Patent Publication Number: US-2020297973-A1

Title: Robotic percutaneous device wiper

Description:
CROSS-REFERENCE TO RELATED PATENT APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 15/785,366 entitled ROBOTIC PERCUTANEOUS DEVICE WIPER FILED Oct. 16, 2017, which is a continuation-in-part of U.S. application Ser. No. 14/216,076 entitled WIPING MECHANISM FOR A Y-CONNECTOR filed Mar. 17, 2014, now U.S. Pat. No. 9,789,285, which claims the benefit of U.S. Provisional Application No. 61/792,353 entitled WIPING MECHANISM FOR A Y-CONNECTOR filed Mar. 15, 2013 and incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     Guide wires are used to facilitate percutaneous procedures in which the guide wire is threaded into a human patient using X-ray guidance. The guide wires are manually threaded by physician or other medical personnel but this requires that the operator be adjacent to the patient and so be in the immediate vicinity of the X-ray radiation providing the image used for guidance. Systems have been developed, such as that disclosed in U.S. Pat. No. 7,887,549 incorporated herein by reference in their entireties, which allow the guide wires to be threaded into the patient robotically and thus allow the user or operator to be remote from the patient and the X-ray radiation. When the guide wire has been threaded into a blood vessel of a human patient it may be become contaminated with blood and if it is threaded into some other type of vessel it may become contaminated with some other bodily fluid. In the course of a procedure involving a guide wire it may become useful or necessary to withdraw it through the Y-connector and/or hemostasis valve. 
     SUMMARY 
     In one embodiment a robotic catheter system includes a first drive mechanism driving a first percutaneous device along its longitudinal axis. A wiper assembly includes a first wiping engaging an outer surface of the percutaneous device along its longitudinal axis as the first percutaneous device moves relative to the wiper along its longitudinal axis. A controller provides a signal to a motor to engage the wiping surface with the outer surface of the percutaneous device while the elongated device is being withdrawn from a patient. 
     In one embodiment a robotic catheter system including a first drive mechanism configured to interact with an elongated medical device to cause the elongated medical device to move along its longitudinal axis. A wiper assembly includes a first wiping surface moving toward and away from the longitudinal axis. A controller provides a signal to a motor to move the first wiping surface toward the longitudinal axis when the elongated device is being withdrawn from a patient 
     In another embodiment a wiping mechanism associated with a Y-connector and/or hemostasis valve wipes any bodily fluids which have become attached to the surface of a guide wire during its passage into a human patient as the guide wire is retracted before it enters or exits the Y-connector and/or hemostasis valve. 
     In a further embodiment, a method of cleaning an elongated medical device includes providing a first drive mechanism configured to interact with an elongated medical device to cause the elongated medical device to move along its longitudinal axis. A wiper assembly is provided having a first wiping surface moving toward and away from the longitudinal axis. The method further includes providing a control signal to a motor from a remote controller to move the first wiping surface toward the longitudinal axis of the elongated device when the elongated device is being withdrawn from a patient. The method also includes wiping fluid from an outer surface of the elongated medical device as the elongated medical device is begin withdrawn from the patient. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic view of a wiper system proximate a hemostasis valve. 
         FIG. 2  to a top plan view a wiper system proximate a channel for an elongate medical device. 
         FIG. 3  is top view of a wiper mechanism at a distal portion of a cassette. 
         FIG. 4  is a view of the wiper mechanism intermediate a cassette and a Y-connector and hemostasis valve. 
         FIG. 5  is a cross sectional view of the wiper mechanism of  FIG. 4 . 
         FIG. 6  is an isometric view of a roller wheel that rotates about an axis perpendicular to a longitudinal axis of an elongated medical device. 
         FIG. 7  is a schematic view of a robotic percutaneous system with a wiper positioned before the juncture. 
         FIG. 8  is a schematic view of a robotic percutaneous system with a wiper positioned proximal the juncture and distal the guide wire drive. 
         FIG. 9  is a schematic view of a robotic percutaneous system with a wiper positioned proximal the juncture and between the linear guide wire drive and the rotational guide wire drive. 
         FIG. 10  is a cross sectional view of the wiper material for multiple percutaneous device wiper. 
         FIG. 10A  is a cross sectional view of a wiper material for multiple percutaneous device wiper. 
         FIG. 11  is a cross sectional top view of a wiper system separating multiple percutaneous devices. 
         FIG. 12  is a schematic view of a dual wiper system for an over the wire system. 
         FIG. 13  is a schematic view of a discrete motion wiper system. 
         FIG. 14  is a schematic view of a wiper module with a wiper element engaged with a flexible percutaneous device. 
         FIG. 15  is the schematic view of a wiper module with a wiper element disengaged with a flexible percutaneous device. 
         FIG. 16  is a schematic view of a wiper module for a first percutaneous device being removably inserted into a second percutaneous device. 
         FIG. 17A-17E  are a schematic view of wiper materials. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG. 1  a robotic system for manipulating an elongated medical device includes a bed side station  12  proximate a bed  22 . A remote-control station  14  includes a controller  16  having a user input  18  to control the bed side station  12 . An x-ray source  24  is used in a Fluoroscopy system to provide an image of on a display  20  in remote station  14 . A robotic system such as that described in U.S. Pat. No. 7,887,549 and/or the system described in and U.S. patent application U.S. Ser. No. 15/029,115 both of which are incorporated herein in their entireties may be used in conjunction with the wiper mechanism described herein. However, it is also contemplated that any drive system used to robotically drive a flexible percutaneous device currently known in the art or later developed may also be used in combination with the wiper systems described herein. 
     Referring to  FIG. 2  a wiping mechanism or wiping assembly  32  may be positioned between a cassette  26  that is part of operatively connected to bed side station  12  and Y-connector and/or hemostasis valve and guide catheter. A guide wire  28  and/or working catheter  30  may be subject to wiping mechanism  32  that is deployed between the human patient and the Y-connector such that it contacts the surface of the guide wire or working catheter as it is retracted from a patient and before it interacts with the drive mechanisms of the cassette  26 . 
     Referring to  FIG. 3  a wiping mechanism assembly  36  having a wiping material  58  is positioned between the cassette  26  and the Y-connector and/or hemostasis valve assembly  44 . The assembly  44  includes a Y-connector  48  having at least two legs with each having a lumen in fluid communication with one another. A hemostasis valve  46  is operatively connected to one of the legs of the Y-connector  48 . 
     Referring to  FIG. 4  in one embodiment wiping mechanism  36  is positioned within cassette  26  and intermediate a juncture  64  and the hemostasis valve assembly  44 . Cassette  26  includes a first channel  40  through which guide wire  28  is operatively driven along its longitudinal axis and a second channel  42  through which a working catheter such as a balloon catheter or stent catheter is linearly driven along its longitudinal axis. Wiping mechanism  36  includes a first and second wipers  58  that move toward and away from the longitudinal axis of channel  40  to operatively engage and wipe the outer surface of guide wire  28 . 
     Referring to  FIG. 5  wiper assembly includes a resilient material  58  configured to wipe the outer surface of a guide wire being retracted from a patient into cassette  26  with a drive mechanism. Resilient material may be absorbent and act to wick and or wipe away fluid from the guide wire and/or working catheter as each is being withdrawn from the patient. Resilient material maybe mounted to two separate pads that are respectively attached to a first arm  50  and a second arm  52 . 
     Arms  50  and  52  are operatively connected through linkages  54  that may be secured to a gear to drive  56 . In this manner rotation of drive  56  causes the resilient opposing materials  58  to move toward and/or away from one another. The resilient pads may be robotically moved away from one another as the guide wire and/or working catheter are inserted into a patient to minimize friction to the guide wire and/or working catheter as these elongated medical devices are being inserted into a patient. The resilient pads may be robotically moved away from one another as the guide wire and/or working catheter is being withdrawn from a patient and withdrawn through the Y-connector and/or hemostasis valve. 
     In one embodiment the wiping mechanism involves two v-shaped members of a resilient material. In one embodiment these resilient members are connected to a mechanism which holds them out of contact with the guide wire when it is being fed forward into the human patient but which brings them into contact with the guide wire when it is being retracted into the Y-connector and/or hemostasis valve. In one embodiment these members are constructed of or carry an absorbent material such as natural or synthetic sponge such that they can absorb the bodily fluid which they wipe from the surface of the guide wire. In another embodiment an absorbent material is placed beneath or around these wiping members to absorb the bodily fluid which is wiped from the surface of the guide wire. In a further embodiment an aspiration apparatus is provided which aspirates the bodily fluid as it is wiped from the guide wire surface. 
     In another embodiment air may be blown over the guide wire proximate the resilient by an air curtain. In one embodiment a wiping fluid is provided by nozzles directed at the guide wire and activated when it is retracted to clean the guide wire. In this embodiment absorbent material may be provided beneath or around the guide wire to absorb the bodily fluid wiped from the guide wire by the stream of directed fluid. In another embodiment the directed fluid is air and/or a liquid and/or spray and the bodily fluid which it wipes from the guide wire is aspirated by a suction mechanism placed in the vicinity of the location on the guide wire where the air stream impinges on the wire. In one embodiment air may be directed about the percutaneous device to remove foreign particulate. In one embodiment air may be directed about the outer circumference of the precautious device to dry any liquid that was used to clean the percutaneous device as described herein. In a further embodiment, resilient material is attached to or part of roller wheels that rotates about an axis that is perpendicular to the longitudinal axis of the guide wire and/or working catheter. The rotation of the roller wheels minimizes the friction of the resilient wiping material with respect to the guide wire and/or working catheter. In one embodiment the wheel is driven by a motor when the elongated medical device is being withdrawn. In one embodiment the robotic catheter system includes a cleaner  60  depositing a fluid  62  on to the elongated medical device as the medical device is being withdrawn from the patient. In one embodiment the fluid is deposited by a remote-controlled dispenser  60  and the rate of fluid flow is determined by the controller and a function of one or more of a user input, speed in which the elongated medical device is being withdrawn. In one embodiment a sensor  64  shown in  FIG. 5  is configured to sense moisture on the wiping surfaces, the sensor providing a signal to a display on a remote station to alert a user that the wiping surface is saturated. In one embodiment the controller  16  automatically provides a signal to a motor to move a wiping surface away from the elongated medical device when the drive mechanism is driving the elongated medical device into a patient. Referring to  FIG. 6  a roller wheel  66  rotates about an axis perpendicular to the longitudinal axis of the elongated medical device  38 . 
     Referring to  FIG. 7  a cassette  26  as discussed above includes a first channel  40  through which a guide wire  28  or other flexible percutaneous device is movably driven there along from a proximal end  72  toward end and through a distal end  74  thereof. As used herein the distal end of guide wire  28  is the free end that is inserted into a vasculature. The proximal end of guide wire  28  is the free end that is outside of the patient during a procedure in the vasculature. Similarly, the distal end of the various features and mechanisms is the end that is closer to the direction that the guide wire moves toward the vasculature and the proximal end is the end or portion that is further from the vasculature. 
     A working catheter  30  such as a balloon catheter or stent catheter or other catheters known in the art for performing a function within a vasculature is movable driven along a second channel  42 . First channel  40  and second channel  42  intersect at a juncture  64 . In one embodiment first channel  40  has a longitudinal axis that is not co-linear with a longitudinal axis of channel  42 . In one embodiment a first wiper assembly  76  is positioned adjacent channel  40  on the proximate side of juncture  64 . Stated another way first wiper assembly  76  is positioned between juncture  64  and the proximal end  72  of cassette  26 . First wiper assembly  76  operatively engages and disengages guide wire  28  as guide wire  28  is moved relative to first wiper assembly  76  along the longitudinal axis of guide wire  28 . In one embodiment first wiper assembly moves a wiper element about the longitudinal axis of guide wire  28  such that it rotate about the outer surface of the guide wire. In one embodiment first wiper assembly moves both along the longitudinal axis of guide wire  28  and about the outer surface of the guide wire. In one embodiment a second wiper assembly  78  is positioned proximate channel  42  to wipe the outer surface of a working catheter  30  along the longitudinal axis of the working catheter as the working catheter is moved relative to the wiper assembly  78 . As described herein below wiper assembly may move along the longitudinal axis of the working catheter or may be stationary as the working catheter  30  moves along its longitudinal axis as the working catheter  30  is moved in and/or out of the vasculature. 
     Referring to  FIG. 8  in one embodiment wiper assembly  76  is positioned proximal a drive mechanism  80  that drives the guide wire  28  along its longitudinal axis into and out of the vasculature. Stated another way wiper assembly  76  is positioned between juncture  64  and linear drive mechanism  80 . In one embodiment wiper assembly  78  is positioned between juncture  64  and linear drive mechanism  82  that drives working catheter  30  along its longitudinal axis. 
     Referring to  FIG. 9  in one embodiment wiper assembly  76  is positioned between distal linear drive  80  or stated another linear drive  80  is positioned between juncture  64  and wiper assembly  76 . In one embodiment a drive  84  is positioned distal wiper assembly  76 . Stated another way wiper assembly is positioned between linear drive  80  and drive  84 . In one embodiment drive  84  is a rotational drive mechanism that rotationally drives guide wire  28  about its longitudinal axis. In one embodiment drive  80  and drive  84  are part of a linear drive system that provides linear movement to the guide wire to move guide wire  28  in and out of the vasculature. In one embodiment drive  80  and drive  84  are part of a drive system that provides both linear and rotational drive to guide wire  28 . In one embodiment drive  80  and drive  84  are part of a drive system that provides linear drive to guide wire  28 . 
     Referring to  FIG. 10  wiper material  86  includes a wiper that may be used as wiper material is wiper mechanism  36  or in any other wiper at or distal juncture  64  in which both guide wire  28  and catheter  30  are wiped by a wiper assembly  36 . In one embodiment wiper material  86  includes a first wiper  88  and a second wiper  90  that moves toward and away from each other to engage guide wire  28  and catheter  30 . First wiper  88  and second wiper  90  each include a first portion  94  and a second portion  92  that engage respectively guide wire  28  and catheter  30 . First portions  94  include a wiping surface  96  and second portion  92  include a wiping surface  98 . When first wiper  88  and second wiper  90  move toward each other surfaces  96  of first portions  94  are closely adjacent one another in direct contact with guide wire  28 . In one embodiment surfaces  96  are sufficiently pliant such that surfaces  86  surround guide wire  28  about its circumference to wipe the entire outer surface of guide wire  28  as guide wire  28  moves relative to wiping mechanism  36  or  76  or  78  along its longitudinal axis. 
     Referring to  FIG. 10A  a wiper system  36  may include a material  100  that includes a first member  102  and a second member  104  that move toward and away from one another toward the longitudinal axis of guide wire  28  and catheter  30 . Each member  102  and  104  include a first recess  106  to receive the outer surface of guide wire  28  and a second recess  108  to receive the outer diameter of catheter  30 . In one embodiment recess  106  and recess  108  have a radius that is equal to the radius of guide wire  28  and catheter  30  respectively. In one embodiment recess  106  and recess  108  have a radius that is less than the radius of guide wire  28  and catheter  30  respectively. In one embodiment recess  107  and recess  108  is made of a pliant material that forms fully engages the entire outer circumference of a portion of guide wire  28  and catheter  30  respectively. In this manner the entire outer surface of guide wire  28  and catheter  30  are wiped as the guide wire  28  and catheter  30  move relative to the wiper system  36  along their longitudinal axis. 
     In one embodiment surfaces  96 ,  98  or  106 , 108  are a distance apart so that that they form a first region and a second region respectively having different distances between the two to accommodate different diameter sized guide wire and flexible percutaneous devices. 
     Referring to  FIG. 11  a wiper system  110  includes a cassette  26  operatively linearly driving guide wire  28  and catheter  30  along their longitudinal axis through a wiper system  112  having a first wiper  116  and a second wiper  114 . Where first wiper  116  wipes guide wire  28  and second wiper  114  wipes catheter  30  as the guide wire and catheter  30  move along their respective liner axis relative to the first wiper  116  and second wiper  114 . Each wiper  116  and  114  include wiper elements as described herein. A diverter  118  and  120  operatively guides guide wire  28  and catheter  30  to respective first wiper  116  and second wiper  114  as the guide wire  28  and catheter  30  are moved along their longitudinal axis where first wiper  116  and second wiper  114  are located intermediate juncture  64  and the y-connector  48  and/or hemostasis valve  44 . In one embodiment a guide catheter  142  is positioned on the distal end  122  of the y-connector. The guide wire  28  and catheter  30  being moved within a lumen  144  of the guide catheter by a drive mechanism in cassette  26 . In one embodiment  FIG. 11  is not to scale and the separation of guide wire  28  and catheter  30  is minimal and just sufficient to align the guide wire and catheter within the recesses formed by features  106  and  108  as described herein. 
     Referring to  FIG. 12  a wiper system  130  for a guide wire and catheter includes a housing  132  including a wiper  134  and a drive  136 . This wiper system is used on an over the wire device in which catheter  30  extends over guide wire  28 . In this over the wire system wiper  134  includes one of the wiper materials as described herein. In one embodiment a holder or seal  138  operatively positions a proximal end  140  of catheter  30  within housing  132 . Housing  132  supports guide wire drive  136  and guide wire wiper  134 . A catheter drive  150  moves catheter  30  along its longitudinal axis toward and away from y-connector  48 . As the proximal end  140  of catheter  30  moves away from y-connector  48  housing  132  moves along with proximal end  140  away from y-connector as well. A catheter wiper  152  operatively is fixed in location relative to y-connector  48  and wipes the outer surface of catheter  30  as proximal end  140  is moved away from y-connector  48 . As housing  132  moves away from y-connector  48  linear drive  136  moves guide wire  28  toward y-connector  48  at the same speed as housing  132  moves away from y-connector  48  such that guide wire  28  is stationary with respect to y-connector  48 . Since housing  132  is moving away from y-connector  48  and guide wire  28  is remaining stationary with respect to y-connector  48  wiper  134  will wipe the outer surface of guide wire as housing  132  moves away from the y-connector. 
     While system  130  has been described with respect to a guide wire  28  and a catheter having a lumen receiving the guide wire therein, the system would also work if guide wire  28  were another catheter. In one embodiment another catheter could be in its own housing with a wiper and drive intermediate guide wire housing  132  and catheter  30 . Stated another way the system would work with multiple telescoping catheter devices. 
     Referring to  FIG. 16  a wiper system  150  includes a housing  152  supporting a wiper  154  and a holder  162  for holding a distal end  164  of catheter  30 . Wiper system  150  is used in one embodiment for a rapid exchange catheter that rides along the guide wire  28  on a mono-rail type support as is known in the art. A guide wire manager includes a movable guide  158  that includes one or more elements that manage the entire length of the guide wire  28  extending from the y-connector  48  to the proximate end  166  of the guide wire. Guide  158  moves toward and away from a longitudinal axis of guide wire  28  when guide wire  28  is coaxial with a lumen of a leg  168  of y-connector to move any bucking portion or extra length of guide wire out of the way of loader  152 . In one embodiment guide  158  moves a portion of guide wire  28  in a direction away from the direction of gravity. In one embodiment guide  158  moves a portion of guide wire  28  in a direction perpendicular to the direction of gravity. In one embodiment guide  158  removably positions a portion of the guide wire in a holder. A brake  160  holds a portion of guide wire in a fixed position relative to y-connector  48  and the portion of guide wire  28  between drive  156  is moved out of the way of an axis extending between drive  156  and y-connector leg  168  such that proximal end  166  is positioned within the rapid exchange portion loader  152 . A linear drive  156  drives proximal end  166  of guide wire  28  away from y-connector  48  toward and into engagement with distal end  164  of catheter  30 . A wiper  154  wipes the outer periphery of guide wire  28  as described herein. As guide wire  28  is moved away from y-connector  48  guide  158  moves toward a longitudinal axis defined by leg  168  of y-connector until the guide wire is on the same longitudinal axis as leg  168 . Guide  158  then moves out of the way to allow catheter  30  to be driven along guide wire  28  through y-connector  48  and into guide catheter  142 . 
     In one embodiment guide wire  28  is fully inserted into catheter  30  such that the longitudinal axis of the guide wire  28  is co-linear with the lumen of leg  168  of Y-connector  48 . In this manner guide  158  is moved out of the way of the longitudinal axis of the guide wire  28 . Once guide wire  158  is fully inserted within catheter  30  if it is an over the wire catheter or fully extended if a rapid exchange catheter such that the proximal end  166  of the guide wire is furthest from Y-connector wiper  154  engages the outer surface of the guide wire and housing  152  is moved along the longitudinal axis of guide wire  28  in a direction away from y-connector  48  such that the wipers of wiper  154  wipes the outer surface of the guide wire. 
     Referring to  FIG. 14  and  FIG. 15 . A wiper system  170  includes wiper elements  172  that operatively engage and wipe catheter  30  but could also be used to operatively engage and wipe guide wire  28 . A fluid  174  is introduced through a conduit  176  into wiper housing  180  and flows around the outer periphery of catheter  30  and exits through a drain conduit  178 . Catheter  30  is wiped by elements  172  as catheter  30  is moved away from the y-connector and cleaned by fluid  174 . Referring to  FIG. 15 . wiping elements  172  move away from catheter  30  as catheter is driven by a drive mechanism toward and through y-connector  48  into guide catheter  142 . In one embodiment wipers  172  are not moved but operate to only wipe catheter  30  as it moves in one direction. In one embodiment wiper elements  172  only wipe when the catheter  30  is moved in a direction away from the y-connector. In one embodiment wiper elements  172  only wipe catheter  30  when the catheter is moved in a direction toward the y-connector. In one embodiment wiper element or elements wipe catheter  30  both when the catheter is moved away from the y-connector and moved toward the y-connector. In one embodiment housing  180  does not include fluid cleaning feature. In one embodiment housing  180  moves back and forth along the longitudinal axis of catheter  30 . 
     In one embodiment the rate of fluid introduced into the cavity of the wiper assembly is robotically controlled based on the length of percutaneous device cleaned and the rate in which the percutaneous device moves through the wiper assembly. In one embodiment, fluid is introduced when the percutaneous device is stationary to clean the wiper surfaces. A flutter valve or umbrella valve may be used to control the flow of the fluid within the wiper assembly. In one embodiment the fluid is introduced at a pressure greater than that of gravity. In one embodiment the fluid is introduced as a high velocity flow or spray. In one embodiment the fluid is introduced in a pulsating means. In one embodiment the fluid forms a bath about the circumference of the percutaneous device within the wiper assembly. In one embodiment the fluid is ultrasonically agitated to aid in the cleaning of the percutaneous device and/or wipers. In one embodiment the fluid may be heated above room temperature. 
     Referring to  FIG. 13  a wiper system  190  includes a movable a drive  192  that has a releasable gripper  192  that releasable engages guide wire  28  or catheter  30 . Referring to  FIG. 13  gripper  192  operatively grips guide wire  28  and moves toward y-connector  48  moving guide wire  28  a distance toward y-connector  48 . This is illustrated in  FIG. 13  as a point A on guide wire  28  being moved a distance  196 . Gripper  192  then releases guide wire  28  and gripper portions move away from the longitudinal axis of guide wire  28 . Wiper elements  194  that were disengaged from guide wire  28  are now moved into wiping engagement with guide wire  28  in a direction toward the longitudinal axis of guide wire  28 . Drive  192  moves in a direction away from y-connector while wiping elements wipe the outer surface of guide wire  28 . Once drive  192  moves away from y-connector a distance  196  the wiping element disengage from the outer surface of guide wire  28  and gripper  192  moves toward the longitudinal axis of guide wire  28  gripping the guide wire  28 . The process then repeats. In one embodiment wiper elements  194  are directly connected to gripper  192 . In one embodiment wiper elements  194  is in its own housing and moves independent of gripper  192  by a separate motor drive system. In one embodiment wiper elements  194  is similar to wiper system  170  where wiper system  170  moves and wipes as indicated herein in a step wise discrete manner. In one embodiment a releasable gripper holder not shown is used to secure the guide wire as the wiper elements are contacting and wiping the outer surface of the guide wire  28  to ensure that the guide wire does not move along with the wiper elements in a direction along the longitudinal axis of the guide wire. 
     Referring to  FIG. 17  various wiper elements are for use in any of the wiper systems described herein. Referring to  FIG. 17A  a duck bill pair of elements  200  engage guide wire  28  or catheter  30  (percutaneous device) by having a pair of flexible members contacting the outer surface of the percutaneous device. Elements have some spring force associated with them such that the terminal ends of the wiper elements remain engaged with the outer surface of the percutaneous device. In one embodiment a second pair of duck bill elements  200  are arranged in an opposing orientation to provide wiping of the percutaneous device when the percutaneous device is being moved along its longitudinal axis in a second direction opposite the first direction. 
     Referring to  FIG. 17C  a flexible micro lip seal effectively wipes percutaneous device  30  as it moves both toward and away from y-connector along its longitudinal axis. Seal  220  being sufficiently flexible wiper to bend in the direction of movement of the percutaneous device. 
     Referring to  FIG. 17D  a plurality of flexible fingers or blades operatively engage the outer surface of the percutaneous device to provide multiple wiping elements to act on the outer surface of the percutaneous device. Referring to  FIG. 17  a flexible bellow member  240  includes a lip portion  242  that extends from a base portion  244  as the percutaneous device moves along its longitudinal axis. Bellow housing member  240  expands in a direction of travel of the percutaneous device. In one embodiment one of the wiper elements as described herein provides an ultrasonic vibration to the percutaneous device sufficient to shed liquid and foreign material from the percutaneous device either alone or in combination with the mechanical wiping of the wiping members. In one embodiment a vacuum is applied to the exit or drain  178  to remove liquid from the wiper assembly  170 . 
     Referring to  FIG. 17E  split wiper members moves radially toward and away from the longitudinal axis of the percutaneous device  30 . The split wiper members may include 2, 3 4 or more members that are moved toward and away from the percutaneous device to effectively wipe the entire circumference of the percutaneous device. 
     In one embodiment a wiper rotates about the circumference of the percutaneous device and has a wiping surface that removable engages the outer surface of the percutaneous device. In one embodiment the rotary wiper is in a housing that in addition to rotating about the circumference of the percutaneous device also moves relative to the percutaneous device along the longitudinal axis of the percutaneous device. In one embodiment both the percutaneous device and wiper housing that supports moves relative to the Y-connector and the 
     In one embodiment a wiping mechanism is robotically controlled moving the wiper toward and away from the moving percutaneous devices. In one embodiment a wiping member may be robotically controlled in a hemostasis valve such as that shown in  FIG. 29  and  FIG. 30  of co-pending U.S. application Ser. No. 15/029,115 in which the hemostasis valve is controlled remotely from a user interface. The hemostasis valve may be modified and or another valve may be placed between the hemostasis valve  44  and cassette  26 . Stated another way wiper assembly  36  includes a robotic controlled hemostasis valve shown in FIG. 29 and FIG. 30 of U.S. patent application Ser. No. 15/029,115 in which the valve is a wiper assembly that is robotically controlled by rotation of the outer housing. In one embodiment the system includes a controller that automatically engages the wiper with the percutaneous valve upon retraction of a device. In one embodiment the system automatically engages a wiper member upon retraction of a device for more than a predetermined time period and/or predetermined distance. 
     In one embodiment the user interface includes a wiper control button to provide instructions to the wiper systems to engage and wipe one percutaneous device and/or all the percutaneous devices. In one embodiment a signal is sent to the motors providing the retraction force to increase the force to overcome the friction that results from the wipers engaging the outer surface of the one or more percutaneous devices being wiped. In one embodiment the wiper materials are formed from a hyrdrophobic material and provides a squeegee action to remove foreign matter from the percutaneous device. In one embodiment the wiping material is a hydrophilic material that absorbs liquid from the percutaneous device. In one embodiment a sensor may send a portion of the wiping material for wetness and provide an alert to the user via a user interface to change replace the wipers and/or to automatically wash the wipers in a fluid rinse as described herein. 
     It is contemplated that the various wiping elements and features of the wiping system be interchangeable with the various systems described herein. In one embodiment Guide wire  28  and catheter  30  are flexible elongated medical devices and are generically referred to herein as percutaneous devices. However other elongated medical devices that are flexible or rigid or in between known in the art are herein referred to as percutaneous devices. 
     Further modifications and alternative embodiments of various aspects of the invention will be apparent to those skilled in the art in view of this description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the invention. Any of the features, elements, or components of any of the exemplary embodiments discussed above may be used alone or in combination with any of the features, elements, or components of any of the other embodiments discussed above. It is to be understood that the forms of the invention shown and described herein are to be taken as presently preferred embodiments. Elements and materials may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the invention may be utilized independently, all as would be apparent to one skilled in the art having the benefit of this description of the invention. Changes may be made in the elements described herein without departing form the spirit and scope of the invention as described in the following claims.