Patent Publication Number: US-2022211980-A1

Title: Midline catheter placement device

Description:
This application is a continuation application of U.S. Ser. No. 16/489,243, filed Aug. 27, 2019, which is a 371 application of PCT/US2018/022780, filed Mar. 16, 2018, which claims priority to U.S. provisional patent application Ser. No. 62/472,984, filed Mar. 17, 2017, which are hereby incorporated by reference in their entirety. 
    
    
     FIELD OF THE INVENTION 
     The invention is in the field of catheter devices for delivering a medication or drug to a patient. Specifically the invention is directed to a catheter insertion device that can be operated in a manner to improve the efficiency of catheter insertion into a patient. The invention is particularly directed to a catheter insertion device that can be operated by one hand. 
     DESCRIPTION OF THE RELATED ART 
     Midline catheters are generally used for parenteral nutrition, IV fluid replacement and the administration of analgesics and antibiotics. Midline catheters are inserted at the bedside using sterile techniques and can remain in place for several weeks. The insertion (venipuncture) is performed above and below the antecubital fossa in the cephalic, basilic, or brachial veins. The catheter tip is advances 3 inches to 8 inches with the tip terminating below the axilla and proximal central veins. 
     The potential advantages of a midline catheter are the reduced frequency of repeated venipunctures for labs/restarts, decreased incidence of catheter related infections, extended implant/indwell duration, improved clinical outcomes, patient satisfaction and associated cost savings. Placing the catheter tip in the larger diameter veins in the upper arm compared to the smaller veins provide improves drug delivery therapy and hemodilution. Midline catheters can be used for infusing contract media at higher flow rates that are typically done by CV catheters such as PICC applications. 
     Prior midline catheter devices typically include an integral guidewire. The guidewire is advanced through the lumen of the needle and into the vein after the needle accesses the vein. Often an ultrasonic probe or imaging device is used to locate the needle in the desired location. The catheter is then advanced over the guidewire into the vein. The needle and guidewire are then detached and separated from the catheter which remains in place in the vein. 
     The prior devices generally require the guidewire to be fully deployed by moving a sliding member into a locked/detent position. To advance the catheter, the clinician must put down the ultrasonic probe and use both hands to advance the catheter and complete the final steps of the procedure. This results in a loss of the visualization of the vein and the location of the catheter relative to the vein. 
     Catheter placement and advancement is dependent on holding the device in a stationary position with one hand while manipulating the catheter advancing mechanism in the other hand without the use of the ultrasonic imaging to assist in proper placement of the catheter. Once the catheter is fully advanced, the clinician must re-position the ultrasonic probe to re-establish the image and confirm proper placement of the catheter. The operation requires a series of sequential steps with specialized training. The additional exchange of hand positions from the ultrasonic probe to the device and back to the probe adds complexity to the procedure and risk the success of the proper placement of the catheter. 
     Earlier methods for placing midline catheters were similar to the PICC placement. The Seldinger technique used a needle, dilator, guidewire, and sheath or catheter to access the vessel and ultimately place the catheter in the vessel. The modified Seldinger technique coupled the dilator and sheath components together. Although providing some benefits, the potential risks remain, such as puncture of the back wall of the blood vessel, air embolism during component exchanges, contamination of components, bloodstream infection, excessive bleeding, blood splash contamination, needle stick injury and loss of cannulation access of loss of guidewire. 
     The accelerated Seldinger technique is a more recent method that combines the four components into a single unit. The resulted in a reduction in the number of component exchanges and open-to-air events, which reduce potential contamination and reduce the time needed to complete the procedure. 
     While the prior devices are generally suitable for the intended use, there is a continuing need for improved devices for controlling the penetration of a cannula for delivering a drug or medicament. 
     SUMMARY 
     The present invention is directed to a catheter insertion device for placement of an IV catheter in a selected location in the patient with reduced risk of movement of the device during insertion with respect to the selected location on the patient. In one embodiment, a midline catheter and a catheter insertion device are provided for insertion and placement of the catheter in the vein or artery of the patient. The catheter insertion device is able to place the catheter in a selected location and enable removal of an introducer needle with reduced risk of movement of catheter during the process. The catheter insertion device of the invention of the catheter does not require a guidewire to be inserted into the patient prior to inserting the catheter. 
     The midline catheter insertion device provides improved ergonomics and one-handed function. The catheter insertion device of the invention provides a one-handed advancement of the catheter while enabling the clinician to operate the ultrasonic probe to obtain images of the target blood vessel. The one-handed operation of the catheter insertion device enables holding the ultrasonic probe in one hand to provide visualization of the advancement of the catheter while holding the insertion device in the other hand. 
     The catheter insertion device in one embodiment includes a housing for supporting a catheter and an introducer needle for positioning the catheter in a selected location within the patient. The insertion device is able to slide the catheter forward over the stationary introducer needle to position the catheter in the vein or artery and then retract the introducer needle from the catheter. The insertion device avoids the need for a guidewire as in the prior devices. 
     The catheter insertion device in one embodiment includes a housing receiving a catheter hub having a catheter extending from one end of the hub and extending from a distal end of the housing. An introducer needle is fixed in the housing and extends through the catheter and extends from a distal end of the catheter for assisting in the insertion of the catheter into a patient. An actuator is operatively connected to the housing for moving the catheter forward to slide over the end of the introducer needle. The catheter and catheter hub can be released from the housing and the introducer needle retracted from the proximal end of the catheter and hub to separate the insertion device from the catheter after insertion. 
     The insertion device in one embodiment includes a housing having a sliding actuator that can be operated by the user to slide the actuator in a longitudinal direction with respect to a longitudinal dimension of the housing. A movable catheter and a fixed introducer needle are provided within the housing. The actuator is operatively connected to the catheter whereby sliding movement of the actuator in the longitudinal direction toward a distal end of the housing slides the catheter forward over the introducer needle. The actuator is configured to be able to move the catheter forward by incremental steps by sliding the actuator back to its original position and then sliding forward again. The actuator is comfortable and easy to use by the operator using one hand. 
     The catheter insertion device of the invention is configured to be held and operated by one hand and to advance the catheter over the introducer needle by a one-handed operation. The catheter insertion device is suitable for use while one hand of the user holds an ultrasonic probe for locating the catheter in a selected location and the other hand is able to hold and operate the catheter insertion device. 
     The catheter insertion device according to one embodiment includes a housing receiving a catheter, an introducer needle for the catheter and a shuttling or indexing assembly and mechanism for deploying the catheter with respect to the introducer needle. The shuttling mechanism is manually operated using one hand while holding the insertion device in a stable position with respect to the patient. The shuttling mechanism is able to deploy the catheter in a step-wise progression from a retracted position to an extended position. Once the catheter is deployed, the catheter and catheter hub can be released from the distal end of the housing so the introducer needle can be withdrawn from the catheter. A needle shield or cover can be deployed over the end of the withdrawn introducer needle to prevent accidental needle stick. 
     The various aspects and features of the invention are attained by providing a catheter insertion device comprising a housing, a catheter and catheter hub, an introducer needle and an actuator. The housing has a longitudinal axis with a distal end and a proximal end. The catheter hub and catheter are received in the housing where the catheter extends from the distal end of the housing. The introducer needle is fixed relative to the housing and is received in the catheter and projects from a distal end of the catheter. The actuator is coupled to the housing for advancing the catheter relative to the housing and the introducer needle by movement of the actuator. 
     The features of the invention are further attained by providing a catheter insertion device comprising a housing having a longitudinal axis with a distal end and a proximal end, a catheter and catheter hub, an introducer needle, and an actuator assembly. The catheter has a proximal end connected to a catheter hub and a distal end for insertion into a patient. The catheter and catheter hub are positioned in a longitudinal passage of the housing and are movable from a retracted position relative of the proximal end of the housing to a second position toward the distal end of the housing. The introducer needle is fixed in the housing and extends through a lumen of the catheter where the introducer needle projects from the distal end of the catheter when the catheter is in the first position. The actuator assembly in one embodiment includes a movable actuator coupled to the housing and is movable in a longitudinal direction relative to the housing and is operatively connected to the needle hub. The movable actuator is able to deploy the catheter relative to the introducer needle in a step-wise progression. 
     The features of the invention are further provided by an actuator for a catheter insertion device where the actuator includes a shuttling or indexing mechanism to advance the catheter forward from the distal end of the housing. The catheter and catheter hub can be released from the housing and the introducer needle can be withdrawn and discarded. 
     The various features of the invention are further attained by providing a method of inserting a catheter into a patient by use of the catheter insertion device. The catheter with the introducer needle projecting from a distal end of the catheter is inserted into the patient in the desired location. An actuator on the insertion device is manually manipulated to slide the catheter in the distal direction relative to the device and the introducer needle to position the distal end of the catheter in the patient with the distal end of the introducer needle positioned within the catheter. The catheter and catheter hub are separated from the housing of the device and the introducer needle retracted from the catheter. 
     It will be understood that each of the preferred or optional features of the various embodiments may be combined with other features and features described in combination with one or more particular features may also be combined with one or more other features of the other embodiments. 
     These and other features of the invention will become apparent from the following detailed description of the invention, which in conjunction with the drawings disclose various embodiments of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The following is a brief description of the drawings in which: 
         FIG. 1  is a perspective view of the catheter insertion device showing the actuator in the starting position; 
         FIG. 2  is a perspective view of the catheter insertion device of  FIG. 1  showing the actuator in the forward actuated position; 
         FIG. 3  is a side view of one housing half of the catheter insertion device of  FIG. 1  showing the catheter and hub in the original starting position with the introducer needle extending from the distal end of the catheter; 
         FIG. 4  is a side view of the housing half of the catheter insertion device of  FIG. 3  showing the actuator moved to the actuated position and the catheter advancing within the housing; 
         FIG. 5  is a side view of the catheter insertion device of  FIG. 3  showing the actuator moved back to the original position while the catheter remains in the advanced position; 
         FIG. 6  is a perspective exploded view showing the catheter and needle shield separated from the housing; 
         FIG. 7  is a side view in cross section of the safety assembly of the needle insertion device in one embodiment; 
         FIG. 8  is a perspective view of the clip of the safety assembly; 
         FIG. 9  is a side view in cross section showing the introducer needle partially withdrawn; 
         FIG. 10  is a side view in cross section showing the introducer needle withdrawn from the blood control valve; 
         FIG. 11  is perspective view in cross section showing the introducer needle withdrawn to activate the spring clip; and 
         FIG. 12  is a perspective view in cross section showing the catheter hub separated from the safety assembly. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     A catheter insertion device is provided for positioning a catheter in a patient for delivering a medication or other substance to a patient. The terms “needle” and “cannula” can be used herein interchangeably to refer to a member having a sharpened or beveled end for insertion into an injection site on a subject. In one embodiment, the needle can be a thin hollow tubular member. The distal end refers to the end of the device toward the patient and the proximal end refers to the opposite end away from the patient. As used herein, the “distal” direction is in the direction toward the patient and injection site, and the “proximal” direction is the opposite direction. “Axial” means along or parallel to the longitudinal axis of the needle and the “radial” direction is a direction perpendicular to the axial direction. The forward direction is the direction toward the distal end of the device. 
     The invention may assume various alternative variations, except where expressly specified to the contrary. It is also to be understood that the specific devices illustrated in the attached drawings, and described in the following specification, are exemplary embodiments of the invention. Specific dimensions and other physical characteristics related to the embodiments disclosed herein are not to be considered as limiting. The embodiments are not intended to be mutually exclusive so that the features of one embodiment can be combined with other embodiments as long as they do not contradict each other. 
     The present embodiments are directed to a catheter insertion device for inserting a positioning a catheter in a patient. The embodiments are particularly suitable for use with midline catheter that can be used in conjunction with an ultrasonic imaging device for assisting in positioning the device in a selected location and selected depth in the patient. The catheter can be a commonly used length and a commonly used diameter. The catheter insertion device  10  of the invention basically includes a main body or housing  12 , a catheter  14  having a catheter hub  16 , an introducer needle  18 , and an actuator assembly  20 . Actuator assembly  20  forms a shuttling or indexing assembly and mechanism to index and advance the catheter  14  over the end of the needle  18 . 
     Referring to  FIGS. 1 and 2 , housing  12  of the insertion device  10  has a longitudinal dimension with a distal end  22  and a proximal end  24 . In the embodiment shown, the housing  12  is formed from two housing halves that are joined together by a suitable attachment mechanism. The halves are aligned by pins protruding from a first half and corresponding recesses  13  on the other half as shown in  FIG. 3 . The housing  12  has a dimension for supporting the introducer needle  18  and catheter  14  during use and to enable the user to manipulate the device in positioning the catheter. The housing has a cavity  50  forming a longitudinal passage. In the embodiment shown the housing  12  has curved side walls  26 , a flat top wall  28  and a flat bottom wall  30 . The flat bottom wall is generally provided to allow the device to be placed on a flat surface in a stable position with reduced risk of falling off the surface. The shape of the device can vary depending on the particular use to provide comfortable and convenient use by the operator. 
     In the embodiment shown, an elongated opening  32  is formed in the top wall  28  for receiving the actuator assembly  20 . A tip  34  having converging sides defines the distal end  22  of the housing. As shown in  FIG. 6 , two hinged walls  36  of tip  34  are pivotally connected to the walls  26  by a respective hinge  38  to access the interior of the housing and allow removal of the catheter from the housing as discussed in further detail below. An outlet opening  40  in tip  34  enables the catheter and introducer needle to extend from the distal end of the housing during use. The converging surfaces of tip  34  enable the device to be positioned at a low angle with respect to the skin of the patient to assist in inserting the catheter  14  and introducer needle  18  into the patient with reduced risk of kinking or folding of the catheter  14 . 
     Referring to  FIGS. 3,7 and 8-12 , catheter  14  is shown extending from catheter hub  16  that fits and slides within the housing  12 . Hub  16  has a distal end  42  connected to catheter  14  and a proximal end  44  having a collar  45 . Proximal end  44  is coupled to a body  47  of a needle safety assembly  46 . The body  47  is a movable body or a body that can slide within the housing  12  and can be referred to herein interchangeably as the body  47 . In the embodiment shown in  FIG. 6 , hub  16  has the radially extending collar  45  at the proximal end for coupling with a luer fitting during use. A flexible seal  48  shown in  FIG. 7  forming a valve is provided in hub  16  at the distal end for closing the end and preventing leakage when the introducer needle is removed from the hub. The flexible seal  48  can be a rubber member or septum with a slit for allowing the introducer needle  18  to pass through and close when removed. A standard luer fitting can be coupled to the proximal end of hub  16  such that an actuator opens the valve to allow delivery of the substance or withdrawing fluid from the patient. 
     Catheter  14  can be a commonly used catheter and have a dimension commonly used in the art. By way of example, catheter can be 18 gauge or less, 20 gauge, 22 gauge, 24 gauge or 26 gauge. In one embodiment, the catheter can have a length of about 3 inches although other lengths can be used. 
     The introducer needle  18  in the embodiment shown in  FIGS. 3-6  is hollow and has a proximal end  52  fixed within a cavity  50  of housing  12  by a post  54  or other support and a distal end  56  shown in  FIGS. 3 and 7  extending from the distal end of housing through the opening  40 . As shown in  FIG. 1 , introducer needle  18  extends from the distal end of the housing a distance to enable proper insertion into the patient. The distal end of the catheter  14  in the initial position is spaced from the distal end of the introducer needle  18  toward the proximal end so that the introducer needle  18  extends past the distal end of the catheter  14  as shown in  FIG. 7 . The distal end  56  of introducer needle  18  in the embodiment shown has a beveled and sharpened tip as known in the art for piercing the skin and inserting into the patient. 
     The body  47  of safety assembly  46  in the embodiment shown is received in the longitudinal passage of the cavity  50  of housing  12  and is coupled to hub  16  during use and separated after insertion of the catheter  14  in the patient. In the embodiment shown in  FIGS. 3-5 , safety assembly  46  defines a shield to cover the distal end of introducer needle after use. Safety assembly  46  and body  47  are able to move or slide within the housing  12  during deployment of catheter  14  with respect to the introducer needle  18 . 
     In the embodiment shown, wall  30  of housing  12  includes at least one tab  60  that allows safety assembly  46  and the catheter to move or slide toward the distal end  22  of housing  12  and to prevent the safety assembly  46  from moving or sliding back toward the proximal end  24  of housing  12 . In one embodiment, a plurality of tabs  60  as shown in  FIGS. 3-5  are provided where each tab is formed at an incline and projects into the open center of the housing and projects toward the distal end  22  of housing  12 . The tabs  60  in one embodiment are integrally formed with the wall  30 . In the embodiment shown, tabs  60  are biased inwardly toward the center axis of the housing  12  and can flex or deform by the forward movement of the body  47  of safety assembly  46  over the tabs and return to the original position to assist sliding toward the proximal end of housing  12  and resisting moving back toward the proximal end of housing  12 . In one embodiment, the flexible tabs  60  allow the body  47  of safety assembly  46  to slide over the body  47  of safety assembly  46 . In other embodiments, tabs  60  can be rigid. The housing  12  can be made of a molded plastic material to provide resilient properties to the tabs  60  for bending and returning to the original position. 
     In one embodiment of the invention, a series or plurality of tabs  60  are provided on the wall  30  and angled at an incline toward the distal end of the housing as shown in  FIGS. 3-5 . The tabs  60  are spaced apart a substantially uniform distance along the length of the housing to define a length of travel of the body  47  of the safety assembly  46  and catheter  14  within housing  12 . The spaced apart tabs  60  form part of a ratcheting, shuttling or indexing assembly or mechanism for advancing the catheter  14  from a first starting position shown in  FIG. 3  to a second extended position shown in  FIG. 5  toward the distal end of housing  12 . The tabs  60  have a distal end  62  that engage a surface  64  on the safety assembly  46  that prevents the body  47  of safety assembly  46  from moving or sliding back toward the proximal end of the housing. The body  47  is able to slide over the tabs  60  by the forward movement of the body where the tabs spring back to the original position to resist movement of the body toward the proximal end of the housing. 
     Actuating assembly  20  is provided in the housing  12  to engage the body  47  of safety assembly  46  to advance the body  47  and catheter  14  toward the distal end  22  of housing  12  after the introducer needle  18  and the catheter  14  are positioned in the selected location in the patient. The actuating assembly  20  forms a ratcheting, shuttling or indexing assembly for advancing or indexing the catheter relative to the needle  18 . In the embodiment shown, actuating assembly  20  includes an actuator body  66  positioned within the housing  12  between the wall  28  and the body  47  of safety assembly  46 . A finger operated button  68  is connected to the actuator body  66  by a connecting member  70  that extends through and slides within the elongated opening  32  in the wall  28 . Button  68  is oriented on the outer surface of top wall  28  for access by the operator. 
     As shown in the drawings, the actuator body  66  has a longitudinal length complementing the longitudinal length of housing  12  to slide and reciprocate within the cavity of the housing  12 . Actuator body  66  has a substantially flat, planar configuration in the embodiment shown with a proximal end  72  and a distal end  74 . The distal end  74  has a guide pin  75  that slides in a slot  77  in the walls  26 . In the embodiment shown the button  68  is connected to the distal end  74  of actuator body  66  for ease of use by the operator. In other embodiments, the button  68  can be located at other suitable locations on the length of the actuator body  66  and the housing  12 . 
     The actuator body  66  of actuator assembly  20  includes at least one and typically a plurality of tabs  76  for engaging the body  47  to advance the body  47  and catheter  14  in a step-wise mariner toward the distal end of the housing by the reciprocating movement of the body  47 . The tabs  76  form a ratcheting mechanism for advancing and indexing the body  47  toward the distal end of the housing. The actuator body can be made of a suitable plastic material. In the embodiment shown, the tabs are formed with a base plate  79  that is attached to a face of the actuator body  66 . In one embodiment, the base plate  79  and tabs  76  can be made of metal or plastic. The tabs  76  can be integrally formed with the actuator body  66  in other embodiments. In one embodiment, the actuator body  66  can be made of plastic. 
     In the embodiment shown, the tabs  76  are formed at an incline in a manner to complement the tabs  60 . Tabs  76  extend from the actuator body  66  and project toward the center axis of the housing  12  and project toward the distal end  22  of the housing  12 . Tabs  76  in the illustrated embodiment are generally flexible to be able to slide over the body  47  of the safety assembly  46 . Distal ends  78  of the tabs  76  are biased inwardly toward the center axis of the housing and spring back to the original orientation after sliding over the body  47  of safety assembly  46 . The plurality of tabs  76  form the ratcheting, shuttling and indexing mechanism and are oriented for moving the catheter  14  and safety assembly  46  toward the distal end of the housing. In other embodiments, tabs  60  can be fabricated as one or more components. Button  68  and actuator  66  can also be made as one or more components 
     In use, the distal end of the  56  of the introducer needle  18  extends from the catheter  14  and the catheter  14  is positioned in a starting position toward the proximal end of the housing as shown in  FIG. 3 . The introducer needle  18  and the catheter  14  are inserted into the selected position in the patient for the intended use. The insertion device  10  is configured for ease of use by one hand to pierce the skin and position the catheter and introducer needle in the patient while freeing the user&#39;s other hand for holding other devices such as an ultrasonic imaging device commonly used to ensure proper placement of the catheter in the patient. The button  68  of the actuator assembly  20  is initially in the retracted position shown in  FIG. 3 . Using one finger or thumb, the user can slide the button  68  forward to the second position shown in  FIG. 4 . The tab  76  toward the proximal end of the actuator body  66  engages the body  47  and slides the body  47  and the catheter  14  forward a distance corresponding to the distance of travel of the actuator button. The tabs  60  on the bottom wall  30  of the housing  12  are positioned to complement the spacing and location of the tabs  76  so that the forward movement of the body  47  toward the distal end of the housing engage the respective tab  60  to retain the body  47  in the advanced position and prevent the body  47  from sliding back toward the proximal end of the housing. The advancing movement of the body  47  advances the catheter forward over the fixed introducer needle  18 . 
     The button  68  can then slide back toward the proximal end of the housing  12  where the tabs  76  slide over the body  47  to engage a contact point on the body  47  as shown in  FIG. 5 . The button  68  can slide by manual manipulation by the user or can slide by a spring member in the housing between the housing and the body. The button  68  can then slide forward again to slide the body  47  and catheter  14  forward to slide the distal end of the catheter past the distal end of the introducer needle. The sliding movement of the button can be repeated in a step-wise manner to advance the catheter to the extended position relative to the introducer needle  18  and housing  12 . In one embodiment of the invention, the button  68  slides by manual manipulation by the user in a repeated sliding movement forward and backward to push the catheter, catheter hub and safety assembly in the distal direction toward the patient by each forward stroke of the button and actuator body. At the completion of each forward stroke, the button is pulled back and the next tab of the actuator body is readied for the next forward stroke. With each forward stroke, the tabs on the housing engage the body  47  to prevent moving to the proximal end of the housing. 
     Once body  47  and catheter hub  16  are advanced to the forward position at distal end  22  of housing  12 , hinged walls  36  are pivoted to the open position shown in  FIG. 5  to release catheter hub  16  and body  47  and safety assembly  46  from housing  12 . The catheter hub  16  is advanced to contact cam surfaces  81  on the inner surface of the doors  36  to push the doors  36  open. Housing  12  can be pulled away from catheter hub  16  to withdraw introducer needle  18  from catheter  14 . Body  47  slides over distal end  56  of introducer needle  18  to enclose the sharp tip and prevent an accidental needle stick. Catheter hub  16  is released and separated from safety assembly  46  when body  47  of safety assembly  46  is actuated by the withdrawing of introducer needle  18 . Housing  12 , with the attached introducer needle  18  and body  47  are discarded in a sharps container. Seal  48  forms a valve that closes to control blood backflow and to allow attachment of an extension set or other device. 
     The actuator assembly  20  as shown is one example of a mechanism that can be used to advance the catheter over the introducer needle. In other embodiments, various mechanisms can be used that are able advance the catheter relative to the needle. In one exemplary embodiment, a wheel or rotatable member can be mounted in the housing to engage the body and advance the catheter hub. The wheel can be rotated manually by the thumb or finger of the user to cause the body and catheter to slide toward the distal end of the housing over the end of the introducer needle. 
     In various embodiments of the invention, the actuator assembly  20  can have other suitable constructions and mechanisms that are able to advance the catheter over the end of the needle by a single operation or by a sequence of repeated operations by the user. In the embodiment shown, the tabs are flexible and formed on the inner surfaces of the opposing walls of the housing that engage the body of the safety assembly although other arrangements of parts and components can be used effectively. In one alternative embodiment, tabs, detents or other members can be formed on or attached to the body of the safety mechanism that engage complementing tabs, detents or members on the actuator body and/or housing to provide the advancement of the catheter over the end to the needle. An inner surface of the housing can be formed with one or more detents, ridges, recesses or other structure that engage the detent or member on the safety assembly. For example, a detent can be formed on one or more surfaces of the body of the safety assembly that engage a complementing detent or recess in the housing that enable the safety assembly and catheter to travel in a direction toward the distal end of the housing to slide the catheter over the end of the needle. A detent or other member can also be formed on the body of the safety assembly to engage a complementing member on a movable actuator that is able to slide or move the safety assembly toward the distal end of the housing in a manner that will advance the catheter over the end of the needle. 
     Body  47  defines the safety needle assembly  46  which is a passive needle shield that can be deployed to cover the tip of the introducer needle  18 . Safety needle assembly  46  is similar to devices disclosed in WO2015/161296 and WO2015/161294 which are hereby incorporated by reference in their entirety. 
       FIGS. 7-12  show one embodiment where the safety assembly  46  includes body  47  with a proximal end  82  and a distal end  84 . In the embodiment shown, distal end  84  has an inner protrusion  86  and an outer ring  88  forming an annular ring for coupling with the proximal end  44  of catheter hub  16  as shown in  FIG. 7 . Proximal end  52  of introducer needle  18  is fixed to proximal end  24  of housing  12  and extends through a longitudinal passage in body  47  and through seal  48  and catheter  14 . 
     The proximal end of catheter hub has an outer diameter that is greater than the portion of the diameter of the hub adjacent to the collar  45 . The collar extends around a portion of the hub and is formed with an opening. 
     The safety assembly  46  includes a resilient clip  100  and a washer  102 . The body  47  of the assembly has an opening to receive the introducer needle  18 . The distal end of the body  47  is configured for coupling with the proximal end of the catheter hub  16 . The resilient clip  100  as shown in  FIG. 8  has a substantially V-shape having a first leg  104  and a second leg  106  connected by a hinged section  110 . In the embodiment shown, the first leg  104  includes a spade  112  having an angled portion for coupling to the body  47 . A first flag  114  extends from the second leg  106  toward the first leg  104  and a second flag  116  extends from the first leg  104  toward the second leg  106 . A foot  118  extends outwardly from the first flag  114  away from the first and second legs  104 ,  106 . A latch  120  extends upwardly from the foot  118  and is positioned between the legs  104 ,  106 . 
     During operation of the device, the body  47  of safety assembly  46  is connected the catheter hub  16  where the introducer needle  18  passes through the catheter hub  16  and the body  47 . The introducer needle  18  cooperates with the clip  100  by biasing the clip into a locked position by pressing legs  104 ,  106  of the clip toward one another. The introducer needle  18  contacts the outer surface of the leg  106  to retain the leg  106  in a compressed state with respect to the first leg as shown in  FIG. 7 . In the locked position, the latch  120  engages the collar  45  on catheter hub  16  to prevent removal of the catheter hub  16  from safety assembly  46 . The clip  100  is in a position that allows the introducer needle  18  to slide within the device. 
     As the needle is withdrawn from the catheter hub and into the safety assembly, the tip of the needle  18  clears the clip  100  and the leg  106  of the clip  100  is allowed to expand outwardly where the second leg  106  moves away from the first leg  106 . As the clip  100  expands, the first and second flags  114 ,  116  block the opening in the body  47  and prevent the tip of the introducer needle  18  from exiting the distal end of the body  47 . 
     Movement of the second leg  106  moves the latch  120  from engagement with the collar  45  of the catheter hub  16  to a position aligned with the opening in the collar. This allows the hub  16  to disengage from the body  47 . As the needle  18  is pulled further in the proximal direction, the needle  18  slides through the body  47  until a crimp or deformation  122  formed near the distal end of the needle  18  engages washer  102 . The washer  102  has an opening to allow passage of the needle shaft but not the crimp or deformation  122 . The opening has an inner dimension less than an outer dimension of the crimp or deformation  122 . The washer prevents the distal tip of the needle  18  and the crimp or deformation  122  from exiting the assembly when the needle is retracted. The combination of the clip  100  and washer  102  function as a needle tip protection mechanism to cover the needle tip and prevent a needle stick injury. In other embodiments, other types of safety mechanisms can be used having different shapes and features used on other peripheral IV catheters. 
     In the embodiment illustrated, a blood flashback feature is provided in the catheter device. Flashback is the visibility of blood that confirms the entry of the needle tip into a vein. Primary flashback can be seen through the catheter tubing  14  as blood travels into the open distal end of the hollow needle  18  and then exits through a notch or opening  126  in the needle  18  near the needle tip as shown in  FIG. 7 . The blood travels up through the internal annular space between the needle  18  and the inside of the catheter  14 . In one embodiment, a secondary flashback can be seen in a needle hub when the blood comes out of the back of the catheter  14  and enters a flash chamber in the needle hub. Air can be vented by a plug in the back of a needle hub or inside the housing by a porous membrane or micro grooves. A tertiary flashback can be seen in the catheter hub when blood from the primary flashback flows into the hub and stops at a blood control septum  48 . Air is vented is vented by micro grooves in the periphery of the blood control septum  48 . The features described in this embodiment can be used in combination with the features described in this invention. 
     The above description of the preferred embodiments is not to be deemed as limiting the invention, which is defined by the appended claims. The disclosure is intended to enable the artisan of ordinary skill to practice variants of the invention described without departing from the scope of the invention. Numerical limitations herein, in the specification and in the claims, are understood to be limited by the modifier “about,” such that minor departures yielding equivalent results is within the scope of the invention. Features or dependent claim limitations disclosed in connection with one embodiment or independent claim may be combined in another embodiment or with a different independent claim without departing from the scope of the invention.