Source: https://patents.google.com/patent/US9078637B2/en
Timestamp: 2019-04-20 11:36:46+00:00

Document:
2009-04-24 Assigned to VIDACARE CORPORATION reassignment VIDACARE CORPORATION ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MILLER, LARRY J.
An apparatus and method for harvesting bone and bone marrow are provided. The apparatus may include a driver operable to be releasably engaged with an intraosseous device. The intraosseous device may include a cannula having a first end operable to penetrate bone and bone marrow and to allow retrieval of portions of bone and/or bone marrow. The cannula may have a second end operable to be releasably engaged with bone marrow sampling equipment. The apparatus may include a removable trocar. The removable trocar may have an inner channel operable to convey portions of bone and/or bone marrow. The removable trocar may have an inner channel and a side port communicating with the inner channel. The removable trocar may have a first end operable to penetrate bone and bone marrow.
This application is a divisional of U.S. patent application Ser. No. 11/427,501 entitled “Apparatus And Methods TO Harvest Bone And Bone Marrow” filed Jun. 29, 2006, the contents of which is hereby incorporated in its entirety by reference.
U.S patent application Ser. No. 11/427,501 is a Continuation-In-Part Application of U.S. patent application Ser. No. 10/448,650 entitled “Apparatus and Method to Access the Bone Marrow for Oncology and Stem Cell Applications” filed May 30, 2003, now Abandoned, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/384,756, filed May 31, 2002, and entitled “Apparatus and Method to Provide Access to Bone Marrow”.
U.S. patent application Ser. No. 11/427,501 is also a Continuation-In-Part Application of U.S. Divisional patent application Ser. No. 11/389,732 entitled “Apparatus and Method to Access the Bone Marrow for Oncology and Stem Cell Applications” filed Mar. 27, 2006, now Abandoned, which claims priority to U.S. Provisional Patent Application Ser. No. 60/384,756, filed May 31, 2002, and entitled “Apparatus and Method to Provide Access to Bone Marrow”.
U.S. patent application Ser. No. 11/427,501 is also a Continuation-In-Part Application of U.S. Divisional patent application Ser. No. 11/389,733 entitled “Apparatus and Method to Access the Bone Marrow for Oncology and Stem Cell Applications” filed Mar. 27, 2006, now Abandoned, which claims priority to U.S. Provisional Patent Application Ser. No. 60/384,756, filed May 31, 2002, and entitled “Apparatus and Method to Provide Access to Bone Marrow”.
U.S. application Ser. No. 10/449,503 entitled “Apparatus And Method To Provide Emergency Access To Bone Marrow”, filed May 30, 2003 now U.S. Pat. No. 7,670,328, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/384,756, filed May 31, 2002, includes examples of apparatus and methods for harvesting bone and bone marrow.
The present disclosure is related to apparatus and methods for obtaining biopsy specimens from bone and/or associated bone marrow and obtaining larger quantities of bone and/or associated bone marrow for diagnostic purposes and/or transplantation of stem cells and/or bone marrow.
There are many clinical conditions where it is important to be able to access and retrieve bone marrow. In some cases it may be necessary to treat diseases with a bone marrow or stem cell transplant to restore functioning blood cells in the body after high-dose chemotherapy. Such conditions may include acute leukemias, brain tumors, breast cancer, Hodgkin's disease, multiple myeloma, neuroblastoma, non-Hodgkin's lymphomas, ovarian cancer, sarcoma and testicular cancer. In other cases it is necessary to access the bone marrow to obtain a sample of the marrow for diagnostic testing. These conditions may include cancer of any type and hematologic disease of any origin.
Gaining access to bone and associated bone marrow for a small biopsy specimen or aspiration of a larger quantity of bone marrow may be difficult, traumatic and occasionally dangerous, depending on the selected target area for harvesting bone and/or associated bone marrow, operator expertise and patient anatomy. Many currently available devices and techniques for gaining access to a bone and associated bone marrow may include using an intraosseous (IO) needle with a removable trocar disposed therein. Handles may be used to apply pressure to and manually rotate the IO needle and trocar as a set. Such manual IO devices often require substantial force to break through the outer cortex of a bone. Exertion of such force may cause pain to a patient and may sometimes damage the bone and/or IO device.
Excessive force when harvesting bone and/or bone marrow from the sternum of a patient may cause penetration through the sternum and potentially damage the underlying heart and/or great blood vessels. Damage may also occur when harvesting bone marrow from children with softer bone structures or any patient with bones deteriorated by disease (cancer).
Retrieving bone and bone marrow samples for diagnostic purposes may often be difficult. Occasionally a core sample of bone and/or bone marrow may not be successfully retrieved using a standard biopsy needle. Thus, multiple insertions at different sites may be necessary to obtain a satisfactory bone and/or bone marrow biopsy specimen. Risks to health care personnel may be higher because of increased handling of blood contaminated sharp instruments. Accidental needle sticks and missed target areas may further complicate procedures and increase risks to health care personnel and/or patients.
Conventional bone marrow transplant techniques may require multiple penetration sites (up to 20 per patient) in order to obtain enough bone marrow (sample size) to perform a routine bone marrow transplant. This is often a labor intensive procedure. Conventional biopsy needles are typically inserted with considerable manual force. This force may cause loss of control or operator fatigue. When the biopsy needle is in place, an associated trocar is generally removed and a syringe attached to the biopsy needle to aspirate a few cubic centimeters of bone marrow. The biopsy needle is then withdrawn. A new site is penetrated by the biopsy needle generally about a centimeter from the first site and the procedure repeated.
One aspect of the present disclosures may include apparatus and methods to access bone and/or bone marrow with minimum trauma to a patient and still allow removal of sufficient amounts of bone and/or bone marrow the first time a bone is penetrated. Such apparatus may include a powered driver and an intraosseous device having an outer penetrator. The outer penetrator may have a tip or first end operable to penetrate bone and associated bone marrow. The outer penetrator may also have a longitudinal bore operable to remove a bone specimen and/or bone marrow from a target area. The outer penetrator may be used to harvest bone and/or associated bone marrow with or without an inner penetrator.
For some embodiments a removable inner penetrator may be slidably disposed within an outer penetrator. The inner penetrator may have a first end operable to penetrate bone and/or bone marrow. The inner penetrator may also have a longitudinal bore operable to remove portions of bone and/or bone marrow from a target area. For some applications the inner penetrator may be a generally solid rod or shaft. For other applications, the inner penetrator may have a longitudinal bore extending therethrough. For still other applications the inner penetrator may include a chamber or cavity formed proximate the first end.
One embodiment may include a method for harvesting bone and/or bone marrow by slidably disposing portions of an inner penetrator within a hollow, outer penetrator to form an intraosseous (IO) device. The IO device may be inserted into a bone and/or associated bone marrow using a powered driver. The inner penetrator may be removed from the hollow, outer penetrator. Suction may then be applied to the hollow, outer penetrator to retrieve portions of bone and/or bone marrow via the hollow, outer penetrator.
One method of harvesting bone and/or bone marrow in accordance with teachings of the present disclosure may include inserting a hollow, outer penetrator and an inner penetrator or first trocar into a bone and associated bone marrow. The inner penetrator may then be removed and a specimen of bone and/or bone marrow may be grasped by inserting a second trocar through the outer penetrator and into the bone marrow. The outer penetrator and the second trocar may cooperate with each other to allow opening one end of the second trocar during insertion of the second trocar into the bone marrow and to close the one end of the second trocar during retrieval of the specimen.
For some embodiments an intraosseous (IO) device may be provided to remove a relatively small specimen of bone and/or bone marrow from a target area. For other embodiments an IO device may be provided to remove relatively larger quantities of bone and/or bone marrow from a target area. Such IO devices may have multiple side ports to remove bone marrow from respective target areas corresponding with each side port.
The use of a powered driver to insert an intraosseous device into a target area to obtain a bone specimen and/or to obtain bone marrow samples may substantially reduce or eliminate many of the problems associated with manually inserted biopsy needles.
Preferred embodiments of the disclosure and its advantages are best understood by reference to FIGS. 1-9D herein like numbers refer to same and like parts.
The term “driver” may be used in this application to include any type of powered driver or manual driver satisfactory for installing an intraosseous (IO) device such as a penetrator assembly or an IO needle into a selected target area. Various techniques may be satisfactorily used to releasably engage or attach IO devices with powered drivers and manual drivers. Various features and steps of the present disclosure may be described with respect to powered drivers. However, various teachings of the present disclosure may also be used with manual drivers. The present disclosure is not limited to use with powered drivers such as shown in FIG. 2.
For some applications a powered driver or a manual driver may be directly coupled with an IO device. For other applications various types of connectors may be used to couple a powered driver or a manual driver with an IO device. A wide variety of connectors and associated connector receptacles, fittings and/or other types of connections with various dimensions and configurations may be satisfactorily used to releasably engage an IO device with a powered driver or a manual driver.
The term “fluid” may be used in this application to include any liquid including, but not limited to, blood, water, saline solutions, IV solutions, plasma or any mixture of liquids, particulate matter, dissolved medication and/or drugs appropriate for injection into bone marrow or other target sites. The term “fluid” may also be used in this patent application to include any body fluids and/or liquids containing particulate matter such bone marrow and/or cells which may be withdrawn from a target area.
The term “intraosseous (IO) device” may be used in this application to include any hollow needle, hollow drill bit, penetrator assembly, bone penetrator, cannula, trocar, inner penetrator, outer penetrator, penetrator net, IO needle or IO needle set operable to provide access to an intraosseous space or bone cavity containing bone marrow. One example of an intraosseous device inserted into bone and associated bone marrow in accordance with teachings of the present disclosure is shown in FIGS. 1 and 4.
A wide variety of trocars, spindles and/or shafts may be disposed within an outer penetrator or cannula. Such trocars, spindles and shafts may sometimes be characterized as inner penetrators. An IO device incorporating teachings of the present disclosure will generally include an outer penetrator. An IO device incorporating teachings of the present disclosure may or may not include an inner penetrator.
The terms “insertion site,” “penetration site,” and “installation site” may be used in this application to describe a location on a bone at which an intraosseous device may be inserted or drilled into the bone and associated bone marrow. Insertion sites, penetration sites and installation sites are generally covered by skin and soft tissue.
The term “target area” may be used in this application to describe selected portions of a bone cavity or locations in a bone cavity from which associated bone marrow may be harvested in accordance with teachings of the present disclosure.
The terms “harvest” and “harvesting” may be used in this application to include both bone marrow biopsy and bone marrow aspiration. Bone and/or marrow biopsy (sometimes referred to as “needle biopsy”) may be generally described as removing a relatively small piece or specimen of bone and/or bone marrow from a selected target area for biopsy purposes. Bone marrow aspiration (sometimes referred to as “bone marrow sampling”) may be generally described as removing larger quantities of bone marrow from a selected target area. Relatively large quantities of bone marrow may be used for diagnostic, transplantation and/or research purposes. For example some stem cell research techniques may require relatively large quantities of bone marrow.
Many current available techniques used to harvest bone and/or bone marrow may require more than one penetration into a bone and associated bone marrow to retrieve an adequate sample of bone and/or bone marrow. Multiple penetration sites may be required in the same bone if a biopsy sample is not satisfactorily retrieved at the first penetration site. Medical personnel may need to insert an IO needle into several different penetration sites on the same bone to obtain adequate quantities of bone marrow for transplant or stem cell research. For example obtaining sufficient quantities of bone marrow from a patient's pelvis may require six or more insertion sites. Multiple insertions may be extremely painful for a patient and may deter some people from donating bone marrow. Multiple insertions may also cause fatigue in medical personnel performing such procedures with manual IO devices.
Bone marrow transplant procedures and various research procedures such as stem cell research often require relatively large quantities of bone and/or bone marrow. Hip bones generally have a large bone cavity and are therefore frequently used as a target area for harvesting bone marrow for transplant procedures, stem cell research procedures or any other procedure requiring relatively large quantities of bone marrow.
In FIGS. 1 and 4 intraosseous device 60 is shown installed in a portion of hip bone 100 referred to as the ilium. One of the penetration sites or insertion sites frequently used for obtaining bone marrow from a hip bone may be the posterior iliac crest. See FIGS. 1 and 4. Another insertion site may be the anterior iliac crest.
Hip bone 100 may include three segments—the ilium, the ischium and the pubis. These segments are generally distinct from each other in young patients but are generally fused together in adults. Skin and soft tissue 102 generally cover insertion sites in crest 104 of the ilium. See FIGS. 1 and 4. All bones generally include a tough, hard to penetrate layer of cortex. Crest 104 typically includes cortex layer 106.
FIGS. 1 and 4 show an enlarged cortex layer for illustration purposes only. A typical thickness for skin and soft tissue layer 102 may be seven to eight millimeters (7 mm to 8 mm). A typical thickness for cortex layer 106 may be approximately two millimeters (2 mm).
As discussed later in more detail, penetrator assembly or intraosseous (IO) device 60 may be inserted in the crest of the ilium or any other insertion site with minimum trauma to obtain bone and/or bone marrow samples in accordance with teachings of the present disclosure.
Oncologists and other health care provides may be unable to successfully obtain a suitable specimen of bone and/or bone marrow because currently available biopsy needles sometimes fail to capture a specimen of bone and/or bone marrow. When a specimen is obtained, the specimen may be damaged or contaminated. An intraosseous device incorporating teachings of the present invention may substantially reduce or eliminate problems associated with obtaining a suitable specimen of bone and/or bone marrow. See for example IO devices 80 a (FIG. 8A), 80 b (FIG. 8B) and IO device 160 (FIGS. 9A-9D).
FIG. 1 shows one example of a system for removing bone marrow from a bone using apparatus and methods incorporating teachings of the present disclosure. Samples of bone and/or bone marrow may be obtained from any suitable bone including, but not limited to, tibia (leg bone), ilium (pelvis) or sternum (chest) using apparatus and methods incorporating teachings of the present disclosure. FIGS. 1 and 4 show intraosseous device 60 inserted into a target area in a patient's ilium.
Various features of the present disclosure may be described with respect to powered driver 200. See FIG. 2. Various features of the present disclosure may also be described with respect to intraosseous devices 60. However, teachings of the present disclosure may be satisfactorily used with a wide variety of drivers and intraosseous devices. The present disclosure is not limited to intraosseous device 60 or driver 200.
For one embodiment, system 20 may include a source of vacuum or low pressure 22, collection container 24, vacuum tubing 26 and collection tubing 28. Source of vacuum 22 may be a pump such as shown in FIG. 1 or may be a portion of a hospital or operating suite low pressure vacuum system (not expressly shown). Vacuum tubing 26 may extend between vacuum source 22 and collection container 24. Various types of tubing may be satisfactorily used to form vacuum tubing 26 and/or collection tubing 28. The length of vacuum tubing 26 and/or collection tubing 28 may be varied depending upon each facility in which system 20 is used.
Collection tubing 28 may extend between collection container 24 and intraosseous (IO) connector assembly 30. Various types of connections and connector assemblies including, but not limited to, IO connector assembly 30 may be used to communicate fluids between IO device 60 and suction tubing 28.
IO connector assembly 30 may include coupling or tubing connector 32 operable to be releasably engaged with one end of collection tubing 28 opposite from container 24. Various types of couplings associated with IV tubing may be satisfactorily used. Relatively short, flexible tubing 34 may extend between coupling 32 and right angle connector 38. For some applications, flow control stop or device 40 may be attached to flexible tubing 34 between coupling 32 and right angle connector 38.
Flow control device 40 may have a first, open position as shown in FIG. 1 and a second, closed position (not expressly shown). Flow control device 40 may be used to prevent fluid flow from IO device 60 during engagement and disengagement with collection tubing 28 or any other apparatus such as IV tubing (not expressly shown) which may be attached to IO connector assembly 30.
Flow control device 40 may be formed from relatively flexible material which allows compressing or squeezing flow control device 40 to engage notch or hook 46 with end 48. Compression of flow control device 40 will preferably result in clamps 42 and 44 compressing or closing off fluid flow through the lumen of flexible tubing 34. Engagement of notch 46 with end 48 will hold flow control stop 40 in its second, closed position.
Right angle connector 38 may be engaged with one end of flexible tubing 34 opposite from coupling 32. Right angle connector 38 allows flexible tubing 34 to be connected to IO device 60 at an angle that will generally not kink or pinch off the lumen of tubing 34. Right angle connector 38 may also include Luer fitting 39 sized to be inserted into tapered opening 74 formed in first end 71 of hub 70. See FIGS. 1 and 4.
Lock nut 36 may be disposed on the exterior of right angle connector 38 adjacent to Luer fitting 39. Flange 35 may also be formed on the exterior of right angle connector 38 adjacent Luer fitting 39. Lock nut 36 may be both rotatably and slidably disposed on the exterior of right angle connector 38 adjacent to Luer fitting 39 with flange 35 disposed between lock nut 36 and Luer fitting 39. Threads 37 formed on interior portions of lock nut 36 may be used to releasably engage right angle connector 38 with threads 77 formed adjacent to first end 71 of hub 70.
Penetrator assembly or IO device 60 as shown in FIGS. 1, 3, 4 and 6 may include connector 50 and hub 70. Connector 50 may be described as having a generally cylindrical configuration defined in part by first end 51 and second end 52. First end 51 may include opening or connector receptacle 54 disposed therein and sized to receive connector 216 of powered driver 200. See FIGS. 2 and 4.
Connector receptacle or opening 54 may be formed with various configurations and/or dimensions. One or more webs (not expressly shown) may be formed in end 51 extending from opening 54. Open segments or void spaces (not expressly shown) may be formed between such webs. Opening 54 and associated webs may be used to releasably engage connector 50 with any driver satisfactory for installing an IO device at a selected insertion site. For some applications metallic disk 55 may be disposed within opening 54 for use in releasably engaging penetrator assembly 60 with a magnet (not expressly shown) disposed on the end of connector 216.
For some applications exterior portion of connector 50 may include an enlarged tapered portion adjacent to first end 51. A plurality of longitudinal ridges 53 may also be formed on the exterior of connector 50 proximate first end 51. The enlarged tapered portion and/or longitudinal ridges 53 may allow an operator to grasp associated penetrator assembly 60 during attachment with a driver and may facilitate disengagement of connector 50 from hub 70 after outer penetrator or cannula 80 has been inserted into a bone and associated bone marrow. Connector 50 may also be used to manipulate an attached trocar or inner penetrator during harvesting of bone and/or bone marrow in accordance with teachings of the present disclosure.
Second opening 56 may be formed in second end 52 of connector 50. See FIG. 4. For some applications threads 57 may be formed on interior portions of second opening 56 extending from second end 52. Threads 57 may be sized to engage threads 77 formed on exterior portions of hub 70. Threads 57 and 77 may be characterized as forming portions of a Luer lock connection. However, the present disclosure is not limited use with threads 57 and 77. Threads 37 of lock nut 36 and threads 57 of connector 50 may have similar configurations and dimensions. Various types of releasable connections including, but not limited to, other types of Luer lock connections may be formed on adjacent portions of connector 50 and hub 70.
Trocar or inner penetrator 62 may be securely engaged with connector 50 extending from second end 52. See FIG. 4. The dimensions and configuration of inner penetrator 62 may be selected to allow inner penetrator 62 to be slidably inserted into longitudinal bore 83 of outer penetrator or cannula 80. Trocar 62 may include first end or tip 64. The dimensions and configuration of tip 64 may be selected to accommodate inserting penetrator assembly 60 into bone and associated bone marrow at a selected penetration site.
Inner penetrator or trocar 62 and outer penetrator or cannula 80 may have sufficient length to allow harvesting bone marrow at target areas in a hip bone located four or five inches from an associated penetration site. Inner penetrator 62 and/or outer penetrator 80 may have a length of six (6) inches or more. For some applications outer penetrator 80 may be generally described as a hollow IO needle.
Hub 70 may include first end 71 and second end 72. See FIGS. 1 and 4. First end 71 of hub 70 may have a generally cylindrical pin-type configuration compatible with releasably engaging hub 70 with second end or box end 52 of connector 50 and lock nut 36. As previously noted, threads 77 formed adjacent to end 71 of hub 70 may be releasably engaged with threads 57 formed on interior portions of opening 56 of connector 50 and threads 37 formed on interior portions of lock nut 36.
For some applications second end 72 of hub 70 may have the general configuration of a flange. The dimensions and configuration of second end 72 of hub 70 may be varied to accommodate associated insertion sites. Hub 70 may be formed with a wide variety of flanges or other configurations compatible with contacting a patient's skin adjacent a respective insertion site.
Passageway 76 may extend from first end 71 through hub 70 to second end 72. Portions of passageway 76 spaced from second end 72 may have dimensions selected to be compatible with securely engaging exterior portions of outer penetrator or cannula 80 with hub 70. Second end 82 of cannula 80 may be disposed within passageway 76 between first end 71 and second end 72.
First end 81 of cannula 80 may extend from second end 72 of hub 70. Portions of passageway 76 extending from first end 71 of hub 70 may have an enlarged inside diameter to accommodate attachment with various types of fluid connectors. For example, see Luer fitting 39 formed on one end of right angle connector 38 in FIG. 1.
Cannula or outer penetrator 80 may have longitudinal bore 83 extending from first end or tip 81 to second end 82. First end 81 may have an opening to allow fluid communication therethrough. End 64 of inner penetrator 62 may also extend through the opening in end 81 of outer penetrator 80. See FIGS. 3 and 5A. Exterior dimensions of trocar or inner penetrator 62 are preferably selected to allow inner penetrator 62 to be inserted through outer penetrator 80 with first end 64 of inner penetrator 62 generally aligned with first end 81 of outer penetrator 80 after threads 77 have been engaged with threads 57. See FIGS. 3 and 5A.
Tip 81 of outer penetrator 80 and/or tip 64 of inner penetrator 62 may be operable to penetrate bone and associated bone marrow. The configuration and dimensions of tip 81 may be selected to allow inserting outer penetrator 80 into a bone and associated bone marrow without the use of inner penetrator 62. However, placing tip 64 within tip 81 may substantially increase stability and minimize any tendency of outer penetrator 80 to wobble during insertion of IO device 60 into a bone and associated bone marrow. The use of inner penetrator 62 with tip 64 may be particularly beneficial during penetration of a cortex layer covering a bone.
The configuration of tips 81 and 64 may be selected to penetrate a bone, bone marrow and other portions of a patient's body with minimum trauma. Tip 64 of inner penetrator 62 may have various shapes such as a generally trapezoid shape with one or more cutting surfaces. For some applications tips 81 and 64 may be ground together as a single unit during an associated manufacturing process. See FIG. 5A.
Hub 70 and particularly second end or flange 72 may be used to stabilize intraosseous device 60 after insertion into a bone and associated bone marrow. Second end 52 of connector 50 may be releasably engaged from first end 71 of hub 70 after insertion of outer penetrator 80 into associated bone marrow. See FIG. 4. The depth of such insertion will be dependent upon the distance between tip 81 of cannula 80 and flange 72 of hub 70. Annular slot or groove 73 may be formed within second end 72 and sized to receive one end of a protective cover or needle cap (not expressly shown). Slot or groove 73 may be used to releasably engage a protective cover with penetrator assembly 60.
Powered driver 200, as shown in FIG. 2, may include housing 202 with various types of motors and/or gear assemblies disposed therein (not expressly shown). A rotatable shaft (not expressly shown) may be disposed within housing 202 and connected with a gear assembly (not expressly shown). Various types of fittings, connections, connectors and/or connector receptacles may be provided at one end of the rotatable shaft extending from end 204 of housing 202.
For some applications pin type fitting or connector 216 may be formed on the one end of the rotatable shaft. A matching box type fitting or connector receptacle may be provided on an intraosseous device so that connector 216 of powered driver 200 may be releasably engaged with the intraosseous device. For some applications, connector 216 may have a pentagonal shaped cross section with tapered surfaces formed on the exterior thereof.
Handle 206 may include a battery (not expressly shown) or other power source. Handle 206 may also include trigger assembly 208 for use in activating powered driver 200. Examples of powered drivers are shown in patent application Ser. No. 10/449,503 filed May 30, 2003 entitled “Apparatus and Method to Provide Emergency Access To Bone Marrow,” now U.S. Pat. No. 7,670,328; Ser. No. 10/449,476 filed May 30, 2003 entitled “Apparatus and Method to Access Bone Marrow,” now U.S. Pat. No. 7,699,850; and Ser. No. 11/042,912 filed Jan. 25, 2005 entitled “Manual Intraosseous Device,” now U.S. Pat. No. 8,641,715.
FIG. 4 shows inner penetrator 62 removed from outer penetrator 80. A cap (not expressly shown) will generally be placed over end 71 of hub 70 unless IO connector assembly 30 will be promptly engaged with end 71 of hub 70 or another penetrator or trocar will be promptly inserted into outer penetrator 80. Such caps are frequently used with biopsy needles and other types of intraosseous devices to prevent undesired fluid communication therethrough.
After inner penetrator 62 has been removed from outer penetrator 60, lock nut 36 may be used to releasably engage IO connector assembly 30 with end 71 of hub 70. See FIG. 1. Other types of penetrators and trocars may also be inserted through opening 74 of hub 70 and longitudinal bore 83 of outer penetrator 80. Inner penetrator 62 e as shown in FIG. 8B and trocar 162 as shown in FIGS. 9A-9D are examples of two such devices which may be inserted through opening 74 in hub 70 and longitudinal bore 83 of outer penetrator 80.
FIG. 5A shows tip 64 of inner penetrator 62 and tip 81 of outer penetrator 80 disposed immediately adjacent to each other after having been ground to form machined cutting surfaces 66 and 86. Grinding tips 64 and 81 as a single unit may also result in forming associated cutting edges 67 a and 87 a and associated cutting edges 67 b and 87 b. Providing a matching fit allows respective tips 81 and 64 to act as a single drilling unit to minimize trauma at an insertion site as portions of penetrator assembly 60 are inserted into a bone and associated bone marrow. Cutting surfaces 66 and 86, associated cutting edges 67 a and 87 a and associated cutting edges 67 b and 87 b may be particularly beneficial for use in cutting the cortex layer covering a bone. For some applications installing inner penetrator 62 with tip 64 within outer penetrator 80 and tip 81 may substantially reduce and/or eliminate any tendency of IO device 60 to wobble while being inserted or drilled through a cortex layer.
Sometimes a longitudinal groove may run along one side of an inner penetrator to allow bone chips and/or tissue to exit an insertion site as a penetrator assembly is drilled deeper into bone and associated bone marrow. FIG. 5B shows inner penetrator 162 slidably disposed within outer penetrator 80. First end or tip 164 of inner penetrator 162 may be disposed adjacent to first end or tip 81 of outer penetrator 80. Tips 164 and 81 may have matching machined surfaces and cutting edges as previously described with respect to tip 64 and 81. Longitudinal groove 165 formed in inner penetrator 162 may extend from tip 164. Longitudinal groove or slot 165 may run along the side of trocar 162 to allow bone marrow and/or tissue to exit an insertion site as an associated intraosseous device is installed at an insertion site.
For some applications an outer penetrator or cannula incorporating teachings of the present disclosure may include an interior threaded portion to grab or “purchase” a bone specimen as an IO device is inserted into a bone. The use of a powered driver may increase effectiveness of an IO device having such interior threads to reliably collect a bone specimen on the first insertion into a bone.
Bone cells function as progenitor cells to produce or manufacture red and white cells for associated bone marrow. As a result, clinicians and medical technologists often use small pieces of bone (spicules) to determine if normal, disease free bone anatomy and architecture are present at an insertion site. A sample of only bone marrow does not satisfactorily indicate the condition of the bone which produced the bone marrow. A bone marrow sample may not indicate the presence of cancer or other diseases (particularly at an early stage) in an associated bone.
Various features of outer penetrators 80 a and 80 b may be described with respect to penetrating cortex layer 106 and adjacent portions of bone 100 and bone marrow 108 as shown in FIGS. 1 and 4. However, intraosseous devices incorporating teachings of the present disclosure as shown in FIGS. 7A-7D may be used to obtain bone and/or bone samples from a wide variety of insertion sites and target areas. Teachings of the present disclosure are not limited to the iliac crest or hip bones.
FIG. 7A shows outer penetrator 80 a having internal threads 92 disposed adjacent to first end or tip 81. Threads 92 may be sized to be releasably engaged with a sample of bone and/or bone marrow during rotation of outer penetrator 80 a by a powered driver. After outer penetrator 80 a and previously described inner penetrator 62 or any other suitable penetrator have been inserted through cortex layer 106 inner penetrator 62 may be withdrawn. A suitable connector such as a second connector 50 without inner penetrator 62 attached thereto (not expressly shown) may be used to re-engage powered driver 200 with hub 70. Powered driver 200 may then be used to continue inserting outer penetrator 80 a into the desired insertion site which will result in first end or tip 81 coring portions of bone and/or bone marrow adjacent to cortex layer 106.
Continued rotation of outer penetrator 80 a will result in threads 92 securely engaging the bone specimen within longitudinal bore 83 of outer penetrator 80 a. Outer penetrator 80 a may then be disconnected from powered driver 200. Hub 70 may be used to disengage or withdraw outer penetrator 80 a from the insertion site. The bone and/or bone marrow sample may be removed from longitudinal bore 83 by inserting an appropriately sized rod (not expressly shown) through first end 81 of outer penetrator 80 a. The rod may be used to push the bone and/or bone marrow sample through longitudinal bore 83 and out of second end 82.
One of the benefits of the present disclosure includes the ability to modify internal thread designs and/or limit the number of threads to optimize retention of a bone or bone marrow sample and at the same time minimize damage which may occur to a bone and/or bone marrow sample during removal from an associated outer penetrator or cannula. For example outer penetrator 80 b as shown in FIG. 7B may include only one or two threads 92 formed within longitudinal bore 83 adjacent to first end 81 as compared with multiple threads 92 disposed within outer penetrator 80 a as shown in FIG. 7A. A bone and/or bone marrow sample may often be more easily disengaged from one or two threads 92 as compared to the larger number of threads 92 shown in outer penetrator 80 a. Respective threads 92 contained in outer penetrators 80 a and 80 b may substantially reduce or eliminate failed attempts to remove a bone sample and/or bone marrow from a target area.
One of the features of the present disclosure may include sampling multiple target areas while at the same time installing or inserting an intraosseous device into only a single penetration site. For example outer penetrator or cannula 80 e as shown in FIG. 8A may include multiple sampling ports or side ports formed in the exterior thereof. For embodiments such as shown in FIG. 8A outer penetrator or cannula 80 e may include sampling ports or side ports 88 a, 88 b and 88 c which extend laterally from longitudinal bore 83 to the exterior of outer penetrator 80 e.
Sampling ports 88 a, 88 b and 88 c may each be operable to provide access to three separate target areas for aspiration of bone marrow. Conventional biopsy needles would generally require using three separate insertion sites in a bone to provide access to three separate target areas in the bone marrow of a hip bone or other bones.
Inner penetrator or trocar 62 e as shown in FIG. 8B may include longitudinal bore 63 extending from first end 64 to second end 69 of inner penetrator 62 e. Sampling port or side port 68 may be formed in inner penetrator 62 e proximate first end 64. Sampling port 68 may be used to communicate fluids and/or bone marrow samples between the exterior of inner penetrator 62 a and longitudinal bore 63.
Various types of connections may be provided on second end 69 of inner penetrator 62 e. For embodiments such as shown in FIG. 8B a Luer type connection represented by threads 77 and opening 74 may be disposed proximate end 71. A wide variety of tubing connectors and various types of bone marrow aspiration equipment may be releasably engaged with end 71 of inner penetrator 62 e. Various techniques and procedures may be satisfactorily used to selectively align sampling port 68 with respective sampling ports 88 a, 88 b and 88 c. When sampling port 68 of inner penetrator 62 a is respectively aligned with sampling port 88 a, 88 b or 88 c of outer penetrator 80 e, respective portions of bone marrow may be suctioned from adjacent target areas.
Generally only a limited volume (a few cubic centimeters) of bone marrow may be retrieved from any one target area before systemic blood begins to enter the target area and will often be retrieved with the bone marrow sample. Therefore, aspiration of bone marrow from multiple target areas is generally required to obtain larger volumes of bone marrow. Forming multiple sampling ports or side ports in an intraosseous device in accordance with teachings of the present disclosure may allow retrieving multiple bone marrow samples from a single insertion site. For example, three sample ports or three side ports may allow retrieving three times the volume of bone marrow samples as compared with using a conventional biopsy needle at the same insertion site. The total number of insertions of an intraosseous device incorporating teachings of the present disclosure may be substantially reduced while still allowing accumulation of relatively large samples of bone marrow for transplantation, diagnostic and/or research procedures.
For embodiments such as shown in FIGS. 8A, 8B and 8C removable trocar 62 e may be inserted into longitudinal bore 83 of outer penetrator 80 e. Sampling port 68 may be aligned with sampling port 88 a of outer penetrator 80 e. Suction or low pressure vacuum may then be applied to end 71 of the Luer type connection attached to removable trocar 62 e. Bone marrow samples may be removed from a target area adjacent to side port 88 a until undesired quantities of systemic blood appear in the bone marrow sample. After removing an appropriate amount of bone marrow from side port 88 a, removable trocar 62 e may be moved to a position adjacent to sampling port 88 b. The same procedure may be repeated to remove an appropriate amount of bone marrow from a target area adjacent to sampling port 88 b. The same sampling procedure may be repeated at sampling port 88 c and any other sampling port or ports formed in exterior portions of outer penetrator 80 e.
Currently available instruments used to obtain samples of bone and/or bone marrow frequently have less than desired ability and reliability to engage and satisfactorily withdraw a sample of bone and/or associated bone marrow. Currently available instruments satisfactory for grasping a bone specimen may not be satisfactory for grasping a more fluid sample of bone marrow. One aspect of the present disclosure includes providing a trocar having one end which may be opened and closed to securely grasp a sample of bone and/or bone marrow.
FIG. 9A-9D show one example of an IO device having a sample chamber or specimen cavity defined in part by a trocar having one end incorporating teachings of the present disclosure. IO device 160 as shown in FIGS. 9A-9D may include outer penetrator or cannula 180 and trocar 162. Outer penetrator or cannula 180 may include longitudinal bore 183 extending from first end 181 to a second end (not expressly shown). Longitudinal bore 183 may include enlarged inside diameter portion 183 a disposed adjacent to and extending from first end 181. Longitudinal bore 183 may also include reduced inside diameter portion 183 b extending from the second end of outer penetrator 180 towards first end 181. Longitudinal bore 183 may also include transition portion or tapered inside diameter portion 183 c extending between enlarged inside diameter portion 183 a and reduced inside diameter portion 183 b. See FIGS. 9A and 9B.
An inner penetrator such as previously described inner penetrator 62 may be disposed within longitudinal bore 183 during installation of intraosseous device 160 at a penetration site. The inner penetrator may be removed from outer penetrator 180 when first end 181 is located at a desired target area for obtaining a bone marrow specimen. Trocar 162 may next be slidably disposed in longitudinal bore 183. See FIGS. 9A and 9B.
Trocar 162 will generally have a length greater than the length of outer penetrator 180. As a result, first end 161 of trocar 162 may extend from first end 181 of outer penetrator 180. Trocar 162 may also include a second end (not expressly shown) which extends from the second end of outer penetrator 180. Connector 50 or any other suitable handle (not expressly shown) may be attached to the second end of trocar 162 for use in manipulating trocar 162.
For some applications inner trocar 162 may be described as having a “split end” configuration or a “split needle” configuration. See FIGS. 9A and 9D. For some applications trocar 162 may be a generally hollow tube extending from first end 161 to the second end. For other applications portions of trocar 162 adjacent to the second end may be a generally solid rod or shaft (not expressly shown).
As shown in FIGS. 9A-9D trocar 162 may include split ends 164 a and 164 b defined in part by first segment 165 a and second segment 165 b extending from first end or tip 164. First segment 165 a and second segment 165 b may sometimes be described as “jaws”. Respective cavities 163 a and 163 b defined in part by interior portions of first segment 165 a and second segment 165 b may be formed adjacent to split ends 164 a and 164 b. Segments 165 a and 165 b may be relatively thin which allow segments 165 a and 165 b to flex relative to each other and to flex relative to adjacent portions of outer penetrator 180.
Respective bump or enlargement 166 a may be formed on exterior portions of first segment 165 a spaced from first end or tip 164 a. A similar bump or enlargement 166 b may be formed on exterior portions of second segment 165 b spaced from tip 164 b. Enlargements 166 a and 166 b may sometimes be referred to as “knobs”. The dimensions and configuration of enlargements 166 a and 166 b may be selected to be compatible with longitudinal movement of trocar 162 within reduced inside diameter portion 183 b of cannula 180. See FIG. 9B.
When the first end 164 of trocar 162 extends from first end 181 of cannula 180, enlargements 166 a and 166 b may expand radially outward into enlarged inside diameter portion 183 a. Tips 164 a and 164 b may then be inserted into bone marrow at a target area adjacent to end 181. As trocar 162 is withdrawn from an extended, open position (see FIG. 9A) to a retracted, closed position (see FIG. 9B), tips 164 a, 164 b and associated jaws 165 a and 165 b may cooperate with each other to break loose bone marrow specimen 108 a and capture bone marrow specimen 108 a within the sample cavity or sample chamber formed by jaws 165 a and 165 b. As trocar 162 is further withdrawn from longitudinal bore 183, enlargements 166 a and 166 b will contact reduced inside diameter 183 b to maintain bone marrow specimen 108 a securely captured within trocar 162.
FIGS. 9A, 9C and 9D show various portions of outer penetrator 180 and trocar 162 with first end or tip 164 of trocar 162 in an open position operable to be inserted into bone marrow at a target area adjacent to first end 181 of outer penetrator 180. FIG. 9B shows inner trocar 162 in a retracted position with bone marrow specimen 108 a securely engaged within a sample cavity or sample chamber defined in part by segments or jaws 165 a and 165 b. FIGS. 9C and 9D show respective cross-sections of the “split needle” configuration associated with trocar 162.
Although the present disclosure and its advantages have been described in detail, it should be understood that various changes, substitutions and alternations can be made herein without departing from the spirit and scope of the disclosure as defined by the following claims.
collection tubing extending between and communicating with a second end of the right angle connector and the bone marrow aspiration equipment to accommodate aspiration of bone marrow through the longitudinal bore of the intraosseous needle.
the flow control device having a first position operable to allow fluid communication through the flexible tubing and a second position operable to block fluid communication through the flexible tubing.
3. The apparatus of claim 1 wherein the lock nut is slidably disposed on exterior portions of the first end of the right angle connector.
the removable trocar having internal threads configured to releasably engage the external threads of the hub.
IN2009DE02581A (en) * 2009-12-11 2015-07-03 Stanford-India Biodesign "device for vascular access"
FR3013958B1 (en) * 2013-12-03 2017-11-03 Thierry Masseglia Trocar biopsy.
IT1316915B1 (en) * 2000-07-20 2003-05-13 Hs Hospital Service Spa Device for transcutaneous biopsy of rigid tissues.
IT1316978B1 (en) * 2000-12-28 2003-05-13 Hs Hospital Service Spa Device for transcutaneous biopsy of rigid tissues, in particolaretessuto osteomedullary.
"Proven reliability for quality bone marrow samples", Special Procedures, Cardinal Health, 6 pages, 2003.
Åström, K. Gunnar O., "CT-guided Transsternal Core Biopsy of Anterior Mediastinal Masses," Radiology 1996; 199:564-567, May 1996.
Åström, K.G., "Automatic Biopsy Instruments Used Through a Coaxial Bone Biopsy System with an Eccentric Drill Tip," Acta Radiologica, 1995; 36:237-242, May 1995.
Australian Exam Report on Patent Application No. 2003240970, 2 pages, Oct. 15, 2007.
BioAccess.com, Single Use Small Bone Power Tool-How It Works, 1 pg, Printed Jun. 9, 2008.
Buckley et al., CT-guided bone biopsy: Initial experience with commercially available hand held Black and Decker drill, European Journal of Radiology 61, pp. 176-180, 2007.
Chinese Office Action with English translation; Application No. 200780001190.7; 12 pgs., Jun. 2, 2010.
Chinese Office Action with English translation; Application No. 200780001196; 12 pgs., Jul. 12, 2010.
Chinese Office Action with English translation; Application No. 200780001198.3; pp. 13, Apr. 27, 2010.
Chinese Office Action, Application No. 200780000590.6, (with English translation), (13 pgs), Aug. 21, 2009.
Communication Pursuant to Article 94(3) EPC, Application No. 05 712 091.7-1265, 4 pages, Apr. 8, 2008.
Communication relating to the results of the partial International Search Report for PCT/US2005/002484, 6 pages, Mailed May 19, 2005.
Cummins, Richard O., et al, "ACLS-Principles and Practice", ACLS-The Reference Textbook, American Heart Association, pp. 214-218, 2003.
European Extended Search Report for European application 10153350.3. Dated Mar. 11, 2010.
European Extended Search Report, Application No. EP08021732.6, 7 pages, Nov. 13, 2009.
European Office Action Communication, Application No. 08158699.2-1265/1967142, 10 pages, Nov. 4, 2008.
European Office Action EP03731475.4, 4 pages, Oct. 11, 2007.
European Office Action sent Apr. 8, 2008 and Response sent May 15, 2008, EP Application No. 05712091.7.
European Office Action sent Dec. 22, 2011 and Response sent Jun. 29, 2012, EP Application No. 09150973.7.
European Office Action sent Feb. 21, 2007 and Response sent Jun. 27, 2007 , EP Application No. 05712091.7.
European Office Action sent Jan. 19, 2011 and Response sent Jul. 21, 2011, EP Application No. 09150973.7.
European Office Action sent Sep. 21, 2007 and Response sent Nov. 26, 2007, EP Application No. 05712091.7.
European Office Action sent Sep. 8, 2010 and Response sent Mar. 17, 2011, EP Application No. 10153350.3.
European Office Action; Application No. 09 155 111.9-2310; pp. 3, Nov. 25, 2009.
European Search Report 08158699.2-1265, 4 pages, Aug. 2008.
European Telephone Consultation Report sent Apr. 21, 2009 and Response sent Jun. 24, 2009, EP Application No. 08158699.2.
European Telephone Consultation Report sent Sep. 23, 2009 and Response sent Oct. 28, 2009, EP Application No. 08158699.2.
Extended European Search Report for European Application 10153350.3, dated Mar. 11, 2010.
F.A.S.T. 1 Intraosseous Infusion System with Depth-Control Mechanism Brochure, 6 pages, 2000.
Gunal et al., Compartment Syndrome After Intraosseous Infusion: an Expiremental Study in Dogs, Journal of Pediatric Surgery, vol. 31, No. 11, pp. 1491-1493, Nov. 1996.
Hakan et al., CT-guided Bone BiopsyPerformed by Means of Coaxial Bopsy System with an Eccentric Drill, Radiology, pp. 549-552, Aug. 1993.
International PCT Search Report and Written Opinion PCT/US2004/037753, 16 pages, Mailed Jul. 8, 2005.
International PCT Search Report and Written Opinion PCT/US2005/002484, 15 pages, Mailed Jul. 22, 2005.
International PCT Search Report PCT/US03/17167, 8 pages, Mailed Sep. 16, 2003.
International PCT Search Report PCT/US03/17203, 8 pages, Mailed Sep. 16, 2003.
International PCT Search Report PCT/US2004/037753, 6 pages, Mailed Apr. 19, 2005.
International Preliminary Report on Patentability PCT/US2005/002484, 9 pages, Mailed Aug. 3, 2006.
International Preliminary Report on Patentability, PCT/US/2007/078204, 11 pages, Apr. 2, 2009.
International Preliminary Report on Patentability, PCT/US/2007/078207, 10 pages, Mar. 26, 2009.
International Preliminary Report on Patentability, PCT/US2007/072202, 10 pages, Mailed Jan. 15, 2009.
International Preliminary Report on Patentability, PCT/US2007/072217, 11 pages, Mailed Feb. 12, 2009.
International Search Report and Written Opinion for International Application No. PCT/US2006/025201 (18 pages), Jan. 29, 2007.
International Search Report and Written Opinion, PCT/US08/500346, 12 pages, Mailing Date May 22, 2008.
International Search Report and Written Opinion, PCT/US08/52943 8 pages, Mailing Date Sep. 26, 2008.
International Search Report and Written Opinion, PCT/US2007/072202, 17 pages, Mailing Date Mar. 25, 2008.
International Search Report and Written Opinion, PCT/US2007/078203, 15 pages, Mailing Date May 13, 2008.
International Search Report and Written Opinion, PCT/US2007/078204, 14 pages, Mailing Date May 15, 2008.
International Search Report and Written Opinion, PCT/US2007/078205, 13 pages, Mailing date Sep. 11, 2007.
International Search Report and Written Opinion, PCT/US2007/078207, 13 pages, Mailing Date Apr. 7, 2008.
International Search Report, PCT/US2006/025201, 12 pages, Mailing Date Feb. 7, 2008.
International Search Report, PCT/US2007/072209, 18 pages, Mailing Date Apr. 25, 2008.
International Search Report, PCT/US2007/072217, 20 pages, Mailing Date Mar. 31, 2008.
Interview Summary for U.S. Appl. No. 11/190,331. Mailed Jul. 13, 2009.
Japanese Office Action with English Translation; Application No. 2004-508,670; PCT/US03/17203; pp. 7, Jan. 20, 2011.
Japanese Office Action, Application No. 2004-508,669, (with English summary), (9 pgs), Aug. 3, 2009.
Liakat A. Parapia, Trepanning or trephines: a history of bone marrow biopsy, British Journal of Haematology, pp. 14-19 2007.
Michael Trotty, "Technology (A Special Report)-The Wall Street Journal 2008 Technology Innovation Awards-This years winners include: an IV alternative, a better way to make solar panels, a cheap, fuel efficient car and a better way to see in the dark", The Wall Street Journal, Factiva, 5 pages, 2008.
Non-Final Office Action, U.S. Appl. No. 10/449,476, 8 pages, Mailed Oct. 29, 2008.
Non-Final Office Action, U.S. Appl. No. 10/449,476, 8 Pages.
Notice of Allowance in U.S. Appl. No. 11/042,912, mailed Sep. 24, 2013.
Notice of Allowance in U.S. Appl. No. 11/380,340 mailed Aug. 22, 2014.
Notice of Allowance in U.S. Appl. No. 11/619,390 mailed Jul. 3, 2014.
Notice of Allowance in U.S. Appl. No. 11/619,390 mailed Nov. 6, 2014.
Notice of Allowance in U.S. Appl. No. 11/620,927 mailed Jun. 3, 2014.
Notice of Allowance in U.S. Appl. No. 11/853,678 issued Jul. 11, 2013.
Notice of Allowance in U.S. Appl. No. 11/853,678, mailed Nov. 8, 2013.
Notice of Allowance in U.S. Appl. No. 11/853,678, mailed Oct. 11, 2013.
Notice of Allowance in U.S. Appl. No. 12/259,745 mailed Nov. 7, 2014.
Notice of Allowance in U.S. Appl. No. 12/331,979, mailed Dec. 23, 2013.
Notice of Allowance in U.S. Appl. No. 12/407,651 mailed Jun. 11, 2014.
Notice of Allowance in U.S. Appl. No. 12/427,310, mailed Nov. 29, 2013.
Notice of Allowance in U.S. Appl. No. 12/899,696 issued Jul. 18, 2013.
Notice of Allowance in U.S. Appl. No. 12/899,696, mailed Nov. 12, 2013.
Notice of Allowance in U.S. Appl. No. 14/721,144 mailed Jul. 22, 2014.
Notice of Allowance issued in U.S. Appl. No. 11/253,467, mailed Mar. 29, 2013.
Notice of Allowance issued in U.S. Appl. No. 11/253,959, mailed May 20, 2013.
Notice of Allowance issued on Mar. 4, 2014 in U.S. Appl. No. 11/253,467.
Notification of the First Chinese Office Action, Application No. 200580003261.8, 3 pages, Mar. 21, 2008.
Office Action (and Search Report) for European application 09150973.7. Dated Oct. 23, 2009.
Office Action for Chinese application 200580003261 (English translation). Dated Jan. 16, 2009.
Office Action for Chinese application 200880000182.5 (English translation). Dated Jun. 27, 2013.
Office Action for Chinese application 200910006631.3 (English translation). Dated Mar. 11, 2010.
Office Action for Chinese application 200910006631.3 (English translation). Dated Nov. 11, 2010.
Office Action for Chinese application 200910006631.3. Dated Mar. 22, 2011.
Office Action for Chinese application 201210169456.0 with English translation. Mailed Aug. 28, 2013.
Office Action for Chinese application 201210169546.0 with English translation. Mailed Apr. 18, 2014.
Office Action for European application 05712091.7. Dated Sep. 21, 2007.
Office Action for European application 08021732.6. Mailed Oct. 2, 2013.
Office Action for European application 10153350.3. Dated Sep. 8, 2010.
Office Action for Japanese application 2004-508,670 (English summary). Dated Apr. 21, 2009.
Office Action for Taiwanese application 093134480 (English Translation). Dated Feb. 11, 2011.
Office Action for Taiwanese application 94102179 (English translation). Dated May 13, 2010.
Office Action for U.S. Appl. No. 10/449,476. Mailed May 29, 2009.
Office Action for U.S. Appl. No. 10/449,503. Mailed Apr. 1, 2009.
Office Action for U.S. Appl. No. 11/042,912. Mailed Jul. 23, 2009.
Office Action for U.S. Appl. No. 11/042,912. Mailed Mar. 19, 2010.
Office Action for U.S. Appl. No. 11/042,912. Mailed Nov. 28, 2008.
Office Action for U.S. Appl. No. 11/064,156. Mailed Jun. 19, 2009.
Office Action for U.S. Appl. No. 11/190,331. Mailed Mar. 23, 2009.
Office Action for U.S. Appl. No. 11/253,467. Mailed Apr. 28, 2011.
Office Action for U.S. Appl. No. 11/253,467. Mailed Jul. 22, 2010.
Office Action for U.S. Appl. No. 11/253,467. Mailed Oct. 29, 2010.
Office Action for U.S. Appl. No. 11/253,959. Mailed Aug. 5, 2010.
Office Action for U.S. Appl. No. 11/253,959. Mailed Mar. 30, 2011.
Office Action for U.S. Appl. No. 11/253,959. Mailed Oct. 18, 2010.
Office Action for U.S. Appl. No. 11/427,501. Mailed May 13, 2009.
Office Action for U.S. Appl. No. 11/427,501. Mailed Oct. 21, 2009.
Office Action for U.S. Appl. No. 11/853,685. Mailed Jun. 24, 2009.
Office Action for U.S. Appl. No. 12/259,745. Mailed Jul. 17, 2009.
Office Action for U.S. Appl. No. 12/905,659. Dated Mar. 21, 2011.
Office Action for U.S. Appl. No. 12/905,659. Dated May 13, 2011.
Office Communication for European application 09150973.7-1269. Dated Jan. 19, 2011.
Office Communication in European Application No. 08021732.6, dated Jun. 20, 2013.
Office Communication in European Application No. 10153350.3, dated Jun. 14, 2011.
Official Action for European Application No. 03756317.8 (4 pages), Dec. 28, 2006.
PCT invitation to Pay Additional Fees, PCT/US2007/072209, 9 pages, Mailing Dec. 3, 2007.
Pediatric Emergency, Intraosseous Infusion for Administration of Fluids and Drugs, www.cookgroup.com, 1 pg, 2000.
Pediatrics, Official Journal of the American Academy of Pediatrics, Pediatrics, 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of Pediatric and Neonatal Patients:Pediatric Advanced Life Support, Downloaded from www.pediatrics.org, Feb. 21, 2007.
Request for Continued Examination and Amendment for U.S. Appl. No. 11/781,568. Filed Sep. 17, 2009.
Response to Extended European Search Report in European Application No. 10153350.3, filed Jun. 30, 2010.
Response to Interview Summary for U.S. Appl. No. 11/190,331 and Amendment. Filed Aug. 12, 2009.
Response to Office Action for European application 10153350.3. Filed Mar. 17, 2011.
Response to Office Action for U.S. Appl. No. 10/449,476, filed Aug. 12, 2009.
Response to Office Action for U.S. Appl. No. 10/449,503, filed Jul. 1, 2009.
Response to Office Action for U.S. Appl. No. 11/190,331, filed Jun. 22, 2009.
Response to Office Action for U.S. Appl. No. 11/427,501, filed Jul. 1, 2009.
Response to Office Communication in European Application No. 10153350.3, filed Feb. 9, 2012.
Riley et al., "A Pathologist's Perspective on Bone Marrow Aspiration Biopsy: I. Performing a Bone Marrow Examination," Journal of Clinical Laboratory Analysis 18, pp. 70-90, 2004.
Special Procedures, Cardinal Health, "Proven reliability for quality bone marrow samples." 2003.
U.S. Appl. No. 11/427,501 Non Final Office Action, 14 pages, Mailed Aug. 7, 2008.
Vidacare Corporation Comments to Intraosseous Vascular Access Position Paper, Infusion Nurses Society, 6 pages, May 4, 2009.

References: Application No. 2003240970
 Application No. 200780001190
 Application No. 200780001196
 Application No. 200780001198
 Application No. 200780000590
 Application No. 05
 Application No. 08158699
 Application No. 05712091
 Application No. 09150973
 Application No. 05712091
 Application No. 09150973
 Application No. 05712091
 Application No. 10153350
 Application No. 09
 Application No. 08158699
 Application No. 08158699
 Application No. 2004
 Application No. 2004
 Application No. 200580003261
 Application No. 08021732
 Application No. 10153350
 Application No. 03756317
 Application No. 10153350
 Application No. 10153350