Patent Publication Number: US-2019167868-A1

Title: Sleeves, Manifolds, Systems, And Methods For Applying Reduced Pressure To A Subcutaneous Tissue Site

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation of U.S. patent application Ser. No. 14/312,343, filed Jun. 23, 2014, which is a Divisional of U.S. application Ser. No. 12/645,146, filed Dec. 22, 2009, now U.S. Pat. No. 8,795,245, which claims the benefit of U.S. Provisional Application No. 61/141,716, filed Dec. 31, 2008, which is hereby incorporated by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present application relates generally to medical treatment systems, and more particularly, to a reduced pressure treatment system and method for applying reduced pressure to a tissue site. 
     2. Description of Related Art 
     Clinical studies and practice have shown that providing a reduced pressure in proximity to a tissue site augments and accelerates the growth of new tissue at the tissue site. The applications of this phenomenon are numerous, but one particular application of reduced pressure involves treating wounds. This treatment (frequently referred to in the medical community as “negative pressure wound therapy,” “reduced pressure therapy,” or “vacuum therapy”) provides a number of benefits, including migration of epithelial and subcutaneous tissues, improved blood flow, and micro-deformation of tissue at the wound site. Together these benefits result in increased development of granulation tissue and faster healing times. Typically, reduced pressure is applied by a reduced pressure source to tissue through a porous pad or other manifold device. In many instances, wound exudate and other liquids from the tissue site are collected within a canister to prevent the liquids from reaching the reduced pressure source. 
     SUMMARY 
     The problems presented by existing reduced pressure systems are solved by the systems and methods of the illustrative embodiments described herein. In one embodiment, a system for applying reduced pressure to a subcutaneous tissue site is provided. The system includes a sleeve, which comprises a lumen, adapted for placement at a subcutaneous tissue site. The sleeve includes an opening. The system further includes a manifold sized and shaped to be inserted into the lumen of the sleeve. The manifold includes at least one aperture and is operable to deliver reduced pressure to the subcutaneous tissue site through the at least one aperture and the opening. 
     In another embodiment, an apparatus for applying reduced pressure to a subcutaneous tissue site includes a manifold having a distal end and a proximal end and a sleeve having a distal end and proximal end. The sleeve is sized and shaped for placement at the subcutaneous tissue site. The sleeve has an interior portion for receiving the manifold. The sleeve is formed with an opening operable to transfer reduced pressure from the manifold to the subcutaneous tissue site. The distal end of the manifold is sized and shaped to be inserted into the interior portion of the sleeve. The manifold is formed with at least one aperture and is operable to deliver reduced pressure to the subcutaneous tissue site through the at least one aperture. 
     In still another embodiment, a method for applying reduced pressure to a subcutaneous tissue site includes inserting a sleeve at the subcutaneous tissue site such that an opening on the sleeve is adjacent the subcutaneous tissue site. A manifold is inserted into the sleeve, the manifold including at least one aperture. Reduced pressure is supplied to the subcutaneous tissue site via the at least one aperture and the opening. 
     In yet another embodiment, a method of manufacturing an apparatus for applying reduced pressure to a subcutaneous tissue site is provided. The method includes forming a sleeve adapted for placement at the subcutaneous tissue site. The sleeve is further adapted to receive a manifold and includes an opening operable to transfer reduced pressure from the manifold to the subcutaneous tissue site. 
     Other objects, features, and advantages of the illustrative embodiments will become apparent with reference to the drawings and detailed description that follow. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates a schematic of a reduced-pressure treatment system for applying reduced pressure to a subcutaneous tissue site according to an illustrative embodiment; 
         FIG. 2  illustrates a side view of an apparatus for applying reduced pressure to a subcutaneous tissue site according to an illustrative embodiment; 
         FIG. 3  illustrates a perspective view of a distal portion of the apparatus of  FIG. 2  with a portion of the apparatus shown in hidden lines; 
         FIG. 4  illustrates a perspective view of the apparatus of  FIG. 2 ; 
         FIG. 5  illustrates a side view of a manifold and end cap according to an illustrative embodiment; 
         FIG. 6  illustrates a cross-sectional front view of the end cap of  FIG. 5  taken at  6 - 6 ; 
         FIG. 7  illustrates a cross-sectional front view of the end cap of  FIG. 5  taken at  7 - 7 ; 
         FIG. 8  illustrates a cross-sectional view of a portion of the end cap of  FIG. 6  taken at  8 - 8 ; and 
         FIG. 9  illustrates a schematic of a reduced-pressure treatment system for applying reduced pressure to a tissue site in an abdominal cavity. 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     In the following detailed description of several illustrative embodiments, reference is made to the accompanying drawings that form a part hereof, and in which is shown by way of illustration specific preferred embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is understood that other embodiments may be utilized and that logical structural, mechanical, electrical, and chemical changes may be made without departing from the spirit or scope of the invention. To avoid detail not necessary to enable those skilled in the art to practice the embodiments described herein, the description may omit certain information known to those skilled in the art. The following detailed description is, therefore, not to be taken in a limiting sense, and the scope of the illustrative embodiments are defined only by the appended claims. 
     The term “reduced pressure” as used herein generally refers to a pressure less than the ambient pressure at a tissue site that is being subjected to treatment. In most cases, this reduced pressure will be less than the atmospheric pressure at which the patient is located. Alternatively, the reduced pressure may be less than a hydrostatic pressure associated with tissue at the tissue site. Although the terms “vacuum” and “negative pressure” may be used to describe the pressure applied to the tissue site, the actual pressure reduction applied to the tissue site may be significantly less than the pressure reduction normally associated with a complete vacuum. Reduced pressure may initially generate fluid flow in the area of the tissue site. As the hydrostatic pressure around the tissue site approaches the desired reduced pressure, the flow may subside, and the reduced pressure is then maintained. Unless otherwise indicated, values of pressure stated herein are gauge pressures. Similarly, references to increases in reduced pressure typically refer to a decrease in absolute pressure, while decreases in reduced pressure typically refer to an increase in absolute pressure. 
     Referring to  FIG. 1 , a reduced-pressure treatment system  100 , which applies reduced pressure to a tissue site  103 , is shown according to an illustrative embodiment. In the embodiment illustrated in  FIG. 1 , the tissue site  103  is a bone tissue site. In particular, the tissue site  103  is a fracture on bone  106 , which in the example illustrated is a femur. It is believed that reduced pressure at tissue site  103  provides a number of benefits. When used to promote bone tissue growth, reduced-pressure treatment can increase the rate of healing associated with a fracture, a non-union, a void, or other bone defects. Reduced-pressure treatment may also be used to improve recovery from osteomyelitis. The treatment may further be used to increase localized bone densities in patients suffering from osteoporosis. Finally, reduced-pressure treatment may be used to speed and improve osseointegration of orthopedic implants, such as hip implants, knee implants, and fixation devices. 
     While the tissue site  103  is bone tissue, the term “tissue site” as used herein may refer to a wound or defect located on or within any tissue, including but not limited to, bone tissue, adipose tissue, muscle tissue, neural tissue, dermal tissue, vascular tissue, connective tissue, cartilage, tendons, or ligaments. The term “tissue site” may further refer to areas of any tissue that are not necessarily wounded or defective, but are instead areas in which it is desired to add or promote the growth of additional tissue. For example, reduced pressure tissue treatment may be used in certain tissue areas to grow additional tissue that may be harvested and transplanted to another tissue location. 
     Referring to  FIG. 1 , a reduced pressure treatment system  100  includes a reduced pressure source  109  and a manifold  112  that is positioned at the tissue site  103 . The reduced-pressure source  109  provides reduced pressure to tissue site  103  through the manifold  112 . The manifold  112  may include a passageway (not illustrated in  FIG. 1 ) for administering reduced pressure and removing or supplying fluids to the tissue site  103 . The passageway may extend from a distal end  113  of the manifold  112  to a proximal end  114 . The manifold  112  receives the reduced pressure from the reduced-pressure source  109  through a delivery conduit  115 , which is in fluid communication with the manifold  112  and delivers reduced pressure to the manifold  112  during treatment. The manifold  112  may include at least one aperture, such as apertures  118 , and may deliver reduced pressure to the tissue site  103  via the apertures  118 . 
     In one illustrative embodiment, the manifold  112  may be inserted into a sleeve  121  to provide reduced pressure treatment to the tissue site  103 . The sleeve  121 , which may be a lumen member, may extend from the tissue site  103 , through the patient&#39;s skin, and to a location external to the patient  124 . The proximal end  127  of the sleeve  121 , which has an opening  130  into which the manifold  112  may be inserted, may protrude from the patient  124  when the sleeve  121  is placed at the tissue site  103 . Exposing the proximal end  127  of the sleeve  121  in this manner facilitates access to the sleeve  121  and the insertion of the manifold  112  into the sleeve  121 . The manifold  112  has a longitudinal length L 1 , the sleeve has a longitudinal length L 2 , and a distance from the tissue site to a location external to the patient is L 3 . In one embodiment, L 1 &gt;L 2 &gt;L 3 . In another embodiment, the proximal end  127  of the sleeve  121  may be subcutaneously disposed in the patient  124 , i.e., L 2 &lt;L 3 . The sleeve  121  may be disposed at the tissue site  103  of a patient  124  in a variety of different spatial orientations, including the flexed orientation shown in  FIG. 1 . The sleeve  121  may be releasably secured to a patient  124  to hold the sleeve  121  in a fixed position with respect to the tissue site  103  or may be unsecured. In one embodiment, the sleeve  121  may be sutured into place or adhered using a medical epoxy, medical tape, or other means. The proximal end  127  may include a flange (not shown) to prevent the proximal end  127  from entering the patient  124 . Moreover, the flange might be put in a position abutting an external portion of the patient  124  and adhered using epoxy, medical tape, sutures, etc. 
     The sleeve  121  is capable of slidably receiving the manifold  112 . The manifold  112  may be inserted into the opening  130  and moved toward the distal end  133  of the sleeve  121 . The manifold  112  may be placed adjacent an opening  136  in sleeve  121 . The opening  136  may be located at a distal portion  139  of the sleeve  121 , may run the length of the sleeve  121 , or may take any shape or size. The manifold  112  may include visual indicia (see by analogy  691  in  FIG. 9 ) to help gauge the extent to which manifold  112  has been inserted into an interior portion of the sleeve  121 . An exterior portion of the manifold  112  or the interior portion of the sleeve  121  or both may include ribs to provide tactile feedback to the healthcare provider regarding the relative position of the sleeve  121  and the manifold  111 . The manifold  112  is capable of delivering reduced pressure from the reduced-pressure source  109  to the tissue site  103  via the opening  136  in the sleeve  121 . 
     In use, it may be desirable to releasably secure the manifold  112  to the sleeve  121 . An interference fit or groove lock may be used as described further below. Alternatively, the manifold  112  may include a longitudinal ridge member (not shown) that is positioned along the length (or a portion of the length) of the manifold  112  and that mates with a longitudinal groove (not shown) on the interior portion of the sleeve  121 . Alternatively, the groove may be on the manifold  112  and the ridge member on the sleeve  121 . This approach to securing the manifold  112  and sleeve  121  may further help assure that the manifold  112  assumes a proper position with respect to opening  136  and ultimately tissue site  103 . 
     The manifold  112  may be both insertable and removable from the sleeve  121  while the sleeve  121  remains at the tissue site  103 . During use, a pneumatic seal may be formed about the manifold  112  and sleeve  121  proximate an opening  119  in the patient  124 , e.g., an opening in the patient&#39;s skin. The pneumatic seal may be formed using a drape material, medical tape, a hydrocolloid, or other sealing members. 
     The manifold  112  may be moved out of the sleeve  121  at any time. By allowing the manifold  112  to be inserted and removed from the sleeve  121  while the sleeve remains at the tissue site  103 , the system  100  facilitates effective reduced-pressure treatment of the tissue site  103 . For example, in the event that the manifold  112  becomes clogged, such as by fibrin, tissue, or any other bodily substance, the manifold  112  may be removed from the sleeve  121  and either cleaned or replaced with another manifold that can be inserted into the sleeve  121 . Indeed, the manifold  112  may be removed or re-inserted for any reason, such as to visually monitor the integrity of the manifold  112  or to facilitate the movement of the patient  124  by disconnecting the patient  124  from the reduced-pressure source  109 . Further, the insertion and removal of the manifold  112  may be repeated any number of times while minimizing the disruption of or damage to tissue in and around the tissue site  103  or at the skin. 
     In one embodiment, clogging of the manifold  112  may be reduced or prevented by delivering a purging fluid to the manifold  112 . In this embodiment, a fluid source  142  may supply a purging fluid. The delivery conduit  115  may deliver the fluid to the manifold  112 . The fluid may be a liquid or a gas, such as air, and may purge any blockages in the manifold  112 . These purged substances, which may include fibrin, tissue, or any other bodily substance, are drawn out of the manifold  112  and toward the reduced-pressure source  109  using reduced pressure from the reduced-pressure source  109 . These substances may be received by a container  145 . In another embodiment, the fluid source  142  may also supply antibacterial agents, antiviral agents, cell-growth promotion agents, irrigation fluids, or other chemically active agents to the tissue site  103 . 
     In one embodiment, a method for applying reduced pressure to the tissue site  103  includes inserting the sleeve  121  at the tissue site  103  such that the opening  136  on the sleeve  121  is adjacent the tissue site  103 . The method may also include inserting the manifold  112 , which includes apertures  118 , into the sleeve  121 . Reduced pressure is supplied to the tissue site  103  via the apertures  118  and the opening  136 . The method may further include removing the manifold  112  from the sleeve  121 . In this embodiment, the sleeve  121  may remain at the tissue site  103 , and the manifold  112 , or any other manifold, may be inserted or re-inserted into the sleeve  121 . The sleeve  121  may also be removed from the tissue site  103  at any time, with or without the manifold  112  being positioned in the sleeve  121 . 
     In one embodiment, a method of manufacturing an apparatus for applying reduced pressure to the tissue site  103  includes forming the sleeve  121 . The method may also include forming the manifold  112 . 
     Referring to  FIGS. 2-4 , an apparatus  201  for applying reduced pressure to a subcutaneous tissue site is shown in accordance with an illustrative embodiment. In particular,  FIGS. 2-4  show a manifold  212  and a sleeve  221 , which are similar to the manifold  112  and the sleeve  121  in  FIG. 1 , respectively. The sleeve  221  and the manifold  212  may have the same lateral cross-sectional shape. In  FIGS. 2-4 , the sleeve  221  and the manifold  212  have a circular lateral cross-section. The sleeve  221  or the manifold  212  may have other lateral cross-sectional shapes, such as an ellipse, a polygon, an irregular shape, or a customized shape. 
     The width  248  of the sleeve  221  is preferably larger than the width  251  of the manifold  212 . However, the width  251  of the manifold  212  is not required to be constant along the entire length of the manifold  219 . The width  251  of the manifold  212  may instead be varied along its length relative to the width  248  of the sleeve  221  to increase or decrease the amount of space between the manifold  212  and the sleeve  221 . 
     The sleeve  221  or the manifold  212  may be made from a variety of biocompatible materials, including silicone. The sleeve  221  may be flexible such that the sleeve  221  is bendable when inserted or disposed subcutaneously. In one embodiment, the sleeve  221  is composed of a more flexible material than the manifold  212 . The rigidity of the manifold  212  may help to prevent the collapse of the manifold  212  when exposed to reduced pressure. 
     The opening  236  of the sleeve  221 , which is functionally analogous to the opening  136  in  FIG. 1 , may be located on a wall  257 , or side wall, of the sleeve  221 . The opening  236  is positioned at or near the most distal portion  233  of sleeve  221  and expands along a length of the sleeve  221 . The opening  236  is capable of transferring reduced pressure from the manifold  212  to a tissue site. In one embodiment, the opening  236  may extend along substantially the entire length  260  of the sleeve  221 . 
     The opening  236  is shown to have a substantially rectangular shape. However, the opening  236  may have any shape, including a circular, elliptical, polygonal, irregular, or customized shape. In the example in which the opening  236  has a customized shape, the opening  236  may be created based on the particular implementation or tissue site being treated by the apparatus  201 . In addition, sleeve  221  may have two or more openings  236 . The two or more openings  236  may face the same or different directions. For example, two openings  236  may be located on opposite sides of the wall  257 . In another example, the two openings  236  may be located on the same side of the wall  257 , and may be aligned along the length  260  of the sleeve  221 . The size, shape, and number of openings  236  may depend on the particular tissue site and type of treatment being implemented. 
     Manifold  212  includes a plurality of apertures  218  that partially or fully surround the manifold  212 . In the example in which the apertures  218  fully surround the manifold  212  and the manifold  212  is substantially cylindrical, the apertures  218  may be located around the circumference of the manifold  212 . In the example in which the apertures  218  partially surround the manifold  212 , each of the apertures  218  may be disposed to substantially face toward the opening  236  when the manifold  212  is inserted in the sleeve  221 . 
     The manifold  212  may also include a flange  263 , which may partially or fully surround the manifold  212 . An outer edge  266  of the flange  263  may at least partially abut an inner surface  269  of the sleeve  221  when the manifold  212  is inserted in the sleeve  221 . Also, the outer edge  266  of the flange  263  may be slidable along the inner surface  269  of the sleeve  221  when the manifold  212  is inserted into the sleeve in the direction of arrow  272  or removed in the direction of arrow  275 . The flange  263  may disposed anywhere along the manifold  212 , including the end  278  of the manifold  212 . Any number of flanges  263 , such as two or more flanges  263  may be included. 
     The flange  263  is capable of moving a substance, such as a bodily substance or fluid, toward the proximal end  227  of the sleeve  221  when the manifold  212  is removed from the sleeve  221  as suggested by arrow  275  in  FIG. 2 . In this embodiment, the removal of the manifold  212  helps to clear the sleeve  221 , including the distal end  239  of the sleeve  221 , of debris, such as exudate, tissue, or any other substance. 
     The width  281 , or outer diameter, of the flange  263  may be larger than the width  283  of the opening  236 . In this embodiment, the flange  263  may help to prevent the manifold  212  from exiting the sleeve  221  through the opening  236 , especially when the manifold  212  is being inserted into the sleeve  221 . In an alternative embodiment (not shown), the interior of the sleeve  221  may including a blocking member designed to engage flange  263  and stop further insertion of manifold  212  into sleeve  221 . Alternatively, the manifold  212  may include a surface feature on a proximal portion that prevents further advancement of the manifold  212  into sleeve  221 . 
     In one embodiment, the flange  263  includes at least one hole, such as holes  285 . The holes  285  allow fluid communication between the space  287  on the distal side of the flange  263  and the space  289  on the proximal side of the flange  263 . The flange  263  may include any number of holes  285 , and the holes  285  may have any shape. In one embodiment, the flange  263  has no holes  285 . In another embodiment, the holes  285  may have one-way valves in the holes  285  that allow fluid to be pulled out of the sleeve  221  when the manifold  212  is removed, but avoid pushing air or other fluids when the manifold  212  is moved into the sleeve  221  (i.e., the valves allow fluid flow through the valves in the direction of arrow  275 , but prevent flow in the direction of arrow  272 ). 
     Although the flange  263  is shown in  FIG. 3  as being positioned along the length of opening  236  when the manifold  212  is fully inserted within the sleeve  221 , the flange  263  could instead be located distal to the opening  236  when the manifold  212  is fully inserted. In this particular embodiment, the positioning of the flange  263  distal to the opening  236  may allow the flange  263  to better remove all bodily debris and substances (when the manifold is removed) that enter the sleeve  221  through the opening  236 . 
     The sleeve  221  includes an end cap  291  that is coupled to a distal end  292  of the sleeve  221 . As used herein, the term “coupled” includes coupling via a separate object, and also includes direct coupling. In the case of direct coupling, the two coupled objects touch each other in some way. The term “coupled” also encompasses two or more components that are continuous with one another by virtue of each of the components being formed from the same piece of material. Also, the term “coupled” includes chemical coupling, such as via a chemical bond. The term “coupled” may also include mechanical, thermal, or electrical coupling. “Coupled” may also mean fixedly coupled or removably coupled. 
     The end cap  291  may prevent fluid and reduced pressure from entering or exiting the sleeve  221  at the distal end  292  of the sleeve  221 . The end cap  291  may have any shape, including a rounded or dome shape. In the example in which the end cap  291  has a rounded or dome shape, the shape of the end cap  291  better facilitates the subcutaneous insertion of the sleeve  221 . Also, the space  293  inside the end cap  291  may be either hollow or solid. In another embodiment, the sleeve  221  does not include the end cap  291 . 
     Referring more specifically to  FIG. 4 , a delivery conduit  215 , which is functionally analogous to the delivery conduit  115  in  FIG. 1 , may deliver reduced pressure or fluid to the manifold  212 . In one embodiment, the delivery conduit  215  may include two or more lumens, such as lumens  293  and  294 . In one example, the lumen  293  delivers reduced pressure to the manifold  212 , and the lumen  294  delivers a fluid to the manifold  212 . The delivery conduit  215  is fluidly coupled to the manifold  212 . 
     Referring to  FIGS. 5-8 , a manifold  512 , which is similar to the manifold  112  in  FIG. 1 , and an end cap  591 , which is similar to the end cap  291  in  FIGS. 2-4 , are shown in an exploded view. The sleeve to which end cap  591  is coupled is not illustrated in  FIG. 5  for purposes of clarity. The end cap  591  includes a securing wall  595  on a sleeve-facing side  596  of the end cap  591 . In one embodiment, the securing wall  595  receives the distal end  578  of the manifold  512  such that the securing wall  595  at least partially surrounds the distal end  578  of the manifold  512  and may form an interference fit. Alternatively, the distal end  578  of the manifold may receive and surround the securing wall  595  and may form an interference fit. The securing wall  595  may stabilize, secure, or prevent relative movement, e.g., lateral or longitudinal movement, of the manifold  512  and sleeve  521  when the manifold  512  is inserted into the sleeve  521 . The space  502  around the securing wall  595  may be hollow or solid. The end cap  591  may be dome-shaped as shown or may be cylindrical, or may take any other shape. 
     In one embodiment, the securing wall  595  may include at least one groove, such as groove  597 , and the manifold  512  may include at least one projection, such as projection  598 , at or near the distal end  578  of the manifold  512 . The projection  598  radially extends from the manifold  512 . When the distal end  578  is inserted into the securing wall  595 , the groove  597  slidably receives the projection  598 . By inserting the projection  598  into the groove  597 , the manifold  512  is substantially prevented from rotational movement with respect to with respect to the manifold  512 . When the groove  597  slidably receives the projection  598 , the manifold is oriented such that the apertures  518  may face the opening (not shown) in the sleeve. By moving the projection  598  into a locking portion  599  of the groove  597 , the movement of the manifold  512  out of the sleeve may be hindered or prevented. In another embodiment, the groove  597  does not include the locking portion  599 . 
     The illustrative embodiments of sleeves and manifolds may be used to provide reduced pressure treatment to one or more tissue sites and at tissue sites located at various locations within a patient. For example, the system  100  in  FIG. 1  is shown applied to a tissue site  103  that is a bone. In another illustrative embodiment illustrated in  FIG. 9 , a reduced-pressure treatment system  600  is capable of providing reduced pressure to an abdominal tissue site  603 . 
     The system  600  is analogous to system  100 , and similar parts to those in  FIG. 1  have been shown with reference numerals indexed by  500 . The tissue site  603  is within an abdominal cavity and in particular within a paracolic gutter  607  of a patient  624 . A manifold  612  is inserted into a sleeve  621 . The sleeve  621  has a distal end  625  and a proximal end  627 . The proximal end  627  of the sleeve  621  has an opening  630  into which the manifold  612  may be inserted. In this embodiment, there is no tissue defect as such, and the manifold  612  is exposed to multiple tissues and tissue sites along an anatomic plane or region, in this case, the abdominal paracolic gutter  607 . It should be noted that system  600  is shown applied to one paracolic gutter  607 , but may be applied bilaterally to provide reduced pressure treatment to a paracolic gutter  611  on the other side of the patient  624 . 
     The sleeve  621  is inserted through an opening in the patient&#39;s abdomen and positioned in the paracolic gutter  607 . The manifold  612  is inserted into the sleeve  621 . The manifold  612  is positioned to have apertures  618  proximate opening  636  and proximate tissue site  603 . The proximal end  690  of the manifold  612  is coupled to a delivery conduit  615 . The delivery conduit  615  provides reduced pressure from a reduced pressure source  609  to remove fluids (e.g., ascites or exudates) from the tissue site  603 , which are then are collected within a container  645 . The delivery conduit  615  may also provide a fluid from a fluid source  642 . The proximal end  690  of the manifold  612  may include visual indicia  691  to help the healthcare provider gauge the extent to which manifold  612  has been inserted into the sleeve  621 . The proximal end  690  may also have a flange or other device to avoid over insertion of the manifold  612  into the sleeve  621 . 
     The system  600  may be used to provide reduced pressure treatment at the wound site  603  or to only remove fluids, e.g., ascites, from the abdominal cavity. Numerous other tissue sites are also possible. 
     It should be apparent from the foregoing that an invention having significant advantages has been provided. While the invention is shown in only a few of its forms, it is not just limited but is susceptible to various changes and modifications without departing from the spirit thereof.