Patent Publication Number: US-10322227-B2

Title: Apparatus, kits and related methods for fluid infusion

Description:
RELATED APPLICATIONS 
     This application is a continuation in part of U.S. patent application Ser. No. 14/214,977, filed Mar. 16, 2014, which claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/800,400 filed Mar. 15, 2013. This application also claims the benefit of and priority to U.S. Provisional Application Ser. No. 62/274,566 filed Jan. 4, 2016, U.S. Provisional Application Ser. No. 62/187,367 filed Jul. 1, 2015, and U.S. Provisional Application Ser. No. 62/120,021 filed Feb. 24, 2015. The contents of the above are hereby incorporated by reference as if recited in full herein. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to dispensing medical fluid from a syringe. More particularly, the present disclosure relates to mechanisms and methods for syringe loading and dispensing fluid with assistance. 
     BACKGROUND 
     Rapid fluid administration is essential for patients suffering from shock, a life-threatening illness resulting from a variety of conditions including bacterial sepsis, hemorrhage, trauma, severe dehydration, and anaphylaxis. The American Heart Association&#39;s Pediatric Advanced Life Support (PALS) guidelines, the American College of Critical Care Medicine, and the Surviving Sepsis Campaign guidelines for adults recommend rapid fluid resuscitation as a key element of initial therapy. For example, PALS calls for 20 ml per kilogram of body weight to be infused over 5 minutes, and up to 60 ml/kg in the first 15 minutes. 
     In practice timely infusion of recommended fluid volumes is rarely achieved. This is often due to the difficulty of obtaining intravenous (IV) access in the setting of critical illness, and to the technical barriers to the infusion of large volumes of fluid. When IV access is difficult to obtain, the preferred technique is now intraosseous (IO) access, in which a needle is drilled directly into one of the long bones the arm or leg, and fluid is administered through the bone marrow into the central circulation. While IO infusion has revolutionized the approach to rapid access for fluid and medication administration in emergency medicine, it presents an additional challenge due to the resistance of the bone marrow, which makes rapid infusion of fluid difficult. These challenges are particularly common in children. 
     The increased resistance of bone marrow is similar to flow through small-bore or long IV catheters, and limits the ability of healthcare providers to deliver recommended volumes of resuscitation fluids rapidly. 
     Healthcare providers use several methods used to deliver fluid rapidly in these situations, include gravity, infusion pumps, pressure bags applied to the fluid reservoir, and hand-operated syringes, and mechanical rapid-infusion systems. 
     The fastest and most practical methods in higher-resistance situations are the hand-operated syringe techniques. The standard set of components used includes a fluid reservoir, a syringe, a three-way stopcock, and IV tubing linking these components with the IO or IV port. The user withdraws the plunger to fill the syringe from the fluid reservoir, turns the stopcock, and then depresses the plunger to drive the fluid through the IO or IV port and into the patient. The process is repeated multiple times until the desired volume has been delivered. Alternatively, one provider fills syringes from the IV fluid bag, while another connects the syringe, administers the fluid, disconnects the empty syringe, and repeats the process. 
     Both of these methods require emergency healthcare providers to either: 1) use great force with a large-volume syringe, often with two hands, and quickly resulting in user fatigue, or 2) to refill a small-bore syringe multiple times to achieve adequate volume, resulting in slow administration times and significant distraction for one or more workers. In either case two providers are often necessary, with one user infusing the fluid, and the other refilling syringes or operating the stopcock, and adequate fluid volumes are rarely achieved within the recommended time period. 
     Consider the example of a 40 kg child with traumatic injury and massive blood loss, who has a tibial IO needle as his only access. This child may require rapid infusion of 40-80 ml/kg of blood products, for a total of 1600-3200 ml. Repeated doses using a standard technique and 20 ml syringe would require 80-160 injections and the full attention of two healthcare workers, resulting in slow resuscitation and inefficient use of resources. The total infusion time could be 15-20 minutes, well outside the range of recommended rates, particularly in an actively bleeding child. 
     SUMMARY 
     This summary is provided to introduce in a simplified form concepts that are further described in the following detailed descriptions. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it to be construed as limiting the scope of the claimed subject matter. 
     In some embodiments, a kit of components for a medical infusion includes a syringe having a syringe body with a liquid chamber having a volumetric capacity in a range of 5 ml to 30 ml, large bore tubing having an inner diameter greater than 3 mm and less than or equal to 6 mm and a length in a range of 4 feet to 10 feet, a valve with an axially extending valve body with opposing first and second ends, and a package holding the syringe pre-attached to the valve body and the large bore tubing in a sterile condition to thereby provide components in a ready-to-use configuration for insertion of the syringe and valve into an infusion device. The syringe has an external surface with visual indicia of volume and a plunger that can slidably extend into and retract at least partially from the syringe body. The large bore tubing has opposing longitudinally spaced apart first and second ends. The valve body includes (a) an inlet tube residing between the first and second ends of the valve body and (b) an exit port on the first end of the valve body. The inlet tube may be attached to the first end of the large bore tubing. The second end of the valve body resides adjacent or inside the syringe and is in fluid communication with the liquid chamber. 
     An axially extending centerline of the inlet tube may be longitudinally spaced apart a distance of 0.7 inches from an exit tip of the syringe body. 
     The kit may further include an infusion device comprising a housing with an interior chamber. The interior chamber may be sized and configured to hold at least the plunger and flange of the syringe. The housing may include a visually transmissive lid that optionally has a length sufficient to enclose the syringe body therein. 
     The valve body may be a dual check valve body with dual one-way check valves. The housing may be configured to hold the pre-attached dual check valve body in a defined orientation with the inlet tube extending out of one side of the housing perpendicular from the axially extending valve body to orient the syringe to have the visual indicia of volume facing up. 
     The inlet tube may extend outward perpendicular to the axially extending valve body to be parallel with a laterally extending plane of the flange of the syringe. Optionally, the flange may reside a distance between 3 inches and 5 inches from an axially extending centerline of the inlet tube. 
     The housing may include a visually transmissive lid that has a length sufficient to enclose the syringe body therein. The lid may cooperate with a lower housing member to hold the valve body with the inlet tube extending out a right or left sidewall adjacent a tip of the housing and with the exit port extending out a tip of the lid. 
     The infusion device may include a trigger extending below the housing in communication with an upwardly extending lever having a fixed pivot point. The lever may include an upper segment residing above the trigger and fixed pivot point that defines a cam path. The trigger may manually drive the lever or may be connected to an onboard power source in communication with the lever. The lever may move the plunger of the syringe in a first direction to dispense fluid through the exit port and may move the plunger of the syringe in the opposing direction to intake fluid through the inlet port. 
     The infusion device may further include a shuttle in the housing that holds an end of the plunger external to the syringe. The shuttle may be attached to the laterally extending pin and left and right end portions of the pin ride in respective longitudinally extending tracks whereby the lever can slidably advance and retract the plunger relative to the syringe body in response to movement of the trigger. 
     The housing may include a lid having opposing front and rear end portions. The rear end portion may be pivotably attached to a lower housing member which holds a stationary housing grip adjacent the trigger. The lid may include at least one downwardly facing aperture on the front end portion. 
     The housing may include a lid having opposing front and rear ends. The rear end may be pivotably attached to a lower housing member which holds a stationary housing grip adjacent the trigger. The lid may include a plurality of spaced apart downwardly facing apertures on or adjacent the front end including a first one extending about the exit port of the valve body and at least one positioned on a right and/or left sidewall of the lid to be adjacent, but spaced longitudinally apart from the first one a distance of between 0.5 inches to 1 inch, optionally about 0.8 inches. 
     The housing may include a lid having opposing front and rear end portions. The rear end portion may be pivotably attached to a lower housing member holding a stationary housing grip adjacent the trigger to hold the syringe in an interior cavity of the housing with the exit port of the valve extending out the front end portion. The front end portion may have an upper tip with a semicircular aperture. The lower housing member have opposing front and rear end portions. The front end portion of the lower housing member may include a lower tip with a semicircular aperture facing the semicircular aperture in the upper tip of the lid. A respective pair of semicircular apertures from the lid and lower housing member may form a circular aperture about the axially extending valve body when the lid is closed against the lower housing member. 
     The housing may include a lid having opposing front and rear ends. The rear end may be pivotably attached to a lower housing member holding a stationary housing grip adjacent the trigger. The front end of the lid may have an upper tip with an aperture and at least one sidewall proximate the upper tip also having an aperture. The lower housing member may have opposing front and rear ends. The front end of the lower housing member may include a lower tip with an aperture facing the aperture in the upper tip of the lid and an aperture on at least one upwardly extending sidewall facing a respective aperture in a corresponding sidewall of the lid. Respective pairs of apertures from the lid and lower housing member may face each other and form cooperating apertures when the lid is closed against the lower housing member. 
     The housing may include a lid having opposing front and rear ends. The rear end may be pivotably attached to a lower housing member holding a stationary housing grip adjacent the trigger. The lid may include an upwardly projecting enclosed cavity that travels up then down as the lid extends from the front toward the rear end of the lid. The upper segment of the lever may be configured to travel up and down and longitudinally back and forth in the enclosed cavity during operative use of the infusion device. 
     The interior chamber may have a first compartment sized and configured to hold the syringe body that merges into a smaller region for a length that holds an external neck of the syringe. The interior chamber may then merge into a second compartment that extends to the tip and holds the valve body therein so that the exit port extends out of the tip and an underlying lower housing member and the inlet tube extends out of the side of the lid and the underlying lower housing member, adjacent the tip. 
     The housing may include a lid having first and second downwardly facing semicircular apertures that face respective upwardly extending semicircular apertures in the underlying lower housing member, one on the tip and one of a right or left side of the infusion device adjacent the tip to define respective exit paths for the inlet tube and the exit port of the valve body. The semicircular apertures of the tip may have a large radius than the side semicircular apertures. 
     The kit may further include a spike attached to the second end of the large bore tubing. 
     The kit may further include blood transfer tubing with first and second spaced apart segments of large bore inlet tubing with respective spikes merging into a filter. The filter may have a filter chamber and an outlet that is attached to a third segment of large bore tubing that connects to the inlet tube of the valve body. 
     The kit may further include contrast agent tubing with first and second segments of inlet tubing, with at least one segment including large bore tubing, each having one end with a spike. The two sections may be connected by a two-way selector valve configured to attach to the inlet port for a cardiology infusion procedure. 
     The kit may further include a small bore tubing assembly with a length of small bore tubing having an inner diameter of between 3 mm to 1 mm configured to attach to the exit port of the valve body or be pre-attached to the exit port of the valve body in the kit, a clamp attached to the small bore tubing, a Y connector attaching adjacent ends of first and second lengths of the small bore tubing, and a syringe including pain medication held in a sterile package apart from the packaging holding the syringe with the pre-attached large bore tubing and valve body. The first and second lengths of small bore tubing each having a free end of the tubing, away from the Y connector, one with a male luer connector and one with a female luer connector. The syringe with the pain medication may be configured to releasably engage with the Y connector. 
     The kit may further include a small bore tubing assembly with a length of small bore tubing having an inner diameter of between 3 mm to 1 mm configured to attach to the exit port of the valve body. The small bore tubing assembly may have a male Luer connection on one end of the small bore tubing. 
     Is some embodiments, an infuser system includes a housing having a grip, a syringe with an interior fluid chamber and a plunger held by the housing, a shuttle configured to mechanically attach to the plunger of the syringe, an actuation lever in the housing that rotates around a fixed point, a return spring, a first one-way valve, and a second one-way valve. The actuation lever includes a first segment and a second segment. The second segment resides above the first segment and above the fixed point. The first segment of the actuation lever includes a trigger for actuation by a user from an extended position to a retracted position. The second segment of the actuation lever is attached to the shuttle to cause linear motion of the plunger in a first direction of the shuttle upon actuation of the trigger and rotation of the actuation lever about the fixed point. In operation, the first segment of the actuation lever travels between 1.5 and 3.5 inches between the extended and retracted positions while the plunger travels between 1.5 and 2.5 inches. The return spring acts between the housing and the actuation lever to bias return of the trigger to the extended position from the retracted position and rotation of the actuation lever therewith. The first one-way valve opens to fill the syringe with fluid from a fluid reservoir upon linear motion of the plunger in a second direction opposite the first direction, and closes upon actuation of the trigger and linear motion of the plunger in the first direction. The second one-way valve opens to dispense fluid from the syringe upon actuation of the trigger and linear motion of the plunger in the first direction, and closes upon linear motion of the plunger in the second direction. 
     The return spring may be connected to the actuation lever at a location that is within a first 25% of a total lever arm of the actuation lever. 
     The second segment of the actuation lever may include a cam path that is connected to the shuttle. 
     The second segment of the actuation lever may include a cam path that converts rotational motion of the actuation lever about the fixed point into an axial motion of the shuttle via a pin in communication with the cam path and a cooperating axial track. 
     The infuser system may further include a mechanical lock having two different diameters that travels within a cam path of varying width of the actuation lever such that the mechanical lock can be depressed into the cam path by a user to hold the actuation lever rigidly with the trigger in the retracted position to facilitate loading and unloading of the syringe in the housing. 
     The shuttle may be in communication with and may advance a ratchet wheel held by the housing that turns a dial visible to the user to indicate a number of times the trigger has been actuated and/or to indicate a volume of fluid dispensed from the syringe. 
     The infuser system may further include a display attached to the housing, an encoder that records start and end positions of multiple movements of the shuttle, and a processor in communication with the encoder and display that calculates and provides to the display a total distance travelled by the shuttle and/or a volume of fluid dispensed from the syringe. 
     The calculation and display of the total distance or volume of fluid dispensed can be reset by a user input. The processor may direct the infuser system to generate an audible and/or visual alert when total fluid dispensed reaches a user set limit. 
     The total distance and/or the volume of fluid dispensed may be displayed next to a pressure measurement taken from tubing downstream of the syringe supplying fluid to a patient. 
     The infuser system may further include a four bar linkage connected between the first segment of the actuation lever and the second segment of the actuation lever that operates upon actuation of the trigger to rotate the second segment of the actuation lever around the fixed point. 
     The infuser system may further include a ratchet and/or gear in the housing in communication with the trigger that operates upon actuation of the trigger to rotate the second segment of the actuation lever around the fixed point. 
     The infuser system may further include a pressure relief valve in fluid communication with the second one-way valve. The pressure relief valve may be configured to regulate pressure at which fluid is dispensed through the second one-way valve. The pressure relief valve may block fluid from being dispensed through the second one-way valve when a pressure exceeds a defined limit such that fluid is directed through the pressure relief valve. 
     The defined limit may be 300 PSI. 
     The infuser system may further include a length of small bore outlet tubing between the second one way valve and the pressure relief valve. 
     In some embodiments, a kit of components for a medical infusion includes a syringe having a syringe body, large bore tubing, a valve with an axially extending valve body with opposing first and second ends, an infusion device holding the syringe and valve body, and a package enclosing the infusion device holding the syringe attached to the valve body and the large bore tubing in a sterile condition to thereby provide components in a ready-to-use configuration. The syringe has a liquid chamber having a volumetric capacity in a range of 5 ml to 30 ml. The syringe has an external surface with visual indicia of volume and a plunger that can slidably extend into and retract at least partially from the syringe body. The large bore tubing has an inner diameter greater than 3 mm and less than or equal to 6 mm and a length in a range of 4 feet to 10 feet. The large bore tubing has opposing longitudinally spaced apart first and second ends. The valve body includes an inlet tube residing between the first and second ends of the valve body and an exit port on the first end of the valve body. The inlet tube is attached to the first end of the large bore tubing. The second end of the valve body resides inside the syringe and is in fluid communication with the liquid chamber. 
     The kit may further include blood transfer tubing with first and second spaced apart lines of large bore inlet tubing with respective spikes and thumb clamps on each line merging into a filter. The filter may have a filter chamber and an outlet that is attached to a third segment of large bore tubing that connects to the inlet tube of the valve body. 
     The kit may further include a small bore tubing assembly and a syringe comprising pain medication held in a sterile package apart from the packaging holding the syringe with the pre-attached large bore tubing and valve body. The small bore tubing assembly may have a length of small bore tubing having an inner diameter of between 3 mm to 1 mm configured to attach to the exit port of the valve body or be pre-attached to the exit port of the valve body in the kit, a clamp attached to the small bore tubing, a Y connector attaching adjacent ends of first and second lengths of the small bore tubing. The first and second lengths of small bore tubing may each have a free end of the tubing, away from the Y connector, one with a male luer connector and one with a female luer connector. The syringe with the pain medication may be configured to releasably engage with the Y connector. 
     In some embodiments, a method of infusing fluid to a subject includes providing a pre-assembled tubing set including at least a first segment of large bore tubing with a length between 3-12 feet with one end portion comprising a spike, providing an infusion fluid delivery device, attaching the pre-assembled tubing set to the infusion delivery device so that inlet tubing adjacent the infusion delivery device extends perpendicularly outward from an axially extending centerline of a syringe held by the infusion delivery device so that the inlet tubing adjacent the infusion delivery device is parallel to a flange of the syringe to place volume indicia of the syringe facing upward, and then repetitively, serially actuating a trigger to move a plunger of a syringe held by the infusion fluid delivery device in a first direction to intake fluid into a syringe, and then actuating the trigger to move the plunger of the syringe in a second opposing direction to dispense fluid from the syringe. 
     The actuating steps may be carried out to intake and dispense at least once to prime a fluid flow path extending between the large bore tubing and the syringe, then infusing the fluid from the syringe to a subject based on the actuating steps from a fluid source through the syringe into small bore tubing attached to the infusion delivery device to deliver the infusion fluid to a subject. 
     The pre-assembled tubing set may include the first segment of large bore tubing attached to a pouch of saline and a second segment of large bore tubing attached to a pouch of blood or blood product or contrast agent. The first and second segments may merge into a third segment of large bore tubing that may be attached to an inlet tube extending out a sidewall of a housing of the infusion delivery device. 
     The method may further include providing a length of small bore tubing with a Y connection attached to an exit port of a dual check valve held by the infusion delivery device, and injecting fluid and/or medication into a port of the small bore tubing prior to infusing the fluid to the subject. 
     The injecting may be carried out to inject a pain medication, optionally a buffered pain medication. 
     It is noted that aspects of the invention described with respect to one embodiment, may be incorporated in a different embodiment although not specifically described relative thereto. That is, all embodiments and/or features of any embodiment can be combined in any way and/or combination. Applicant reserves the right to change any originally filed claim or file any new claim accordingly, including the right to be able to amend any originally filed claim to depend from and/or incorporate any feature of any other claim although not originally claimed in that manner. These and other objects and/or aspects of the present invention are explained in detail in the specification set forth below. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The previous summary and the following detailed descriptions are to be read in view of the drawings, which illustrate particular exemplary embodiments and features as briefly described below. The summary and detailed descriptions, however, are not limited to only those embodiments and features explicitly illustrated. 
         FIG. 1  is a cross sectional view of a delivery mechanism according to at least one embodiment of the invention. 
         FIG. 2  is a side view of the delivery mechanism of  FIG. 1  according to embodiments of the invention. 
         FIG. 3  is an isometric view of the delivery mechanism of  FIGS. 1-2  according to embodiments of the invention. 
         FIG. 4  is a side view of the delivery system of  FIG. 1  in a closed position, showing an exemplary non-binding dimensional measurement according to embodiments of the invention. 
         FIG. 5  is a side view of the delivery system of  FIG. 1  in an open position, showing another exemplary non-binding dimensional measurement according to embodiments of the invention. 
         FIG. 6  is a perspective view of a shuttle mechanism of  FIG. 1  engaging the operator-end of a syringe plunger according to embodiments of the invention. 
         FIG. 7  is a perspective view of just the shuttle mechanism of  FIG. 6  according to embodiments of the invention. 
         FIG. 8A  is a view of a delivery mechanism having a tracking wheel for counting strokes of the trigger according to at least one embodiment according to embodiments of the invention. 
         FIG. 8B  is a close view of the tracking wheel of  FIG. 8A , taken along the plane of the wheel according to embodiments of the invention. 
         FIG. 8C  is a close view of gear and pawl devices of the tracking wheel of  FIGS. 8A and 8B  according to embodiments of the invention. 
         FIG. 8D  is a view of the gear and pawl devices of  FIG. 8C  shown in a more advanced counting position, the pawl shown engaged as when advancing the gear during forward advancement of the shuttle of the delivery mechanism according to embodiments of the invention. 
         FIG. 8E  is a view of the gear and pawl devices of  FIGS. 8C and 8D , the pawl shown disengaged as when allowing the shuttle to retract according to embodiments of the invention. 
         FIG. 9  is a view of a delivery mechanism of  FIGS. 1-3 , having an added pressure transducer and display according to embodiments of the invention. 
         FIG. 10  is a view of the delivery mechanism of  FIGS. 1-3 , having and added an encoder linked to the trigger to be used to determine trigger position and optionally to calculate or confirm a volume of liquid infused according to embodiments of the invention. 
         FIG. 11  is a cross sectional view of a powered delivery mechanism, according to at least one embodiment, having a powered shuttle advancement for dispensing fluid from a syringe according to embodiments of the invention. 
         FIG. 12  is a view of the motor and gear of  FIG. 11 , taken along the advancement axis, shown engaging the shuttle according to embodiments of the invention. 
         FIG. 13A  is a cross-sectional view of a mechanism for locking the lid of the delivery mechanism of  FIGS. 1-3  according to embodiments of the invention. 
         FIG. 13B  is an isometric view of the locking mechanism of  FIG. 13A  according to embodiments of the invention. 
         FIG. 14A  is an isometric view of another locking mechanism for locking the lid of the delivery mechanism of  FIGS. 1-3  according to embodiments of the invention. 
         FIG. 14B  is an isometric view of the locking mechanism of  FIG. 14A  unlocked and the lid of the delivery mechanism shown as open according to embodiments of the invention. 
         FIG. 15  is a cross-sectional view of a delivery mechanism having a four-bar advancement system shown in a retracted position of its shuttle mechanism ready for dispensing fluid from a syringe according to embodiments of the invention. 
         FIG. 16  is a cross-sectional view of the delivery mechanism of  FIG. 15A , shown with the four-bar advancement system shown in its shuttle-advanced position after dispensing fluid from a syringe according to embodiments of the invention. 
         FIG. 17  is a cross-sectional view of a delivery system with tubing and fluid bag attached for use according to embodiments of the invention. 
         FIG. 18  is a view depicting the delivery system of  FIG. 17  in use in a clinical environment according to embodiments of the invention. 
         FIG. 19A  is a top view of an example embodiment of a basic tubing set for an infusion device according to embodiments of the invention. 
         FIG. 19B  is an enlarged end view of the inlet tube relative to the syringe valve according to embodiments of the invention. 
         FIG. 19C  is a top view of the tubing set of  FIG. 19A  illustrating connected adaptor tubing according to embodiments of the invention. 
         FIG. 19D  is a top view of a set of components useful for treating a respective patient which can be provided in one or more packages according to embodiments of the invention. 
         FIG. 20  is a schematic illustration of an example embodiment of saline and blood product administration tubing according to embodiments of the invention. 
         FIG. 21  is a schematic illustration of an example embodiment of saline and contrast media tubing according to embodiments of the invention. 
         FIG. 22  is a side perspective view of an example embodiment of an infusion device according to embodiments of the invention. 
         FIG. 23A  is a top view of an example embodiment of a housing without a lid according to embodiments of the invention. 
         FIG. 23B  is a bottom view of an example embodiment of a lid of a housing according to embodiments of the invention. 
         FIG. 23C  is a side view of an example embodiment of a housing without an attached tubing set according to embodiments of the invention. 
         FIG. 24A  is an oblique front view of an example embodiment of a housing and lid according to embodiments of the invention. 
         FIG. 25  is a cross-sectional view of an example embodiment of a housing illustrating a latching mechanism according to embodiments of the invention. 
         FIG. 26A  is a schematic illustration of an infusion housing with a torsion spring and travel stop indicators of the housing according to embodiments of the invention. 
         FIG. 26B  is a side view of the infusion device shown in  FIG. 26A  according to embodiments of the invention. 
         FIG. 27A  is a schematic illustration of an example embodiment of a pulse lavage extension according to embodiments of the invention. 
         FIG. 27B  is a schematic illustration of an example embodiment of the pulse lavage extension illustrated in  FIG. 27A . 
         FIG. 28  is a schematic illustration of an example embodiment of an automated pump schematic according to embodiments of the invention. 
         FIG. 29  is a schematic illustration of an example embodiment of a motorized enclosure with an internal fluid bag according to embodiments of the invention. 
         FIG. 30  is a schematic illustration of an example embodiment of a motorized enclosure with an external fluid bag according to embodiments of the invention. 
         FIG. 31  is an isometric view of an example embodiment of a compact housing according to embodiments of the invention. 
         FIG. 32A  is a side view of an example embodiment of a compact housing in the open position according to embodiments of the invention. 
         FIG. 32B  is a side view of the example embodiment shown in  FIG. 32A  according to embodiments of the invention. 
         FIG. 33A  is a schematic illustration of another example embodiment of a compact housing according to embodiments of the invention. 
         FIG. 33B  is an enlarged view of an example embodiment for the compact housing of  FIG. 33A  of a syringe flange according to embodiments of the invention. 
         FIG. 33C  is an enlarged view of an example embodiment for optional locking tabs for the compact housing of  FIG. 33A  according to embodiments of the invention. 
         FIG. 33D  is an enlarged view of an example embodiment for optional detents of the compact housing of  FIG. 33A  according to embodiments of the invention. 
         FIG. 34  is an isometric view of an example embodiment of an additional compact housing configuration according to embodiments of the invention. 
         FIG. 35A  is a side view of an example embodiment of a lever of an infusion device in operative position, according to embodiments of the invention. 
         FIG. 35B  is a side view of the lever shown in  FIG. 35A , after breaking due to exertion of a force above a defined amount, according to embodiments of the invention. 
         FIG. 36A  is a side view of an example embodiment of a housing with the lever shown in  FIG. 35A  before the lever breaks according to embodiments of the invention. 
         FIG. 36B  is a side view of an example embodiment of the housing shown in  FIG. 36A  after the lever breaks according to embodiments of the invention. 
         FIG. 37A  is a side view of an example embodiment of a lever with a resettable hinge according to embodiments of the invention. 
         FIG. 37B  is a side view of the lever shown in  FIG. 37A  with the resettable hinge, after disengaging, according to embodiments of the invention. 
         FIG. 37C  is a cross-sectional view of the example embodiment of the lever with the resettable hinge shown in  FIG. 37A , according to embodiments of the invention. 
         FIG. 37D  is a side view of an example embodiment of a lever with a resettable hinge with a magnetic latch according to embodiments of the invention. 
         FIG. 37E  is a side view of the lever shown in  FIG. 37D  with the resettable hinge, after disengaging, according to embodiments of the invention. 
         FIG. 37F  is a partial cross-sectional view of the example embodiment of the lever with the resettable hinge shown in  FIG. 37D , according to embodiments of the invention. 
         FIG. 38  is a top view of an example embodiment of an outlet tubing set with a pressure relief valve that can be connected to a valve, according to embodiments of the invention. 
         FIG. 39A  is a partial schematic side view of an example embodiment of a pressure monitoring system, according to embodiments of the invention. 
         FIG. 39B  is a partial schematic side view of the pressure monitoring system of  FIG. 39A  shown in a locked position, according to embodiments of the invention. 
         FIG. 40  is a side view of an example embodiment of an infusion device with a syringe inside a housing, according to embodiments of the invention. 
         FIG. 41A  is a top view of an example embodiment of an infusion device with a housing with integrated or attached inlet tubing management features, according to embodiments of the invention. 
         FIG. 41B  is a side view the infusion device shown in  FIG. 41A , according to embodiments of the invention. 
         FIG. 41C  is a side view of an infusion device similar to that shown in  FIG. 41A , according to other embodiments of the invention. 
         FIG. 42  is a side view of example syringe bodies with varying volumes but with a constant stroke for infusion devices according to embodiments of the invention. 
         FIG. 43  is a side view of a syringe such as those shown in  FIG. 42 , illustrated with the plunger shown in the fully depressed and fully retracted (broken line) positions, according to embodiments of the invention. 
         FIG. 44  is a front view of example syringe bodies with different sizes for use in a common infusion device, according to embodiments of the invention. 
         FIG. 45A  is a partial schematic side view of an infusion device that can serially and interchangeably hold syringes with different volumes, according to embodiments of the invention. 
         FIG. 45B  is a top view of the infusion device in  FIG. 45A  containing a syringe of a first size and a syringe detection sensor configuration according to embodiments of the invention. 
         FIG. 45C  is a top view of the infusion device from  FIG. 45A  containing a syringe of a second size different from the syringe of the first size shown in  FIG. 45B , according to embodiments of the invention. 
         FIG. 45D  is a schematic view of a monitoring system for the infusion device of  FIGS. 45A-45C  configured to determine a size of a respective syringe, according to embodiments of the invention. 
         FIG. 46A  is a side view of an infusion device incorporating an electromechanical actuation member, according to embodiments of the invention. 
         FIG. 46B  is a side view of the infusion device of  FIG. 46A  with the trigger extended, according to embodiments of the invention. 
         FIG. 47A  is a side view of an embodiment of a handheld infusion device incorporating a motor, according to embodiments of the invention. 
         FIG. 47B  is a side view of the infusion device of  FIG. 47A  in a retracted position, according to embodiments of the invention. 
         FIG. 48A  is a side view of an embodiment of a handheld infusion device incorporating a linear actuator, according to embodiments of the invention. 
         FIG. 48B  is a side view of the infusion device of  FIG. 48A  in a retracted position, according to embodiments of the invention. 
         FIG. 49  is an isometric view of a container incorporating an infusion device, pain medication and an interosseous access system according to embodiments of the invention. 
         FIG. 50  illustrates exemplary operations for infusing fluid to a subject according to embodiments of the invention. 
     
    
    
     DETAILED DESCRIPTION 
     These descriptions are presented with sufficient details to provide an understanding of one or more particular embodiments of broader inventive subject matters. These descriptions expound upon and exemplify particular features of those particular embodiments without limiting the inventive subject matters to the explicitly described embodiments and features. Considerations in view of these descriptions will likely give rise to additional and similar embodiments and features without departing from the scope of the inventive subject matters. Although the term “step” may be expressly used or implied relating to features of processes or methods, no implication is made of any particular order or sequence among such expressed or implied steps unless an order or sequence is explicitly stated. 
     Any dimensions expressed or implied in the drawings and these descriptions are provided for exemplary purposes. Thus, not all embodiments within the scope of the drawings and these descriptions are made according to such exemplary dimensions. The drawings are not made necessarily to scale. Thus, not all embodiments within the scope of the drawings and these descriptions are made according to the apparent scale of the drawings with regard to relative dimensions in the drawings. However, for each drawing, at least one embodiment is made according to the apparent relative scale of the drawing. 
     Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the specification and relevant art and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein. Well-known functions or constructions may not be described in detail for brevity and/or clarity. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a,” “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. Like numbers typically refer to like elements throughout. In the figures, the thickness of certain lines, layers, components, elements or features may be exaggerated for clarity. As used herein, phrases such as “between X and Y” and “between about X and Y” should be interpreted to include X and Y. As used herein, phrases such as “between about X and Y” mean “between about X and about Y.” As used herein, phrases such as “from about X to Y” mean “from about X to about Y.” 
     The term “about” means that the recited parameter can vary from the noted value, typically by +/−20%. 
     The term “sterile” means that the noted device or material meets or exceeds defined medical guidelines (e.g., regulatory) of cleanliness such as those required by the U.S. Food and Drug Administration (FDA) and is substantially (if not totally) without contaminants so as to be suitable for medical uses. In some embodiments, sterile devices or materials may be provided in a sterile package such as, but not limited to, a flexible pouch. 
     The term “instructional media” refers to electronic and/or paper manuals, videos, user guides, or the like illustrating and/or describing operation of the debridement tool and/or the spinal facet debridement surgical procedure. 
     The term “large bore” refers to tubing or openings with an ID (inner diameter) between greater than 3 mm and less than or equal to 6 mm, typically greater than or equal to 3.5 mm and less than or equal to 6 mm. Large bore can be about 3.5 mm, about 4 mm, about 4.5 mm, about 5 mm, about 5.5 mm, or about 6 mm. The term “small bore” refers to tubing or openings with an ID between greater than or equal to 1 mm and less than or equal to 3 mm, typically between greater than or equal to 2 mm and less than or equal to 3 mm. 
     The term “pain medication” refers to analgesics and/or anesthetics, including medications comprising lidocaine, prilocaine, benzocaine, mepivicaine, etidocaine, articaine, bupivicaine, procaine, tetracaine, and/or marcaine. In some embodiments, a medical buffering solution may be added to pain medication to decrease pain experienced during administration of the pain medication. The medical buffering solution may include, for example, sodium bicarbonate, sodium hydroxide, calcium bicarbonate, magnesium oxide, potassium hydroxide, sodium carbonate, tris(hydroxylmethyl)aminomethane and the like. 
     The embodiments of the invention discussed herein may be used with both humans and animals. As such, the term “patient” refers to both human and animal patients. 
       FIGS. 1-5  depict a system  10  to infuse fluid. The system  10  may operate to infuse fluid from a syringe  48  in response to input from a user. In some embodiments, the syringe  48  may be serially interchangeable in the system  10 . The system  10  may accept various sizes of syringes  48 . For example, the system  10  can accept 5 ml, 10 ml, 15 ml, 20 ml, 25 ml, and 30 ml syringes  48 , though the present invention is not limited thereto. In some embodiments, the system  10  may be configured so as to allow the user to interchange a first syringe  48  of a first size with a second syringe  48  of a second size, different from the first size, during use of the system  10 . The syringe  48  can be integral to the system  10 , affixed thereto or releasably attached. 
     The system  10  may also include a stationary grip  39  for the user to grasp the system  10  during operation. As shown in  FIGS. 1-5 , the system  10  may include a trigger  37  accessible to the user while holding the grip  39 . The trigger  37  may be a manual/mechanical trigger  37  as shown in  FIGS. 1-5  or may comprise an electronic trigger  37 ′ (i.e.,  FIGS. 11, 47A ) which allows a user to intake and dispense fluid from the syringe  48 . In some embodiments, the trigger  37  can rotate about a fixed pivot point  53 . 
     The infusion device  10  can include a lever  52 . The upper part of the lever  52 U ( FIG. 4 ) is in communication with and/or includes a lever  52  containing a cam  52 C which may have a closed cam path  52 P that can change the rotational motion of the trigger  37  into axial motion of the shuttle mechanism  56 , which, in turn, holds the plunger  41 . A pin  57  or other attachment member can be fixed to the shuttle mechanism  56  and can travel along a track  52 T in response to interaction with a cam  52 C ( FIG. 4 ) of the lever  52 . A return spring  55  can return the trigger  37  to an extended open position ( FIG. 5 ) when firing is complete by actuation of the trigger  37  to the retracted position ( FIGS. 1-4 ). The return spring  55  can be connected close to the pivot point  53  on the lever  52  portion of the actuation trigger  37 , and also to the housing  62  and can be contained within a stationary grip  39  of the housing  62 . Trigger  37  is shown in a closed state in  FIGS. 1 and 4 . The shuttle mechanism  56  can have a slot  64  which accepts the outer end of the syringe plunger  41 . Slot  64  can be open at the top so a syringe  48  can be dropped in from above. The body of the syringe  48  can have a flange  40  which is held by a receiving slot  50  in the housing body (illustrated in  FIG. 22 ). This can hold the syringe  48  in place while the plunger  41  is actuated. A lid  42  can pivot open and close about a fixed pivot  63 , which allows access for the syringe  48  during loading, but protects the user from all moving parts during use. Lid  42  can be held down to the lower housing member  162  with magnets or other attachments or locks. A number of different features including, but not limited to, magnets, detents, latches or other mechanisms may also be used to secure the lid  42  to the housing  62 . The lid  42  may contain a lid cavity  42 C. An upper portion  52 U ( FIG. 4 ) of the lever  52  can be configured to travel up and down a distance of between about 1.25 inches and about 2.25 inches in the lid cavity  42 C during the use of the housing  62 . The lever  52  may have a stroke distance that is the same or no more than 20% longer than the stroke distance of the plunger  41 . As illustrated in  FIGS. 4 and 5 , the lever  52  may travel a stroke distance which may be a distance D 1  to a distance D 2  from a given point on the stationary grip  39 . In some embodiments, the stroke distance may be from 1.25 inches to 3.5 inches. A lock button  24  can be moved transversely by the user. When moved to the locked position, the trigger  37  will be held in the closed position as shown. When the lock button  24  is moved to the unlocked position, the trigger  37  is free to move unimpeded. This can be accomplished by a large diameter present on the lock button, which enters a large diameter circular cut-out in the trigger, locking the motion. When the lock button  24  is pushed to the “unlock” position, a smaller diameter in the lock button can align with the smaller diameter cut-out in the trigger to allow unimpeded motion. The syringe  48  can be connected to a dual check valve  31 . The inlet  34  of the dual check value  31  can allow fluid from the fluid reservoir to enter the syringe  48  when the plunger  41  is retracted. The outlet  32  of the dual check valve  31  can allow high pressure fluid to exit the syringe  48  when the plunger  41  is forcibly depressed, and travel to the patient. 
     Suitable dual check valves are currently manufactured by a number of suppliers in the medical field, including companies such as BBraun (B. Braun Medical Inc., Bethlehem, Pa.) and Merit (Merit Medical Systems, Inc., Salt Lake City, Utah). Non-exhaustive examples of possible valves include part numbers S5401086SN, S5401096SN, and S5069200N from BBraun and part numbers 500012002, 500012003, and 500012006 from Merit. These valves provide a variety of different connection methods to the inlet tubing, outlet tubing, as well as the syringe, including slip fit, luer fit, and tubing pocket fits. In some embodiments, the infusion system can be configured to reduce the resistance to flow on the exit and/or the inflow of the fluid into the syringe. Embodiments of the invention can also or alternatively be configured to reduce the amount of turbulent flow that occurs, especially when passing blood products through the tubing. To that end, appropriate valve designs may be utilized such as to reduce the resistance to fluid flow. Check valve designs such as ball check, diaphragm check, duckbill, lift check and/or flapper valves may be used to create the dual check valve configuration for operation. Ball and cage valves are another option which may be well suited for cycling blood. Additionally or alternatively, a split flapper valve can be used. The split flapper valve can be configured to pivot open in the center and can allow the fluid to travel in a straighter path, reducing resistance to flow. Alternatively or additionally, a split valve with two pivot points located outside the main fluid travel channel with the split located in the center of the channel can also allow the fluid to travel in a straighter path. Some valves mentioned above have small bore openings when going through luer fittings and other connections to the syringe and or tubing. A syringe with a large bore opening may be used to directly integrate into at least one of the valve housings, which may also reduce resistance to fluid flow and/or decrease turbulent flow. In some embodiments, large bore openings may also be used in all fluidic inlet and/or outlets from the dual check valve. 
       FIGS. 6 and 7  depict a shuttle mechanism  56  having a slot  64  which can hold the operator end of the syringe plunger  41 . Slot  64  can be configured such that the plunger  41  can be dropped into the shuttle mechanism  56  vertically from above, and then can actuate the plunger  41  while remaining in place in the shuttle mechanism  56 . A view of the shuttle mechanism  56  without the plunger  41  present is also shown. 
     The shuttle  56  can be approximately 1.5 inches in length, 1 inch in width, and 1 inch in height. The shuttle  56  can capture the syringe plunger  41  in a slot  64  positioned at its forward end, and can be connected to the lever  52  at its rear end by a 0.25 inch diameter pin, which further slides within two 0.25 inch slots which guide the shuttle  56  parallel to the long axis of the device. The shuttle  56  can have a small groove just large enough for the plunger  41  of a 5 ml, 10 ml, 20 ml or 30 ml syringe  48  to be dropped in from the top. In some embodiments, other syringe  48  sizes may be supported. The groove can be sized to capture more than 50% of the syringe plunger  41 . This can allow the syringe  48  to be dropped in freely from the top, but can securely capture the device during actuation. A similar groove can also present on the housing  62 , which can capture the body of the syringe  48 , and can allow the shuttle  56 , when moved back and forth, to actuate the syringe  48 . 
     In some embodiments, the volume of fluid dispensed from the syringe  48  can be electronically or mechanically tracked. There are multiple ways to track the volume of fluid being infused. For example, a mechanical counting mechanism can be integrated into the housing  62 , which can count each full closure of the trigger  37 . One embodiment of a mechanism is shown in  FIGS. 8A-8E . A spring loaded pawl  81  can push a gear  84  forward, at the completion of a stroke. The pawl  81  can push into a stop  82  while in air, or when advancing the gear  84 . When the shuttle  56  is being retracted, the pawl  81  can be allowed to rotate to clear gear teeth. The gear  84  can be connected to a dial wheel  85 , with an indicator arrow  86  outside the housing  62 , in a location visible to the user. The user can determine the number of times the device has been actuated by looking at markings  87  on the side of the housing. An additional set of gear teeth and ratchet can be incorporated into shaft  83  to prevent the wheel from moving backwards inadvertently. In  FIG. 8A  the dial wheel  85  can be in such a position that the indicator  86  is pointing at 0, which indicates the device has not yet been cycled. A wide variety of markings with corresponding gear sizes are possible.  FIGS. 8C-8E  show cross-sectional views. The user may also be able to reset the dial by pressing the dial down to bypass the additional gear teeth and ratchet and manually spinning the wheel to zero or another desired location. 
       FIG. 9  shows a display  90  integrated into the housing. The display  90  may show volume infused, number of a strokes completed, infusion pressure or other information to the user on a LCD screen, electronic ink, or other screen  91 . Buttons  92  may allow the user to choose set points, change units, and or reset the values displayed on the screen. In this configuration a pressure transducer  93  is shown in communication with the patient side of the tubing and connected to the display  90 . In some embodiments, a wired or wireless connection may be connected to this display  90  from an encoder tracking housing movement, or a processor calculating multiple parameters. In some embodiments, the housing may include an encoder in communication with the syringe, a processor in communication with the encoder. The processor may be configured to calculate a dispensed volume and provide the dispensed volume to the display  90 . In some embodiments, the processor may be configured to direct the device to generate an alert with a defined amount of fluid has been dispensed. In some embodiment, the buttons  92  may allow the user to set a desired target dispensed volume amount. In some embodiments, a priming amount of liquid can be electronically decremented from the dispensed volume or the user reset input can direct the processor to calculate the dispensed volume after a priming operation. 
       FIG. 10  is a cross sectional view of a housing mechanism including a rotary encoder. In this embodiment, an optical encoder wheel  75  can be mounted to the trigger  37 . The sensor can be mounted on the housing and may measure the location of the trigger  37 , shuttle  56  and plunger  41  as they move together. A linear encoder attached to the shuttle can be another embodiment of this configuration. In this case the sensor can remain on the housing  62 , but in a different location. Magnetic or other types of encoders can replace the optical encoders as alternate embodiments. The encoders can be connected electrically to a processor capable of calculating the total amount of travel, and can display that information to the user. The amount of travel can be used to calculate a volume of liquid infused. A zeroing button or other method of resetting the display can allow the user to start or stop the count at any point. Alternately the user may select a desired amount of fluid to infuse and the system may provide an auditory or visual alert when that level was reached, or nearly reached. 
       FIG. 11  depicts a system  600  with a powered (i.e., motor driven) injection mechanism. A motor  151  can actuate a series of gears, depicted as a rack  155  and pinion  154  in the embodiment shown, however a number of other gear combinations and configurations can be used, including a worm gear, a series of spur gears, planetary gears and/or bevel gears. The motor  151  is shown perpendicular to the motion of the shuttle travel, located in the grip  39 . Other locations for the motor  151  can include being parallel to the motion of the shuttle, above or below the track. The motor  151  can also be located proximal to the shuttle, at the back of the housing, or in front. The rack  155  is attached to a shuttle mechanism  156 . The shuttle mechanism  156  has a track  14  which holds the plunger  41  of the syringe  48 , and allows for axial motion of the plunger  41 . Multiple pins  157  can hold the shuttle mechanism  156  in position as the rack and pinion gears turn. The motor  151  may be either powered by a cable plugged into a standard outlet or a battery pack as depicted as  152 . A trigger  37 ′ can be an electronic control button or switch. The control button  37 ′ can allow the user to control the flow of fluid. Additional buttons can be added if the user desires additional control inputs, such as pressure or volume targets or limits. A processor such as a CPU  158  can be used to control the actions of the motor  151 , record performance, and/or modify performance based on additional inputs such as pressure transducers. An encoder or encoders can be integrated into the motor  151 , to calculate the position of the shuttle mechanism  156  at all times. Alternately a linear encoder may be placed on the shuttle  156 , with the sensor mounted on the housing  62 .  FIG. 12  depicts a closer view of the rack and pinion mechanism as shown from a rear view. 
     In  FIG. 13A , a cross section view is shown of the lid and a detent lever  127  to secure the lid  42  to the housing. A detent  125  on the lid  42  can have an interference fit with a groove on the housing  126 . The length of the detent lever  127  and amount of interference with the housing can allow the force to be tuned to a low enough level appropriate for a user to open the lid  42  when desired, but remain high enough to keep the lid in place during normal use. Ledges  128  can allow the user to gain additional leverage when releasing the detent  125  from the housing  62 .  FIG. 13B  is an isometric view of the same mechanism. The detent  125  can be on a single side of the housing  62 , or on both sides. 
     Alternately, other locks can be used, e.g., a two piece locking mechanism can allow the user to twist a knob to the “locked” position to hold the lid in place, and can be twisted to an “unlocked” position when the lid  42  can be released.  FIG. 14A  shows this mechanism with a lock knob  135  twisted into the locked position.  FIG. 14B  shows this mechanism with a lock knob  135  twisted into the unlocked position, and the lid  42  in an open position such that a syringe  48  may be loaded. Lock knob  135  can engage with lip  136  to hold the lid  42  in place. Additional features added to the housing  62  may limit the movement of the lock knob  135  such that the user may be able to find the unlocked and locked positions, and avoid over or under rotation. Magnets or other methods may also be used to secure the lid  42 . 
       FIG. 15  depicts a mechanical system with a four bar linkage system. The actuation lever  172  can be connected to the lever  52  with a cam path  52 P, and a cross link  171 . Cross link  171  can be connected to a fixed pivot point and a second cross link. The cam path  52 P can rotate about a second fixed point  173 .  FIG. 16  depicts the same system in a closed configuration. 
       FIGS. 17 and 18  depict a system in use in a clinical environment. The patient is shown lying on a table in  FIG. 18 . Tubing  100  can connected from a fluid bag to the patient, and the housing  62  is shown in the user&#39;s hand in  FIG. 18 . In this case the fluid is delivered through the patient&#39;s tibial plateau through an intraosseous port. A cross sectional view in  FIG. 18  shows an illustration of the fluid perfusion through the trabecular bone of the tibial plateau. Other configurations for connections to the patient may include, but are not limited to, using the system to connect directly to a peripheral catheter. Additionally, the system can be used for wound irrigation or other methods where direct connection to the patient is not required. The system shown in  FIGS. 17-18  generically represents any of the above described embodiments. 
       FIG. 19A  is a top view of an example embodiment of a basic tubing set  10 S for an infusion device  10  according to embodiments of the invention.  FIG. 19B  is an enlarged front view of the inlet tube  34  relative to the syringe  48  valve. An exemplary tubing set  10 S which includes a single-spike inlet tubing set  100  is described below. A 10 ml syringe  48  (or other sizes, such as 5 ml, 20 ml, or 30 ml, not shown) can be directly connected (e.g. pre-attached) to a dual check valve  31 , comprising two valves, an inlet valve  34  and an output valve  32 . The syringe  48  has a syringe body  48 B, a plunger  41  and a flange  40 . Large bore inlet tubing  100  with a length of about 2-12 feet can be attached directly to the inlet valve  34 , typically about 5 feet. In some embodiments, for example, lesser lengths or greater lengths may be used. Examples of bore tubing  100  lengths include 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12 feet, or greater. In some embodiments, the ID of the large bore inlet tubing  100  can be about 3.5 mm, about 4 mm, about 4.5 mm, about 5 mm, or about 6 mm. In some particular embodiments, the ID is about 4.3 mm. The other end of the inlet tubing  100  can be attached to an inlet spike  102 , which is compatible with standard IV fluid bags, among other containers, and includes a finger grip  101 , and inlet spike connection  103 . The output of the dual check valve  32  may be or comprise a male luer connection, which can allow connection to a multitude of currently available tubing. The inlet portion  34  of the dual check valve  31  can be lined up to be parallel with the indicia  38  on the syringe body  48 . The indicia  38  may provide visual indicia of a volume of the syringe  48 . In some embodiments, the visual indicia  38  of the volume of the syringe  48  may be a marking or other indicator in a graduated scale on an outer surface of the syringe  48 . The alignment of the indicia may allow the housing  62  to orient the inlet tubing  100  and/or inlet valve  34  such that the indicia  38  may be visible to the operator during use, to allow precise control of the amount of fluid infused into the patient. The inlet tube  34 T may be parallel and oriented to extend outward from either the right or left side. In the embodiment shown, the inlet tubing  100  is oriented to extend perpendicularly outward from the housing to the right. If the provider is standing on the right side of the patient and the fluid bag is near the patient&#39;s feet, this configuration can minimize clashing or looping of the inlet tubing  100  with the other activities being performed on the patient. Additional asymmetries may be present on the syringe body  48 , the check valve  31 , or tubing  100  to assist the user when aligning the syringe  48  into the housing  62 . Without this alignment feature, it may be possible for the user to place the indicia  38  on the syringe  48  such that they are not visible during use. This may go unnoticed during set-up, and the user may be reluctant to disassemble the system in order to make the indicia  38  visible if set-up incorrectly. Because this may be a usability concern, and usability is typically a concern for both the FDA and the International Organization for Standardization (ISO) when getting clearance for the use of medical devices, facilitating and/or forcing proper alignment during insertion of the syringe  48  as part of the design can avoid/address this issue. 
     Precisely controlling the distance between the syringe body  48  and the inlet tube  34 T with the inlet tubing  100  may allow for the housing  62  to encapsulate at least a sub-segment of the inlet tube  34 T attached to the inlet tubing  100  and/or valve tube holding the inlet tubing, and prevent the assembly of the device in an incorrect orientation. In the configuration shown, the inlet tube  34 T with the inlet tubing  100  can be at a distance D of between about 0.5 inches and about 0.9 inches from the end of the syringe. That is, an axially extending centerline of the inlet tube  34 T can be a distance D of between about 0.5 inches and about 0.9 inches from the discharge end of the syringe  48  which is attached to the check valve  31 . In some embodiments, the distance D is about 0.7 inches. Also shown in  FIG. 19A , the inlet tube  34 T with the inlet tubing  100  can be at a distance L of between about 2 inches and about 5 inches from the flange  40  of the syringe  48 , typically between about 3.25 inches and 4.25 inches. That is, an axially extending centerline of the inlet tube  34 T can be a distance L of between about 2 inches and about 5 inches from the flange  40  of the syringe  48 . In some embodiments, the distance L is about 3.75 inches. This configuration may additionally prevent, inhibit or reduce rotation of the tubing  100  during use, which can allow the user to avoid the clashing or catching of the inlet tubing  100  while performing other tasks related to the resuscitation of the patient. 
     To facilitate easier connections to the IV or IO needle, a set of adaptor tubing  109  may be used. This set of adaptor tubing  109  may be about 6 inches to 12 inches in length, in the configuration shown here, although longer lengths may also be used. In order to allow the injection of other fluids beyond the fluid in the previously mentioned IV fluid bag, a second set of adaptor tubing  109  may also be pre-attached or provided separately to connect to the output port  32  of the dual check valve  31 . The adaptor tubing can include a female luer connection  104 , which may be a needleless female luer connection, connected via a tubing pocket connection  106  to small bore tubing  109 . The female luer  104  may be connected directly to the output  32  of the check valve  31 . The small bore tubing  109  may connect directly to a male luer  112 , via another tubing pocket connection capable of withstanding high pressures. This male luer connection  112  can connect directly to an IV or IO placed into a patient. Alternatively, as shown in this figure, a Y connector  108  may be used. The Y connector  108  may contain a needleless female luer connection  107 . The Y connector  108  can allow direct connection to a syringe containing other fluids which may be injected into the patient, or may also be used for a gravity feed IV line.  FIG. 19C  is a top view of the tubing set of  FIG. 19A  illustrating adaptor tubing  109  connected to the output  32  of the check valve  31 . 
     One or more thumb clamps  110  may be present to stop the flow of fluid. If needed, the set of adaptor tubing  109  described above may be removed from the infusing tubing, and remain with the patient when transferring from an ambulance to a hospital, or other situations. 
     The tubing set  10 S can be provided in a ready-to-use kit  10 K. The kit  10 K can include at least one package that holds the tubing set  10 S in a sterile condition. The kit  10 K can include instructional media  8 . The instructional media  8  can be provided either electronically and/or in paper form that facilitates proper use, assembly, and/or training of the tubing set  10 S. The media can include a suitably descriptive title and/or label identifying the content as instructions/training material for the tubing set  10 S. Electronic instructional media  8  can include a video or electronic instructional manual that can be shown on a display. The instructional media  8  can be provided via the Internet such as at a hosted internet portal/site, via an APP for a smart phone, computer, electronic notebook or tablet and the like, typically via the use of an icon with defined functionality as is known to those of skill in the art. Paper instructional media  8  can include a paper user manual or booklet such as an instructional manual showing proper usage of the tubing set  10 S. 
       FIG. 19D  is a top view of a set of components useful for treating a respective patient which can be provided in one or more packages, typically in a single external package  10 K holding multiple internal sterile kit packages  10 K 1 ,  10 K 2 . As shown, the set of components can include at least one pre-filled syringe  901 , which can optionally comprise first and second separate pre-filled syringes  901 , 911  of different substances along with a tubing set  10 S having or attachable to the infusion syringe  48  according to embodiments of the invention. In some embodiments, the set of components can be provided as a kit  10 K that can comprise a first sterile package which provides the tubing set  10 S and at least one other (i.e., a second) sterile kit package with the at least one pre-filled syringe  901  and/or  911  comprising medication that can be administered to a respective patient with the tubing set  10 S. The at least one pre-filled syringe  901  can comprise a local anesthetic. Where more than one pre-filled syringe  901 ,  911  is included, the second pre-filled syringe  911  can comprise a buffering agent that can be mixed in situ with the local anesthetic and delivered via outlet tubing of the tubing set  10 S to a patient. 
     The pre-filled syringes  901 ,  911  may be provided in one package within a single kit  10 K, or may be provided in separate packages which are external to, separate from, or attached to a package of the kit  10 K holding the tubing set  10 S. In some embodiments, the kit  10 K may comprise one sterile package (indicated by the broken line perimeter about the set of components) which includes both the syringes  901 ,  911  and the tubing set  10 S. In some embodiments, the kit  10 K may comprise a first sterile package  10 K 1  with the tubing set  10 S and a separate second sterile package  10 K 2  with a pre-filled syringe  901  for local pain relief, optionally with the buffering agent pre-filled syringe  911  in the second package  10 K 2  or in a third package holding only the buffering agent syringe  911 . One or more pre-filled syringes  901  can comprise lidocaine, or other local anesthetic, and may be packaged in a single kit package  10 K 1  along with the tubing set  10 S. In some embodiments, the kit  10 K can provide a kit package  10 K 1  for the tubing set  10 S and a separate at least one kit package  10 K 2  containing one, or both, pre-filled syringes  901 ,  911 , at least one of which is a pre-filled syringe  901  containing a local anesthetic, such as lidocaine, and at least one of which is a pre-filled syringe  911  containing a buffering agent, such as sodium bicarbonate. 
       FIG. 20  is a schematic illustration of an example embodiment of saline and blood product administration tubing according to embodiments of the invention. When transferring blood into a patient, additional configurations of tubing sets  200  may be used. In the configuration shown, tubing set  200  is capable of transferring blood and blood products to a patient. Two inlet spikes  202  are connected to two fluid bags,  201  and  212 . One bag  201  can contain blood or blood products, while a second bag  212  contains saline or other similar fluids. As used herein, blood products can include products derived from blood including platelets, plasma, plasma derivatives, cryoprecipitated antihemophilic factor, and red blood cells, though the present invention is not limited thereto. In order to selectively isolate each bag, two clamps  203  and  211  can be provided, one on each inlet line  217  and  218 . These clamps  203 ,  211  may be roller clamps which can both limit and fully shut off the tubing, and/or a thumb clamp which can only be fully opened or fully closed. The inlet tubing  217  and  218  may be large bore tubing, typically about 4.3 mm inner diameter. The two inlet tubes  217 ,  218  may be joined at a Y connection  204 , which may be configured to have reduced or no restrictions to flow. The fluid may then pass through a filter  205  and may continue through a common inlet tube  216  to the dual check valve  31 . In the configuration shown, a large bore connection  208  with little or no narrowing (e.g., a constant inner diameter connection) may be present between the dual check valve  31  and the syringe  48 . The fluid can exit the outlet  215 , which is a male luer connection. This connection may be connected to adaptor tubing  109  ( FIG. 19A ) previously described. 
     This tubing  216  can be primed with saline by connecting one inlet spike  202  to a bag of saline  212  or similar fluid, and opening all clamps and allowing fluid to flow through the entire system, using both gravity and cycling the syringe plunger  41 . After the system is (fully) primed, the second inlet spike  202  can be placed into a bag containing blood products  201 . The user can then select either the blood or, for example, saline to infuse, and open the appropriate clamp,  203  or  211 . If roller clamps  203  are used, the user may set the clamps such that a tunable mixture of both blood and, for example, saline is pulled into the inlet tubing  216 . Once the bag of blood products  201  is fully emptied the bag of saline or other fluid  212  may be used to flush the remaining blood products present in the tubing  216 . A new bag of blood  201  and/or saline or other similar fluid may be attached to the system via a sterile technique, if desired by the user. 
       FIG. 21  is a schematic illustration of an example embodiment of saline and contrast media tubing according to embodiments of the invention. A manually-activated syringe  48  with a connection for saline and contrast media can be used in interventional cardiology procedures to administer contrast media when performing heart surgery through the use of catheters. In this embodiment, contrast tubing  250  can include two large bore inlet tubes  217  and  218 . In another embodiment, inlet tube  217  may be small bore tubing. Inlet tube  217  can be connected to a container of contrast media  229  via a vented spike  225 . Contrast media is typically provided in hard glass bottles of about 150 ml. A second inlet spike  202  can connect to a fluid bag filled with saline or other products  230 . The two inlet tubes  217 , 218  can connect at a two way selector valve  226 . This two-way selector valve  226  can allow the user to select between the two different fluids when infusing into the patient. In some embodiments, the two-way selector valve  226  can reside to the side of the dual check valve  31 . In some embodiments, the two-way selector valve  226  can be present on the side of the housing  62 , within closer reach of the actuation mechanism (e.g. trigger  37 ,  FIG. 22 ) on the housing  62 . This configuration can have a further length of inlet tubing which can fluidly couple the two-way selector valve  226  to the dual check valve  31 . The dual check valve  31  can be connected to a syringe  48 , which can be between 30 ml and 5 ml in size. At the exit of the dual check valve  31  a pressure transducer  227  can be present to measure the pressure of the fluid. Smaller diameter (smaller than the inlet tubing) exit tubing  228  can transfer the fluid to a needleless Y valve  231 , and then to a male luer connection  232 . The male luer connection  232  can be used to connect to a cardiac catheter. 
       FIG. 22  is a side perspective view of an example embodiment of an infusion device according to embodiments of the invention. The inlet portion  34  of the dual check valve  31  can be lined up to be parallel with the volume indicia  38  on the syringe body  48 . This alignment allows the housing  62  to orient the tubing set such that the volume indicia  38  is visible to the operator during use, to allow precise control of the amount of fluid infused into the patient. The inlet portion  34  may be oriented to extend out of either the right or left side. In the configuration shown, the inlet tubing is oriented to the right. The syringe  48  fits in slots in the housing  62 , with the plunger  41  captured in the shuttle  56 . Additional asymmetries may be present on the syringe body  48 , the dual check valve  31 , or tubing to assist the user when aligning the syringe  48  into the housing  62 . Without this alignment feature, it may be possible for the user to place the volume indicia  38  on the syringe  48  such that the volume indicia  38  are not visible during use. As noted above, this may go unnoticed during set-up, and the user may be reluctant to disassemble the system in order to make the indicia  38  visible. Because this is a usability concern, and usability is typically a concern for both the FDA and ISO when getting clearance for the use of medical devices, facilitating or forcing proper alignment during insertion of the syringe  48  as part of the design can address this issue. 
     In some embodiments, precisely controlling the distance between the syringe body  48  and the inlet tube  34 T with the inlet tubing  100  can allow for the housing  62  to encapsulate at least a sub-segment or portion of the inlet tube  34 T with the inlet tubing  100 , and can inhibit or prevent the assembly of the device from resulting in an incorrect orientation. In the configuration shown, the inlet tube  34 T with the tubing  100  is at a distance of between 0.5 inches and 0.9 inches from the end of the syringe  48 . This configuration can also inhibit or prevent rotation of the tubing during use which allows the user to avoid clashing or catching of the inlet tubing  100  while performing other tasks related to the resuscitation of the patient. 
       FIG. 22  shows the check valve  31  of the tubing set  10 S loaded within the housing  62 , and the lid  42  open. A dual check valve assembly  31  with an inlet  34  and outlet  32  is connected to a syringe  48 . The connection between the syringe  48  and check valve  31  may be a male/female luer connection, or it may be a large bore custom connection. The inlet  34  is aligned to be parallel with the flange  40  of the syringe  48 , and positioned such that the volume indicia  38  are visible when viewed from above, and the inlet tubing  100  extends out to the right. Alternate configurations include having the inlet tubing  100  extending out to the left, or at the bottom of the housing  162 . There can be specific cutouts  33 ,  46  in the housing  62  to receive the syringe  48  and check valve  31 . One housing cutout  33  (to be clear “cutout” refers to an aperture or access opening) in the sidewall can encircle inlet tubing  34 , a second cutout  46  in the tip can reside about outlet  32 . The cutouts can be entirely in the lower housing  162 , entirely in the lid  42 , or provided as pairs of cutouts in the lid  42  and lower housing  162  that face each other. The sidewall aperture for the inlet tube  34 T can be circular (typically semi-circular in the upper and lower housing members) and can be on a right and/or left side. In some embodiments, the apertures can be other shapes, such as, for example, rectangular, triangular, oval, and the like. The sidewall aperture can be larger or smaller than the tip aperture for outlet  32 . 
     There can be corresponding cutouts  45 ,  46  in the lid  42  which, together with the lower housing  162  cutouts, can completely encircle the inlet tube  34 T and the valve outlet  32 , and can ensure the desired orientation of the inlet tubing  100 , indicia  38  and syringe  48  when assembled. There can be additional features in both the lower housing  162  and lid  42  to receive and secure the syringe  48 . A slot  50  in the housing  62 , typically the lower housing  162 , can receive the flange  40 . A circular cutout  35  can be sized and configured to receive the connection between the check valve body  31  and syringe  48 . There can be corresponding cutouts in the lid  42  to receive these two features as well. As shown, the lid  42  can have latch features  47  which secure the lid  42  to the housing  62  via latch points  36 . When latched, the lid  42  can hold the syringe  48  securely in place in one orientation, and also can protect and orient the check valve  31 . The lid can prevent rotation of the syringe  48  by trapping the flange  40 . The latch  47  can be released by a user when desired by squeezing the two latch extensions  51  simultaneously, allowing the latch  47  to release the corresponding latch points  36 . The latch extensions  51  can be visually evident to the user by one or more features. Shown in  FIG. 22  is a scalloped cut in the lid  42  at the location of the latch extension  51 , and two downwardly extending slots  44 . The slots  44  can serve a second purpose, to reduce the bending force required to release the latches. The lid  42 , can be visually transmissive, typically transparent, and may have a highly polished window  43  which may allow easy visualization of the syringe  48  and its contents during use. The syringe  48  can be activated by moving a trigger  37 , while holding a grip  39 . The trigger  37  can be connected via a cam path  52 P to a shuttle  56 , which can actuate the plunger  41 . 
       FIG. 23A  is a top view of an example embodiment of a housing  62  without a lid  42  according to embodiments of the invention.  FIG. 23B  is a bottom view of an example embodiment of the lid  42  of the housing  62 .  FIG. 23C  is a side view of an example embodiment of a housing  62  without an attached tubing set. These illustrations show the features that interact with and restrain the syringe  48 , check valve  31 , and inlet tubing  100  during use. As shown in  FIG. 23A , the receiving slot  50  for the syringe flange  40  can be seen in the housing  62 . Support ribs  193  located on the lid  42  can also serve to locate and restrain the syringe flange  40 . Flats present on both the receiving slot  50  and support ribs  193  serve to prevent rotation of the syringe flange  40 . Adjacent to this slot  50  is a circular recess  48 C for the body of the syringe  48 . Latch points  36  can also be seen in this view, as well as the cutout  35  that receives the syringe tip. A chamber  31 C surrounds the dual check valve  31  and can provide protection and orientation guidance. This chamber  31 C can have three exits, syringe neck or tip cutout  35 , inlet cutout  33  and exit cutout  46 , which can allow the syringe tip, dual check valve inlet  34  and dual check valve outlet  32  to pass through. A midline of the inlet cutout  33  may be a distance L from the receiving slot  50 . In some embodiments, the distance L may be between about 2 and about 5 inches, typically between about 3.25 inches and 4.25 inches. In some embodiments, L is 3.75 inches. Some or all of same features can be located on the lid  42  as well. Shuttle  56  can move back and forth to move the syringe plunger  41  during use. The syringe plunger  41  can fit into receiving slot  64 , and the shuttle  56  may be moved by the lever  52 , which can transfer movement from the user&#39;s hand. A cam path  52 P on the lever  52  can transfer force through a glide pin bushing  190 B, into a glide pin  190 , and then into the shuttle  56 . A fixed pivot  63  can allow for rotation of the lid  42  through a pivot point  63 P. 
     In this embodiment, syringe tip cutout  35 , receiving slot  50 , and the support ribs  193  are the main points of contact which can mechanically restrain the tubing set  10 S during use. 
       FIG. 24A  is an oblique front view of an example embodiment of a housing and lid according to embodiments of the invention. In this oblique isometric view the opening for the inlet valve  33 , opening for dual check valve exit  46  and cutout  35  for syringe tip are visible from a different angle, without the tubing present. 
       FIG. 25  is a cross-sectional view of an example embodiment of a housing illustrating a latching mechanism according to embodiments of the invention. The lid latch  47  can overlap engagement catch  60  such that a vertical force or side force will not inadvertently open the lid  42 . Latch extensions  51  can allow users to press on the sides of the latches to release. Side slots  44  may be used to decrease the force required to release the latch  47 . The tabs  163  which can hold the syringe flange  40  in place can also be seen in this view. The plunger  41  of the syringe  48  is also visible in the view. These can be supported by a support rib  62 S in the housing  62 . A side view of the pin lock  61  is also visible. 
       FIGS. 26A and 26B  show side views with an embodiment containing a torsion spring  657  instead of an extension spring.  FIG. 26B  is another side view of the torsion spring  657  and travel stop indicators of the housing  62 . As shown, the torsion spring  657  can have one anchor point  654  on the lever  52 , and another point on the handle  656 . The central loop of the torsion spring  657  is shown outside of the trigger pivot  53 , but it may also be centered around the trigger pivot  53 . It may also be useful for the user to get audible and/or tactile feedback when the trigger  37  reaches full open and full closed position. There are multiple ways to accomplish this. An embodiment illustrated in these figures is the use of small tabs  655 ,  652  which can interfere with the actuation trigger. The rectangular tabs can be stiff, but can allow buckling at a certain amount of deflection, this buckling can provide both an audible and tactile feedback. One tab can indicate full open  655  or full closed positions  652 , or any other desired position within the range of travel of the actuation trigger  37 . Other detent designs or alternatives may also be used to indicate these positions. Two configurations are shown in these figures: full open ( FIG. 26B ) and full closed ( FIG. 26A ). In the full open position, the full open tab  655  is shown in the deflected state, and the torsion spring  657  is shown in the fully compressed state. In the full closed position, the full closed detent  652  is shown deflected and the torsion spring  657  is partially compressed. 
     In some embodiments, a cutout  651  for a lock, such as lock  24  illustrated in  FIG. 1 , can facilitate locking of the actuation trigger  37 . 
       FIG. 27A  is a schematic illustration of an example embodiment of a pulse lavage extension according to embodiments of the invention.  FIG. 27B  is a schematic illustration of an example embodiment of the pulse lavage extension illustrated in  FIG. 27A . A pulse lavage system  275  may be attached to an IV bag and can be actuated by the dispenser housing  62 . A female luer connection  277  can be compatible with the dual check valve outlet port  32 . This can be connected by either flexible or rigid extension tubing  276  to fluidly couple the dual check valve  31  to the exit nozzle  279 . The exit nozzle  279  includes a gradually narrowing opening configured to accelerate fluid to a high velocity at exit, to assist with lavage of tissue. The shape of this exit nozzle  279  may be a simple circular opening or an oblong oval shape, depending on user desire. A protective nose cone  278  can prevent splash back from exiting the target area. The handle of the device can be squeezed, which can force water or other sterile fluid through the exit nozzle  279 , resulting in a high pressure flow. The high pressure flow can be directed at a wound requiring debridement. The trigger  37 ,  37 ′ can be repeatedly cycled to refill automatically through the attached IV bag, connected to the inlet tubing via a spike (not shown). 
       FIG. 28  is a schematic illustration of an example embodiment of an automated pump schematic according to embodiments of the invention. 
     Other embodiments contemplate a motorized version of the infusion system  1100 , utilizing a syringe  48  and tubing  100 , but the plunger  41  is moved linearly by the action of a motor rather than manually. In some embodiments, the tubing set may be identical to the previously disclosed tubing set  10 S ( FIG. 19A ), having an inlet spike  102 , large bore tubing  100  about 5 feet in length, a dual check valve  31  and a syringe  48  (e.g., having a volume between 5 ml to 30 ml), which may or may not be connected to extension tubing. In some embodiments, the tubing set may have much shorter inlet tubing  1113  (0.5 feet-3 feet) and the inlet tubing may be large bore, or may be traditional smaller bore tubing. In other embodiments, two bags of fluid may be connected to a single syringe pump, with a Y joint and clamps to selectively control which bag provides fluid at any one time. 
     A motor pack  1101  may be used to actuate the plunger  41  on the syringe  48 . The motorized system  1100  can have a slot  1102  for retaining the syringe  48 , and an asymmetric orientation to ensure the tubing is properly oriented when placing for use. The syringe  48  can be held in a vertical position to facilitate the elimination of air bubbles while the system is being primed. The syringe  48  can be actuated by a motor linked by gears to create linear motion of the plunger  41 . The motor output can drive an actuator  1103  up and down an actuator track  1114 . The motor output may be controlled with several different control methods. In one embodiment the motor can be displacement controlled such that the motor torque output can be adjusted continuously to achieve a known fluid delivery rate. In another embodiment the motor may be current controlled such that it applies a known torque which generates a constant vacuum pressure and constant output pressure. In this case, the fluid infusion rate can vary, but the user can know that fluid is being infused at a known pressure, and can know if the line is blocked or not placed properly in the patient. It may also be possible to vary the torque applied so that the vacuum pressure created by motor retracting the syringe  48  can be at a different set point than the output pressure, created by the motor advancing the syringe  48 . It may be advantageous to allow user selection of the desired output pressure, while maintaining a single vacuum pressure for maximum refill rate. 
     When using the motorized device the user can insert the inlet spike  1115  into a bag of fluid  1112  (saline, blood products, or other necessary fluid). The syringe  48  can be placed into the slot  1102  on the motorized system  1100 . In one embodiment, the bag  1112  can be placed with the outlets pointing down in a traditional manner. In another embodiment, the bag of fluid  1112  can be placed with the spike  1115  facing upwards in the motorized system  1100 , which can allow the user to purge the air from the system while all components were secured into the system. The system may have a sensor which detects the presence of a syringe  48  loaded into the slot  1102 . They system may also have an RFID  1116 , barcode, or other information on the body of the syringe which can provide information to the motorized system  1100  about the type of tubing inserted. The lid, lids, or other retaining features, can be closed to secure the fluid bag  1112  and the syringe  48 . The lid, lids or other retaining features can have sensors which detect the proper closure of the system. Once the system detects that a certain tubing set has been properly secured, lights  1119  can illuminate the fluid bag  1112  to assist in the visual identification of any air bubbles present in the bag. A “purge” button may be depressed, which can cycle the plunger  41  at a slow and low torque until the user determined that all air had been removed from the fluid bag  1112 , and the user can then release the purge button. Lights  1120  can then illuminate the vertical syringe  48 . Tue user can again depress the purge button  1131  until all air bubbles are eliminated from the syringe  48  and any attached tubing. The tubing can then be connected to the patient, and infusion can begin. 
     In some embodiments, the fluid bags  1112  may be hung outside the motorized system  1100 , and the entire unit placed on a stand near the patient, or hung from an IV pole near the patient. 
       FIG. 29  is a schematic illustration of an example embodiment of a motorized enclosure with an internal fluid bag according to embodiments of the invention.  FIG. 30  is a schematic illustration of an example embodiment of a motorized enclosure with an external fluid bag according to embodiments of the invention. 
     In one embodiment, the user may select a known infusion rate, and/or a known infusion volume in the input screen  1130 , and press the “infuse” button  1132 . In another embodiment, the user can manually hold the infuse button  1132  down in order to keep fluid flowing. 
     In some embodiments, a user may manually select a desired input pressure and total infusion volume in the input screen  1130  and press the infuse button  1132 . In a fourth embodiment, the user may select the type of access present on the patient, such as IV, IO, central line, and then select the size of the appropriate access type (i.e. IV—20 gauge, or Central line—4 French). In this case, the computer (e.g., at least one processor) can select an appropriate input pressure based on preprogrammed set points which correspond to each access type. While the system is infusing a display screen  1130  may indicate one or more of the following: total fluid infused, current infusion pressure, current infusion rate, average infusion rate, patient access type and size selected, tubing type present in system, among other pertinent information. 
     Other embodiments may include the use of a counter that automatically tracks the amount of fluid infused and operates with a “setpoint”  1133  that provides an audible and visual alarm when the desired setpoint is reached. A “reset” button  1134  may also be used to re-zero the counter, if some fluid was used for priming or other purposes that did not reach the patient. A display  1130  showing the setpoint and current amount infused, next to a set of up/down buttons for the setpoint  1133  and a reset button  1134 , can provide this functionality. 
     In some embodiments, a motorized enclosure can receive power from a battery pack  1137  and/or a power connector  1138 . The enclosure may include a stand  1135  and/or a cover  1136 . 
     Another configuration may have fewer components and have a smaller profile.  FIG. 31  is an isometric view of an example embodiment of a compact housing according to embodiments of the invention.  FIG. 31  shows system  299 . This system can include a syringe  48  and dual check valve  31 . Other two-valve systems may be used instead of a dual check valve  31 . The syringe  48  can have a flange  40 , and a plunger  41 . The plunger  41  can have a feature at the distal end with a cross bar  365  and a second cross bar  366 , held together by two connecting ribs  358 . These features and/or components can create a bracket  354  with an opening which can allow a curved actuation member  352  to move the plunger  41  linearly in and out, as a result of a rotational movement of actuation lever  353  generated by the user grabbing loop trigger  37 . The cross bars  365 ,  366  can be cylindrical to allow sliding with minimal friction when sliding against the actuation member  352 . This configuration can eliminate the need for a separate piece acting as a shuttle. The cross bars  365 ,  366  may be alternately constructed of, for example, a lubricious plastic, a plastic core with a metal sleeve on the exterior, a metal rod surrounded by a plastic exterior, and/or a solid metal piece. 
     The actuation lever  353  can be connected via a pivot point to the rigid grip  39 . A torsion spring  355  can bias the actuation lever  353  to the open position. The torsion spring  355  may be covered by a torsion spring cover  368  to keep contamination out of the torsion spring, or the torsion spring may be exposed. Alternately, or additionally, a leaf spring may be used to bias open the actuation lever  353 . The leaf spring may connect to the bottom of the loop trigger  37  and also the bottom of the rigid grip  39 , and contain a joint near the pivot point created by the grip  39  and actuation lever  353 . The rigid grip  39  can be continuously connected to a holding mount  363 , which can have a receiving slot  364 . The receiving slot  364  may be sized to receive the syringe flange  40 . The receiving slot  364  and syringe flange  40  may have an asymmetry present to force the user to assemble the housing and tubing assemblies together in a single orientation. There may be a rotating tab or other locking feature which can trap the syringe  48  inside the holding mount  363  when the locking feature is deployed by the user. The rigid grip  39  may also have an extension  367  which allows stop pins  359 , to provide a consistent stopping point for the actuation lever  353 . The location of the stop pins  359  can be correlated with a desired syringe volume. The stop pins  359  can also be used as a pivot point for the housing. 
       FIG. 32A  is a side view of an example embodiment of a compact housing in the open position according to embodiments of the invention.  FIG. 32B  is a side view of the example embodiment shown in  FIG. 32A  according to embodiments of the invention. These figures show detailed views of the torsion spring  657 . A protrusion of the rigid handle  658  can form the pivot point for the actuation lever  353 . A first leg  656  of the torsion spring  657  is anchored in the pivot protrusion  658 , and a second leg  654  is anchored in the actuation lever  353 . The torsion spring  657  biases the actuation lever  353  into the open position. In both of these views the extension  367  and stop pins  359  are not shown. 
       FIG. 33A  is a schematic illustration of another example embodiment of a compact housing according to embodiments of the invention. The outer cover  370  can have holes  371  which receive the stop pins  359 . The cover  370  can pivot about these pins  359 , and this can allow the user to place the syringe  48  into the receiving slots  364  when the cover  370  is pivoted open, and can capture and hold the syringe  48  in place when closed. Locking tabs  372  or other features can be used to hold the outer cover  370  in place.  FIG. 33C  is an enlarged view of an example embodiment for optional locking tabs  372  for the compact housing of  FIG. 33A  according to embodiments of the invention. The locking tabs  372  may be located near or on the holding mount  363 . The outer cover  370  may be removed entirely if desired for the user for greater access, or for cleaning between procedures through a variety of methods. The user may pry apart the outer cover  370  at the holes  371 , which can allow the cover  370  to be removed from the stop pins  359 .  FIG. 33D  is an enlarged view of an example embodiment for optional detents  373  of the compact housing of  FIG. 33A  according to embodiments of the invention. In these embodiments, the holes  371  may have channels with detents  373 , which can allow the user to pull the outer cover  370  off when pivoted to the open position.  FIG. 33A  also shows a torsion spring cover  368 . 
       FIG. 33B  is an enlarged view of an example embodiment for the compact housing of  FIG. 33A  of a syringe flange  40  according to embodiments of the invention.  FIG. 33B  shows one possible asymmetry  372  which may be present in the syringe flange  40 , and can be used to control orientation during use. A corresponding mating feature can be present in the receiving slot  364 . 
       FIG. 34  is an isometric view of an example embodiment of an additional compact housing configuration according to embodiments of the invention. This configuration can have a loop trigger  37  and grip  39 . The grip  39  can be part of a housing  304 . The housing  304  can include two halves which may be sealed together via a seal  303 . The shuttle  300  is shown on the exterior of the housing  304 . As in other configurations the shuttle  300  can have a receiving slot  314  which receives the plunger  312  of a syringe  313 . However the shuttle  300  can be connected by a cylinder  301  to the driving mechanism within the housing  304 . The cylinder  301  can be sealed by an o-ring  302  or other component which can prevent or reduce water and other fluids from entering the housing  304 . The syringe flange can have a feature which includes leg extensions  311  and placement tabs  310 . The placement tabs can be configured to fit into receiving tabs  309  present on the exterior of the housing  304 . The receiving tabs  309  can hold the syringe  313  in place during use, and the leg extensions  311  can provide a natural boundary when the shuttle  300  is moving linearly to cycle the syringe plunger  312 . The user can drop the syringe  313  vertically into both the receiving slot  314  and receiving tabs  309  before use. A pin lock  306  may be used to hold the loop trigger  37  and actuation lever  353  in a desired position, which can result in the shuttle  300  being pre-aligned with the plunger  312 . A variety of previously disclosed actuation mechanisms may be used to actuate the shuttle motion. 
       FIG. 35A  is a side view of an example embodiment of a lever  52  of an infusion device in operative position, according to embodiments of the invention. The lever  52  engages the shuttle mechanism as described above.  FIG. 35A  depicts the lever  52  with a narrow segment of material  753  having a defined width dimension X measured from an outer perimeter of the lever  52  to a line drawn tangent to an aperture  700 . The dimension X of the narrow segment of material  753  may range from 0.01 inches to 0.15 inches though the present invention is not limited thereto. The narrow segment of material  753  may extend between an upper segment of the lever  52  and a lower segment  752  in or attached to the lever  52  which can disengage, break, and/or deform if an input force greater than a defined threshold is applied by a user. This force can correlate to an infusion pressure provided by the infusion device and the disengagement, breaking, and/or deformation of the lower segment  752  may inhibit overpressure of the fluid delivery by the infusion device. The greater than desired force can be above 10 lbf, typically above 50 lbf, 60 lbf, 70 lbf, or 80 lbf, though the present invention is not limited thereto. In some embodiments, the force at which the lever  52  can disengage, break, and/or deform may be defined so as to limit the pressure at which fluid is delivered by the infusion device to below a defined pressure from 5.8 PSI to 325 PSI, typically 5.8 PSI, 10 PSI, 50 PSI, 100 PSI, 200 PSI, 300 PSI, or 320 PSI, though the present invention is not limited thereto. The lower segment  752  can be integral to the lever  52  or can be attached to the lever  52 . In some embodiments, the dimension “X” of the narrow segment of material  753  is associated with an upper aperture  700  positioned under the pivot point  53 . A second aperture  701  may also serve to hold the lever  52  in place in the housing, but may not participate in determining the force for disengaging, breaking, and/or deforming the lower segment  752  of the lever  52 . Also illustrated in  FIG. 35A , the lever  52  can attach or define the trigger pivot  53 , the return spring anchor point  654 , and/or the pin lock cutout  651 . When the user applies a greater than desired amount of force to the infusion device via the trigger  37 , the segment of material  753  adjacent the upper aperture  700  can fracture, and the lower segment  752  of the lever  52  may extend rearward relative to its intact configuration during normal operation as a result of the undue input force. Though the lever  52  is described as having a segment that can break, it will be understood by those of skill in the art that breaking of the lever  52  may include other types of structural disengagement, deformation and/or derivatives thereof that render the lever  52  with a diminished ability to operate the shuttle of the housing. 
       FIG. 35B  is a side view of the lever  52  shown in  FIG. 35A , after breaking due to exertion of a force above a defined amount, according to embodiments of the invention.  FIG. 35B  depicts the lever  52  after an input force has been exceeded a defined threshold value. The lower segment  752  of the lever  52  extends more rearward relative to its intact configuration during normal operation, and the narrow segment of material  753  near upper aperture  700  has separated. In some embodiments, this separation may deform or otherwise alter the aperture  700  of  FIG. 35A  to define a deformation zone  700   f  in the lever  52 . The thickness of dimension X can be varied as desired to increase or reduce the force at which the lower segment  752  of the lever  52  disengages, breaks, and/or deforms. In some embodiments, when the lower segment  752  of the lever  52  disengages, breaks, and/or deforms, this action can provide a tactile response to the user. This allows the user to detect the overpressure condition of the undue applied force without direct visualization, such as in loud or distracting environments. Additionally, when disengaged, broken, and/or deformed, the lever  52  will no longer travel through the full range of linear stroke motion, providing another tactile and visual signal to the user that the infusion device has exceeded the force threshold. 
     In some embodiments, the dimension X of the narrow segment  753  may be approximately 0.07 inches in an aluminum lever  52  which is approximately 0.12 inches thick, though the present invention is not limited thereto. This configuration may result in a break-away force of approximately 70 lbf. This break-away force can be tuned greater or lesser depending on the desired function of the device. The break-away force may be controlled using only dimension X if desired. Additionally, the material thickness, material type or aperture  700  location may also be varied as desired. The breakaway force can be checked through finite element modeling (FEA). In some embodiments, the break-away force may be tuned relative to the output pressure of the fluid exiting the infusion device, rather than, or in addition to, the input force. Input force and output pressure may be linearly correlated, and can be calculated as desired. It will be understood that a break-away force may include force which only deform or otherwise alter the lever  52  or a segment attached thereto and that a full breakage is not required to achieve the objectives of the present invention. 
       FIG. 36A  is a side view of an example embodiment of a housing  62  with the lever  52  shown in  FIG. 35A  before the lever  52  breaks according to embodiments of the invention.  FIG. 36B  is a side view of an example embodiment of the housing  62  shown in  FIG. 36A  after the lever  52  breaks according to embodiments of the invention. These figures illustrate the breakage of the lever  52  of  FIGS. 35A &amp; 35B  as viewed when assembled with a trigger  37  and housing  62 . The connectors through upper aperture  700  and lower aperture  701  that can hold the trigger  37  onto lever  52  are visible in this view. 
       FIG. 37A  is a side view of an example embodiment of a lever  52 ′ with a resettable hinge  701  according to embodiments of the invention.  FIG. 37B  is a side view of the lever  52 ′ shown in  FIG. 37A  with the resettable hinge  701 , after disengaging, according to embodiments of the invention.  FIG. 37C  is a cross-sectional view of the example embodiment of the lever  52 ′ with the resettable hinge  701  shown in  FIG. 37A , according to embodiments of the invention. In some embodiments, the lever  52 ′ may include a lower segment  706  that can disengage without permanent damage thereto.  FIGS. 37A &amp; 37B  illustrate an example embodiment of the resettable lever  52 ′ in a normal and disengaged position, respectively. In some embodiments, the resettable lever  52 ′ may include an upper segment  708  and a lower segment  706  under pivot point  53 , which can be a primary pivot point. In some embodiments, the lower segment  706  can be attached to the upper segment  708  via a secondary pivot point  700 ′, which may allow the lower segment  706  to disengage if a defined force is exceeded. The lower segment  706  may normally be held rigidly in place relative to the upper segment  708 . In some embodiments, the lower segment  706  may be held rigidly in place relative to the upper segment  708  by two spring loaded ball plungers  705  which form a detent. The ball plungers  705  may seat into two recesses  707  which can allow purchase against the upper segment  708 , during normal use of the lever  52 ′. A secondary pivot pin  709  may extend through both the upper segment  708  and the lower segment  706 , through the secondary pivot point  700 ′. The amount of force required to disengage the lower segment  706  can be dependent on the spring force of the ball plungers  705 , and the amount of interference with the recesses  707 . If the defined force is exceeded, a user may return the lower segment  706  to be rigidly connected to the upper segment  708  of the lever  52 ′, by pulling the lower segment  706  outward. The edges of the upper segment  708  may be chamfered or radiused to allow the force used to reset the lower segment  706  to be lower than the force required to disengage the lower segment  706 . The force at which the lower segment  706  will disengage may be above 10 lbf, typically above 50 lbf, 60 lbf, 70 lbf, or 80 lbf, though the present invention is not limited thereto. In some embodiments, the force at which the lower segment  706  will disengage may be defined so as to limit the pressure at which fluid is delivered by the infusion device to below a defined pressure from 5.8 PSI to 325 PSI, typically 5.8 PSI, 10 PSI, 50 PSI, 100 PSI, 200 PSI, 300 PSI, or 320 PSI, though the present invention is not limited thereto. In some embodiments, a metal loop may be positioned by the user such that that no movement may be possible around the secondary pivot point  700 ′. This may allow the user to use the device at greater pressures in urgent situations, and then return to normal use as desired. In some embodiments, fixation devices may also be used instead of ball plungers  705  to rigidly hold the lower portion  706  of the lever  52 ′ to the upper portion  708 . In some embodiments, a resettable hinge  701  with a fixed detent, or pairs of magnets, may be used instead of, or in addition to, ball plungers  705 . Those of ordinary skill in the art will appreciate that additional configurations to achieve the resettable hinge  701  of the lever  52 ′ may be possible as contemplated by the present invention. 
       FIG. 37D  is a side view of an example embodiment of a lever  52 ″ with a resettable hinge  701 ′ with a magnetic latch according to embodiments of the invention.  FIG. 37E  is a side view of the lever  52 ″ shown in  FIG. 37D  with the resettable hinge  701 ′, after disengaging, according to embodiments of the invention.  FIG. 37F  is a partial cross-sectional view of the example embodiment of the lever  52 ″ with the resettable hinge  701 ′ shown in  FIG. 37D , according to embodiments of the invention. In some embodiments, the resettable hinge  701 ′ may include at least one magnet within a part of the lever  52 ″ which secures an upper segment  708 ′ to a lower segment  706 ′. Thus, the upper segment  708 ′ of the lever  52 ″ may releasably engage the lower segment  706 ′ of the lever  52 ″ via magnetic force. In some embodiments, the magnetic force may be applied by an upper magnet  714  that may be connected to the upper segment  708 ′ of the lever  52 ″ and a lower magnet  715  that may be connected to the lower segment  706 ′ of the lever  52 ″. Upper segment  708 ′ and/or lower segment  706 ′ may include fastening means for elements of the housing, such as, for example, screw holes  716  and  717 . A return spring, such as torsion spring  657  illustrated in  FIG. 26A  may be connected to the lever  52 ″ via attachment points, such as spring attachment hole  718 . When in use, the upper segment  708 ′ and the lower segment  706 ′ of the lever  52 ″ may remain connected via the magnetic force so as to pivot the lever  52 ″ about the pivot point  53 , which may be a primary pivot point, in response to user input. When a force exceeding a defined force is applied to the lever  52 ″, the lower segment  706 ′ may disengage from the upper segment  708 ′ of the lever  52 ″. The lower segment  706 ′ may pivot about the secondary pivot point  700 ″, and the upper segment  708 ′ may no longer move in response to user input to stop the plunger of the syringe from further movement and thereby stop further liquid delivery from the syringe.  FIG. 37E  depicts the lower segment  706 ′ after separation from the upper segment  708 ′. The desired force to achieve this breakaway may be tuned by varying the composition, diameter, thickness and/or separation distance of magnets, such as magnets  714  and  715 , connected to the upper and lower segments  708 ′/ 706 ′ of the lever  52 ″. Though two magnets are illustrated in  FIGS. 37D and 37E , other configurations of magnets are possible without deviating from the invention. In some embodiments, a magnet  714  or  715  can be attached to one of the lower or upper segment  706 ′/ 708 ′ and the other segment  708 ′/ 706 ′ may be metal. In some embodiments, a single magnet may be used between two steel plates (or other metal) to increase the separation force. 
     In some embodiments, the location of a magnetic element may be adjusted to increase or decrease the lever between the magnetic element and the secondary pivot point  700 ″. Moving the magnets further from the secondary pivot point  700 ″ may decrease the magnetic force required to maintain the resettable magnetic hinge  701 ′. In some embodiments, a rare earth magnet and/or ferromagnetic material may be used to generate the force required. In some embodiments, neodymium magnets may be used to generate the force required. In some embodiments, the defined force at which the resettable magnetic hinge  701 ′ will disengage may be 100 lbf in order to limit the pressure in the syringe to approximately 100 PSI. If the magnets  714 / 715  are located 0.75 inches from the secondary pivot point  700 ″, and the center distance of the input force is 0.25 inches from the secondary pivot point  700 ″ a magnetic force of 33 lbs is required.  FIG. 37F  shows a partial cross section view of the secondary pivot  700 ″, and the upper  708 ′ and lower  706 ′ segments of the lever  52 ″. Those of ordinary skill in the art will appreciate that additional configurations to achieve the resettable hinge  701 ′ of the lever  52 ″ may be possible as contemplated by the present invention. 
       FIG. 38  is a top view of an example embodiment of an outlet tubing set  100  with a pressure relief valve  710  that can be connected to a valve  31 , according to embodiments of the invention. The tubing set  100  may be similar to the tubing set  100  illustrated in  FIG. 19A  with the addition of the pressure relief valve  710 . The pressure relief valve  710  may limit the fluidic pressure which can be applied to the patient. In some embodiments, the pressure relief valve  710  may open to release fluids being dispensed through the output tubing when pressure as determined at the pressure relief value  710  exceeds a defined limit. In some embodiments, the pressure relief valve  710  may reduce or block fluids being dispensed through the output tubing when pressure as determined at the pressure relief value  710  exceeds a defined limit. The pressure relief valve  710  may be connected directly to the outlet of the dual check valve  31 , and there may be a male luer connection  711  on the outlet side of the pressure relief valve  710 . In some embodiments, there may also be a length of small bore outlet tubing between the outlet of the dual check valve  31  and the pressure relief valve  710 . The pressure relief valve  710  may be set as desired to a clinically relevant pressure. Some “high pressure” infusers have a maximum pressure of 300 or 320 PSI, and this may be used as a set point. Other set pressure points may also be chosen as desired. One example of a pressure relief valve which may be used in some embodiments includes the “T” pressure relief valve provided by Halkey-Roberts Corporation of Saint Petersburg, Fla. In some embodiments, the pressure relief value  710  can be mechanically combined with a pressure transducer, such as the pressure transducer  93  of  FIG. 9  and/or the pressure transducer  227  of  FIG. 21 . 
     In some embodiments, a user may choose to override the pressure relief valve  710  if required by the clinical situation. A screw-on cap, a retaining lever, or other device may be actuated by the user to mechanically close the pressure relief valve  710 . This may allow the user to continue to apply greater pressures if needed. This override may require positive action from the user in order to override the pressure limit. 
       FIG. 39A  is a partial schematic side view of an example embodiment of a pressure monitoring system  815 , according to embodiments of the invention.  FIG. 39B  is a partial schematic side view of the pressure monitoring system of  FIG. 39A  shown in a locked position, according to embodiments of the invention. This pressure monitoring system  815  may allow a user to know the pressure being applied to the pressure monitoring system  815  at various points during infusion, and may be used to alert the user if a pressure limit is exceeded. In some embodiments, the pressure monitoring system  815  may lock out the infusion system so greater than desired fluidic pressures cannot be applied to the patient. A load cell  800  may detect the force applied between the syringe flange  40  and the housing  62 , when a trigger, such as trigger  37  of  FIGS. 36A &amp; 36B , is being actuated and fluid is being forced into or out of the syringe  48 . The trigger may apply a force through a series of linkages to the shuttle  804  which moves the plunger  41 . Fluid pressure may be generated when a force is applied to the plunger  41  and the flange  40  resists movement. The syringe flange  40  may impart axial force within the housing  62 . The housing  62  may impart some vertical forces on the syringe  48  through the length of the syringe  48 , and some incidental frictional forces in the axial direction. Some embodiments may use the distal tip of the syringe  48 , or other parts of the syringe  48 , plunger  41 , or valve assembly to measure these forces. 
     The axial force on the syringe flange  40  can be translated into a pressure measurement, if the diameter of the syringe plunger  41  is known [Pressure=(Measured Force)/(Area of Plunger)]. The force may be measured by a button load cell or other load cell  800  mounted between the housing  62  and a mounting bracket  806 . There may be one centrally mounted load cell  800  below and mid-line on the syringe  48 , two load cells placed at lateral sides of the mounting bracket  806 , or more than two load cells  800  placed in multiple locations. If two or more load cells  800  are used, the total measured force may be summed between all load cells  800 . A cut-out  807  present in the housing  62  may provide a defined channel to keep the mounting bracket  806  in-line with the load cells  800 . In some embodiments, bushings, linear bearings, and/or other methods may be used to reduce friction between the mounting bracket  806  and the housing  62 . The load cell  800  may be a button load cell, which registers compressive forces as the plunger  41  is depressed. In some embodiments, the load cell  800  may be screwed into both the housing  62  and the mounting bracket  806 , which may allow both tension and compression to be measured. 
     In some embodiments, a display  802  on the outside of the housing  62  may show the current pressure being applied to the fluid in the syringe  48 . The display  802  may be similar to the display  90  illustrated in  FIG. 9  and may include a screen and user interface input such as the screen  91  (which can be a touchscreen) and/or input buttons  92  of  FIG. 9 . The display  802  can display information including, but not limited to, maximum pressure, current pressure, average pressure, and/or not-to-exceed pressure. The not-to-exceed pressure threshold may be set by the user and/or pre-programmed. Some examples of pre-programmed limits, based on the size of the IV/IO attached are included in Table 1. This data is correlated with a 10 ml syringe. 
                     TABLE 1                  Pressure Alarm Limits                                     Upper   Lower               Alarm   Alarm               Limit   Limit           IV/IO access size   (PSI)   (PSI)                                             15G IO needle   55.8   0.0           16G   40.0   9.5           22G   94.0   21.1           22G Central Line   110.6   30.0                        
A user may input an IV/IO size using an input and/or display similar to the display  90  ( FIG. 9 ), or by other input means such as, for example, a touchscreen with graphics. The system  815  may then select an alarm limit based on the table above. If no IV/IO is selected the system  815  may proceed without alarm limits, or may be locked to prevent any motion of the syringe plunger  41  until an IV/IO size is selected. In some embodiments, the not-to-exceed pressure threshold may be the upper alarm limit as illustrated in Table 1. In some embodiments, the upper alarm limit may be a percentage of the not-to-exceed pressure, such as 80% or 90%.
 
     The display  802  may an independent display  802 . In some embodiments, the display  802  may be multi-purpose and show volume of fluid transfused and/or other metrics. The display  802  may be connected to the load cell  800  via a processer  809  to translate the signal from the load cell  800 . The processer  809  may be connected to a speaker  803 , which may be programmed to sound an audible alarm when the pressure reaches or exceeds the not-to-exceed threshold. In some embodiments, the audible alarm may be generated when the pressure reaches or exceeds a level lower than the not-to-exceed threshold, such as the lower alarm limit illustrated in Table 1. The processor  809  may be connected to a pivot point lock  801 , a solenoid and/or other device which extends or retracts with force into the trigger to prevent the user from being able to impart any additional force to the trigger and plunger until the force is reduced below the not-to-exceed threshold. In some embodiments, a plunger lock  805  may be advanced by a solenoid or other mechanism and prevent any subsequent plunger  41  movement once a not-to-exceed pressure is reached. The plunger lock teeth  817  may be angled to slightly retract the plunger  41  as the plunger lock  805  engages. This may reduce the applied pressure as the lock is applied. Locking mechanisms may be released by the user pressing a release button  810 , which may electronically signal the processer  809 . In some embodiments, the processor  809  may release a lock mechanism after a pre-determined amount of time has elapsed. 
       FIG. 40  is a side view of an example embodiment of an infusion device with a syringe  48  inside a housing  712 , according to embodiments of the invention. In this view, the flange  40  of a syringe  48  and the syringe plunger  41  may be within a housing  712 . The housing  712  may have a smaller axial extent that encloses the plunger  41  and flange, while the syringe body  48  may be external. A plunger  41  which interfaces directly with the lever  52  is depicted here, but other configurations of plunger  41  and lever  52  may be used. In some embodiments, the housing  712  may be pre-loaded with the syringe  48 , and may be locked or sealed so as to inhibit, prevent, or make the housing  712  difficult to open by the user. This may reduce set-up and/or the potential for use errors, because the system requires little assembly by the user. The syringe  48  may be attached to a dual check valve  31 . A spike  102  may be connected to large bore inlet tubing  100 , which leads to the inlet of the dual check valve  31 . Outlet tubing  109  may lead to a pressure relief valve  710 . Also shown is a thumb clamp  110  and male luer outlet  111 . Additional tubing features such as a needleless Y valve may also be incorporated in some embodiments of the configuration. As shown in this embodiment, the syringe body  48  may be external to the housing  712  and directly visible to the user. As described above, other embodiments may include a housing  712  which encapsulates the entire syringe body  48 , and may have a clear canopy to view the syringe body  48 . In some embodiments, this canopy may not be able to pivot open during use. Other embodiments may incorporate or integrate the body of the syringe  48  directly into the housing  712 , such that the syringe body  48  and the body of the housing  712  may be a single integrated piece. This may further reduce assembly time and/or manufacturing costs. 
       FIG. 41A  is a top view of an example embodiment of an infusion device with a housing with integrated or attached inlet tubing management features  750 , according to embodiments of the invention.  FIG. 41B  is a side view the infusion device shown in  FIG. 41A , according to embodiments of the invention.  FIG. 41C  is a side view of an infusion device similar to that shown in  FIG. 41A , according to other embodiments of the invention. In some embodiments, the tubing management feature  750  may comprise a retaining feature. The inlet tubing management feature  750  may be a semi-circular cross-channel or opening  751  which has a large enough diameter to receive inlet tubing  100 , but a small enough opening  751  to retain the inlet tubing  100  during normal use. The inlet tubing  100  may deform as it is pressed into the tubing management feature  750  and may remain trapped until the user pulls it free. This opening  751  may be used if the inlet tubing  100  is exiting to the right (as illustrated in  FIG. 41A ), but the user may wish to connect the inlet tubing  100  to a bag of fluid which is to the left of the user. The tubing  100  may be looped underneath the housing  62 , and held in place by the tubing management feature  750 . The tubing management feature  750  may orient the inlet tubing  100  in such a way as to generate a bend  100 B in the tubing  100 . The bend  100 B in the tubing  100  may be a distance S 1  from a centerline of an outlet tubing  109  of the housing  62 . In some embodiments, the distance S 1  may be between about 2 and about 10 inches. The bend  100 B in the tubing  100  may be a distance S 2  from an edge of the housing  62 . In some embodiments, the distance S 2  may be between about 1 to about 9 inches. The tubing management feature  750  may orient the inlet tubing  100  so as to cross the housing  62  at a distance S 3  from an inlet portion  34  of the dual check valve  31 . In some embodiments, the distance S 3  may be between about 1 to about 8 inches. In some embodiments, the tubing management feature  750  may be a clamp  755  held under the housing  62  as illustrated in  FIG. 41C . 
       FIG. 42  is a side view of example syringe bodies with varying volumes but with a constant stroke for infusion devices according to embodiments of the invention.  FIG. 42  depicts two different syringes bodies that have the same overall length, but which hold varying volumes of fluids. The syringe body  48 ′ may have indicia which cover a fixed length L I    831 . The inner radius can have multiple sizes such as, for example, R 1    825  or R 2    826 . The thickness (T F )  832 , the height (not shown), and width (W F )  827  of the flange  40 ′ may be fixed, as well as the location of the flange (L F )  828  relative to the most proximal indicia mark. The diameter of the exit (D E )  830  may also remain constant, and may be sized to receive a female luer fitting. The exit may also be a fixed distance (L E )  829  from the most proximal indicia. To allow the stroke length to remain constant irrespective of the volume of the syringe  48 ′, a radius R of the syringe body  48 ′ can follow the following formula: R=√{square root over (V/(Lπ))} where V is the syringe volume, and L is the fixed length of the indicia. For example, using this formula a 10 cc syringe  48 ′ with a fixed length of 5 cm may have an inner radius of 0.798 cm, while a 20 cc syringe with the same fixed length may have an inner radius of 1.128 cm. 
       FIG. 43  is a side view of a syringe such as those shown in  FIG. 42 , illustrated with the plunger shown in the fully depressed and fully retracted (broken line) positions, according to embodiments of the invention. The fully depressed position illustrates where the plunger  41 ′ has been pushed forward and the fluid evacuated from the syringe body  48 ′. The fully retracted position illustrates where the plunger  41 ′ has been pulled back to the greatest volume shown on the syringe indicia. The plunger  41 ′ that fits within a syringe  48 ′ that meets this formula may have the same travel distance (L I )  831  as the length of the indicia on the syringe  48 ′. The width (W P )  833  and thickness (T P )  834  of the plunger  41 ′ may also be fixed, and the radius (R) of the plunger  41 ′ may match the radius of the syringe  48 ′. 
       FIG. 44  is a front view of example syringe bodies with different sizes for use in a common infusion device, according to embodiments of the invention. An example of a syringe with a smaller diameter R 1    825  configuration is shown as a dotted line, and an example of a syringe with a larger diameter R 2    826  configuration is shown as a solid line. In some embodiments, both configurations may have the same size syringe flange  40 ′ and/or exit  830 . In some embodiments, the width (W F )  827 , and height (H F )  835  of the flange  40 ′ may be fixed. 
       FIG. 45A  is a partial schematic side view of an infusion device that can serially and interchangeably hold syringes with different volumes, according to embodiments of the invention. In some embodiments, the infusion device may detect a volume of a syringe  48  placed within the housing  62 . In some embodiments, the detection may be automatic. One or more syringe detection sensors  841 , such as, for example, an infrared proximity sensor, other proximity sensor, a pressure sensor, an optical sensor, and/or RFID reader, may detect objects placed in the housing  62 . In some embodiments, the proximity sensor  841  may be directed at the syringe  48 . The proximity sensor  841  may be used to measure the distance between the housing and the syringe body  48 , when placed on the centerline of the syringe body  48 . A larger distance between the proximity sensor  841  and the syringe  48  may indicate the presence of a smaller syringe (e.g. 10 ml), and a smaller distance between the proximity sensor  841  and the syringe  48  may indicate a larger syringe (e.g. 20 ml). Additionally or alternatively, multiple sensors may be used at once to determine syringe size and location. 
       FIG. 45B  is a top view of the infusion device in  FIG. 45A  containing a syringe  48  of a first size and a syringe detection sensor configuration  841 / 842  according to embodiments of the invention. In this view, two sensors, a midline sensor  841 , and a lateral sensor  842 , are shown. In some embodiments, when a syringe  48  with a radius R 1  is held in the housing  62 , the mid-line sensor  841  may indicate that an object is present, and the lateral sensor  842  may not indicate that an object is present. This may indicate that a smaller syringe  48  was being used (10 ml, as one example). This dual sensor configuration may have the advantage of utilizing a presence detection sensor as compared to a distance detection sensor such as the single midline sensor  841  of  FIG. 45A . 
       FIG. 45C  is a top view of the infusion device from  FIG. 45B  containing a syringe  48  of a second size different from the syringe  48  of the first size shown in  FIG. 45B , according to embodiments of the invention. In this view two sensors are shown, a midline sensor  841  and a lateral sensor  842 . In some embodiments, when a larger syringe  48  with a radius R 2  is held in the housing  62 , the mid-line sensor  841  may indicate that an object is present, and the lateral sensor may also indicate that an object is present. This may indicate that a larger syringe was being used (20 ml, as one example). In some embodiments, additional sets of sensors may be used at different axial and/or radial locations to better characterize the syringe location and size. 
     Variable syringe sizes may impact both pressure and volume transfused. In some embodiments, the sensors  841  and  842  may provide a pre-programmed syringe size to a processor  158 ″ of a volume calculation system  818 , to calculate the volume infused. Table 2 illustrates volume calculations for example syringe sizes. 
                     TABLE 2                  Volume Infused Based on Syringe Volume                                         Full   50%   25%               stroke   stroke   stroke               Volume   volume   volume           Syringe Volume   (ml)   (ml)   (ml)                                                 10 ml   10   5   2.5           20 ml   20   10   5           30 ml   30   15   7.5                        
In Table 2, three example syringe size are shown indicating the housing  62  can serially and interchangeably hold at least these three different sizes of syringe  48 . However, two, four, or other syringe sizes may also be possible. The applied pressure may also vary based on plunger diameter. The previous example demonstrated two syringe plunger diameters (e.g. R 1  and R 2 ) which may be possible if used in this configuration. For example, a 10 ml syringe  48  with a fixed length of 5 cm may have an inner radius of 0.798 cm, while a 20 ml syringe with the same fixed length may have an inner radius of 1.128 cm. The user input force F, would result in various fluid pressures within the syringe, according the following formula:
 
               P   =       F   *   C       π   ⁢           ⁢     R   2           ,         
where P is the fluid pressure in the syringe, F is the user input force applied to the handle, C is a constant based on the mechanical advantage of the lever connecting the user input force to the syringe plunger, and R is the radius of the syringe plunger. Example values for this formula are shown Table 3 below, where C is given as 0.9. The column “Linear Plunger Force” is the horizontal force applied to the plunger resulting from a given user input on the lever.
 
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Pressure Based on Input Force 
               
            
           
           
               
               
               
               
               
            
               
                   
                   
                 Linear 
                 10 ml 
                 20 ml 
               
               
                   
                   
                 Plunger 
                 Syringe 
                 syringe 
               
               
                   
                 User Input Force 
                 Force 
                 Pressure 
                 Pressure 
               
               
                   
                 (LBF) 
                 (LBF) 
                 (PSI) 
                 (PSI) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                 50 
                 45 
                 90 
                 45 
               
               
                   
                 70 
                 63 
                 126 
                 63 
               
               
                   
                 100 
                 90 
                 180 
                 90 
               
               
                   
                 150 
                 135 
                 270 
                 135 
               
               
                   
                 167 
                 150 
                 300 
                 150 
               
               
                   
                   
               
            
           
         
       
     
     By constraining the body of the syringe  48  at two points, the flange  40 ′ and the exit  830 , a variety of syringe sizes may be used within a single housing  62  with only one set of receiving slots. For example, in some embodiments 5 cc, 10 cc, 20 cc, 30 cc, 50 cc and/or 60 cc syringes may be used, though the present invention is not limited thereto. A receiving slot  50 ′ in the housing  62  body may restrain the syringe flange  40 ′, while the circular cutout  35 ′ may restrain the syringe exit  830 . The receiving slot  50 ′ may provide an axial restraint. If the plunger  41 ′ also remains a constant size, a receiving slot  64 ′ in the shuttle  56 ′ may be used to control the plunger  41 ′ movement on a variety of syringe sizes. Because the indicia length may be the same between a variety of syringes, the same actuation trigger can work to actuate any of the syringes used in this system  818 . This can allow the use of multiple syringe sizes with a single housing  62  design. As illustrated in  FIG. 45B  compared to  FIG. 45C , the smaller diameter syringes R 1 , may have a larger gap between the walls of the syringe  48  and the housing  62 , but may still be fully constrained by the exit  830 , syringe flange  40 ′, and plunger  41 ′. 
       FIG. 45D  is a schematic view of a monitoring system  818  for the infusion device of  FIGS. 45A-45C  configured to determine a size of a respective syringe, according to embodiments of the invention. The system  818  of  FIG. 45D  may include a display  90 ′ similar to the one illustrated in  FIG. 9 , a processor  158 ″, a power source  152 , and/or one or more sensors  841 / 842 . The display  90 ′ may include a screen  91 ′ and buttons  92 A/ 92 B. The screen  91 ′ may allow a use of the infusion device to view the pressure being applied at any given moment. The buttons  92 A/ 92 B may allow the user to interact with the monitoring system to perform functions such as, for instance, manually entering a syringe size in use. The display  90 ′ may be connected to a processor  158 ″ which may provide an indication of pressure. The indication of pressure by the processor  158 ″ may be based in part on input from sensors, such as sensors  841  and  842 . The processor  158 ″ may be powered by a power source  152 . The power source  152  may be a battery or other power source such as a plug-in cord configured to be connected to a power receptacle, but the present invention is not limited thereto. The processor  158 ″ may also direct a locking of the infusion device, such as that of the embodiment illustrated in  FIGS. 39A and 39B . In some embodiments, the processor  809  of  FIGS. 39A and 39B  may be the same or similar as the processor  158 ″ illustrated in  FIG. 45D . 
       FIG. 46A  is a side view of an infusion device incorporating an electromechanical actuation member  850 , according to embodiments of the invention.  FIG. 46B  is a side view of the infusion device of  FIG. 46A  with the trigger  37  extended, according to embodiments of the invention. As described herein a pin  57  may travel along a cam surface  52 C within a path  52 P of the lever  52  as the lever  52  rotates. In some embodiments, lever  52  of the infusion device may be mechanically coupled to electromechanical actuation member  850 . The electromechanical actuation member  850  may comprise a linear actuator or lead screw motor and may be activated continuously to move a plunger  853  in response to input by the user. This electromechanical actuation member  850  may serve as an alternate actuation member for the system previously disclosed in  FIG. 11 . In some embodiments, the infusion device may include a force sensor which detects user input force and the electromechanical actuation member  850  may assist the user, allowing use of the device with decreased force. In some embodiments, the actuation member  850  may control substantially all motion and force provided to the syringe. In some embodiments, the trigger portion  37  of the lever  52  may be embodied as a button as illustrated in  FIG. 11 . The electromechanical actuation member  850  may be anchored to the housing by housing attachment point  851 , and may be coupled to the lever  52  by lever attachment point  852 . Either or both attachment points  851 / 852  may allow pivoting about the attachment point  851 / 852 . 
     The electromechanical actuation member  850  may also comprise solenoid which may be actuated as determined by a processor  158 ″. The solenoid may retract with force, to inhibit the user from being able to impart additional force to the trigger  37  and plunger  853  until the force is reduced below the not-to-exceed threshold. Locking devices may be released by the user pressing a release button, which may electronically signal the processer  158 ″. In some embodiments, the processor  158 ″ may release a lock device after a pre-determined amount of time has elapsed. 
     One of ordinary skill in the art will recognized that other devices and configurations of motors may be used to actuate the lever  52  without deviating from the present invention. 
       FIG. 47A  is a side view of an embodiment of a handheld infusion device incorporating a motor  151 ′, according to embodiments of the invention.  FIG. 47A  depicts a rotational motor  151 ′ which has a bevel gear  860  on the end of a shaft.  FIG. 47A  illustrates the syringe  48  with the plunger  41  fully advanced.  FIG. 47B  is a side view of the infusion device of  FIG. 47A  in a retracted position, according to embodiments of the invention.  FIG. 47B  illustrates the plunger  41  of the syringe  48  fully retracted by the rotational motor  151 ′. As described herein a pin  57 ′ may travel along a cam surface  52 C within the lever  52 ′″ to advance the shuttle  56  as the lever  52 ′″ rotates. A mating bevel gear  861  may be integrated into the lever  52 ′″ of the infusion device and centered around the pivot point  53 ″. The motor  151 ′ may be a stepper or other motor and/or may use a processor  158 ′ in order to automatically advance and retract the shuttle  56  and plunger  41  to the desired point. A battery  152 ′ may provide electrical power to the motor  151 ′. A trigger  37 ′ can be an electronic control button or switch. The control button  37 ′ may allow the user to control the flow of fluid through the operation of the motor  151 ′. Additional user inputs may be present to provide additional control inputs, such as pressure and/or volume targets and/or limits. 
       FIG. 48A  is a side view of an embodiment of a handheld infusion device  859 ′ incorporating a linear actuator  850 ′, according to embodiments of the invention.  FIG. 48A  depicts the linear actuator  850 ′ which is connected axially to a shuttle  56 ′.  FIG. 48A  shows the syringe  48  with the plunger  41  fully advanced.  FIG. 48B  is a side view of the infusion device  859 ′ of  FIG. 48A  in a retracted position, according to embodiments of the invention.  FIG. 48B  shows the syringe  48  with the plunger  41  fully retracted. The linear actuator  850 ′ may be controlled by a processor  158 ′ in order to advance and retract the shuttle  56 ′ and plunger  41  to the desired point. This embodiment is shown with an in-line handle, and may have indentations  862  for the user&#39;s fingers to rest during actuation of the control button  37 ′. A battery  152 ′ may provide electrical power to the system. A trigger  37 ′ can be an electronic control button or switch. The control button  37 ′ may allow the user to control the flow of fluid through the operation of the linear actuator  850 ′. Additional user inputs may be present to provide additional control inputs, such as pressure and/or volume targets and/or limits. In some embodiments, the canopy  42 ′ may not have a protrusion, as illustrated in this configuration. 
       FIGS. 48A and 48B  show generally how the infusion device  859  of  FIGS. 47A and 47B  can be implemented in an infusion device  859 ′ with an inline configuration. Similarly, while certain embodiments herein are illustrated with a pistol grip configuration, these embodiments may be configured to have an in-line handle or “pen-like” body with a trigger/lever. 
     As also illustrated herein, embodiments of the infusion device may be automated or manual, and each may be configured in the alternative. In some embodiments, the trigger may be a manual trigger such as, for example, trigger  37  illustrated in  FIG. 22 . In some embodiments, the trigger may be an automatic trigger, such as, for example, trigger  37 ′ in  FIG. 47A . 
     While the embodiments presented herein are well suited for use with IO infusion, they may be used in a similar manner to infuse fluids through an intravenous access point as well. By using universal connectors such as male/female luer connection, a wide variety of devices may be connected to the tubing. These devices may also work well with narrow gauge IV needles, which can sometimes cause existing transfusion pumps to function poorly. 
       FIG. 49  is an isometric view of a container  900  incorporating an infusion device  10 / 10 K, pain medication  901  and an intraosseous access system  902 / 903  according to embodiments of the invention. The container  900  may contain an intraosseous access system, a volume delivery system, and pain management. The intraosseous (IO) access system may include a sterile IO needle  903  and a delivery system  902 . Some examples of sterile IO needles  901  and delivery systems  902  include the EZ-IO access system from Teleflex of Morrisville, N.C., FAST 1  from Pyng Medical of British Columbia, Canada, Jamshidi Intraosseous Needles from Carefusion of Waukegan, Ill., and Bone Injection Gun (B.I.G.) from Persys Medical of Houston, Tex. The volume delivery system may consist of an infusion device  10 , and a basic tubing set  10 S, which may be included as part of a sterile tubing kit  10 K. The pain management system may contain pre-filled syringes  901  of local anesthetic, such as lidocaine. In some embodiments, the pain management system may also include pre-filled syringes  901  of local anesthetic and prefilled syringes  911  of buffering agent, such as sodium bicarbonate. The container  900  may have a door which allows easy access for users to obtain any of the three elements, as needed, in an emergency. In some embodiments, the container  900  may be configured to be placed on a counter. In some embodiments, the container  900  may be configured to be mounted on a wall. In other embodiments, the container  900  may be configured to be placed in a drawer, mounted to a trolley, hospital cart or other medical device, or under a bed, though the present invention is not limited thereto. 
       FIG. 50  illustrates exemplary operations for infusing fluid to a subject according to embodiments of the invention. The method of infusing fluid to a subject may include providing a pre-assembled tubing set comprising at least a first segment of large bore tubing with a length between 3-12 feet with one end portion comprising a spike (block  5001 ), providing an infusion delivery device (block  5002 ), attaching the pre-assembled tubing set to the infusion delivery device so that inlet tubing adjacent the infusion delivery device extends perpendicularly outward from an axially extending centerline of a syringe held by the infusion delivery device so that the inlet tubing adjacent the infusion delivery device is parallel to a flange of the syringe to place volume indicia of the syringe facing upward (block  5003 ). Further, the method may include repetitively, serially actuating a trigger to move a plunger of a syringe held by the infusion delivery device in a first direction to intake fluid into a syringe (block  5004 ), and then actuating the trigger to move the plunger of the syringe in a second opposing direction to dispense fluid from the syringe (block  5005 ). 
     In some embodiments, the actuating steps may be carried out to intake and dispense at least once to prime a fluid flow path extending between the large bore tubing and the syringe, then infusing the fluid from the syringe to a subject based on the actuating steps from a fluid source through the syringe into small bore tubing attached to the infusion delivery device to deliver the infusion fluid to a subject. 
     In some embodiments, the pre-assembled tubing set (e.g., tubing set  10 S of  FIG. 19A ) may include the first segment of large bore tubing attached to a pouch of saline and a second segment of large bore tubing attached to a pouch of blood or blood product or contrast agent, the first and second segments merging into a third segment of large bore tubing that is attached to an inlet tube extending out a sidewall of a housing of the infusion delivery device. 
     In some embodiments, the method may further include providing a length of small bore tubing with a Y connection attached to an exit port of a dual check valve held by the infusion delivery device, and injecting fluids or other medications into a port of the small bore tubing prior to infusing the fluid to the subject. 
     Particular embodiments and features have been described with reference to the drawings. It is to be understood that these descriptions are not limited to any single embodiment or any particular set of features, and that similar embodiments and features may arise or modifications and additions may be made without departing from the scope of these descriptions and the spirit of the appended claims.