptable injected fluid]/[injection rate of Y volume/time]÷(Safety factor).
 
     The rate of activation of the detecting component (number of activations per unit time)=1/time period between activation events of the detecting component. 
     It is also contemplated that the signal processing component  118  may be used to determine the rate of activation of the detecting component  106  using the above formulas after a nurse or technician has input an unacceptable injected volume (X volume) and the current fluid injection rate (Y volume/time). 
     In  FIG. 3 , in an exemplary embodiment of the system  100 , the device  104  and remote apparatus or receiver  124  (see  FIG. 1 ) are depicted respectively as an RF device  300  and a remote receiver  302 . The RF device  300  has RF transmit (TX) antenna(s)  304  that are driven and RF receive (RX) antenna(s)  306  that are read by an Application Specific Integrated Circuit (ASIC) or miniaturized, low-power circuitry  308  that performs at least portions of the functions of the detector component  106 , signal processing component  118 , and wireless interface  122  ( FIG. 1 ). 
     To that end, a controller  310 , such as a low-power microprocessor, Digital Signal Processor (DSP), or Field Programmable Gate Array (FPGA), sweeps across the RF frequency range of interest, such as 300 MHz to approximately 30 GHz, and more particularly up to 10 GHz, by driving an RF Voltage Controlled Oscillator (VCO)  312  or digital frequency synthesis circuit. The transmit antenna(s)  304  of the RF device  300  are then driven by the VCO  312  and the same signal is split as a reference signal  314  to a gain/phase measurement circuit/IC  316  (e.g., AD 8302 ). The RX antenna(s)  306  return a signal corresponding to power  318 ,  318 ′ (power  318 ′ passes through fluid  332  in the patient) propagated through the tissue to the gain/phase measurement circuit/IC  316  which then sends voltages (representing gain/loss and phase information for the TX and RX signals) to two Analog-to-Digital Converters (ADC)  320 ,  322  which then digitize the corresponding gain and phase voltage information to the controller  310 . The controller  310  can perform digital signal processing and direct a separate or integral wireless interface  324  to report to the remote receiver  302 . 
     In use, a fluid supply  326  (e.g., infuser supply, contrast agent injector, IV drip, etc.) provides fluid  327  via a conduit  328  (e.g., catheter, needle, etc.) to a vascular body  330  of the body portion  102 . As depicted at  332 , extravasation or infiltration can cause an increase in a level of fluid that directly affects a signal  318 ′ propagating through the tissue, such as based in a change in permittivity. Alternatively, a resulting change in dimensions of the body portion  102 , as depicted at  334 , can cause a change in the signal  318 ′. 
     The reference signal  314  is provided to compensate for the signal generated by the VCO  312 , which may vary over time or may change in the transmission pathway extending up to the RX antenna(s)  306 . 
     In order to sense an extravasation or infiltration, the controller  310  compares a first ratio of the returned signal from the RX antenna(s)  306  to the reference signal  314  (during fluid injection into a patient) with a second ratio of the returned signal from the RX antenna(s)  306  to the reference signal  314  (taken during a baseline detection operation, e.g., just before fluid is injected into the body portion). The first ratio defines a current received power level during patient fluid injection, while the second ratio defines a baseline received power level. When the first ratio is equal to or less than a predefined percentage, e.g., 90% or less, of the second ratio, then the controller  310  determines that an unacceptable fluid level change, i.e., an unacceptable extravasation/infiltration, has occurred. 
     The rate at which the RF device  300  is active (e.g., rate of RF sweeps, rate of reports, etc.) can be optimized between power consumption and a prudent rate of monitoring in order to extend the service life of the power supply 
     In  FIG. 4 , in another exemplary embodiment of the system  100 , the device  104  and remote apparatus or receiver  124  are depicted respectively as an ultrasonic device  400  and a remote receiver  401 . In one aspect, an ASIC or miniaturized, low-power circuitry  408  performs at least portions of the functions of the detector component  106 , signal processing component  118 , and wireless interface  122  ( FIG. 1 ). The ultrasonic device  400  has ultrasonic transceiving antenna(s)  402   a ,  402   b  that are driven and are read by an ultrasonic sensor  404  under the control of a controller  406  that reports via a wireless interface  424 . 
     In use, the fluid supply  326  (e.g., infuser supply, contrast agent injector, IV drip, etc.) provides fluid  327  via the conduit  328  (e.g., catheter, needle, etc.) to a vascular body  330  of the body portion  102 . In a baseline state, the ultrasonic transceiving antenna(s)  402  a transmits and receives an ultrasonic signal  418 . Extravasation or infiltration can cause an increase in a level of fluid, as depicted at  332 , that directly affects an ultrasonic signal  418 ′ sensed by the ultrasonic transceiving antenna(s)  402   b  due to a resulting change in dimensions of the body portion  102 , as depicted at  434 , or due to acoustic properties of the fluid relative to surrounding tissue. 
     In another exemplary aspect, the ultrasonic device  400  is worn by a patient that is ambulatory or otherwise mobile. The wireless interface  424  comprises a Personal Access Network (PAN) interface, such as BLUETOOTH, that communicates with a remote apparatus  440  via a receiver  401  having a cell phone link, such as a Publicly Switched Telephone Network (PSTN) number for Machine-to-Machine (M2M) reporting to a hospital outpatient monitoring system. 
     While the foregoing disclosure discusses illustrative aspects and/or embodiments, it should be noted that various changes and modifications could be made herein without departing from the scope of the described aspects and/or embodiments as defined by the appended claims. Furthermore, although elements of the described aspects and/or embodiments may be described or claimed in the singular, the plural is contemplated unless limitation to the singular is explicitly stated. Additionally, all or a portion of any aspect and/or embodiment may be utilized with all or a portion of any other aspect and/or embodiment, unless stated otherwise. 
     It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure, material set forth herein, will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.