Patent Publication Number: US-2019167967-A1

Title: Hemostasis valve systems and associated methods

Description:
RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Application No. 62/593,441, filed on Dec. 1, 2017 and titled “Hemostasis Valve Systems and Associated Methods,” which is hereby incorporated by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates generally to hemostasis valves. More specifically, the present disclosure relates to hemostasis valves configured for passage of two or more elongate medical devices. This disclosure also relates to hemostasis valve systems including a hemostasis valve and a medical device such as a sheath introducer, wherein the hemostasis valve is coupleable to the medical device. Related methods are also disclosed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The embodiments disclosed herein will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. While various aspects of the embodiments are presented in drawings, the drawings depict only typical embodiments, which will be described with additional specificity and detail through use of the accompanying drawings in which: 
         FIG. 1A  is a perspective view of a hemostasis valve system. 
         FIG. 1B  is a side view of the hemostasis valve system of  FIG. 1A . 
         FIG. 1C  is an end view of a proximal end portion of the hemostasis valve system of  FIG. 1A . 
         FIG. 1D  is an exploded view of the hemostasis valve system of  FIG. 1A . 
         FIG. 1E  is a cross-sectional view of the hemostasis valve system of  FIG. 1B  taken through line  1 E- 1 E. 
         FIG. 1F  is a partial exploded view of the hemostasis valve system of  FIG. 1A . 
         FIG. 2  is an end view of a proximal end portion of a hemostasis valve. 
         FIG. 3  is an end view of a proximal end portion of another embodiment of a hemostasis valve. 
         FIG. 4A  is a side view of another embodiment of a hemostasis valve. 
         FIG. 4B  is a cross-sectional view of the hemostasis valve of  FIG. 4A  taken through line  4 B- 4 B. 
         FIG. 4C  is an end view of a proximal end portion of the hemostasis valve of  FIG. 4A . 
         FIG. 4D  is a side view of the hemostasis valve of  FIG. 4A  coupled to an introducer sheath. 
         FIG. 5  is an exploded view of another embodiment of a hemostasis valve. 
         FIG. 6  is an end view of a valve member. 
         FIG. 6A  is a cross-sectional view of the valve member of  FIG. 6  taken through line  6 A- 6 A. 
         FIG. 6B  is a cross-sectional view of the valve member of  FIG. 6  taken through line  6 B- 6 B. 
         FIG. 7  is an end view of another embodiment of a valve member. 
         FIG. 7A  is a cross-sectional view of the valve member of  FIG. 7  taken through line  7 A- 7 A. 
         FIG. 7B  is a cross-sectional view of the valve member of  FIG. 7  taken through line  7 B- 7 B. 
         FIG. 8  is an end view of another embodiment of a valve member. 
         FIG. 9  is an end view of another embodiment of a valve member. 
         FIG. 10  is a partial exploded view of another embodiment of a hemostasis valve system. 
         FIG. 11  is a perspective view of another embodiment of a hemostasis valve system. 
         FIG. 12A  is a perspective view of a guidewire and a valved medical device. 
         FIG. 12B  is a view showing introduction of the guidewire through the valved medical device. 
         FIG. 12C  is a perspective view of an insertion device and a hemostasis valve. 
         FIG. 12D  is a view showing the insertion device disposed in the hemostasis valve and the guidewire disposed in the valved medical device. 
         FIG. 12E  is a view showing introduction of the guidewire through the insertion device. 
         FIG. 12F  is a view showing coupling of the hemostasis valve and the valved medical device. 
         FIG. 12G  is a view showing removal of the insertion device from the coupled hemostasis valve and valved medical device. 
         FIG. 13  is a perspective view of a hemostasis valve system in use. 
     
    
    
     DETAILED DESCRIPTION 
     The various embodiments disclosed herein generally relate to hemostasis valves and hemostasis valve systems. In some embodiments, the hemostasis valve includes a valve member, wherein the valve member includes a first sealable opening disposed through a first portion of the valve member and a second sealable opening disposed through a second portion of the valve member. The valve member may also include three or more sealable openings. In certain embodiments, a hemostasis valve system may include a hemostasis valve and a first medical device (e.g., a sheath introducer). The hemostasis valve may be releasably coupleable to the first medical device. 
     Various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure. Many of these features may be used alone and/or in combination with one another. 
     Embodiments may be understood by reference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the present disclosure, as generally described and illustrated in the drawings herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus is not intended to limit the scope of the disclosure, but is merely representative of possible embodiments of the disclosure. In some cases, well-known structures, materials, or operations are not shown or described in detail. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated. 
     The phrases “connected to,” “coupled to,” and “in communication with” refer to any form of interaction between two or more entities, including but not limited to mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be coupled to each other even though they are not in direct contact with each other. For example, two components may be coupled to each other through an intermediate component. 
     The terms “proximal” and “distal” refer to opposite ends of a medical device, including the devices disclosed herein. As used herein, the proximal portion of a medical device is the portion nearest a practitioner during use, while the distal portion is the portion at the opposite end. For example, the proximal end of a hemostasis valve is defined as the end closest to the practitioner during utilization of the hemostasis valve. The distal end is the end opposite the proximal end, along the longitudinal direction of the hemostasis valve. 
     The term “resilient” refers to a component, device, or object having a particular shape that can then be elastically deformed into a different shape, but that may return to the original shape when unconstrained. For example, a wall of a valve member may have a first shape when unconstrained (i.e., when not engaged with an elongate medical device) and, in use, the wall may then be constrained (i.e., temporarily engaged with the elongate medical device) to elastically deform the wall into a second shape (i.e., displaced laterally due to interaction with a portion of the elongate medical device), then unconstrained (i.e., removed from engagement with the elongate medical device) such that the wall returns to its first shape or substantially returns to its first shape. 
     Various examples of hemostasis valve systems described herein comprise sealable openings configured to allow passage of instruments through a valve while maintaining hemostasis across the valve. Various examples herein reference sealable openings comprising one or more slits in a valve member. Notwithstanding any specific example to slits herein, sealable openings within the scope of this disclosure include single slits, intersecting slits, expandable holes, pin holes, multi-diameter holes, and so forth. Accordingly, any suitable sealable opening may be used in connection with the specific embodiments described herein. 
       FIG. 1A  is a perspective view of a hemostasis valve system  100 ,  FIG. 1B  is a side view of the hemostasis valve system  100 , and  FIG. 1C  is an end view of a proximal end portion  116  of the hemostasis valve system  100 . The hemostasis valve system  100  can include a hemostasis valve  110  and another medical device such as first medical device  105 . The hemostasis valve  110  can be releasably coupleable to the first medical device  105 . In various embodiments, the first medical device  105  may be a valved medical device (e.g., a traditional hemostasis valve, a valved sheath introducer, etc.). Other suitable first medical devices  105  are also within the scope of this disclosure. In certain embodiments, the hemostasis valve  110  is independent of the hemostasis valve system  100 . For example, the hemostasis valve  110  may be provided and/or used without the first medical device  105  or any other component of the hemostasis valve system  100  as provided herein. Furthermore, the hemostasis valve  110  may be configured for universal adaption. That is, the hemostasis valve  110  may be coupleable to a first medical device  105  of any suitable size. For example, the first medical device  105  may be an introducer having a size between about 4 French and about 8.5 French, and the hemostasis valve  110  may be coupleable to the introducer. 
     In some embodiments, the hemostasis valve  110  can include a body  120  and a valve member  130  (see also  FIGS. 1D and 1E ). The valve member  130 , or at least a portion of the valve member  130 , may be formed from a resilient material or a stretchable material. For example, the valve member  130  may be formed from an elastomeric material. The valve member  130  can be coupled to the body  120  at a position at or adjacent the proximal end portion  116  of the body  120 . 
     In certain embodiments, the hemostasis valve  110  can further include a cap  140 . The cap  140  may be coupled to the body  120  such that at least a portion of the valve member  130  is disposed between at least a portion of the body  120  and at least a portion of the cap  140 . For example, the cap  140  may secure the valve member  130  to the body  120 . The cap  140  may be releasably coupleable to the body  120 . For example, a practitioner may desire to remove the cap  140  to access the valve member  130 . In various embodiments, the practitioner may desire to access the valve member  130 , for example, to replace the valve member  130 , to clean the valve member  130 , etc. In various embodiments, the cap  140  may provide protection to at least a portion of the valve member  130 . For example, the cap  140  may be formed from a rigid material and the cap  140  may limit or prevent at least a portion of the valve member  130  from being compromised or damaged (e.g., upon contact with a surface, a body part, another medical device, etc.). In various other embodiments, the hemostasis valve  110  may lack the cap  140 . The valve member  130  may comprise a swabable or cleanable surface with or without the cap  140 . 
     In some embodiments, the hemostasis valve  110 , or at least a portion of the hemostasis valve  110 , may be formed from a clear or transparent material. Accordingly, a color of a portion (e.g., an end) of an introducer that is coupled to the hemostasis valve  110  may be visible (e.g., to a practitioner) through at least a portion of the hemostasis valve  110 . In certain embodiments, the color of the end of the introducer may correspond to the size (e.g., the French size) of the introducer. 
     In various embodiments, the hemostasis valve  110 , or at least a portion of the hemostasis valve  110 , may include one or more indicia. The indicium may be a color. The one or more indicia of the hemostasis valve  110 , or at least a portion of the hemostasis valve  110 , may communicate a size of the hemostasis valve  110  to a user. For example, the hemostasis valve  110 , or at least a portion of the hemostasis valve  110 , may be blue and the blue color may correspond to a size of 8.5 French, which may indicate to a user that two or more elongate medical devices may be disposed through the hemostasis valve  110  that add up to a total of 8 French (e.g., two 4 French catheters, a 2 French catheter and a 6 French catheter, etc.). Other suitable colors and corresponding sizes are also within the scope of this disclosure. In some embodiments, the hemostasis valve  110  may be a neutral color, including clear or white. 
     In some embodiments, the valve member  130  may include a first sealable opening  132   a  disposed through a first portion of the valve member  130 . As shown, the valve member  130  may also include a second sealable opening  132   b  disposed through a second portion of the valve member  130 . The first and second portions of the valve member  130  may be adjacent to each other (e.g., as shown in  FIGS. 1A and 1C ), or the first and second portions of the valve member  130  may be spaced apart from each other. Other suitable dispositions of the first and second portions of the valve member  130  are also within the scope of this disclosure. In some circumstances, a practitioner may desire to access and/or treat two branches of a vessel (e.g., simultaneously or sequentially). As further discussed herein, a hemostasis valve having two or more sealable openings, as disclosed herein, may aid in such access and/or treatment. 
     Furthermore, the first sealable opening  132   a  may include a first slit  134   a  disposed through at least a portion of the first sealable opening  132   a  and/or along at least a portion of the diameter of the first sealable opening  132   a . The first sealable opening  132   a  may also include a second slit  134   b , wherein the second slit  134   b  may intersect at least a portion of the first slit  134   a . Likewise, the second sealable opening  132   b  may include the first slit  134   a ′ disposed through at least a portion of the second sealable opening  132   b  and/or along at least a portion of the diameter of the second sealable opening  132   b . The second sealable opening  132   b  may also include a second slit  134   b , wherein the second slit  134   b  may intersect at least a portion of the first slit  134   a . As depicted, the first slits  134   a ,  134   a ′ may be disposed substantially perpendicular to the second slits  134   b ,  134   b ′. The first slit  134   a  may be continuous with the first slit  134 ′ (see  FIG. 1D ). Stated another way, the first slit  134  can be integral with the first slit  134 ′. In some other embodiments, the first slit  134  and the first slit  134 ′ may be separate or distinct slits. In certain embodiments, the valve member  130  may include a third sealable opening, a fourth sealable opening, a fifth sealable opening, a sixth sealable opening, a seventh sealable opening, an eighth sealable opening, or more sealable openings. 
     The sealable openings (e.g., the first sealable opening  132   a  and the second sealable opening  132   b ) may be configured such that an elongate medical device (e.g., a guidewire, a stylet, a catheter, etc.) may be disposed through at least a portion of the slits of the sealable opening, and the sealable opening and/or the slits may form a seal (e.g., a hemostatic seal) around the elongate medical device. In some embodiments, the sealable openings, or at least a portion of each of the sealable openings, may be formed from a resilient or stretchable material such that the sealable opening and/or the slits of the sealable opening may form a seal (e.g., around an outside surface of an elongate medical device). The sealable openings may also be configured such that the sealable openings are substantially sealed when no object (e.g., an elongate medical device) is disposed through the sealable openings. An elongate medical device may be disposed through the first sealable opening  132   a  and then the elongate medical device may be transitioned along at least a portion of the first slits  134   a ,  134   a ′ (e.g., when the first slits  134   a ,  134   a ′ are integral) such that the elongate medical device is disposed through the second sealable opening  132   b , or vice versa. 
     With continued reference to  FIGS. 1A-1C , the hemostasis valve  110  may further include a sidearm  112 . The sidearm  112  may include a sidearm lumen  114 , the sidearm lumen  114  extending through at least a portion of the sidearm  112 . In some embodiments, the sidearm lumen  114  may be in fluid communication with a lumen or a hemostasis valve lumen  111  of the hemostasis valve  110  (see also  FIGS. 1D and 1E ). Accordingly, a practitioner may dispose or introduce a fluid through the sidearm lumen  114  to flush and/or clean at least a portion of the hemostasis valve lumen  111 . 
     The first medical device  105  may also include a sidearm  109 . The sidearm  109  may include a sidearm lumen  104 , the sidearm lumen  104  extending through at least a portion of the sidearm  109 . In some embodiments, the sidearm lumen  104  may be in fluid communication with a lumen or a first medical device lumen  103  of the first medical device  105  (see also  FIGS. 1D and 1E ). Accordingly, a practitioner may dispose or introduce a fluid through the sidearm lumen  104  to flush and/or clean at least a portion of the first medical device lumen  103 . The sidearm  112  may rotate independent of the sidearm  109 , for example, when the hemostasis valve  110  is coupled to the first medical device  105 . Furthermore, the hemostasis valve  110  may be configured such that upon coupling of the hemostasis valve  110  to the first medical device  105 , the sidearm lumen  104  is not blocked by a portion of the hemostasis valve  110 . For example, fluid communication through the sidearm lumen  104  may be substantially maintained upon coupling of the hemostasis valve  110  to the first medical device  105 . In various embodiments, each of the sidearm lumens  104 ,  114  may be in fluid communication with each of the first medical device lumen  103  and the hemostasis valve lumen  111  (e.g., when the first medical device  105  is coupled to the hemostasis valve  110 ). 
     The hemostasis valve  110  may also include a coupling member (not shown) disposed, for example, at or adjacent a distal end portion  118  of the hemostasis valve  110 . The coupling member may be configured to couple, or releasably couple, the hemostasis valve  110  to the first medical device  105 . In certain embodiments, the coupling member may be configured to form a snap fit between the hemostasis valve  110  and the first medical device  105 . In certain other embodiments, the coupling member may be configured to threadably couple the hemostasis valve  110  and the first medical device  105  to each other (e.g., the coupling member may include one or more threads). Other suitable coupling mechanisms are also within the scope of this disclosure. 
       FIG. 1D  is an exploded view of the hemostasis valve system  100 . As shown, the hemostasis valve system  100  can include the hemostasis valve  110 . As discussed above, the hemostasis valve  110  can include the body  120  and the sidearm  112  extending radially outward relative to a longitudinal axis L of the hemostasis valve  110 . 
     As shown, the hemostasis valve lumen  111  can extend between the proximal end portion  116  and the distal end portion  118  of the hemostasis valve  110 . Accordingly, there may be fluid communication between the proximal end portion  116  and the distal end portion  118  of the hemostasis valve  110 . 
     The hemostasis valve  110  can further include the valve member  130 , wherein the valve member  130  is configured to be disposed at or adjacent the proximal end portion  116  of the hemostasis valve  110 . Stated another way, the valve member  130  may be coupleable to the hemostasis valve  110  at a position at or adjacent the proximal end portion  116  of the hemostasis valve  110  (e.g., at a valve member coupling portion  122 ). The valve member coupling portion  122  may be configured to limit or prevent movement (e.g., longitudinal movement) of the valve member  130  relative to the hemostasis valve  110  when the valve member  130  is coupled to the hemostasis valve  110 . For example, the valve member coupling portion  122  may include one or more ridges which engage or interact with at least a portion of the valve member  130  such that the valve member  130  is secured to the hemostasis valve  110 . The valve member coupling portion  122  may also be configured to limit or prevent leakage around an edge of the valve member  130 . For example, the valve member coupling portion  122  may form a seal around at least a portion of the valve member  130  (i.e., between the body  120  and the valve member  130 ) when the valve member  130  is coupled to the body  120 . 
     As depicted, the valve member  130  includes the first sealable opening  132   a  disposed through a first portion of the valve member  130  and the second sealable opening  132   b  disposed through a second portion of the valve member  130 . Additionally, each of the first and second sealable openings  132   a ,  132   b  includes the first slits  134   a ,  134   a ′ and the second slits  134   b ,  134   b ′, respectively, disposed through at least a portion of the first and second sealable openings  132   a ,  132   b . The valve member  130  can further include a wall or a flow divider  136  disposed between the first sealable opening  132   a  and the second sealable opening  132   b . As illustrated, the first slits  134   a ,  134   a ′ can extend through the wall  136  between each of the first and second sealable openings  132   a ,  132   b . At least a portion of the wall  136  may be resilient or deformable (e.g., at least a portion of the wall  136  may be formed from a resilient material). In some embodiments, the wall  136  may be resilient such that it may bias away from the first sealable opening  132   a  toward the second sealable opening  132   b , or vice versa. The resilient wall  136  may be configured to release pressure on at least a portion of the valve member  130 , for example, upon displacement of an elongate medical device through the first and/or the second sealable opening  132   a ,  132   b.    
     In some embodiments, the wall  136  may be displaceable between at least a resting position, a first lateral position, and a second lateral position. As such, the wall  136  may be disposed in the resting position (e.g., as depicted in  FIG. 1D ) when the wall  136  is not engaged with an object such as an elongate medical device disposed through one of the sealable openings  132   a ,  132   b . Interaction between the wall  136  and an object may displace (e.g., laterally displace) at least a portion of the wall  136 . For example, displacement of an elongate medical device through the first sealable opening  132   a  may exert a force on the wall  136  such that at least a portion of the wall  136  is displaced laterally away from the first sealable opening  132   a . Stated another way, in such a configuration the wall  136  may transition from the resting position to the second lateral position. Analogously, displacement of an elongate medical device through the second sealable opening  132   b  may exert a force on the wall  136  such that at least a portion of the wall  136  is displaced laterally away from the second sealable opening  132   b . In other words, in such a configuration the wall  136  may transition from the resting position to the first lateral position. 
     Likewise, the sealable openings (e.g., the first and second sealable openings  132   a ,  132   b ) may have a resting configuration and a non-resting configuration. That is, a sealable opening may be in the resting configuration when the sealable opening is not biased or stretched (e.g., due to an interaction with an object such as an elongate medical device). The first and second sealable openings  132   a ,  132   b , as illustrated in  FIG. 1D , are in the resting configuration. Upon interaction with an object, however, the sealable openings may transition from the resting configuration to the non-resting configuration. In the non-resting configuration the sealable openings may be biased, deformed, and/or stretched. 
     Upon displacement of the wall  136  a size of the first sealable opening  132   a  can decrease as a size of the second sealable opening  132   b  increases, or vice versa. Such a configuration may aid in the displacement of elongate medical devices having different profiles or sizes (e.g., larger profiles relative to the size of the first or second sealable opening  132   a ,  132   b  in the resting configuration) through the first and second sealable openings  132   a ,  132   b . For example, a practitioner may desire to displace a first elongate medical device having a first profile through the first sealable opening  132   a . The first profile, however, may be greater than a size of the first sealable opening  132   a  when the first sealable opening  132   a  is in the resting configuration. Accordingly, the practitioner may displace the wall  136  from the resting position to the second lateral position such that the size of the first sealable opening  132   a  increases and displacement of the first elongate medical device through the first sealable opening  132   a  is allowed or permitted. 
     Also depicted in  FIG. 1D  is the cap  140 . The cap  140  can include a first cap opening  142   a  and a second cap opening  142   b . The first cap opening  142   a  may be disposed through the cap  140  such that upon coupling of the cap  140  to the hemostasis valve  110 , the first cap opening  142   a  is in substantial alignment with the first sealable opening  132   a . Likewise, the second cap opening  142   b  may be disposed through the cap  140  such that upon coupling of the cap  140  to the hemostasis valve  110 , the second cap opening  142   b  is in substantial alignment with the second sealable opening  132   b . As noted above, the valve member  130  may include more than two sealable openings. Accordingly, in some embodiments, the cap  140  may include three, four, five, or more cap openings. A wall  146  can be disposed between the first and second cap openings  142   a ,  142   b . In some embodiments, at least a portion of the wall  146  may be resilient or deformable. The wall  146  may be resilient such that it may bias away from the first cap opening  142   a  toward the second cap opening  142   b , or vice versa. An elongate medical device may be disposed through the first cap opening  142   a  and the first sealable opening  132   a  and then the elongate medical device may be transitioned along at least a portion of the first slits  134   a ,  134   a ′ such that the elongate medical device is disposed through the second sealable opening  132   b , or vice versa. In such a configuration, the resilient wall  146  may bias such that the elongate medical device may transition between at least a portion of the each of the first and second sealable openings  132   a ,  132   b . In some other embodiments, the hemostasis valve  110  may lack the cap  140  such that an elongate medical device may transition between the first and second sealable openings  132   a ,  132   b  without interacting with the wall  146 . 
     At least a portion of an edge surrounding the first and/or the second cap opening  142   a ,  142   b  may be chamfered or sloped. Such a configuration may aid in guiding an elongate medical device through the first and/or the second cap opening  142   a ,  142   b  and through the first and/or the second sealable opening  132   a ,  132   b.    
     The first and second sealable openings  132   a ,  132   b  can provide communication between the hemostasis valve lumen  111  and a position proximal of the hemostasis valve  110  (e.g., via the first slits  134   a ,  134   a ′ and the second slits  134   b ,  134   b ′). For example, as discussed above, an elongate medical device may be disposed through at least a portion of the slits of the sealable opening such that access is provided to the hemostasis valve lumen  111  from a position outside of the hemostasis valve  110  (e.g., from a position proximal of the hemostasis valve  110 ). 
     The hemostasis valve system  100  may also include the first medical device  105 . As illustrated, the distal end portion  118  of the hemostasis valve  110  may be shaped (e.g., skirt-shaped or otherwise shaped) such that upon coupling of the hemostasis valve  110  and the first medical device  105  at least a portion of the distal end portion  118  extends around at least a portion of a proximal end portion  106  of the first medical device  105 . In certain embodiments, the first medical device  105  may include a valve  108 ; for example, the first medical device  105  may be a valved medical device. Furthermore, the hemostasis valve  110  may include a valve bypass portion  125 , wherein the valve bypass portion  125  extends distally from the distal end portion  118  of the hemostasis valve  110 . In some embodiments, the hemostasis valve lumen  111  may extend through at least a portion of the valve bypass portion  125 . 
     The valve bypass portion  125  may be configured to bypass or override the valve  108  of the valved medical device  105  when at least a portion of the valve bypass portion  125  is disposed through at least a portion of the valve  108  of the valved medical device  105 . For example, at least a portion of the valve bypass portion  125  may be configured to be displaced through the valve  108  (e.g., via slits  109   a ,  109   b  of the valve  108 ) and the valve  108  may be configured to form a seal (e.g., a hemostatic seal) around the valve bypass portion  125 . Accordingly, the valve bypass portion  125  may be configured to couple the hemostasis valve  110  to the first medical device or valved medical device  105 . Upon coupling of the hemostasis valve  110  and the valved medical device  105 , the hemostasis valve  110  may be in fluid communication with the valved medical device  105  (e.g., via the hemostasis valve lumen  111 ). 
       FIG. 1E  is a cross-sectional view of the hemostasis valve system  100  through line  1 E- 1 E of  FIG. 1B . The hemostasis valve system  100  can include the hemostasis valve  110  and the first medical device  105 . As discussed above, the hemostasis valve  110  can include the body  120  and the valve member  130 . The valve member  130  can be coupled to the body  120  at a position at or adjacent the proximal end portion  116  of the body  120 . The hemostasis valve  110  can further include the cap  140 . The cap  140  may be coupled to the body  120  such that at least a portion of the valve member  130  is disposed between at least a portion of the body  120  and at least a portion of the cap  140 . 
     As illustrated, the valve member  130  can include the first sealable opening  132   a  disposed through a first portion of the valve member  130  and the second sealable opening  132   b  disposed through a second portion of the valve member  130 . The hemostasis valve  110  can further include the sidearm  112  (see  FIGS. 1A-1D ). The sidearm  112  may include the sidearm lumen  114 , wherein the sidearm lumen  114  can extend through at least a portion of the sidearm  112 . As depicted, the sidearm lumen  114  may be in fluid communication with at least a portion of the hemostasis valve lumen  111  of the hemostasis valve  110 . The hemostasis valve lumen  111  can be shaped such that upon displacement of a first elongate medical device through the first sealable opening  132   a , the first elongate medical device may be directed from a proximal end of the hemostasis valve lumen  111  toward a distal end of the hemostasis valve lumen  111 . For example, as shown, the sides or inner surfaces of at least a portion of the hemostasis valve lumen  111  are sloped from a first, wider diameter D 1  at or adjacent the proximal end of the hemostasis valve lumen  111  to a second, narrower diameter D 2  at or adjacent the distal end of the hemostasis valve lumen  111 . Likewise, the shape of the hemostasis valve lumen  111  can aid in the displacement of a second elongate medical device through the second sealable opening  132   b  from the proximal end of the hemostasis valve lumen  111  to the distal end of the hemostasis valve lumen  111 . 
     As discussed above, the distal end portion  118  of the hemostasis valve  110  may be shaped such that upon coupling the hemostasis valve  110  and the first medical device  105  at least a portion of the distal end portion  118  extends around at least a portion of the proximal end portion  106  of the first medical device  105 . In the illustrated embodiment, at least a portion of the distal end portion  118  is skirt-shaped. In some other embodiments, at least a portion of the distal end portion  118  may be conical, cap-shaped, or otherwise suitably shaped. Furthermore, the hemostasis valve  110  may include the valve bypass portion  125  extending distally from the distal end portion  118  of the hemostasis valve  110 . As illustrated, the hemostasis valve lumen  111  can extend through at least a portion of the valve bypass portion  125 . 
     With continued reference to  FIG. 1E , at least a portion of the valve bypass portion  125  may be configured to be displaced through the valve  108  of the first medical device  105 . As such, the valve bypass portion  125  may couple the hemostasis valve  110  to the first medical device or valved medical device  105 . Upon coupling of the hemostasis valve  110  and the valved medical device  105 , the hemostasis valve  110  may be in fluid communication with the valved medical device  105 . In some embodiments, a distal end of the valve bypass portion  125  may be rounded such that the distal end of the valve bypass portion  125  is atraumatic (e.g., the distal end of the valve bypass portion  125  may be configured to avoid or limit damaging or traumatizing the valve  108  of the first medical device  105 ). 
       FIG. 1F  is a partial exploded view of the hemostasis valve system  100  showing a distal end of the cap  140 . As depicted, the cap  140  may include two recessed portions  144   a ,  144   b  and the proximal end portion  116  of the body  120  may include a single raised portion  124 . Caps with more or fewer recessed portions and raised portions are likewise within the scope of this disclosure. In the illustrated embodiment, the raised portion  124  extends radially outward from the proximal end portion  116  of the body  120 . The recessed portion  144   a  may be disposed about 180° from the recessed portion  144   b  along the circumference of the cap  140 , though other relative positions are within the scope of this disclosure. For example, in some other embodiments, the recessed portions  144   a ,  144   b  may be disposed about 30°, about 45°, about 90°, or another suitable number of degrees relative to each other and the cap  140  may comprise additional recessed portions, spaced equally or irregularly about the circumference of the cap  140 . 
     The raised portion  124  may be configured to receive one of the recessed portions  144   a ,  144   b . Upon coupling the cap  140  to the body  120 , the recessed portion  144   a  or the recessed portion  144   b  may engage or interact with the raised portion  124 . The engagement of the raised portion  124  with one of the recessed portions  144   a ,  144   b  can form a key/lock mechanism, such that when the cap  140  is coupled to the body  120 , the cap  140  cannot be rotated relative to the body  120 , or vice versa. Stated another way, the key/lock mechanism may “lock” the rotational position of the cap  140  in relation to the body  120 . In some embodiments, the cap  140  may include one, three, four, five or another suitable number of recessed portions and the proximal end portion  116  of the body  120  may include two, three, four, five, or another suitable number of raised portions  124 . 
       FIG. 2  illustrates a hemostasis valve  210  that can, in certain respects, resemble components of the hemostasis valve  110  described in connection with  FIGS. 1A-1E . It will be appreciated that all the illustrated embodiments may have analogous features. Accordingly, like features are designated with like reference numerals, with the leading digits incremented to “2.” For instance, the cap is designated as “ 140 ” in  FIGS. 1A-1E , and an analogous cap is designated as “ 240 ” in  FIG. 2 . Relevant disclosure set forth above regarding similarly identified features thus may not be repeated hereafter. Moreover, specific features of the hemostasis valve  110  and related components shown in  FIGS. 1A-1E  may not be shown or identified by a reference numeral in the drawings or specifically discussed in the written description that follows. However, such features may clearly be the same, or substantially the same, as features depicted in other embodiments and/or described with respect to such embodiments. Accordingly, the relevant descriptions of such features apply equally to the features of the hemostasis valve  210  of  FIG. 2 . Any suitable combination of the features, and variations of the same, described with respect to the hemostasis valve  110  and components illustrated in  FIGS. 1A-1E  can be employed with the hemostasis valve  210  and components of  FIG. 2 , and vice versa. This pattern of disclosure applies equally to further embodiments depicted in subsequent figures and described hereafter. 
       FIG. 2  is an end view of a proximal end of a hemostasis valve  210 . The hemostasis valve  210  can include a valve member  230 . As depicted, the valve member  230  may include a first sealable opening  232   a  disposed through a first portion of the valve member  230 . The valve member  230  may also include a second sealable opening  232   b  disposed through a second portion of the valve member  230 . A first slit  234   a  and a second slit  234   b  may be disposed through at least a portion of the first sealable opening  232   a , and a first slit  234   a ′ and a second slit  234   b ′ may be disposed through at least a portion of the second sealable opening  232   b . As depicted, the first sealable opening  232   a  may be substantially the same size as the second sealable opening  232   b . In some other embodiments, the first sealable opening  232   a  may be larger than the second sealable opening  232   b , or vice versa. 
     The valve member  230  may also include a third sealable opening  232   c  disposed through a third portion of the valve member  230 . Furthermore, a first slit  234   a ″ and a second slit  234   b ″ may be disposed through at least a portion of the third sealable opening  232   c . As depicted, the third sealable opening  232   c  may be larger than each of the first sealable opening  232   a  and the second sealable opening  232   b . In various embodiments, a practitioner may displace a first guidewire through the first sealable opening  232   a  and a second guidewire through the second sealable opening  232   b . The practitioner may also displace an elongate medical device having a larger profile than either of the first or second guidewire through the third sealable opening  232   c  (e.g., such as a balloon catheter). 
     In some embodiments, the hemostasis valve  210  may include one or more exchange slits (not shown) and may lack a cap. For example, the exchange slit can be disposed through a portion of the valve member  230  and extend between the first sealable opening  232   a  and the third sealable opening  232   c . As such, the practitioner may dispose the first guidewire through the first sealable opening  232   a , through the hemostasis valve  210 , and then into at least a portion of a vessel of a patient. The practitioner may then displace the first guidewire from the first sealable opening  232   a  to the third sealable opening  232   c  via the exchange slit. Upon displacement of the first guidewire to the third sealable opening  232   c , the practitioner may then dispose an elongate medical device such as a balloon catheter over and along the first guidewire and through the third sealable opening  232   c  of the hemostasis valve  210 . The hemostasis valve  210  may include one, two, three, or more exchange slits. For example, a second exchange slit may be disposed between the second sealable opening  232   b  and the third sealable opening  232   c.    
     Other relative sizes of the each of the first, second, and third sealable openings  232   a ,  232   b ,  232   c  are also within the scope of this disclosure. For example, in some other embodiments, each of the first, second, and third sealable openings  232   a ,  232   b ,  232   c  may be a different size (e.g., the first sealable opening  232   a  may be a first size, the second sealable opening  232   b  may be a second size, and the third sealable opening  232   c  may be a third size). 
     The sealable openings (e.g., the first sealable opening  232   a , the second sealable opening  232   b , the third sealable opening  232   c ) may be configured such that an elongate medical device (e.g., a guidewire, a stylet, a catheter, etc.) may be disposed through at least a portion of the slits of the sealable opening and the sealable opening and/or the slits may form a seal (e.g., a hemostatic seal) around the elongate medical device. 
     In some embodiments, a first balloon catheter may be disposed through the first sealable opening  232   a  and a second balloon catheter may be disposed through the second sealable opening  232   b . Furthermore, a contrast agent (e.g., for an angiogram) may be introduced through the third sealable opening  232   c  (e.g., via a catheter). For example, the first and second sealable openings  232   a ,  232   b  may be configured to seal around at least a portion of 12 French first and second balloon catheters and the third sealable opening  232   c  may be configured to seal around at least a portion of a 14 French contrast agent catheter. 
     The hemostasis valve  210  may also include the cap  240 . The cap  240  may be coupleable to a proximal end portion of the hemostasis valve  210  such that at least a portion of the valve member  230  is disposed between the cap  240  and a body of the hemostasis valve  210 . As stated above, in some other embodiments, the hemostasis valve  210  may lack a cap. The cap  240  can include a first cap opening  242   a  and a second cap opening  242   b . The first cap opening  242   a  may be disposed through the cap  240  such that upon coupling of the cap  240  to the hemostasis valve  210 , the first cap opening  242   a  is in substantial alignment with the first sealable opening  232   a . The second cap opening  242   b  may be disposed through the cap  240  such that upon coupling of the cap  240  to the hemostasis valve  210 , the second cap opening  242   b  is in substantial alignment with the second sealable opening  232   b . The cap  240  may also include a third cap opening  242   c . The third cap opening  242   c  may be disposed through the cap  240  such that upon coupling of the cap  240  to the hemostasis valve  210 , the third cap opening  242   c  is in substantial alignment with the third sealable opening  232   c.    
       FIG. 3  is an end view of a proximal end of a hemostasis valve  310 . The hemostasis valve  310  can include a valve member  330 . As depicted, the valve member  330  may include a first sealable opening  332   a  disposed through a first portion of the valve member  330  and a second sealable opening  332   b  disposed through a second portion of the valve member  330 . A first slit  334   a  may be disposed through at least a portion of the first sealable opening  332   a , and a second slit  334   b  may be disposed through at least a portion of the second sealable opening  332   b . Furthermore, an elongate slit  335  may be disposed through a portion of the valve member  330 . The first sealable opening  332   a  and the second sealable opening  332   b  may be coupled via the elongate slit  335 . In such a configuration, a first elongate medical device may be disposed through the first sealable opening  332   a  and then displaced from the first sealable opening  332   a  to the second sealable opening  332   b  via the elongate slit  335 . Likewise, a second elongate medical device may be disposed through the second sealable opening  332   b  and then displaced from the second sealable opening  332   b  to the first sealable opening  332   a  via the elongate slit  335 . 
     The hemostasis valve  310  may also include a cap  340 . The cap  340  can include a cap opening  342 . The cap opening  342  may be disposed through the cap  340  such that upon coupling of the cap  340  to the hemostasis valve  310 , the cap opening  342  is disposed around each of the first and second sealable openings  332   a ,  332   b  and/or provides access (e.g., to a practitioner) to each of the first and second sealable openings  332   a ,  332   b.    
       FIG. 4A  is a side view of a hemostasis valve  410 ,  FIG. 4B  is a cross-sectional view of the hemostasis valve  410  through line  4 B- 4 B of  FIG. 4A , and  FIG. 4C  is an end view of a proximal end of the hemostasis valve  410 . The hemostasis valve  410  can include a body  420  extending between a proximal end portion  416  and a distal end portion  418 . The hemostasis valve  410  can also include a valve member  430 , wherein the valve member  430  may be coupled to the body  420  at a position at or adjacent the proximal end portion  416 . The hemostasis valve  410  can further include a cap  440 , wherein the cap  440  may be coupled to the body  420  such that at least a portion of the valve member  430  is disposed between at least a portion of the body  420  and at least a portion of the cap  440 . In some embodiments, the hemostasis valve  410  may lack a cap. 
     The valve member  430  can include a first sealable opening  432   a  disposed through a first portion of the valve member  430  and a second sealable opening  432   b  disposed through a second portion of the valve member  430 . The hemostasis valve  410  can further include a sidearm  412 . The sidearm  412  can include a sidearm lumen  414 , wherein the sidearm lumen  414  can extend through at least a portion of the sidearm  412 . As depicted, the sidearm lumen  414  may be in fluid communication with at least a portion of a hemostasis valve lumen  411  of the hemostasis valve  410 . Furthermore, the hemostasis valve lumen  411  can extend through at least a portion of the hemostasis valve  410 . As illustrated, the hemostasis valve lumen  411  extends between the proximal end portion  416  and the distal end portion  418  of the hemostasis valve  410 . As discussed above regarding the hemostasis valve lumen  111 , the shape of the hemostasis valve lumen  411  can aid in the displacement of an elongate medical device through the hemostasis valve  410 . 
     The distal end portion  418  of the hemostasis valve  410  may be configured such that the hemostasis valve  410  can be coupled to another medical device. For example, a coupling mechanism may be coupled to or disposed at or adjacent the distal end portion  418  (e.g., a luer connector, a snap fit mechanism, a plurality of threads). In some embodiments, another medical device may extend distally from the distal end portion  418  of the hemostasis valve  410 . For example, a sheath introducer may be integral with the hemostasis valve  410  and the sheath introducer may extend distally from the distal end portion  418 . Other suitable medical devices may also be coupled to or integral with the hemostasis valve  410  (e.g., a catheter, medical tubing, etc.).  FIG. 4D  is a side view of the hemostasis valve  410  coupled to an introducer sheath  401  adjacent the distal end portion  418  of the body  420 . 
     Analogous to the introducer sheath  401  of  FIG. 4D , any of the hemostasis valves described herein may be coupled to a variety of elongate medical devices, including introducer sheaths, catheters, conduits, and so forth. As noted above, in some instances the hemostasis valve may snap onto the hub of an elongate device, including hubs that include an existing hemostasis valve. In other embodiments, the hemostasis valves described herein may be configured to attach to an elongate medical instrument via a luer lock. For instances, a hemostasis valve within the scope of this disclosure may comprise a luer lock at the distal end portion  418  which may be configured to couple to a catheter; in some embodiments the catheter may be a standard catheter with a luer fitting on its proximal end. Similarly, hemostasis valves described herein may be coupled to a variety of devices through use of a variety of connectors, including snap fits, luer fittings, barb fittings, adhesives, and so forth. 
       FIG. 5  is an exploded view of a hemostasis valve  510  including a valve dividing member  560 . As illustrated, the valve dividing member  560  can include a first elongate portion  562  that extends between an actuator  564  and a hinge portion  566 . Furthermore, the first elongate portion  562  can extend through a slot  517 , wherein the slot  517  is disposed through a proximal end portion  516  of the hemostasis valve  510 . The valve dividing member  560  can further include a second elongate portion  568 , wherein the second elongate portion  568  is coupled to the first elongate portion  562  and/or the actuator  564  via a transverse portion  561 . 
     Upon coupling of the hemostasis valve  510  to a valve member  530 , the first elongate portion  562  and the second elongate portion  568  may be configured to couple, engage with, and/or interact with the valve member  530 . The first elongate portion  562  and the second elongate portion  568  may be configured as a divider displaceable along a sealable opening  532  of the valve member  530 . The divider may allow a practitioner to divide the sealable opening  532  into a first side and a second side, for example to separate two guidewires positioned in different points of a patient&#39;s anatomy. Displacement of the valve dividing member  560  in one direction may increase the available space to advance a larger therapy (such as a balloon) over one guidewire. At the conclusion of the initial therapy, the valve dividing member  560  could be displaced in the other direction to provide more space for treatment via a wire on the other side of the valve dividing member  560 . This embodiment may allow a practitioner to separate two guidewires and accommodate larger therapies when needed, while minimizing the overall size of the hemostasis valve  510 . 
     The first elongate portion  562  and the second elongate portion  568  may provide structure and support above and below the valve member  530  such that a practitioner may displace the first elongate portion  562  and the second elongate portion  568  to change the effective length of the sealable opening  532  on other side of the first elongate portion  562  and the second elongate portion  568 . This support structure may allow the sealable opening  532  to remain sealed on a guidewire on one side of the valve dividing member  560  while a large therapy such as a balloon is inserted through the sealable opening  532  on the other side of the valve dividing member  560 . The support structure may facilitate simultaneous sealing of the sealable opening  532  on both the balloon on one side and a guidewire on the other side of the valve dividing member  560 . 
     The valve dividing member  560  may be configured to be displaceable between at least a resting position, a first lateral position, and a second lateral position. The resting position may correlate to a central position when the valve dividing member  560  is disposed in a middle portion of the valve member  530  (e.g., as depicted in  FIG. 5 ). Displacement of the valve dividing member  560  (e.g., via the actuator  564 ) in a first direction as indicated by the arrow D 1  may displace the first elongate portion  562  and the second elongate portion  568  in the first direction (i.e., to the first lateral position). In the first lateral position, the sealable opening  532  has a longer effective or usable length on the side of the first elongate portion  562  and the second elongate portion  568  associated with the second direction (indicated by arrow D 2 ). Thus, in this position a practitioner may be able to advance larger therapies (such as a balloon) through the sealable opening  532  on the side of the valve dividing member  560  associated with the second direction. Again, the sealable opening  532  may simultaneously seal against a guidewire on the first side of the valve dividing member  560  and a larger device on the second side of the valve dividing member  560 . 
     Likewise, displacement of valve dividing member  560  in a second direction as indicated by the arrow D 2  may displace at least a portion of the first elongate portion  562  and the second elongate portion  568  in the second direction (i.e., to the second lateral position). This displacement may provide a greater effective length of the sealable opening  532  on the side of the valve dividing member  560  associated with the first direction. 
     In some other embodiments, a first iris-like support member may provide structure and support above a valve member and/or a second iris-like support member may provide structure and support below the valve member. At least a portion of the iris-support member may be analogous to a camera aperture. The first and/or second iris-like support members may be configured to transition from a first diameter to a second diameter, wherein the first diameter is greater than the second diameter. The first and/or second iris-like support members may be disposed around a sealable opening, as provided herein, having a first slit and a second slit wherein the intersecting first and second slits form at least four leaflets in the valve member at the sealable opening. 
     When the first and/or second iris-like support members are in the first diameter, a first elongate medical device having a first diameter may be disposed through the sealable opening and the leaflets can form a seal around the first elongate medical device. When a second elongate medical device having a second, smaller diameter is disposed through the sealable opening, a practitioner may transition the first and/or second iris-like support members to the second smaller diameter such that the leaflets are supported (i.e., by the first and/or second iris-like support members) and can form a seal around the second elongate medical device having the second, smaller diameter. 
       FIG. 6  illustrates a valve member  630 .  FIG. 6A  is a cross-sectional view of the valve member  630  taken through line  6 A- 6 A and  FIG. 6B  is a cross-sectional view of the valve member  630  taken through line  6 B- 6 B. As shown, the valve member  630  can include a first sealable opening  632   a  having a first slit  634   a  disposed through at least a portion of the first sealable opening  632   a  and/or along at least a portion of the diameter of the first sealable opening  632   a . The first sealable opening  632   a  may also include a second slit  634   b , wherein the second slit  634   b  may intersect at least a portion of the first slit  634   a . Likewise, the first slit  634   a  may be disposed through at least a portion of a second sealable opening  632   b  and/or along at least a portion of the diameter of the second sealable opening  632   b . The second sealable opening  632   b  may also include a second slit  634   b ′, wherein the second slit  634   b ′ may intersect at least a portion of the first slit  634   a . As depicted, the first slit  634   a  may be disposed substantially perpendicular to the second slits  634   b ,  634   b′.    
     The valve member  630  can further include a wall  636  disposed between the first sealable opening  632   a  and the second sealable opening  632   b . As illustrated, the first slit  634   a  can extend through the wall  636  between each of the first and second sealable openings  632   a ,  632   b . As discussed above, at least a portion of the wall  636  may be resilient or deformable. At least a portion of a first edge  639   a  surrounding the first sealable opening  632   a  and/or at least a portion of a second edge  639   b  surrounding the second sealable opening  632   b  may be chamfered or sloped. Such a configuration may aid in guiding an elongate medical device through the first and/or the second sealable openings  632   a ,  632   b.    
     With reference to  FIG. 6A , the first slit  634   a  may extend inward from a first surface  631  of the valve member  630  and through at least a portion of the each of the first and second sealable openings  632   a ,  632   b . As illustrated, the first slit  634   a  may form a substantially arc-shaped cut or slit in at least a portion of the valve member  630 . Other shapes of the first slit  634   a  (e.g., linear, wavy, etc.) are also within the scope of this disclosure. Furthermore, the second slits  634   b ,  634   b ′ may extend inward from a second or opposite surface  633  of the valve member  630 . Each of the second slits  634   b ,  634   b ′ may intersect with at least a portion of the first slit  634   a  to form the first and second sealable openings  632   a ,  632   b.    
     With reference to  FIG. 6B , the first slit  634   a  may extend inward from the first surface  631  of the valve member  630  and through at least a portion of the first sealable opening  632   a . Furthermore, the second slit  634   b  may extend inward from the second surface  633  of the valve member  630 . The second slit  634   b  may intersect with at least a portion of the first slit  634   a  to form the first sealable opening  632   a . As illustrated, the second slit  634   b  may form a substantially arc-shaped cut or slit in at least a portion of the valve member  630 . Other shapes of the second slit  634   b  (e.g., linear, wavy, etc.) are also within the scope of this disclosure. The second slit  634   b ′, which is not shown in  FIG. 6B , may be configured in a similar manner to that of the second slit  634   b.    
       FIG. 7  illustrates a valve member  730 .  FIG. 7A  is a cross-sectional view of the valve member  730  taken through line  7 A- 7 A and  FIG. 7B  is a cross-sectional view of the valve member  730  taken through line  7 B- 7 B. As shown, the valve member  730  can include a first sealable opening  732   a  and a second sealable opening  732   b . A first slit  734   a  can be disposed through at least a portion of the first and second sealable openings  732   a ,  732   b . The first sealable opening  732   a  may also include a second slit  734   b , wherein the second slit  734   b  may intersect at least a portion of the first slit  734   a . Likewise, the second sealable opening  732   b  may also include a second slit  734   b ′, wherein the second slit  734   b ′ may intersect at least a portion of the first slit  734   a . As depicted, the first slit  734   a  may be disposed substantially perpendicular to the second slits  734   b ,  734   b′.    
     With reference to  FIG. 7A , the first slit  734   a  may extend inward from a first surface  731  of the valve member  730  and through at least a portion of each of the first and second sealable openings  732   a ,  732   b . As illustrated, the first slit  734   a  may form a substantially arc-shaped cut or slit in at least a portion of the valve member  730 . Other shapes of the first slit  734   a  (e.g., linear, wavy, etc.) are also within the scope of this disclosure. Furthermore, the second slits  734   b ,  734   b ′ may extend inward from a second or opposite surface  733  of the valve member  730 . Each of the second slits  734   b ,  734   b ′ may intersect with at least a portion of the first slit  734   a  to form the first and second sealable openings  732   a ,  732   b.    
     With reference to  FIG. 7B , the first slit  734   a  may extend inward from the first surface  731  of the valve member  730  and through at least a portion of the first sealable opening  732   a . Furthermore, the second slit  734   b  may extend inward from the second surface  733  of the valve member  730 . The second slit  734   b  may intersect with at least a portion of the first slit  734   a  to form the first sealable opening  732   a . As illustrated, the second slit  734   b  may form a substantially arc-shaped cut or slit in at least a portion of the valve member  730 . Other shapes of the second slit  734   b  (e.g., linear, wavy, etc.) are also within the scope of this disclosure. The second slit  734   b ′, which is not shown in  FIG. 7B , may be configured in a similar manner to the second slit  734   b.    
       FIG. 8  illustrates a valve member  830 . As shown, the valve member  830  can include a first sealable opening  832  having a first slit  834   a  disposed through at least a portion of the first sealable opening  832  and/or along at least a portion of the diameter of the first sealable opening  832 . The first sealable opening  832  may also include a second slit  834   b , wherein the second slit  834   b  may intersect at least a portion of the first slit  834   a . Likewise, a first slit  834   a ′ may be disposed through at least a portion of a second sealable opening  832 ′ and/or along at least a portion of the diameter of the second sealable opening  832 ′. The second sealable opening  832 ′ may also include a second slit  834   b ′, wherein the second slit  834   b ′ may intersect at least a portion of the first slit  834   a ′. As depicted, the first and second slits  834   a ,  834   b  may be disposed such that they form an X shape. The first and second slits  834   a ′,  834   b ′ may also be disposed such that they form an X shape. The slits forming the X shape may intersect at various angles and are not necessarily perpendicular to each other. 
       FIG. 9  illustrates a valve member  930 . As shown, the valve member  930  can include a first sealable opening  932  having a single slit  934  disposed through at least a portion of the first sealable opening  932  and/or along at least a portion of the diameter of the first sealable opening  932 . Likewise, a single slit  934 ′ may be disposed through at least a portion of a second sealable opening  932 ′ and/or along at least a portion of the diameter of the second sealable opening  932 ′. Any of the sealable openings and/or slits depicted in  FIGS. 1A-5  may be formed in manner analogous to any of the sealable openings and/or slits depicted in  FIGS. 6-9 . 
       FIG. 10  is an exploded view of a hemostasis valve  1010 . The hemostasis valve  1010  can include a body  1020 . The hemostasis valve  1010  can further include a first valve member  1030   a  and a second valve member  1030   b , wherein the first and second valve members  1030   a ,  1030   b  are configured to be disposed at or adjacent a proximal end portion  1016  of the hemostasis valve  1010 . Stated another way, the first and second valve members  1030   a ,  1030   b  may be coupleable to the hemostasis valve  1010  at a position at or adjacent the proximal end portion  1016  of the hemostasis valve  1010  (e.g., at a first and second valve member coupling portion  1022   a ,  1022   b , respectively). The first and second valve member coupling portions  1022   a ,  1022   b  may be configured to limit or prevent movement (e.g., longitudinal movement) of the first and second valve members  1030   a ,  1030   b  relative to the hemostasis valve  1010  when the first and second valve members  1030   a ,  1030   b  are coupled to the hemostasis valve  1010 . 
     As depicted, the first valve member  1030   a  includes a first sealable opening  1032   a  disposed through a first portion of the first valve member  1030   a  and a second sealable opening  1032   b  disposed through the second valve member  1030   b . As discussed above, each of the first and second sealable openings  1032   a ,  1032   b  can include one or more slits disposed through at least a portion of the first and second valve members  1030   a ,  1030   b . In some embodiments, the hemostasis valve  1010  may include three, four, five, or more valve members. 
     Any of the valve members depicted in  FIGS. 1A-9 or 11  may be formed in a manner analogous to the valve members depicted in  FIG. 10 . In other words, the valve member may include a single piece or member including two or more sealable openings or the valve member may include multiple pieces or members. Additionally, any of the hemostasis valves provided herein may be stand-alone hemostasis valves for use with a hemostasis valve system or the hemostasis valves may be configured such that they may retrofit a standard (e.g., off-the-shelf) hemostasis valve system. 
       FIG. 11  is a perspective view of a hemostasis valve system  1100 . The hemostasis valve system  1100  can include a hemostasis valve  1110  and another medical device such as a first medical device  1105 . The hemostasis valve  1110  can be releasably coupleable to the first medical device  1105 . The first medical device  1105  may comprise or be releasably coupleable to a first elongate member  1170  including, for example, a length of tubing  1171  coupled to a stopcock  1174 . The hemostasis valve  1110  may also comprise or be releasably coupleable to a second elongate member  1180  including, for example, a length of tubing  1181  coupled to a stopcock  1184 . In certain embodiments, the first medical device  1105  may be independent of the first elongate member  1170  and/or the hemostasis valve  1110  may be independent of the second elongate member  1180 . For example, the first medical device  1105  may be provided and/or used without the first elongate member  1170 . Likewise, the hemostasis valve  1110  may be provided and/or used without the second elongate member  1180 . 
     In some embodiments, the first medical device  1105  may be a traditional hemostasis valve, a valved sheath introducer, or another valved medical device. The first medical device  1105  may be an off-the-shelf medical device such that the tubing  1171  has a standard length. For example, the tubing  1171  of an off-the-shelf first medical device  1105  may be about 8 inches in length or another suitable length. In certain embodiments, the length of the tubing  1181  of the hemostasis valve  1110  may be greater than the length of the tubing  1171  of the first medical device  1105 . For example, if the length of the tubing  1171  of the first medical device  1105  is 8 inches, the length of the tubing  1181  of the hemostasis valve  1110  may be between about 8.5 inches and about 9.5 inches, about 9 inches, between about 9.5 inches and about 10.5 inches, about 10 inches, between about 10.5 inches and about 11 inches, about 11 inches, or another suitable length. In certain other embodiments, the length of the tubing  1181  of the hemostasis valve  1110  may be less than the length of the tubing  1171  of the first medical device  1105 . For example, if the length of the tubing  1171  of the first medical device  1105  is 8 inches, the length of the tubing  1181  of the hemostasis valve  1110  may be between about 6.5 inches and about 7.5 inches, about 7 inches, between about 5.5 inches and about 6.5 inches, about 6 inches, between about 4.5 inches and about 5.5 inches, about 5 inches, or another suitable length. Accordingly, the length of the tubing  1181  of the hemostasis valve  1110  may be an indicium. Stated another way, the length of the tubing  1181  of the hemostasis valve  1110  may be an indicium that communicates to a user which tubing is coupled to the hemostasis valve and which tubing is coupled to the first medical device  1105 . The first and second lengths of the tubings  1171 ,  1181  can distinguish the tubings  1171 ,  1181  (and/or the first medical device  1105  and the hemostasis valve  1110 ) from each other. Other suitable indicia may also be used. For example, while the tubing  1171  of the first medical device may be clear or transparent, the tubing  1181  of the hemostasis valve  1110  may have a color or tint (e.g., the tubing  1181  may be green). Likewise, the stopcocks  1174 ,  1184  may be color coded to correspond with a portion of the hemostasis valve  1100 ,  1110  to which they are directly coupled. 
     The hemostasis valve  1110  can include a body  1120  and a valve member  1130 . The valve member  1130  can be coupled to the body  1120  at a position at or adjacent a proximal end portion  1116  of the body  1120 . The valve member  1130  may include a first sealable opening  1132   a  disposed through a first portion of the valve member  1130 . The valve member  1130  may also include a second sealable opening  1132   b  disposed through a second portion of the valve member  1130 . As discussed herein, a hemostasis valve having two or more sealable openings may aid in access and/or treatment. In certain embodiments, the valve member  1130  may include a third sealable opening, a fourth sealable opening, a fifth sealable opening, a sixth sealable opening, a seventh sealable opening, an eighth sealable opening, or more sealable openings. 
     With continued reference to  FIG. 11 , the hemostasis valve  1110  may further include a sidearm  1112 . The sidearm  1112  may include a sidearm lumen  1114 , the sidearm lumen  1114  extending through at least a portion of the sidearm  1112 . In some embodiments, the sidearm lumen  1114  may be in fluid communication with a lumen or a hemostasis valve lumen  1111  of the hemostasis valve  1110 . In various embodiments, the sidearm lumen  1114  may be in fluid communication with a lumen or a second elongate member lumen  1182  of the second elongate member  1180 . 
     The first medical device  1105  may also include a sidearm  1109 . The sidearm  1109  may include a sidearm lumen  1104 , the sidearm lumen  1104  extending through at least a portion of the sidearm  1109 . In some embodiments, the sidearm lumen  1104  may be in fluid communication with a lumen or a first medical device lumen  1103  of the first medical device  1105 . In certain embodiments, the sidearm lumen  1104  may be in fluid communication with a lumen or a first elongate member lumen  1172  of the first elongate member  1170 . As shown, the first elongate member  1170  may be coupled or releasably coupled to the sidearm  1109  and the second elongate member  1180  may be coupled or releasably coupled to the sidearm  1112 . 
     As discussed above, the sidearm  1112  may rotate independent of the sidearm  1109 , for example, when the hemostasis valve  1110  is coupled to the first medical device  1105 . The hemostasis valve  1110  may also be configured such that upon coupling of the hemostasis valve  1110  to the first medical device  1105 , the sidearm lumen  1104  is not blocked by a portion of the hemostasis valve  1110 . In various embodiments, each of the first and second elongate member lumens  1172 ,  1182  may be in fluid communication with each of the first medical device lumen  1103  and the hemostasis valve lumen  1111  (e.g., when the first medical device  1105  comprising the first elongate member  1170  is coupled to the hemostasis valve  1110  comprising the second elongate member  1180 ). 
     Methods of using the hemostasis valve systems and hemostasis valves are also disclosed herein. In some embodiments, a method of using a hemostasis valve system or hemostasis valve as disclosed herein may include displacing a first elongate medical device (e.g., a first guidewire) through a first sealable opening of the hemostasis valve. The method may further include displacing a second elongate medical device (e.g., a second guidewire) through a second sealable opening of the hemostasis valve. 
     In certain embodiments, the method of using the hemostasis valve system or hemostasis valve may include coupling the hemostasis valve to a valved medical device (e.g., another hemostasis valve) such that a lumen of the hemostasis valve is in fluid communication with a lumen of the valved medical device, and such that the hemostasis valve bypasses the valve of the valved medical device. In various embodiments, the hemostasis valve may be sealably coupled to the valved medical device. 
     Procedures wherein a hemostasis device having multiple sealable openings is coupled to a valved medical device during use of the valved medical device are within the scope of this disclosure. For instance, during a procedure wherein a single guidewire or other device is disposed within a single sealable opening valved medical device, a practitioner may desire placement of a second guidewire or medical device. Simply inserting a second guidewire or medical device through a standard sealable opening may cause blood loss, as the sealable opening is not configured to seal around two devices. Rather, such sealable openings may be configured to seal about the outside diameter of one medical device.  FIGS. 12A-12G  illustrate an exemplary procedure wherein a hemostasis valve having multiple sealable openings can be coupled to a valved medical device, without removing a device disposed within the valved medical device, while minimizing blood loss by only presenting one device outside diameter for the valved medical device to seal against. 
       FIG. 12A  is view of a guidewire  2  and a valved medical device  1205  (also referred to herein as a first medical device). As depicted, the valved medical device  1205  can be a valved sheath introducer. Other valved medical devices are also within the scope of the present disclosure, for example, the valved medical device  1205  may be a traditional hemostasis valve. As illustrated in  FIG. 12B , the guidewire  2  may be introduced into the valved medical device  1205  (e.g., through an opening and/or a valve of the valved medical device  1205 ). In some embodiments, the guidewire  2  may be introduced into the valved medical device  1205  at a proximal end portion  1206  of the valved medical device  1205 . The guidewire  2  may then be displaced through the valved medical device  1205  such that at least a portion of the guidewire  2  extends distal of a distal end portion  1207  of the valved medical device  1205 . In various embodiments, the guidewire  2  may be introduced through the valved medical device  1205  from the distal end portion  1207  to the proximal end portion  1206 . 
     Upon disposition of the guidewire  2  within the valved medical device  1205 , a distal end of the guidewire  2  may be disposed distal of the distal end portion  1207  of the valved medical device  1205  and a proximal end of the guidewire  2  may be disposed proximal of the proximal end portion  1206  of the valved medical device  1205 . In certain embodiments, at least the distal end of the guidewire  2  may be disposed within a patient (e.g., within a vasculature of the patient). 
     The valved medical device  1205  may have a single sealable opening. However, as noted above, in some embodiments, a practitioner may desire to dispose more than one elongate medical device through the valved medical device  1205 . Stated another way, the practitioner may desire to introduce two or more medical devices into a patient via the valved medical device  1205 . Accordingly, the practitioner can use a hemostasis valve as provided herein. For example, the practitioner may use a hemostasis valve as discussed above, such as, but not limited to, hemostasis valves  110 ,  210 ,  310 ,  410 ,  510 ,  1010 ,  1110 . 
       FIG. 12C  illustrates a hemostasis valve  1210  and an insertion device  1290 . In certain embodiments, the insertion device  1290  may include an elongate member  1291 , wherein a lumen  1292  extends through at least a portion of the elongate member  1291 . The insertion device  1290  may also include a handle  1293  disposed at a proximal end of the insertion device  1290  and an opening  1294  disposed at a distal end of the insertion device  1290 . The handle  1293 , as illustrated, may include one or more ridges or protrusions  1298 . The handle  1293  and/or the protrusions  1298  can aide a practitioner in grasping the insertion device  1290  (e.g., during use of the insertion device  1290 ). 
     The insertion device  1290  can also include a side opening  1295  disposed through a sidewall of the insertion device  1290 . The side opening  1295  can provide fluid communication between the lumen  1292  and an exterior of the insertion device  1290 . As depicted, the insertion  1290  may also include a bend or curve portion  1299 . The side opening  1295  can be disposed at or adjacent the bend portion  1299  such that at least a portion of an elongate medical device such as the guidewire  2  can be displaced from within the lumen  1292 , through the side opening  1295 , and to the exterior of the insertion device  1290 . In certain embodiments, the insertion device  1290  may also include a slit (not shown) extending through at least a portion of the side wall of the insertion device  1290 , for example, between the opening  1294  and the side opening  1295 . The slit may be configured such that at least a portion of an elongate medical device such as the guidewire  2  can be displaced from within the lumen  1292 , through the slit, and to the exterior of the insertion device  1290 . 
     With continued reference to  FIG. 12C , a distal end portion  1297  of the insertion device  1290  can be tapered. The tapered shape of the distal end portion  1297  of the insertion device  1290  may aide in or ease the introduction of the insertion device  1290  into the hemostasis valve  1210  and/or the valved medical device  1205 . In some other embodiments, a distal end portion of an insertion device may not be tapered. In such an embodiment, an opening at a distal end of the insertion device may be larger than the opening  1294  in the insertion device  1290 , which includes a taper. Such larger openings may ease the insertion of the guidewire  2  through the opening and into the lumen of the insertion device. 
     The insertion device  1290  can be configured to be disposed through at least a portion of the hemostasis valve  1210 . In some embodiments, the hemostasis valve  1210  may include two or more sealable openings (see, e.g.,  FIG. 11  depicting the hemostasis valve  1110  including the first sealable opening  1132   a  and the second sealable opening  1132   b ). The practitioner may dispose the insertion device  1290  through a desired sealable opening of the hemostasis valve  1210 . For example, with reference to  FIG. 11 , the practitioner may dispose the insertion device  1290  through either one of the first or second sealable openings  1132   a ,  1132   b.    
     In  FIG. 12D , the insertion device  1290  has been disposed through at least a portion of the hemostasis valve  1210  such that the handle  1293  is disposed proximal of the hemostasis valve  1210  and the opening  1294  is disposed distal of the hemostasis valve  1210 .  FIG. 12D  also depicts the guidewire  2  that has been displaced through at least a portion of the valved medical device  1205 . 
     As illustrated in  FIG. 12E , the practitioner may dispose a proximal end of the guidewire  2  through the opening  1294  and into the lumen  1292  of the insertion device  1290 . At least a portion of the guidewire  2  may then be displaced through the lumen  1292  and may exit the lumen  1292  at the side opening  1295  of the insertion device  1290 . The insertion device  1290  can ease the displacement of the guidewire  2  through the hemostasis valve  1210 . For example, it may be difficult to dispose the guidewire  2  through at least a portion of the hemostasis valve  1210  (e.g., through a sealable opening, a lumen, or another portion of the hemostasis valve  1210 ) without a device such as the insertion device  1290 . The distal and/or the proximal end portions of the guidewire  2  may be configured to be atraumatic, for example, the distal and/or the proximal end portions of the guidewire  2  may be easily bendable (e.g., flexible or not rigid). 
       FIG. 12F  illustrates that the hemostasis valve  1210  may be coupled to the valved medical device  1205 , for example, when the guidewire  2  and/or the insertion device  1290  are disposed through the hemostasis valve  1210  and the valved medical device  1205 . As shown in the  FIG. 12G , the insertion device  1290  may be displaced from within the hemostasis valve  1210  and/or the valved medical device  1205 , for example, as indicated by the arrow. Furthermore, the guidewire  2  may remain disposed within each of the hemostasis valve  1210  and the valved medical device  1205  as the insertion device is removed from the around the guidewire  2  and from within each of the hemostasis valve  1210  and the valved medical device  1205 . In some embodiments, the insertion device  1290  may be removed from the around the guidewire  2  prior to the coupling of the hemostasis valve  1210  and the valved medical device  1205   
     With continued reference to  FIGS. 12A-12G , methods of disposing elongate medical devices, such as the guidewire  2 , through a hemostasis valve may include, introducing at least a portion of the insertion device  1290  through a first sealable opening of the hemostasis valve  1210 . The methods may also include, obtaining the guidewire  2 , wherein at least a portion of the guidewire  2  is disposed through the valved medical device  1205 . As noted above, the procedure depicted in  FIGS. 12A-12G  resulting in coupling of the hemostasis valve  1210  to the valved medical device  1205 , without removing the guidewire  2  from the valved medical device  1205  and while only presenting one outside diameter (either the guidewire  2  or the insertion device  1290 ) at a time to any sealable opening (either in the valved medical device  1205  or the hemostasis valve  1210 ). 
     In some embodiments, the methods may include inserting the proximal end of the guidewire  2  through the opening  1294  at the distal end of the insertion device  1290 . Furthermore, at least a portion of the guidewire  2  may be displaced through at least a portion of the insertion device  1290  such that the proximal end of the guidewire  2  is disposed proximal of each of the hemostasis valve  1210  and the valved medical device  1205 . The hemostasis valve  1210  may also be coupled to the valved medical device  1205 , or vice versa. In various embodiments, when the hemostasis valve  1210  is coupled to the valved medical device  1205  a lumen of the hemostasis valve  1210  may be in fluid communication with a lumen of the valved medical device  1205  and the hemostasis valve  1210  may bypass a valve of the valved medical device  1205 . 
     In certain embodiments, methods of disposing the guidewire  2  through the hemostasis valve  1210  may include displacing the proximal end of the guidewire  2  through the side opening  1295  disposed adjacent a proximal portion of the insertion device  1290 . Additionally, the insertion device  1290  can be removed or retrieved from within the hemostasis valve  1210  such that the guidewire  2  remains disposed through each of the hemostasis valve  1210  and the valved medical device  1205 . In some embodiments, the methods may also include inserting a second guidewire through a second sealable opening of the hemostasis valve  1210  and displacing the second guidewire through each of the hemostasis valve  1210  and the valved medical device  1205 . 
     In various embodiments, a practitioner may dispose the insertion device  1290  through a first sealable opening or a second sealable opening of the hemostasis valve  1210 . The practitioner may displace the insertion device  1290  along a proximal portion of a first guidewire that is disposed through the valved medical device  1205 . The practitioner may then remove or retrieve the insertion device  1290  from within the hemostasis valve  1210  when the first guidewire is disposed through each of the hemostasis valve  1210  and the valved medical device  1205 . 
     In some embodiments, the practitioner may couple (e.g., sealably couple) the hemostasis valve  1210  to the valved medical device  1205 . Furthermore, the practitioner may dispose a second guidewire through the second sealable opening when the first guidewire is disposed through the first sealable opening or dispose the second guidewire through the first sealable opening when the first guidewire is disposed through the second sealable opening. In some embodiments, the hemostasis valve  1290  may include three or more sealable openings, as discussed above. In such a configuration, the practitioner may dispose three or more elongate medical devices, such as guidewires, through the hemostasis valve. 
       FIG. 13  depicts a use of a hemostasis valve system. The hemostasis valve system may include the hemostasis valve  1210  and the insertion device  1290 . As depicted, the hemostasis valve  1210  can be coupled to the valved medical device  1205 . The insertion device  1290  can be disposed through each of the hemostasis valve  1210  and the valved medical device  1205 . As such, the insertion device  1290  can aide in the disposition of the guidewire  2 , or another suitable elongate medical device, through at least a portion of each of the hemostasis valve  1210  and the valved medical device  1205   
     Additional methods and/or method steps can be derived from  FIGS. 1A-13  and the corresponding disclosure. Any methods disclosed herein comprise one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified. 
     References to approximations are made throughout this specification, such as by use of the term “substantially.” For each such reference, it is to be understood that, in some embodiments, the value, feature, or characteristic may be specified without approximation. For example, where qualifiers such as “about” and “substantially” are used, these terms include within their scope the qualified words in the absence of their qualifiers. For example, where the term “substantially sealed” is recited with respect to a feature, it is understood that in further embodiments, the feature can have a precisely sealed configuration. 
     Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment. 
     Similarly, in the above description of embodiments, various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. 
     The claims following this written disclosure are hereby expressly incorporated into the present written disclosure, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims. Moreover, additional embodiments capable of derivation from the independent and dependent claims that follow are also expressly incorporated into the present written description. 
     Without further elaboration, it is believed that one skilled in the art can use the preceding description to utilize the invention to its fullest extent. The claims and embodiments disclosed herein are to be construed as merely illustrative and exemplary, and not a limitation of the scope of the present disclosure in any way. It will be apparent to those having ordinary skill in the art, with the aid of the present disclosure, which changes may be made to the details of the above-described embodiments without departing from the underlying principles of the disclosure herein. In other words, various modifications and improvements of the embodiments specifically disclosed in the description above are within the scope of the appended claims. Moreover, the order of the steps or actions of the methods disclosed herein may be changed by those skilled in the art without departing from the scope of the present disclosure. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order or use of specific steps or actions may be modified. The scope of the invention is therefore defined by the following claims and their equivalents.