Patent Publication Number: US-2022218252-A1

Title: Probe Advancement Device and Related Systems and Methods

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims priority to U.S. Provisional Application No. 63/135,377, filed Jan. 8, 2021, which is hereby incorporated by reference in its entirety. 
    
    
     BACKGROUND 
     A catheter is commonly used to infuse fluids into vasculature of a patient. For example, the catheter may be used for infusing normal saline solution, various medicaments, or total parenteral nutrition. The catheter may also be used for withdrawing blood from the patient. 
     The catheter may include an over-the-needle peripheral intravenous (“IV”) catheter. In this case, the catheter may be mounted over an introducer needle having a sharp distal tip. The catheter and the introducer needle may be assembled so that the distal tip of the introducer needle extends beyond the distal tip of the catheter with the bevel of the needle facing up away from skin of the patient. The catheter and introducer needle are generally inserted at a shallow angle through the skin into vasculature of the patient. 
     In order to verify proper placement of the introducer needle and/or the catheter in the blood vessel, a clinician generally confirms that there is “flashback” of blood in a flashback chamber of a catheter assembly that includes the catheter. After placement of the needle has been confirmed, the clinician may remove the needle, leaving the catheter in place for future blood withdrawal or fluid infusion. 
     Catheters typically provide an access port by which other devices may obtain access to the catheter while the catheter is positioned in a patient&#39;s vasculature. These other devices may be employed to perform various tasks such as obtaining a blood sample, injecting a fluid, performing a measurement, monitoring, etc. In many instances, the catheter of an IV catheter device may become occluded (e.g., due to a thrombus or fibrin sheath) which may prevent the performance of such tasks. If the catheter has become occluded, a clinician may attempt to remove the occlusion such as by inserting a needle, wire, or other structure through the catheter. However, removing an occlusion using currently available techniques is not always effective, is oftentimes difficult to perform, and may cause trauma to the vasculature of the patient. 
     The subject matter claimed herein is not limited to embodiments that solve any disadvantages or that operate only in environments such as those described above. Rather, this background is only provided to illustrate one example technology area where some implementations described herein may be practiced. 
     SUMMARY 
     The present disclosure relates generally to probe advancement devices to facilitate advancement of a probe within a catheter, as well as related systems and methods. In some embodiments, a probe advancement device may be employed to perform various tasks, including obtaining a blood sample. In many instances, the catheter of an IV catheter device may become occluded (e.g., due to a thrombus or fibrin sheath) which may prevent a successful blood draw. In some embodiments, the probe may be advanced by the probe advancement device to remove or provide a pathway through an occlusion. 
     In some embodiments, a probe advancement device may be configured to couple to a catheter assembly. In some embodiments, the probe advancement device may include a flexible housing, which may include a proximal end and a distal end. In some embodiments, a probe advancement element may be coupled to the proximal end of the flexible housing. In some embodiments, the probe advancement element may include a probe extending in a distal direction within the flexible housing. In some embodiments, the flexible housing may be configured to collapse along an axis in response to the probe being advanced in the distal direction. 
     In some embodiments, the probe may include one of a guidewire and a tube. In some embodiments, a proximal end of the probe advancement element may be configured to couple to a blood collection device. 
     In some embodiments, the probe advancement device may include a support element disposed within the flexible housing. In some embodiments, a distal end of the support element comprises a male luer and a proximal end of the support element comprises a female luer. In some embodiments, the probe may extend through the support element. 
     In some embodiments, the probe advancement device may include multiple support elements spaced apart within the flexible housing. In some embodiments, the probe may extend through the support elements. In some embodiments, a distal end of each of the support elements may include a male luer and a proximal end of each of the support elements may include a female luer. In some embodiments, each of the support elements may be configured to lock on the probe. 
     In some embodiments, an end connector may be disposed at a distal end of the flexible housing and another connector may be disposed at a proximal end of the flexible housing. In some embodiments, in response to the probe being advanced in the distal direction and collapse of the flexible housing, the end connector may be configured to couple to the other connector. In some embodiments, the end connector may include a female luer adapter and the other connector may include a male luer adapter. 
     In some embodiments, the probe advancement device may include an alignment rod disposed within the flexible housing to maintain alignment between the probe advancement element and the end connector. In some embodiments, at least a portion of the flexible housing may be transparent such that the probe is visible through the flexible housing. 
     In some embodiments, the probe advancement device may include a biasing member disposed within the flexible housing between the probe advancement element and the distal end of the flexible housing. In some embodiments, the biasing member may be configured to bias the probe in a retracted position. In some embodiments, the probe advancement element may be configured to compress the biasing member in a distal direction to collapse the flexible housing along the axis in response to the probe being advanced in the distal direction. 
     In some embodiments, the probe advancement device may include a near access grip element disposed within the flexible housing towards the distal end of the flexible housing. In some embodiments, the near access grip element may be configured to manipulate a position of the probe within the flexible housing. In some embodiments, the near access grip element may include a first end and a second end configured to be resiliently pinched together such that the probe is retained therebetween. In some embodiments, the near access grip element may be configured to be selectively translated along or parallel to the axis within the flexible housing. 
     In some embodiments, a probe advancement system may include the blood collection device, the flexible housing, and the probe advancement element. In some embodiments, a fluid pathway may extend through the flexible housing and/or into the blood collection device. In some embodiments, the probe advancement system may include the catheter assembly, which may be coupled to the distal end of the flexible housing and in fluid communication with the fluid pathway. In some embodiments, the catheter assembly may be configured to receive the probe therethrough. 
     In some embodiments, the fluid pathway may extend around the probe and/or between the probe and an inner surface of the flexible housing. In these embodiments, the fluid pathway may be configured to collapse along an axis of the flexible housing in response to the probe being advanced in the distal direction. In some embodiments, the probe may include a tube, and the fluid pathway may extend through the tube. In some embodiments, the proximal end of the flexible housing may include the other connector. In some embodiments, the other connector may include a shaft and the tube may extend distally from the shaft. In some embodiments, the distal end of the flexible housing may include the end connector, and the shaft may be configured to insert into the end connector to form a fluid-tight seal. 
     In some embodiments, a method to advance the probe for a blood draw may include coupling the probe advancement device to the catheter assembly. In some embodiments, the catheter assembly may include a catheter adapter, which may include a proximal end, a distal end, and a lumen extending therethrough. In some embodiments, the catheter assembly may include a catheter extending from the distal end of the catheter adapter and which may be intravenous. In some embodiments, the method may include coupling a blood collection device to the probe advancement device. In some embodiments, the probe may be advanced in a distal direction to create a fluid pathway through the catheter assembly. In some embodiments, after the probe is advanced in the distal direction, the blood collection device may be actuated to collect blood from a patient via the fluid pathway. 
     It is to be understood that both the foregoing general description and the following detailed description are examples and explanatory and are not restrictive of the invention, as claimed. It should be understood that the various embodiments are not limited to the arrangements and instrumentality illustrated in the drawings. It should also be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural changes, unless so claimed, may be made without departing from the scope of the various embodiments of the present invention. The following detailed description is, therefore, not to be taken in a limiting sense. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Example embodiments will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
         FIG. 1A  is a perspective view of an example probe advancement device, in accordance with some embodiments; 
         FIG. 1B  is an upper perspective view of an example probe advancement system in accordance with some embodiments; 
         FIG. 2A  is a cross-sectional view of another example probe advancement device, illustrating an example probe including a tube, in accordance with some embodiments; 
         FIG. 2B  is a cross-sectional view of another example probe advancement device, illustrating an example probe including a guidewire, in accordance with some embodiments; 
         FIG. 3  is a perspective view of another example probe advancement device in accordance with some embodiments; 
         FIG. 4  is a cross-sectional view of another probe advancement device configured in accordance with some embodiments; 
         FIG. 5  is a cross-sectional side view of an example support elements disposed within an example flexible housing in accordance with some embodiments; 
         FIG. 6A  is a cross-sectional view of one example of a septum disposed within an example adapter in accordance with some embodiments; 
         FIG. 6B  is a cross-sectional view of the septum of  FIG. 6A  illustrating another example probe, in accordance with some embodiments; 
         FIG. 6C  is a cross-sectional view of another example of a septum disposed within the adapter in accordance with some embodiments; 
         FIG. 6D  is cross-sectional view of another example of a septum disposed within the adapter in accordance with some embodiments; 
         FIG. 6E  is cross-sectional view of the septum of  FIG. 6D , illustrating an example probe advanced through the septum, in accordance with some embodiments; 
         FIG. 7A  is an upper perspective view of a near access grip element in accordance with some embodiments; 
         FIG. 7B  is a side view of the near access grip element of  FIG. 7A ; 
         FIG. 7C  is a perspective view of the near access grip element of  FIG. 7A  and an example probe in accordance with some embodiments; 
         FIG. 7D  is a perspective view of the near access grip element of  FIG. 7A  actuated to grip the probe in accordance with some embodiments; and 
         FIG. 7E  is a perspective view of the near access grip element of  FIG. 7A  actuated to translate the probe through an example septum in accordance with some embodiments. 
     
    
    
     DESCRIPTION OF EMBODIMENTS 
     In the specification and the claims, the term “catheter assembly” should be construed as any device that includes an IV catheter. The term “probe advancement device” should be construed as any device that is configured to advance and/or retract a probe within an IV catheter. In some embodiments, a probe advancement device may be a separate device from a catheter assembly with which the probe advancement device may be used. In other embodiments, a probe advancement device may include a catheter assembly or may be monolithically formed with the catheter assembly as a single unit. 
       FIGS. 1A and 1B  illustrate a probe advancement device  30  for advancing a probe  46  within a catheter  72 . In some embodiments, the probe  46  may include a tube through which blood may flow. In other embodiments, the probe  46  may include a guidewire, such as, for example, a nickel titanium guidewire. 
     Various embodiments of the probe advancement device  30  may be employed to perform various tasks, including obtaining a blood sample, for example. For example, in some embodiments, the probe advancement device  30  may deliver a probe  46  through a catheter assembly  62  to clear a portion of a catheter  72  that has become occluded (e.g., due to a thrombus or fibrin sheath). Failing to clear such an occlusion may prevent a successful blood draw. Some embodiments presented herein may shorten an effective length of the buckling column of the probe  46  and/or reduce drag as the probe  46  is advanced distally. 
     Referring now to  FIG. 1A , in a first set of example embodiments, the probe advancement device  30  may include a flexible housing  32  having a proximal end  36  and a distal end  38 . In some embodiments, the flexible housing  32  may include a flexible biocompatible plastic material or other suitable flexible medical-grade polymer, such as, for example, one or more of the following: polyethylene, PEEK, polycarbonate, polyetherimide, polysulfone, polypropylene, and polyurethane. In some embodiments, the flexible housing  32  may include a transparent material to facilitate visualization of obstructions and/or advancement or a probe  46  therein. In some embodiments, the flexible housing  32  may include an accordion-like structure forming a collapsible lumen or fluid pathway. In some embodiments, the flexible housing  32  may be aligned with an axis  42 . In some embodiments, the axis  42  may include a central or longitudinal axis of the flexible housing  32 , which may extend through the proximal end  36  and the distal end  38  which. 
     In some embodiments, a probe advancement element  44  may be coupled to the proximal end of the flexible housing  32 . In some embodiments, the probe advancement element  44  may include a rigid or resilient material. In some embodiments, the probe advancement element  44  may include a shape substantially matching a cross-sectional profile of the flexible housing  32 . As illustrated, for example, the flexible housing  32  may form a cylinder while the probe advancement element  44  may form a circle having a diameter substantially matching a diameter of the cylinder. In this manner, in some embodiments, the probe advancement element  44  may substantially occlude the proximal end  36  of the flexible housing  32 . In some embodiments, the probe advancement element  44  may include any suitable shape to substantially occlude the proximal end  36  of the flexible housing  32 . 
     In some embodiments, the proximal end  36  of the probe advancement device  30  may include a luer adapter or other coupling feature configured to couple to a corresponding luer adapter or coupling feature disposed at the distal end  38 . In this manner, in some embodiments, the flexible housing  32  may be compressed or fully compressed by coupling the coupling feature at the proximal end  36  to the corresponding coupling feature at the distal end  38 . In some embodiments, the proximal end  36  of the probe advancement device  30  may include a male luer, which may include a shaft  81  configured to couple to a female luer at the distal end  38 . 
     In some embodiments, the probe  46  may extend in a distal direction from the probe advancement element  44  within the flexible housing  32 . In some embodiments, the probe  46  may include a guidewire or tube. In some embodiments, the tube may be cylindrical. In some embodiments, the flexible housing  32  may be configured to collapse along the axis  42  when the probe  46  is advanced in the distal direction. For example, in some embodiments, the accordion-like structure of the flexible housing  32  may result in the flexible housing  32  having a length that progressively shortens in response to the probe  46  advancing in the distal direction. 
     In some embodiments, as discussed in more detail below, the probe advancement device  30  may further include a near access grip element  52 . In some embodiments, the near access grip element  52  may be disposed within the flexible housing  32  and/or proximate to the distal end  38 . Some embodiments of the near access grip element  52  may be configured to manipulate a position of the probe  46  within the flexible housing  32 . In this manner, the probe  46  may advance through part or all of a catheter (see, for example, the catheter  72  in  FIG. 1B ) to clear obstructions, thereby facilitating blood draw success. 
     In some embodiments, a seal, such as, for example, an O-seal or other suitable rubber or plastic seal, may be disposed between the probe advancement element  44  and the proximal end  36  of the flexible housing  32 . In some embodiments, a luer adapter or other coupling feature may be coupled to or integrated with the probe advancement element  44 . In these and other embodiments, the luer adapter or other coupling feature may form a seal at the proximal end  36 . In this manner, in some embodiments, the probe  46  may include a guidewire and/or the flexible housing  32  may form an air-tight fluid pathway through which blood can be drawn using a VACUTAINER® LUER-LOK™ Access Device (“LLAD”, available from Becton Dickinson &amp; Company of Franklin Lakes, N.J.), a syringe, or another suitable blood collection device. 
     In some embodiments, the probe  46  may include a tube, and the tube may extend from the probe advancement element  44 . In some embodiments, when the tube is advanced in a distal direction through the flexible housing  32 , the tube may form a fluid path through which blood can be drawn using a blood collection device  60  such as an LLAD or syringe, for example. 
     In some embodiments, the probe  46  may clear obstructions by one or more of the following: moving the catheter  72  tip; removing thrombus or other obstructions from the catheter  72 ; extending a new fluid path to a new blood source; holding thrombus at bay; opening one or more valves; and moving the catheter  72  away from an obstruction. In some embodiments, a location and/or position of the probe  46  may be adjusted after initial deployment to facilitate clearing a path for a blood draw. In some embodiments, the probe advancement device  30  may provide tactile and/or auditory feedback to a user to indicate that the initial advancement of the probe  46  is complete. 
     Referring now to  FIG. 1B , a probe advancement system  78  may include a blood collection device  60 , the probe advancement device  30 , and a catheter assembly  62 . In some embodiments, the catheter assembly  62  may include a catheter adapter  64  having a proximal end  68 , a distal end  70 , and a catheter  72  extending from the distal end  70 . In some embodiments, an extension tube  66  may extend from a side port of the catheter adapter  64 .  FIG. 1B  illustrates, according to some embodiments, the probe advancement system  78  just prior to coupling of the probe advancement device  30  to the catheter assembly  62  by insertion of a male luer into the proximal end  68  or a connector  69 . 
     In some embodiments, the probe advancement element  44  may be disposed at the proximal end  36  of the flexible housing  32  and may be coupled to the blood collection device  60 . In some embodiments, the probe advancement element  44  may include the probe  46  extending in a distal direction within the flexible housing  32 . In some embodiments, the flexible housing  32  may be configured to collapse along the axis  42  in response to the probe  46  being advanced in the distal direction. 
     Some embodiments of the flexible housing  32  may form a collapsible fluid pathway in fluid communication with the blood collection device  60 . In these and other embodiments, blood may flow around the probe  46 , which may include a guidewire. In other embodiments, the probe  46  may include a tube, and blood may flow through the tube and not between the tube and an inner surface of the flexible housing  32 . 
     In some embodiments, the probe advancement device  30  may include a connector element  50  disposed within the flexible housing  32  and configured to couple to an end connector  54  at the distal end  38  of the flexible housing  32 . In some embodiments, at least a portion of the flexible housing  32  may be transparent such that the probe  46  is visible through an exterior surface  34 . In some embodiments, the shaft  81  and/or the probe  46  may be configured to fit through a hole of the connector  50  or may be configured to couple to a corresponding luer of the connector  50 . In some embodiments, the connector  50  may include a generally circular disc and/or an extension extending distally from the generally circular disc to the end connector  54 , to which the extension may be attached. 
     As discussed in more detail below, in some embodiments, the near access grip element  52  may be disposed within the flexible housing  32  proximate to the distal end  38 . In some embodiments, the near access grip element  52  may be secured to the extension of the connector element  50 . Some embodiments of the near access grip element  52  may be configured to manipulate a position of the probe  46  within the flexible housing  32 . 
     In some embodiments, a biasing member  56 , such as, for example, a spring, may extend between the connector element  50  and the proximal end  36  such that the probe  46  is biased in a retracted position. In some embodiments, the biasing member  56  may be compressed when the probe  46  is advanced distally. In some embodiments, the biasing member  56  may be configured to automatically retract the probe  46  in the proximal direction. 
     In some embodiments, the catheter assembly  62  may be coupled to the distal end  38  of the flexible housing  32 . In some embodiments, the catheter assembly  62  may be coupled to the probe advancement device  30  and in fluid communication with the collapsible fluid pathway and/or a fluid pathway through the probe  46 . In some embodiments, the catheter assembly  62  may be configured to receive the probe  46  therethrough. 
     Referring now to  FIGS. 2A-2B , in some embodiments, advancement of the probe  46  may be accomplished by gripping the proximal end  36  of the probe advancement device  30  and moving the probe  46  distally toward and/or through the catheter  72 . In some embodiments, the proximal end  36  of the probe advancement device  30  may include a shape and/or texture to facilitate gripping the proximal end  36  to maneuver a position of the probe  46 . It is understood that, in some embodiments, one or more features of  FIG. 2  may be combined with one or more features of  FIG. 1A  and/or  FIG. 1B .  FIG. 2A  illustrates the probe  46  as a tube, according to some embodiments. In some embodiments, the tube may be secured within the shaft  81  in a fluid-tight manner, such as via adhesive or another suitable method.  FIG. 2B  illustrates the probe  46  as a guidewire, which may be secured to the shaft  81  via adhesive or another suitable method. In some embodiments, the guidewire may be embedded in the shaft  81 . In some embodiments, the guidewire may include various shapes to facilitate thrombus removal. In some embodiments, the guidewire may include a straight portion and/or a spiral portion  79 . In some embodiments, a distal end of the guidewire may include a blunt element  81 , which may include a ball, rounded surface, or another blunt element to avoid damage to the vein. 
     In some embodiments, the probe  46  may be moved in a distal direction through a catheter assembly and into the vasculature or vein of the patient. In some embodiments, the proximal end  36  of the probe advancement device  30  may be turned or its orientation may be otherwise adjusted to facilitate the flexible housing  32  to facilitate the probe  46  to further advancing in the distal direction. In some embodiments, the probe  46  may be advanced in the distal direction until it is extended through the catheter  72  (see, for example,  FIG. 1B ). 
     In some embodiments, the probe  46  may encounter an obstacle that inhibits advancement, such as a thrombus formed inside the tip of the catheter  72  or an S-curve in the catheter  72  resulting when the catheter  72  is plunged into the skin. In these embodiments, a near access grip element  52  located near the distal end  38  may be used to support and advance the probe  46 . In some embodiments, the near access grip element  52  may facilitate the probe  46  to be maneuvered more easily by providing a reduced buckling column length. 
     Indeed, in some embodiments, the probe  46  may have a small moment of inertia when it passes through the catheter  72  or the catheter assembly  62 . In some embodiments, while portions of the tube or probe  46  may be well-supported by the catheter assembly  62  in an extended position, other portions may not. As a result, these unsupported portions may buckle when the insertion load is applied. 
     In this regard, Euler&#39;s buckling equation provides: 
         Pcr =pi{circumflex over ( )}2 EI/L{circumflex over ( )} 2
 
     where the bending moment of inertia I is equal to I=pi r{circumflex over ( )}4/4 for a solid wire or guidewire, and I=pi(Ro{circumflex over ( )}4−Ri{circumflex over ( )}4)/4 for a tube. In some embodiments, since the probe  46  must pass through the inside diameter of the catheter  72 , the R values may be very small, resulting in a very flexible column which may be prone to buckling. In some embodiments however, shortening a push distance may result in the column being significantly stiffer such that it may support a needed insertion force. 
     In some embodiments, the near access grip element  52  may include rubber, plastic, metal, or any other suitable material to grip and/or maneuver the probe  46  within the flexible housing  32 . In some embodiments, the near access grip element  52  may facilitate translation of the probe  46 . In some embodiments, the near access grip element  52  may include exterior features that may be felt and/or manipulated by the user through the flexible housing  32 . In some embodiments, the near access grip element  52  may further include one or more surfaces configured to interface with or engage the probe  46 . For example, in some embodiments, the surface may include one or more grooves, indentations, or other texture or material to facilitate a secure interface between the near access grip element  52  and the probe  46 . 
     In some embodiments, a user may manipulate the near access grip element  52  to grasp at least a portion of a length of the probe  46 . In some embodiments, the user may move the near access grip element  52  to move the probe  46 . In some embodiments, near access grip element  52  may be translated or moved along the axis  42  to advance or retract the probe  46  within the catheter  72 . In some embodiments, the user may manipulate the near access grip element  52  simultaneously with the proximal end  36  of the flexible housing  32  to move the probe  46  towards and/or through the catheter  72 . 
     In some embodiments, the end connector  54  may include an adapter  80 , which may include a female luer adapter on a proximal side and/or a male luer adapter on a distal side. In some embodiments, the proximal end  36  of the probe advancement device  30  may include a luer adapter, such as, for example, a male luer as illustrated in  FIG. 2 , which may include a width  57 . In some embodiments, in response to advancement of the probe  46  distally and collapse of the flexible housing  32 , the male luer may be configured to insert into the female luer of the end connector  54  such that the male luer seals the end connector  54 . In some embodiments, a width or shape of the female luer may receive the width or shape of the male luer. In some embodiments, male luer may contact an inner surface of the adapter  80  to form a seal, which may reduce or prevent fluid flow through the adapter  80  when the probe  46  is advanced distally and the flexible housing  32  is collapsed. In some embodiments, the flexible housing  32  may be compressed or fully compressed by coupling the male luer to the female luer. In some embodiments, the probe advancement device  30  may not include a septum, which may reduce drag on the probe  46 . In other embodiments, the probe advancement device  30  may include a septum. 
     In some embodiments, a method to advance a probe  46  for a blood draw may include coupling a probe advancement device  30  (see, for example,  FIGS. 1-7 ) to a catheter assembly  62  (see for example,  FIG. 2B ). In some embodiments, the catheter assembly  62  may include the catheter adapter  64  having the proximal end  68 , the distal end  70 , and the catheter  72  extending from the distal end  70 . 
     Some embodiments of the probe advancement device  30  may include the flexible housing  32  and the probe advancement element  44 . In some embodiments, the flexible housing  32  may include the proximal end  36  and the distal end  38 . In some embodiments, the flexible housing  32  may form the collapsible fluid pathway between the proximal end  36  and the distal end  38  and/or around the probe  46 , which may include a guidewire. In other embodiments, as illustrated in  FIG. 2 , a fluid pathway may extend through the probe  46 , which may include a tube. In these embodiments, the fluid pathway may not extend between the tube and the flexible housing  32 . 
     In some embodiments, the probe advancement element  44  may be coupled to the proximal end  36  of the flexible housing  32 . Some embodiments of the probe advancement device  30  may include the probe  46  extending in a distal direction within the flexible housing  32 . In some embodiments, the flexible housing  32  may be configured to collapse along the axis  42  in response to the probe  46  being advanced in the distal direction. 
     In some embodiments, the method may include coupling the blood collection device  60  to the probe advancement device  30 . In some embodiments, the probe  46  may be translated in the distal direction to create a fluid path through the catheter assembly  62 . Finally, in some embodiments, the blood collection device  60  may be actuated to collect blood from a patient via the fluid path. 
     Referring now to  FIG. 3 , in some embodiments, an alignment mechanism  58  may be disposed within the flexible housing  32  to maintain alignment between the proximal end  36  and the distal end  38  of the flexible housing  32 . In some embodiments, a first end  59  of the alignment mechanism  58  may be slidably coupled to the probe advancement element  44 . In some embodiments, a second end  61  of the alignment mechanism  58  may be coupled to the end connector  54 . In some embodiments, the end connector  54  may include the adapter  80  or may be coupled to the adapter  80  to create a fluid path between the probe advancement device  30  and the catheter assembly  62  or another device. In some embodiments, the adapter  80  may include a male luer or another suitable adapter. 
     As illustrated, in some embodiments, the alignment mechanism  58  may include a rigid or resilient rod or other suitable structure extending along or parallel to the axis  42  between the probe advancement element  44  and the end connector  54 . In this manner, in some embodiments, the probe advancement element  44  may slide in a distal direction along the alignment mechanism  58  as the flexible housing  32  is compressed to advance the probe  46 . Similarly, in some embodiments, the probe advancement element  44  may slide in a proximal direction along the alignment mechanism  58  as the probe  46  is retracted. 
     Referring now to  FIG. 4 , in some embodiments, the probe  46  may include a guidewire that may include various shapes to facilitate thrombus removal. In some embodiments, the guidewire may include a straight portion and/or a spiral portion. In some embodiments, a distal end of the guidewire may include a ball or another blunt element to avoid damage to the vein. 
     In some embodiments, the near access grip element  52  may include a pinching element, which may be configured to pinch the probe  46  similar to a clothes pin or another pinching mechanism. In some embodiments, opposing sides of the pinching element may be brought together by the user to pinch the probe  46 , which may facilitate advancement of the probe  46  when its path is impeded. 
     In some embodiments, a shaft  81  of the male luer of the probe advancement element  44  may be long enough to reach from the near access grip element  52  (with the flexible housing  32  compressed) to an inside of the adapter  80 , to seal the probe advancement device  30 . In some embodiments, a space between the opposing sides of the pinching element may be large enough to allow the shaft  81  to pass through or greater than a width of the shaft  81 . In some embodiments, blood may flow proximally through the probe advancement device  30  and proximally through the shaft  81  for collection. In some embodiments, the probe  46 , which may include a guidewire, may extend from the shaft  81  and/or may be bent to align with a longitudinal axis of the probe advancement device  30 . 
     Referring now to  FIG. 5 , in some embodiments, the probe advancement device  30  may include a one or more support elements  51   a - c  (which may be referred to collectively in the present disclosure as “support elements  51 ”), which may be disposed within the flexible housing  32  between the proximal end  36  and the end connector  54  at the distal end  38 . In some embodiments, each of the support elements  51  may include mating and sealing luers. In further detail, in some embodiments, a distal end of each of the support elements  51  may include a male luer and a proximal end of each of the support elements  51  may include a female luer. In some embodiments, the support elements  51  may thus be configured to couple together. In some embodiments, the distal end of a first of the support elements  51  may couple to a proximal end of a second of the support elements  51  immediately distal to the first of the support elements  51 . In some embodiments, the proximal end of the first of the support elements  51  may couple to a distal end of a third of the support elements  51  immediately proximal to the first of the support elements  51 . In some embodiments, the probe  46  may extend through the support elements  51 , which may support the probe  46  and reduce buckling during advancement of the probe  46  in the distal direction. 
     In some embodiments, each of the support elements  51  may be configured to lock and unlock. In some embodiments, the support elements  51  may be configured to lock in response to pinching by the user similar to the near access grip element  52 . In some embodiments, when a particular support element  51  is locked, the particular support elements  51  may pinch the probe  46  such that movement of the particular support element  51  moves the probe  46 . In some embodiments, when the particular support element  51  is unlocked, the particular support element  51  may not pinch the probe  46  and may allow the probe  46  to slide through the particular support element  51 . In some embodiments, the third of the support elements  51  may be locked and advanced distally to and/or coupled to the first of the support elements  51 , which may be unlocked. In some embodiments, the first of the support elements  51  may then be locked and the third of the support elements  51  may be unlocked, followed by advancement of the first of the support elements  51  and the probe  46  distally. In some embodiments, the first of the support elements  51  may be advanced distally to the second of the support elements  51  and/or may be coupled together with the second of the support elements  51 . In some embodiments, the first of the support elements  51  may then be unlocked and the second of the support elements  51  may be locked, followed by advancement of the second of the support elements  51  and the probe  46  distally. In some embodiments, the support elements  51  may facilitate advancement of the probe  46  when the probe  46  encounters an obstacle that inhibits advancement. 
     In some embodiments, the support elements  51  may provide several advantages, including supporting the probe  46  at various points along a length of the probe  46 , which may reduce buckling during advancement of the probe  46 . Also, in some embodiments, the support elements  51  between the distal end  38  and the proximal end  36  may reduce blood flowing through the flexible housing  32 . In some embodiments, because it may be difficult for blood to pass through the support elements  51 , fewer (or no) septa may be disposed within the adapter  80 , which may reduce drag on the probe  46  as the probe  46  is advanced. In some instances, drag created by septa may increase a likelihood of buckling of the probe  46 . 
     Referring now to  FIGS. 6A, 6B, and 6C , in some embodiments, a septum  88  (or multiple septa  88 ) may be disposed within the adapter  80 . In some embodiments, the septum  88  may facilitate adjustment of the probe  46  after initial placement into or through the catheter  72  (see, for example,  FIG. 1B ). As illustrated in  FIG. 6A , in some embodiments, in response to collapse of the flexible housing  32  and movement of the probe  46  in the distal direction, the shaft  81  and/or the probe  46  may be moved through the septum  88 .  FIG. 6A  illustrates the probe  46  moving distally through the septum  88 , according to some embodiments. 
     In some embodiments, the probe  46  may include a tube, as illustrated, for example in  FIG. 6A , and may be configured to draw blood when extended through the catheter  72 . In some embodiments, the probe  46  may include a guidewire, as illustrated, for example in  FIG. 6B , and may extend from and/or be embedded in the shaft  81 . 
     As illustrated in  FIG. 6C , in some embodiments, in response to collapse of the flexible housing  32  and movement of the probe  46  in the distal direction, the probe  46 , which may include a guidewire, may be moved through the septum  88 . In these and other embodiments, the probe  46  may be embedded in the shaft  81  and/or may be off-center. Thus, in some embodiments, the septum  88  may include a slit that is off-center. 
     In some embodiments, one or more O-rings  89  may be disposed within the adapter  80  and/or proximal to the septum  88 . In some embodiments, the O-rings  89  and/or an elastomeric region  90  of the septum  88  may facilitate movement of the probe  46  between a number of different axial positions while also facilitating support of the probe  46  and fluid sealing. In some embodiments, the O-rings and the elastomeric region  90  may form a seal around the tube or the shaft  81 . 
     In some embodiments, the septum  88  may prevent blood from flowing into a lumen encased by the flexible housing  32  previous to and during advancement of the probe  46 . In some embodiments, the septum  88  may also prevent blood from flowing into the lumen encased by the flexible housing  32  during dwell of the catheter  72  with the probe  46  extending therethrough and/or during retraction of the probe  46 . In some embodiments, the septum  88  may provide a seal between the shaft  81  and the adapter  38 , which may facilitate application of suction for blood collection when the probe  46  is a guidewire. In some embodiments, the seal between the shaft  81  and the adapter  38  provided by the septum  88  may create enough of a hold to allow the user to let go of the proximal end  36  while the user draws blood via the blood collection device  60  and adjust a position of the probe  46 , such as via axial advancement. In some embodiments, if there is an obstruction of a fluid pathway flowing into the probe  46  or tube, adjusting the position of the probe  46  may open up the fluid pathway and facilitate blood flow through the probe  46  and/or into the blood collection device  60 . 
     As illustrated in  FIGS. 6A-6E , a shape of the septum  88  may vary. Referring now to  FIGS. 6D-6E , an inner surface of the septum  88  may include bumps  91  and/or other bumps  93 , which may provide a similar function as the O-rings  89  and the elastomeric region  90 . In further detail, the bumps  91  and/or the other bumps  93  may form a seal around the probe  46  or the shaft  81  and/or may support the probe  46  or the shaft  81 . In some embodiments, the bumps  91  may be on one side of a folded portion of the septum and the other bumps  93  may be on an opposite side of the folded portion. In some embodiments, the folded portion may perform a same or similar function as the elastomeric region  90  and may provide a seal around the shaft  81 . In some embodiments, a proximal end of the septum  88  may include a lead-in or tapered portion  95  to facilitate guidance of the probe  46 . In some embodiments, the septum  88  may include an H-shape cross-section and a middle portion of the H-shape cross-section and septum  88  may open in response to the shaft  81  and/or the probe  46  moving through the septum  88 , as illustrated in  FIGS. 6D-6E . In these embodiments, the middle portion may fold towards the elastomeric region  90 . 
     Referring now to  FIGS. 7A-7E , in some embodiments, the near access grip element  52  may include a resilient material having a hinge  86  such that the near access grip element  52  may be configured to grasp or pinch the probe  46  between a first end  74  and a second end  76 . In some embodiments, the hinge  86  may be formed to have a spring tendency to maintain the first end  74  and the second end  76  in an open position. In some embodiments, the near access grip element  52  may include a biasing mechanism integrated therewith or coupled thereto to maintain the open position between the first end  74  and the second end  76 . In some embodiments, the near access grip element  52  may be visible through the flexible housing  32  and may include a size and a shape to facilitate visualizing and/or manipulating the near access grip element  52  through the flexible housing  32 . 
     In some embodiments, in the event advancement of the probe  46  is impeded, the near access grip element  52  may be actuated to grip the probe  46 . In some embodiments, the near access grip element  52  and probe  46  may be manually translated in a distal direction to move the probe  46  to overcome or bypass the obstacle. In some embodiments, the probe advancement element  44  and/or the near access grip element  52  may further advance the probe  46  after passing or otherwise overcoming the obstacle. In some embodiments, the probe advancement element  44  and/or the near access grip element  52  may also be utilized to retract the probe  46  in the proximal direction within the flexible housing  32 . 
     It is understood that embodiments of one or more of  FIGS. 1-7  may be combined. For example, the probe advancement device  30  of  FIG. 1A  may be similar or identical to the probe advancement device  30  of  FIG. 1B  in terms of one or more features and/or operation. As another example, the probe advancement device  30  of  FIG. 1A  may be similar or identical to the probe advancement device  30  of  FIG. 2  in terms of one or more features and/or operation. As a further example, the probe advancement device  30  of  FIG. 3  may be similar or identical to the probe advancement device  30  of  FIG. 4  in terms of one or more features and/or operation. 
     All examples and conditional language recited herein are intended for pedagogical objects to aid the reader in understanding the invention and the concepts contributed by the inventor to furthering the art and are to be construed as being without limitation to such specifically recited examples and conditions. Although embodiments of the present inventions have been described in detail, it should be understood that the various changes, substitutions, and alterations could be made hereto without departing from the spirit and scope of the invention.