It was not possible either with a smaller size. Again, when the doctor tried to insert the plug, it was painful. Once, the first attempt, it seems that the plug was almost inside, but I startled and the opportunity was lost.
The doctor suggested doing the insertion with local anesthetics injected under the eye, and with me lied on a stretcher. But isn't that too much? Apart from that, I don't know what to do, except trying the absorbable plugs with a different doctor, although I wanted to try a "permanent" one, because I could compare more clearly the difference between Plugs vs No plugs. If I were you I would look into other doctors.
Also most people I have seen on this forum seem to report absorbable plugs not working very well. I should also mention that when my doctor would insert my plugs he would use the slit lamp. This was also more relaxing for me and made it easier for me to keep my head still. Here is a pretty good video on what punctal plug insertion should be like in my experience. Sorry for the late response. My doctor also used a slit lamp, in the way you described it. I had seen some of these videos before.
The second one, is like the perfect insertion, huh? I don't know if it is about experience, I can't judge that. In accordance with the preferred embodiment of the invention shown herein the anchoring member also includes reinforcing means, e. The mesh serves to aid in reinforcing the scar tissue which forms adjacent the opening 26 in the tissue wall 24 when the anchoring member 38 is in place. In fact, if desired, it is contemplated that no reinforcing means be used in the anchoring member, particularly if the sealing member includes reinforcing means described earlier.
In the embodiment of the invention wherein the anchoring member is reinforced it serves to reinforce any scar tissue which will form in the immediately adjacent tissue. The anchoring member 38 includes a pair of apertures 54 and 56 extending through it. These apertures are arranged to have portions of the filament 42 extended therethrough, as will be described later, to couple the various components of the device 20 to one another. As can be seen in FIGS. In accordance with a preferred embodiment of this invention the member 40 is rigid or stiff and is resorbable, e.
The apertures 58 and 60 are arranged to have portions of the filament 42 extended therethrough, as will be described later, to couple the various components of the device 20 to one another.
The filament 42 preferably comprises a very thin flexible member, e. In particular the filament is threaded through the aperture 58 in the holding member 40, from there through the aperture 48 in the plug member from one side to the opposite side thereof and out the aperture 50, from there into the aperture 56 in the anchoring member, from there out of aperture 54 in the anchoring member, from there in through the aperture 50 in the plug member from one side to the opposite side thereof and out the aperture 48, from there through the aperture 60 in the holding member This arrangement produces a pair of proximal end portions 42A and 42B.
A knot 62 is provided in the end portion 42A of the filament immediately proximally of the aperture 60 in the holding member The needle 44 is connected to the free end of end portion 42B. As can be seen clearly in FIG. Accordingly, as will be described later when the device 20 is deposited in the puncture 22 by the deployment instrument the end portions 42A and 42B of the filament 42 extend out of the puncture tract This arrangement enables the filament 42 to be manipulated to effect the proper seating of the device in place.
Moreover, the ends 42A and 42B are arranged to be secured together, e. If desired, one or more additives, such as a radiopaque material or hemostatic agent or antibacterial agent, or any other biologically active ingredient, can be blended into or coated upon the holding member, the anchoring member, the filament member, or the sealing member or any combination thereof.
Referring now to FIG. As can be seen therein the deployment instrument basically comprises an elongated tube or carrier 64 having an open distal free end 66 and a plunger assembly 68 located at the proximal end. The device 20 is disposed within the hollow interior of the carrier tube 64 adjacent its open free end 66, with the anchoring member 38 located immediately adjacent the free end and oriented so that its longitudinal axis is parallel to the longitudinal axis of the carrier tube.
The sealing member is located immediately proximally of the anchoring member, and the holding member is located immediately proximally of the sealing member. The plunger assembly comprises a cylindrical cap 70 having a central passageway 72 extending therethrough in axial alignment and communicating with the interior of the tube An elongated, cylindrical plunger 74 is located within the passageway 72 in the cap The proximal end of the plunger is in the form of an enlarged head or button An annular recess 78 is provided about the periphery of the plunger.
A pair of diametrically opposed nibs 80 FIG. A longitudinally oriented slot 82 FIG. A tamping member 84, in the form of an elongated sleeve, is disposed within the hollow interior of the carrier tube 64 between the holding member 40 and the distal end of the plunger The sleeve includes a thin slot 86 FIG.
The tamping member, being an elongated sleeve includes a central passageway extending fully therethrough. The end portions 42A and 42B of the filament are arranged to extend through the central passageway in the tamping member 84, as shown clearly in FIGS. The sheath has an open distal end and a valve assembly 90 located at its proximal end. The valve assembly 90 includes any suitable valve member 92 to enable the deployment instrument to be inserted therethrough, as shown in FIGS.
The device 20 of the subject invention is arranged to be used after the minimally invasive interventional procedure e. To that end, the physician inserts the delivery or deployment instrument 32 containing the device 20 into the trocar 34 so that the distal end of the deployment instrument is extended through the opening 26 in the tissue wall as shown in FIG.
The plunger 74 of the deployment instrument is then depressed by pressing on its head or button 76 to release it from the ready position of FIG.
This action causes the distal end of the plunger 74 to push on the proximal end of the tamping member 84, thereby moving the tamping member distally. This action, in turn, pushes on the holding member 40, the sealing member 36, and the anchoring member 38, to cause the anchoring member to pass out of the distal end of the instrument and trocar sheath, thereby deploying the anchoring member into the abdominal cavity.
The deployment instrument and trocar are then withdrawn from the puncture This withdrawing action causes the anchoring member 38 to engage e. Continued withdrawal of the instrument and trocar deposit the sealing member 36, the holding member 40, and the distal end of the tamping member 84 of the deployment instrument into the puncture tract, as shown in FIG.
The tamping member is then grasped and gently pushed or tamped repeatedly into the puncture tract to push on the holding member. At the same time the free end of the filament 42 is pulled in the proximal direction. This combined action is shown in FIG. The knot 62 on the filament 42 adjacent the end portion 42A serves to hold the holding member 40 against the proximal end of the deformed sealing member. As will be appreciated by those skilled in the art since the sealing member is formed of compressed collagen or other hydrolytic material it expands automatically in the presence of blood or body fluids within the puncture tract when deployed, thereby further contributing to its deformation, e.
Moreover, for some applications it is contemplated that the holding means 40 may be constructed like the compressible disk locking mechanism of the intravascular puncture closure disclosed in copending U. The puncture closure of that application includes an anchoring member, a sealing member or plug of collagen foam, the locking mechanism, and a filament.
The filament connects the anchoring member located within the interior of an artery with the plug in the puncture tract in a pulley-like arrangement so that the plug is movable toward the anchoring member. The compressible disk locking mechanism is arranged to be actuated, e.
It is also contemplated that the filament and the anchoring means of this invention can be constructed like those locking mechanism components of the aforementioned copending application, wherein the anchoring means includes a notched passageway through which the filament extends and the filament comprises a portion having plural projections or teeth thereon adapted to slide into the notched passageway of the anchoring means in one direction but resistant to sliding in the opposite direction.
In any case, when the sealing member is in place within the puncture tract as described above it has the effect of sealing the puncture tract from the flow of fluid therethrough, while also preventing tissue from gaining egress therethrough. For example, in the case of thoracic placement the sealing member will prevent ingress of air into or out of the thoracic cavity.
In the case of peritoneal placement the sealing member will prevent the egress of blood or some other body fluid out of the abdominal wall, while also preventing any tissue from gaining egress through the opening in the peritoneum. Once the sealing member has been deformed and placed as just described, the tamping member 84 is then removed from the puncture tract To that end the extending portions 42A and 42B of the filament 42 are slid through the tamping member's longitudinally extending slot 86, thereby freeing the tamping member from the device The end portions 42A and 42B of the filament extending out of the puncture tract are then knotted together.
In particular, using standard surgical techniques, the filament end 42B with the stainless steel needle 44 is used to suture the skin 30 surface contiguous with the puncture 22 to form a conventional surgical knot 94 and thereby secure the device in place. In FIG. The device can be used in any of the applications as discussed with reference to the device 20, and can be deployed through any type of trocar, by any type of deployment instrument.
In FIGS. For some applications it may not be necessary to utilize any trocar to effect the placement of the device within the percutaneous puncture. Before describing the device and its method of use, a brief description of the trocar and the deployment instrument is in order. To that end, as can be seen in FIG. The sheath is arranged to pass through the percutaneous puncture and terminates in an open distal end C communicating with the interior of the patient's body, e.
The trocar includes a hemostatic valve D located at within the hollow cap A. The valve is arranged to enable the deployment instrument to be inserted therethrough, as shown in FIG. Other conventional, or non-conventional type trocars can be used to enable the device to be deployed into a puncture tract in accordance with this invention.
The deployment instrument is also a conventional device, e. By squeezing the handles together the jaws close, whereas release of the handles causes the jaws to open. Other instruments can be used as deployment devices, as well, providing they include means for holding the anchoring member to enable it to be inserted through the percutaneous puncture and then released from the instrument so that the anchoring member can be retracted against the desired tissue, as will be described later.
The anchoring member is somewhat similar in construction to the anchoring members disclosed in the aforementioned U. Thus, as can be seen the anchoring member is an elongated, low-profile component which is, preferably, sufficiently rigid such that once it is in position within the abdomen as will be described later it is resistant to deformation to preclude it from bending to pass back through the opening in the peritoneum and through the contiguous puncture tract. The member has a generally planar top surface A, a radially contoured bottom surface B and a peripheral side surface C.
Each end of the member is rounded and the side surface of the member tapers inward slightly from its top surface to its bottom surface to facilitate its removal of it from the mold making it. A dome-like projection D is located at the center of the top surface of the anchoring member, with the top of the dome being flatted. A longitudinally extending slot E extends through the dome D of the anchoring member and the underlying portion of the anchoring member to the bottom surface of the anchoring member as shown in FIGS.
In accordance with a preferred embodiment of the anchoring member , it may be constructed of the same material as that of anchoring member Moreover, the anchoring member , like anchoring member 38, need not be resorbable at all.
It should be noted that the anchoring member shown herein does not include any reinforcing means, like that of anchoring member However, it may, if desired, include such means, depending upon the application it is to be put. For example, if it is desired to reinforce the opening in the peritoneum to strengthen the scar tissue forming thereat, and thus lessen the likelihood that a hernia will form at that site at some time in the future, the sealing device may include the heretofore identified and described reinforcing means.
Moreover, like the device 20, one or more additives, such as a radiopaque material, or hemostatic agent, or antibacterial agent, or an anti-adhesion agent, or any other biologically active ingredient, can be blended into or coated upon the anchoring member or the filament member or any combination thereof.
The filament preferably comprises a very thin flexible member, e. To that end, as clearly can be seen in FIG. The proximal end of the filament is secured to the needle The needle is arranged to be removed from the filament after the device has been deployed and secured, as will be described later.
Thus, the needle may be releasably secured to the filament, or the filament may be severable so that it can be cut or otherwise severed to remove the needle therefrom. The needle may be of any shape and construction, e. The sealing device , like the device 20 described heretofore, is arranged to be used after the minimally invasive interventional procedure e. For example, when used after a laparoscopic procedure it blocks the opening 26 in the peritoneum to reduce the risk of herniation in the short term.
It may also reduce the long term risk of herniation, particularly if it includes reinforcing means, by enhancing the long-term strength of the scar tissue which will naturally form at the opening. When used for thoracic applications, the placement of the device in the percutaneous puncture, precludes air from gaining ingress into the thoracic cavity through the puncture tract.
The use of the device is as follows: with the trocar in place extending through the puncture so that its distal end C is within the abdomen, the physician utilizes the grasper to grasp one end of the anchoring member of the device between its jaws A and B.
The anchoring member is then inserted into the proximal end cap A of the trocar through its valve D so that the anchor is within the interior of the sheath as shown in FIG. The proximal portion of the filament with the needle thereon remains outside of the trocar, with the intermediate portion of the filament extending through the valve D. The grasper is then moved in the distal direction until the anchoring member and the jaws are fully within the abdomen, as shown in FIG.
This action opens the jaws and releases the anchoring member from the grasper, as shown. The anchoring member, being coupled to the trocar, is thus not free within the abdomen since the filament extends through the valve D and is trapped thereby.
The handles of the grasper are then squeezed together, whereupon the jaws close. The grasper is then retracted out of the trocar, leaving the device in the position shown in FIG. The proximal end of the filament is then pulled in the proximal direction to draw the anchoring member against the free end C of the trocar, to trap it thereon as shown in FIG. This uncertainty lessens the apprehension of the user since the user is unable to predict with any exactness when the device will trigger.
The perimeter pressure also produces an on-target finger bulge toward the skin-engagement region 24 to ensure a quality wound yielding the needed droplets of blood without a need for milking the finger. Moreover, the recessed nature of the skin-engagement region 24 acts to prevent unintended triggering of the puncture device Only a ridged appendage will trigger the device and the compression must be primarily along the axis of the puncture device.
Casual handling of the device is unlikely to cause triggering. While the present invention has been described as puncturing a fingertip, often it is the side of the finger or even an ear lobe which is punctured. The configuration in operation of the single-use puncture device 10 permits such use.
Moreover, the puncture device may be used for infant heel-puncture bleeding. Typically, limiting lance penetration to a depth of 2. Because the skin-engagement region 24 preferably has a contour which is adapted to that portion of individual's anatomy which is to be punctured, different puncture devices are needed for puncturing a heel, a finger and an ear lobe. Alternatively, the escapement assembly of the puncture device may be rotatably coupled to the cylindrical side wall 16, and as a rotation is initiated a cam-stop may be used to change the contour of the skin-engagement region or to change the maximum displacement of the lance 30 from the puncture device.
For example, referring to FIG. Rotation of the escapement assembly would then permit selection of alignment of the reduced stop turn with the different elevation steps of the stop turn limit surface. An astringent pad reduces post-puncture bleeding. This advantage is particularly important to those persons who might otherwise experience prolonged bleeding because of an abnormality in blood-clotting factors. I claim: 1.
A single-use skin puncture device comprising, a housing having a skin-engagement region and an access aperture through said skin-engagement region, said housing further having a sidewall and a flexible diaphragm connecting said skin engagement region to said sidewall at a front end of said housing, the application of force at said skin-engagement region causing deformation of said diaphragm about said skin-engagement region, said deformation defining a limited range of motion of said skin-engagement region relative to said sidewall,.
The single-use puncture device of claim 1 wherein said spring means is a helical spring encircling a portion of said lance means. The single-use puncture device of claim 1 wherein said sidewall is generally cylindrical.
The single-use puncture device of claim 3 wherein said catch means is a plurality of catch members contacting said spring means to hold said spring means in said position to store potential energy, said catch members being displaced from said spring means by said deformation of said diaphragm. The single-use puncture device of claim 4 wherein said spring means is a helical spring having a stop turn, said stop turn being in contact with said catch members prior to said deformation.
The single-use puncture device of claim 1 wherein said lance means is one of a lance needle and a lance blade. A puncture device comprising, an elongated housing having a generally cylindrical rigid sidewall and a skin-engagement region at the front end,. The puncture device of claim 7 wherein said trigger means is a flexible diaphragm. The puncture device of claim 8 wherein said diaphragm is an annular member.
The puncture device of claim 8 wherein said catch means is a plurality of catch members connected to said diaphragm at a first end and to said spring at a second end, flexing of said diaphragm causing lateral movement of said catch members to release said spring. The puncture device of claim 7 wherein said spring is a helical spring encircling said lance means.
A single-use puncture device comprising, a housing having a rigid sidewall and a front end, said front end having a deformable region made of a flexible material and having a skin-engagement region, said skin-engagement region being displaced axially upon application of axial force at said front end, said front end having an access aperture therethrough,. The puncture device of claim 12 wherein said lance means is a lance needle. The puncture device of claim 12 wherein said sidewall has a cylindrical shape and wherein said front end has a central skin-engagement region connected to said sidewall by a flexible diaphragm.
The puncture device of claim 14 wherein said skin-engagement region includes a raised annulus and a depressed area within said raised annulus. The puncture device of claim 14 wherein said flexible diaphragm has an annular configuration.
The puncture device of claim 12 wherein said spring is a helical spring encircling said lance means. A single-use skin puncture device comprising, a housing having a skin-engagement region and an access aperture through said skin-engagement region, said housing having the characteristic such that the application of force at said skin-engagement region causes deformation about said skin-engagement region, said deformation defining a limited range of region motion,.
USA en. Automatic retractable safety penetrating instrument for portal sleeve introduction and method of use. Safety penetrating instrument with triggered penetrating member retraction and single or multiple safety member protrusion. Safety penetrating instrument with triggered penetrating member retraction and safety member protrusion. Safety penetrating instrument with penetrating member protected after penetration to predetermined depth.
USB1 en. USB2 en. Method for lancing a dermal tissue target site employing a dermal tissue lancing device with a tiltable cap. Method and apparatus for a multi-use body fluid sampling device with analyte sensing. Plus Device. Electronic Album 11 Songs.
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