Patent Publication Number: US-6905481-B2

Title: Percutaneous catheter assembly

Description:
RELATED APPLICATION 
   This application is a continuation of U.S. application Ser. No. 09/741,695, filed Dec. 19, 2000, to issue Dec. 3, 2002 as U.S. Pat. No. 6,488,662, which is expressly incorporated herein in its entirety by reference. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The present invention relates generally to a percutaneous catheter for the introduction and withdrawal of fluids from the vascular system of a patient and, more particularly, to a catheter assembly that employs a multi-diameter catheter housing, a proximal end cap for the housing having a central bore therein, and a dilator for passage through the catheter housing and the cap. 
   2. Description of the Related Art 
   Under various circumstances in the treatment of a patient experiencing cardiac problems, it is desired to cannulate the patient&#39;s vasculature for either blood perfusion or other treatment, such as the insertion of a catheter, a cannulae or an IABP. In a surgical environment, the surgeon typically exposes the blood vessel through a cut-down process. To cannulate the blood vessel, a small slit is made in the vessel wall of a clamped vessel to permit insertion of either an arterial perfusion catheter or a therapeutic catheter for the application of, for example, an IABP. With a perfusion catheter, often an atraumatic tip dilator is positioned concentrically within the catheter over a guidewire to assist in advancing the catheter to the desired point with minimal trauma to the epithelial layer. The dilator and guidewire are then removed and the catheter left in place for treatment. 
   In an environment such as a cardiac catheterization laboratory, an interventional clinician is not trained to perform a surgical cut down to penetrate the patient&#39;s vasculature. Thus, a percutaneous cannulation is necessary. With a percutaneous cannulation, a very small diameter insertion needle having a hollow lumen therein is used to penetrate the vessel wall. Then a guidewire is inserted through the insertion needle, and the needle removed. Next, an angio-cath, which may be made of polyethylene, is inserted over the guidewire, replacing the needle. Where it is desired only to establish a low flow rate of fluid percutaneously, either for aspiration or infusion, the angio-cath is left in place. The angio-cath may then be connected at its proximal end to a source of fluid or a syringe to inject fluid or to remove blood. 
   Where it is desired to establish a larger flow of fluid or to apply some level of cardiac treatment to the patient, a guide wire may then be inserted within the lumen of the insertion needle to permit removal of the insertion needle, leaving the guide wire in place. Once the guide wire is positioned where desired, an introducer sheath is inserted over the guide wire and through the vessel wall. In order to dilate the wall opening with minimal trauma to the blood vessel, a stylet (dilator) is placed concentrically within the introducer sheath so that both ride over the guide wire to position the sheath within the vessel wall. The dilator has a very small distal diameter to permit easy penetration through the small opening in the vessel wall. The dilator is tapered with increasing diameter toward the proximal end up to the diameter of the sheath so that the opening in the vessel wall is gradually expanded. Once the sheath is positioned within the vessel wall, the dilator is then removed, leaving the sheath within the wall with the guide wire remaining therethrough. The clinician has now established communication with the blood vessel at the desired diameter. The guide wire is then typically advanced into the patient&#39;s vasculature as far as is desired to either establish remote fluid communication with the patient or to a point where treatment with an perfusion catheter or other device is desired. For the passage of large devices or for the passage of a large volume of blood, a large diameter introducer sheath is required. With this sheath/guide wire arrangement, the clinician may exchange any one of a number of catheters without risk of losing that communication, because the sheath remains in place. The clinician threads the catheter over the guide wire to the desired location. Even where treatment is discontinued, the sheath may be left in place temporarily to permit the clinician to apply treatment again without having to reopen the blood vessel wall. Typically, the introducer sheath has a hemostasis valve at its proximal end to control the flow of fluid therethrough. 
   Once the sheath is in place, a perfusion catheter of a desired size (smaller than the sheath, however) may be inserted over the guide wire and through the sheath. The guide wire may then be removed, if so desired. Where fluid communication with the patient is desired at a location remote from the penetration site, a guiding catheter may first be inserted within the sheath and over the guide wire while it is advanced to the desired point in the patient&#39;s vasculature. To serve its function as a guide, the guiding catheter typically has a radiopaque marker at the distal end that may be seen through an x-ray monitor via fluoroscopy technique. The marker typically consists of a metallic ring detectable via fluoroscopy by the x-ray. With such a marker, the clinician may follow the location of the distal end as it advances through the vasculature. If desired, radiopaque contrast fluid may be directed through the guiding catheter and out into the vessel at the distal end to permit viewing of the vasculature through which the guiding catheter is passing. This serves the purpose of showing the general profile of the vessel as the guiding catheter is advanced. Such contrast may expose problems with continuing to proceed in that particular vessel before the guiding catheter has advanced too far. 
   Once the guiding catheter has been advanced to the desired point, an intravascular device, such as an angioplasty balloon, may be inserted the guiding catheter for vascular treatment. Or, a perfusion catheter may be inserted within the guiding catheter as well, to permit blood flow. In either case, it may be desirable to remove both the guiding catheter and the guide wire to permit treatment to be applied. The introducer sheath may be of the type that remains in place, or it may be of the type that tears away, leaving whatever device is in the sheath to maintain the opening in the vessel wall. Once the sheath is removed, however, that device (i.e., a guiding catheter or other device) provides the only vehicle to maintain the vessel wall opening at that diameter. 
   The advantage of an introducer sheath is that it permits exchange of catheters over time without losing the benefit of an established vessel wall opening. The disadvantage is that it hampers the use of large diameter catheters, i.e., where it is desired to establish fluid communication with the patient&#39;s vasculature at high flow rates. With a large diameter introducer sheath, occlusion of the blood vessel may occur, leading to possible ischemia of the limb served by the blood vessel. For example, if it is desired to establish fluid communication on the order of 1.5 liters per minute or greater through the femoral artery, it would be desirable to use a 12 French (outer diameter) perfusion catheter. To do so, however, would require at least a 12 French (inner diameter) introducer sheath. An even larger sheath would be necessary if it were also desired to have a guiding catheter inserted within the sheath and the perfusion catheter inserted within the guiding catheter. Given the size of the femoral artery, such a large introducer sheath has risks of occluding the femoral artery. 
   Thus, it would be desirable to establish a large fluid flow connection percutaneously to an artery or vein without the need for an introducer sheath or without a guiding catheter, but yet still provide a way of serving the function normally served by a guiding catheter. 
   SUMMARY OF THE INVENTION 
   It is therefore an object of the present invention to establish a large fluid flow connection percutaneously to an artery or vein without either an introducer sheath or a guiding catheter. In that regard the present invention comprises a percutaneous catheter assembly intended for long-term use of several days. The catheter assembly comprises generally three components: a catheter housing having three sections, each of preferably differing diameter, an end cap for closing off the proximal end of the catheter housing during insertion, and a dilator having an outer diameter substantially the same size as the inner diameter of the smallest section of the catheter housing. 
   The catheter housing of a preferred embodiment comprises three sections, a distal end section, which is tapered at the tip to facilitate penetration of a vessel wall, a mid-section having an inner diameter greater than the distal section, having a tapered transition between the distal end section and the mid-section, and a proximal section having an inner diameter of preferably about ⅜″ to permit connection to standard components, such as a flow probe and/or a pump. A polyester sleeve may be provided over the catheter housing, positioned to correspond with the point on the catheter adjacent the patient&#39;s skin. The sleeve may be sutured to the patient to resist relative movement. In addition to or in place of the sleeve, a disk surrounding the catheter housing may be used at or about the same position on the catheter. Also, a reinforcing member, such as a helical coil, is provided in the wall of at least the distal end section and the mid-section of the catheter for reinforcement purposes. At the distal end of the catheter housing, one or more radiopaque markers may be positioned to assist in intravascular location during insertion of the catheter assembly. Proximate the distal tip is a plurality of openings or perforations. 
   Various coatings may be applied to the catheter housing to improve its performance. For example, an anti-bacterial or anti-microbial coating may be applied to reduce infection risk; an anti-thrombotic coating may be applied to reduce adhesions to the catheter housing and any other component that comes into contact with blood for any significant period of time. 
   The cap is configured to seal off the proximal end of the catheter housing during insertion until the proximal end of the catheter housing is ready for connection to a tube for aspiration or infusion. The cap includes an internal bore that has an inner diameter the same size as the dilator. 
   The dilator comprises a long tube with a concentrically tapered distal end and a hemostasis valve at the proximal end. Extending from the hemostasis valve is a tube with a luer connector for connecting to a source of radiopaque contrast. The dilator includes a plurality of struts extending axially through the length of the dilator for stiffening the dilator. The distal tip of the dilator includes a plurality of openings, a first set positioned preferably adjacent the tip and a second set proximal thereto. It is intended that, when the dilator is placed within the catheter housing, that the distal tip of the dilator project beyond the distal tip of the housing so that the second set of holes in the dilator align generally with the perforations in the distal end of the catheter housing. 
   The invention also comprises a preferred method of operation of the catheter assembly. The method comprises penetrating a patient&#39;s vasculature so as to permit a guide wire to be inserted in the patient&#39;s blood vessel. The cap is placed within the proximal end of the catheter housing. The dilator is then placed within the catheter housing through the cap so that the distal tip of the dilator extends just beyond the distal tip of the catheter housing. Saline is flushed through the hemostasis valve and out through the distal tip to flush the assembly of air. The catheter assembly is then placed over the guide wire and inserted through the patient and into the blood vessel. Radiopaque contrast may then be injected through the hemostasis valve and out through the first set of holes in the distal end of the dilator to permit detection of the distal end as the catheter assembly is being advanced through the patient. The radiopaque contrast also advantageously exits the second set of holes in the distal end of the catheter so as to detect the location of the perforations in the catheter housing. 
   Once the catheter assembly is advanced to the desired point within the blood vessel, the guide wire may be removed. Then the dilator may then be removed, leaving the cap in place. When the distal tip of the dilator is within the proximal section of the catheter housing, a hemostat may be used to clamp the catheter so as to prevent the flow of blood out of the proximal end of the catheter housing. Also, once the catheter housing is positioned, a sleeve and/or disk may be used to secure the catheter housing to the patient to minimize relative movement between the patient and the catheter housing. At that point, the cap may be removed and a delivery (or withdrawal) line attached to the proximal end of the catheter housing. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
       FIG. 1  is a perspective view of the present invention percutaneous catheter assembly showing its preferred components in an assembled position. 
       FIG. 2  is a side view of the catheter housing, the end cap, and the dilator of the assembly of FIG.  1 . 
       FIG. 3  is a cross-sectional view of the dilator of FIG.  2 . 
       FIG. 4  is a front view of the suturing disk applied to the catheter housing. 
       FIG. 5  is a side view of the sleeve applied to the catheter housing with internal structure shown in broken lines. 
       FIG. 6  is a front view of the sleeve applied to the catheter housing. 
   

   DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
   Reference is now made to the figures wherein like parts are designated with like numerals throughout. Referring first to  FIG. 1 , the present invention comprises a percutaneous catheter assembly  10  that may be used for long-term use of at least several days.  FIG. 1  shows the three main components of the assembly  10  in assembled form for application to a patient. The assembly  10  comprises a catheter housing  12  having a single lumen therein, wherein the housing  12  has a distal end  14  and a proximal end  16 , with the distal end  14  intended to project into the vascular system of a patient. The assembly  10  further comprises an end cap  18  configured to fit snugly within the proximal end of the catheter housing  12  to seal the housing against flow through the proximal end during use. The assembly  10  also comprises a dilator  20  configured to protrude through the end cap  18  and through the lumen of the catheter housing  12 . 
   Referring to  FIG. 2 , the catheter housing  12  can be described in greater detail. The catheter housing is made of a pliable but durable plastic material, such as urethane, although other similar materials would be acceptable. The catheter housing  12  preferably has three sections: a distal section  22 , a mid-section  24 , and a proximal section  26 , each of different diameters. The distal section  22  has a relatively small inner diameter of preferably about 10 French, although other sizes that would effectively pass through a blood vessel without patient trauma while permitting high blood flow would be acceptable. The mid-section  24  has an inner diameter of preferably about 16 French, with a first tapered section  28  positioned between the distal section  22  and the mid-section  24 . The mid-section is of larger diameter than the distal section to prevent kinking of the catheter during insertion and tunneling. Sizes other than 16 French would be acceptable. The proximal section  26  has an inner diameter of preferably ⅜″ to permit connection to standard components, such as a flow probe or a pump. The proximal section  26  is preferably configured to slip onto a barbed connector, although other connector configurations would be acceptable. A second tapered section  30  is positioned between the mid-section  24  and the proximal section  26 . It is intended that only the distal section  22  would penetrate the patient&#39;s vascular system, with the mid-section sized to permit subcutaneous tunneling. The length of the distal section  22  may be selected depending upon where the vessel penetration site is and where in the patient&#39;s vasculature (remote from the site) the clinician desires to establish fluid communication. For example, if the vessel penetration site were somewhere on the left femoral artery, but the fluid communication site were further up in the descending aorta, the distal section  22  would need to be sufficiently long to span that distance. Similarly, the length of the mid-section  24  may be selected depending upon where the vessel penetration site is and where the desired patient exit site is. For example, if it were desired to penetrate the left axillary artery but have the patient exit site close to the patient&#39;s waist, the mid-section  24  would need to be sufficiently long to span that distance. Also, the thickness of the proximal section  26  is preferably configured to permit the attachment of an external sonic based flow meter thereto. 
   A tip  32  of the distal section  22  is preferably tapered to facilitate penetration of a vessel wall, although it not need be tapered if so desired. Adjacent the distal section tip  32  is a radiopaque marker  34  to assist in locating the tip of the catheter housing  12  during insertion. Proximate the distal tip  32  is a first set of openings comprising one or more perforations  36  in the wall of the catheter housing that serve to permit peripheral distribution of a contrast fluid, i.e., radiopaque contrast, from the distal section  22  of the catheter housing  12  during insertion, as explained further below. As described further below, that peripheral distribution serves to better facilitate location and insertion of the distal end of the catheter housing  12 . Other arrangements of one or more perforations would be acceptable. 
   Referring to  FIGS. 1 ,  2 ,  5  and  6 , the preferred embodiment of the catheter assembly  10  further comprises an interface portion  38  that comprises a sleeve  40  comprising a synthetic material for permitting enhanced securement of the catheter assembly  10  to a patient during use. During use, particularly when the patient is ambulatory, there is a tendency for a percutaneously applied catheter to move relative to the patient as the catheter slides at the exit site. Having a sleeve with a configuration and characteristic that permits a physician to suture the catheter to the patient would be a significant advantage. Preferably, the sleeve  40  comprises a third synthetic material having a textile property to enhance the use of sutures as a means for securing the catheter to the patient. More preferably, the sleeve  40  is made of polyester or other material having similar properties. The sleeve  40  is bonded to the catheter assembly  10  in a manner to prevent relative movement between the sleeve and the catheter. The length of the sleeve  40  may be selected as desired. The length should be sufficient, however, to give some flexibility to the physician in the placement of the catheter with respect to the exit site. In one embodiment, the sleeve  40  is manufactured already bonded to the catheter with a length pre-selected to give flexibility to the physician. If desired, the sleeve length may be kept at a minimum but be manufactured discretely from the balance of the catheter, permitting, if desired, the physician to locate the sleeve where desired and then to bond the sleeve to the catheter after it is optimally positioned on the catheter. For short term use, a technique as simple as clamping the extracorporeal portion of the sleeve to the catheter wall without occluding the inner flow path might be acceptable. For longer term use, bonding with an adhesive at the proximal end of the sleeve with a bonding material that would not travel undesirably toward the skin and into the patient would be desired. 
   Referring now to  FIGS. 1 and 2 , a preferred embodiment of the catheter housing  12  preferably further comprises axial reinforcing member  42  preferably extending the entire length of the distal end section and, if desired, the mid-section, for purposes of adding stiffness to the catheter housing  12 . The reinforcing member  42  may be a helical coil, as is known in the art. It need not be limited to helical coils, however, as many other reinforcement members are known in the art. For example, the axial reinforcing member  42  need not extend the entire length of the catheter housing  12 . Where the catheter housing material is sufficiently stiff, however, the axial reinforcing member  42  may not be necessary so long as the catheter housing  12  is sufficiently stiff to withstand axial forces applied at its proximal end to facilitate insertion into the patient&#39;s vascular system. 
   As shown in  FIGS. 1 and 2 , the catheter housing  12  may also include a positioning disk  44 . In one embodiment, the disk is integrally made with the catheter housing so that relative movement between the disk and catheter housing is minimized. In another embodiment, the disk  44  and catheter housing  12  are separately made and the disk  44  has an inner diameter which is sufficiently larger than the outer diameter of the portion of the catheter housing exiting the patient&#39;s skin to permit relative movement of the disk over the housing. This relative movement permits the physician to locate the disk where desired. Once positioned, the disk is fixed to the catheter housing, minimizing relative movement between the catheter housing and the disk. In one embodiment, the disk is fixed by a tight interference fit. In yet another embodiment the physician bonds the disk to the catheter after it is optimally positioned on the catheter. For short term use, a technique as simple as clamping the disk to the catheter wall without occluding the inner flow path might be acceptable. For longer term use, bonding with an adhesive at the proximal end of the disk with a bonding material that would not travel undesirably toward the skin and into the patient would be desired. The disk  44  may also have suturing features  46  which are conveniently placed around the disk to facilitate securement of the disk  44 —and hence the catheter housing  12 —to the patient&#39;s body. As mentioned above, in connection with the sleeve  40 , this may prevent relative movement of the percutaneously inserted catheter housing. 
   The cap  18  is configured to seal off the proximal end of the catheter housing during insertion until the proximal end of the catheter housing is ready for connection to a tube or other device for aspiration or infusion. The cap  18  has a first section  48  having an outer diameter the same size as the inner diameter of the proximal end  30  of the catheter housing  12  to permit a tight but removable fit therebetween. The cap  18  also has a second section  50  configured to enclose the end of the proximal section  26  of the catheter housing when the cap  18  is fully inserted, as shown in FIG.  1 . Traversing axially the entire length of the cap  18  is a central bore  52  having an inner diameter preferably the same or just slightly larger than the outer diameter of the dilator  20 . The cap  18  is configured to permit the dilator  20  to slide through the cap  18  while the cap is inserted into the proximal end of the catheter housing. The inner diameter of the cap  18  may also be configured with ridges or teeth which further grip the dilator to provide both a snug fit and also improve the seal. This may prevent blood from seeping out at the interface between the dilator  20  and the cap  18  at the proximal end of the cap. The end cap may be made of a polymer such as rubber, polypropylene or silicone, but may comprise other similar materials as well. 
   The dilator  20  generally comprises a long tube  54  with a lumen therethrough having a concentrically tapered open distal end  56  and a hemostasis valve  58  at the proximal end. The outer diameter of the tube  54  is preferably smaller than 10 French so that there is clearance fit between the distal end  56  of the tube  54  and the distal section  22  of the catheter housing. Extending from the hemostasis valve  58  is a tube  60  having a luer connector  62  ( FIG. 1 ) at the end for connecting to a source of radiopaque contrast (not shown). Referring to  FIG. 3 , the dilator  20  preferably further comprises a plurality of struts  64  extending preferably the length of the dilator for purposes of adding stiffness to the tube  54 . The struts  64  need not extend continuously along the length of the lumen of the dilator and preferably do not extend into the tapered distal end  56 . The struts  64  converge radially inward toward a central axial hub  66 . The central hub  66  has an inner diameter sufficiently large to permit passage therethrough of a guide wire, described more fully below. A hub diameter of at least 0.038 inches is preferable. The dilator with struts may be configured similar to off-the-shelf multi-lumen tubes presently available. The dilator is preferably made of a somewhat stiffer material than the catheter housing, preferably polyethylene, polypropylene, or other similar material. Where the material chosen is sufficiently stiff, struts may not be necessary. Either way, the dilator must be sufficiently stiff to withstand axial forces applied at its proximal end to facilitate insertion of the catheter housing and the dilator into and through a patient&#39;s vascular system. 
   The distal end  56  of the dilator  20  preferably comprises at least one opening  68  in a side wall of the dilator, but preferably a plurality of openings comprising a first set, preferably positioned close to the distal end  56  and more preferably on the tapered portion of the distal end so that at least one of the openings in the first set of openings, but preferably more than one, at least partially projects distally of the tip  32  of the catheter housing  12  when the dilator  20  is inserted within the housing, as shown in FIG.  1 . The projection of the first set of openings  68  beyond the catheter housing permits ejection of the radiopaque contrast axially forward of the catheter housing  12  during the insertion process. Positioned proximally from the first set of openings  68  is at least one other opening or perforation  70 , but preferably a plurality of openings comprising a second set positioned so that, when the dilator  20  is placed within the catheter housing  12 , the second set of openings align generally axially and preferably radially with the perforations  36  in the distal section  22  of the catheter housing. The radiopaque contrast flowing outwardly through the second set of openings  70  will preferably pass directly into and through the first set of openings or perforations  36  in the catheter housing  12 . When axially and radially aligned, the contrast in the lumen of the catheter housing  12  will pass through the openings  70  and directly out of the perforations  36  into the patient&#39;s blood vessel. When not aligned, the contrast will pass through the openings  70  and into the lumen of the catheter housing  12  before passing through the perforations  36 . In either case, the contrast projects axially forward from the first set of openings  68  in the dilator. 
   Thrombosis is a common reaction when foreign matter is introduced into the vasculature. This can interfere with treatments involving insertion of foreign matter, such as catheters, into the vasculature by causing apertures and lumens to become occluded. This problem is especially acute in longer term treatments where significant build-up can occur due to the length of time the cannula is in the vessel. As a result, certain coatings can be beneficial if applied to cannulae inserted into the vasculature. For example, an anti-thrombotic coating is especially useful for longer term treatments because it prevents adhesion of blood components to the coated surface, which might otherwise eventually occlude a lumen or aperture. For this reason, at least the interior and exterior of the catheter housing  12  may have an anti-thrombotic coating. Also, if any other catheter housing component is exposed to the interior lumen of the catheter housing  12 , it too may be coated. 
   Since patients using this improved percutaneous catheter assembly are ambulatory, there is an increased risk of infection at the patient&#39;s exit site. Consequently, anti-microbial or anti-bacterial coating may be beneficial, especially in relatively longer term treatments. When placed at least on the exterior surface of the catheter housing  12 , this coating reduces the chance of infection occurring at or near the patient&#39;s exit site. Of course, any securing device used in connection with the catheter housing  12 , such as the sleeve  40  or disk  44 , may also advantageously use an anti-microbial or anti-bacterial coating to reduce the risk of infection of the patient&#39;s exit site. 
   The invention also comprises a method of operation of the catheter assembly  10 . The method comprises penetrating the arterial site with a standard cannulation procedure, such as the Seldinger technique described in part above, so as to permit a guide wire to be inserted in the blood vessel (not shown). The cap  18  is placed within the proximal section  26  of the catheter housing  12 . The dilator  20  is then placed within the catheter housing  12  through the cap  18  so that the distal end  56  of the dilator  20  extends beyond the distal tip  32  of the catheter housing. Saline is flushed through the hemostasis valve  58  and out through the distal end  56  to flush the catheter assembly  10  of any air that would be detrimental to a patient. The catheter assembly  10  is then placed over the guide wire and inserted through the patient and into the blood vessel. Radiopaque contrast is then injected through the hemostasis valve  58  and out through the first set of openings  68  in the distal end  56  of the dilator  20  to permit detection of the distal end  56  as the catheter assembly  10  is being advanced through the patient. The radiopaque contrast also exits the second set of holes  78  in the dilator  20  and the-perforations  36  of the catheter housing  12  so as to permit detection of the location of the distal end  14  of the catheter housing. 
   Once the catheter assembly  10  is advanced to the desired point within the blood vessel, the guide wire is removed. Then the dilator  20  is retracted from the catheter housing  12 , leaving the cap  18  in place. The cap  18  prevents backflow of the blood through the proximate end  16  of the housing  12  during removal of the dilator  20 . When the distal end  56  of the dilator  20  is within the proximal section  26  of the catheter housing  12 , a hemostat (not shown) may be used to clamp the catheter housing so as to prevent the flow of blood out of the proximal end  16  of the catheter housing. At that point, the cap  18  may be removed from the catheter housing  12  and a delivery line attached to the proximal end  16  of the catheter housing for aspiration or infusion. 
   The present invention has application to most any aspiration and infusion treatment desired. It has particularly beneficial application to the system and method described in U.S. Ser. No. 09/166,005, now U.S. Pat. No. 6,200,260 to Bolling, U.S. Ser. No. 09/289,231, now U.S. Pat. No. 6,428,464 to Bolling, U.S. Ser. No. 09/470,841, now U.S. Pat. No. 6,387,037 to Bolling et al., and U.S. Ser. No. 09/552,979, now U.S. Pat. No. 6,390,969 to Bolling et al, each of which are incorporated in their entirety by reference. 
   In the case where the exit site of the patient is desired to be positioned away from the penetration site of the blood vessel, the present invention catheter assembly  10  is configured to permit the assembly  10  to be tunneled subcutaneously between the two sites. For example, if it were desired to have the catheter assembly connected to a delivery line exiting the patient at the waist area, but have the catheter penetrate the left axillary artery, the above procedure could be followed at the shoulder area of the patient to cannulate the blood vessel, and then follow a tunneling procedure to bring the proximal end of the catheter housing subcutaneously toward the patient&#39;s waist area while the distal end remains within the left axillary artery. For example, with the system described in U.S. Ser. No. 09/166,005, now U.S. Pat. No. 6,200,260, it may be desired to have the patient carry a subcardiac pump near the patient&#39;s waist area with the inflow and outflow lines penetrating the patient&#39;s skin proximate the pump. Where it is desired that the inflow line connect to the left femoral artery and the outflow line connect to the patient&#39;s left axillary artery, the above procedures could be followed. If a single penetration site were desired, a multi-lumen catheter system could be used to penetrate the patient&#39;s vascular system, as described in U.S. Ser. No. 09/470,841, now U.S. Pat. No. 6,387,037, but following the procedures described above. In that regard, it is contemplated that the catheter housing of the present invention be configured to have more than one lumen therethrough for certain applications. 
   The invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiment is to be considered in all respects only as illustrative and not restrictive and the scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.