Abstract: A method can include coupling a penetration system to an automated driver. The penetration system can include a cannula hub; a cannula attached to the cannula hub and defining a lumen; an elongated instrument positioned within the lumen of the cannula, the shield defining a distal tip; and a shield coupled to each of the cannula hub and the elongated instrument. The method can include driving the penetration system into a bone via the automated driver to position the cannula within the bone; retracting the elongated instrument in a proximal direction relative to the cannula while the cannula remains positioned within the bone and while the shield remains coupled to each of the cannula hub and the elongated instrument; and automatically locking the shield to the elongated instrument upon further retraction of the elongated instrument.

Abstract: A system can include an elongated instrument that is positioned within a cannula portion of a cannula assembly. The system can include a shield that is coupled with both the elongated instrument and the cannula assembly when in an unlocked state. The shield can permit proximal movement of the elongated instrument relative thereto when in the unlocked state. The shield can automatically transition to a locked state to attach to a distal end of the elongated instrument to restrict access to a distal tip of the elongated instrument.

Abstract: A method can include inserting a distal tip of a needle through a sidewall of a vessel of a patient and into a lumen defined by the vessel while the needle is coupled with a catheter and while the catheter is coupled with a cannular stiffener that is positioned between the catheter and the needle with a distal tip of the stiffener being positioned proximally relative to a distal tip of the catheter. The method can include, with the distal tip of the needle positioned in the lumen of the vessel, holding the needle stationary relative to the vessel while simultaneously advancing the stiffener and the catheter over the needle until the catheter is located at a final indwelling position within the vessel. The method can also include retracting the stiffener and the needle fully from the catheter while the catheter remains at the final indwelling position within the vessel.

Abstract: A method can include engaging the pericardium of a patient at two engagement positions of the pericardium. The method can further include moving the two engagement positions of the pericardium away from each other to tension a portion of the pericardium. The method can further include advancing an access device through the tensioned portion of the pericardium to introduce the access device into the pericardial space of the patient. Other and further methods are also disclosed.

Abstract: A system can include a needle that includes a distal tip configured to be inserted into a vessel of a patient, the needle defining an outer surface. The system can further include a catheter that includes a distal end and an inner surface that defines a lumen within which a portion of the needle is positioned, the distal tip of the needle being at a position that is distal to the distal end of the catheter, the catheter further comprising a catching region of reduced diameter that extends inwardly at the distal end of the catheter.

Abstract: An embodiment of a tissue engagement device having a sheath, a first arm, a second arm, a first tissue engaging member, a second tissue engaging member, and an actuation cannula. At least a proximal portion of each arm is within the sheath and the tissue engaging members may be positioned on a distal end of each arm. The actuation cannula is also within the sheath, and can move within the sheath between a retracted position and an extended position. The actuation cannula moves at least a portion of each of the first and second arms into a region between an exterior surface of the actuation cannula and an interior surface of the sheath as the actuation cannula moves to the extended position. The engaging members are configured to pierce a desired tissue and anchor to the desired tissue layer when the actuation cannula is in the extended position.

Abstract: An intraosseous access system can include a needle that defines a lumen and a longitudinal axis about which the needle can be rotated during an insertion event. The needle can include a proximal end that remains at an exterior of a patient during use, a distal end that can be inserted through the skin of the patient into contact with a bone of the patient, and a distal tip at a distalmost point of the distal end of the needle that is positioned at the longitudinal axis of the needle. The system can further include an obturator sized to be received within the lumen of the needle that can inhibit material from entering the needle as the system is inserted into the bone.

Abstract: A method can include engaging the pericardium of a patient at two engagement positions of the pericardium. The method can further include moving the two engagement positions of the pericardium away from each other to tension a portion of the pericardium. The method can further include advancing an access device through the tensioned portion of the pericardium to introduce the access device into the pericardial space of the patient. Other and further methods are also disclosed.

Abstract: A method can include engaging the pericardium of a patient at two engagement positions of the pericardium. The method can further include moving the two engagement positions of the pericardium away from each other to tension a portion of the pericardium. The method can further include advancing an access device through the tensioned portion of the pericardium to introduce the access device into the pericardial space of the patient. Other and further methods are also disclosed.

Abstract: A system can include an elongated instrument that is positioned within a cannula portion of a cannula assembly. The system can include a shield that is coupled with both the elongated instrument and the cannula assembly when in an unlocked state. The shield can permit proximal movement of the elongated instrument relative thereto when in the unlocked state. The shield can automatically transition to a locked state to attach to a distal end of the elongated instrument to restrict access to a distal tip of the elongated instrument.

Abstract: A system for intraosseous access can include an elongated instrument that is positioned within a cannula portion of a cannula assembly. The system can include a shield that is coupled with both the elongated instrument and the cannula assembly when in an unlocked state. The shield can permit proximal movement of the elongated instrument relative thereto when in the unlocked state. The shield can automatically transition to a locked state to attach to a distal end of the elongated instrument to restrict access to a distal tip of the elongated instrument.

Abstract: A system can include a needle that includes a distal tip configured to be inserted into a vessel of a patient, the needle defining an outer surface. The system can further include a catheter that includes a distal end and an inner surface that defines a lumen within which a portion of the needle is positioned, the distal tip of the needle being at a position that is distal to the distal end of the catheter, the catheter further comprising a catching region of reduced diameter that extends inwardly at the distal end of the catheter.

Abstract: An intraosseous access system can include a hub coupled to a cannula that can be introduced into a bone of a patient. The system further includes a securement device that can couple with the hub when transitioned from an open orientation to a closed orientation. The securement device includes a first segment and a second segment that are spaced apart from each other when the securement device is in the open orientation and are approximated and secured to each other when the securement device is in the closed orientation. The first segment includes a first receptacle that receives a portion of the hub therein and contacts the hub to restrain movement of the hub relative to the securement device when the securement device is coupled with the hub in the closed orientation. The first segment also includes a first arm coupled to the first receptacle, the first arm biasing the first receptacle toward the hub when the securement device is coupled with the hub in the closed orientation.

Abstract: A system can include a handle and a needle fixedly secured to the handle. The needle can include a distal tip that can be inserted through a sidewall of a vessel of a patient. The system can further include a catheter that defines a lumen through which the needle extends and includes an engagement surface at an interior thereof. A stiffener can be positioned within the lumen of the catheter at an exterior of the needle and can include an engagement surface that can press distally on the engagement surface of the catheter to advance the catheter distally over the needle and through a lumen of the vessel when the stiffener is advanced distally over the needle. The system can further include a stiffener hub attached to the stiffener, the stiffener hub being movably coupled with the handle so as to translate relative thereto.

Abstract: An intraosseous access system can include a needle that defines a lumen and a longitudinal axis about which the needle can be rotated during an insertion event. The needle can include a proximal end that remains at an exterior of a patient during use, a distal end that can be inserted through the skin of the patient into contact with a bone of the patient, and a distal tip at a distalmost point of the distal end of the needle that is positioned at the longitudinal axis of the needle. The system can further include an obturator sized to be received within the lumen of the needle that can inhibit material from entering the needle as the system is inserted into the bone.

Abstract: An intraosseous access system can include a hub coupled to a cannula that can be introduced into a bone of a patient. The system further includes a securement device that can couple with the hub when transitioned from an open orientation to a closed orientation. The securement device includes a first segment and a second segment that are spaced apart from each other when the securement device is in the open orientation and are approximated and secured to each other when the securement device is in the closed orientation. The first segment includes a first receptacle that receives a portion of the hub therein and contacts the hub to restrain movement of the hub relative to the securement device when the securement device is coupled with the hub in the closed orientation. The first segment also includes a first arm coupled to the first receptacle, the first arm biasing the first receptacle toward the hub when the securement device is coupled with the hub in the closed orientation.

Abstract: An intraosseous access system can include a needle that defines a lumen and a longitudinal axis about which the needle can be rotated during an insertion event. The needle can include a proximal end that remains at an exterior of a patient during use, a distal end that can be inserted through the skin of the patient into contact with a bone of the patient, and a distal tip at a distalmost point of the distal end of the needle that is positioned at the longitudinal axis of the needle. The system can further include an obturator sized to be received within the lumen of the needle that can inhibit material from entering the needle as the system is inserted into the bone.

Abstract: A method can include engaging the pericardium of a patient at two engagement positions of the pericardium. The method can further include moving the two engagement positions of the pericardium away from each other to tension a portion of the pericardium. The method can further include advancing an access device through the tensioned portion of the pericardium to introduce the access device into the pericardial space of the patient. Other and further methods are also disclosed.

Abstract: Tissue engagement devices can include a sheath, a first arm, a second arm and an actuation cannula. At least a proximal portion of each arm is within the sheath. The actuation cannula is also within the sheath, and can move within the sheath between a retracted position and an extended position. The actuation cannula moves at least a portion of each of the first and second arms into a region between an exterior surface of the actuation cannula and an interior surface of the sheath as the actuation cannula moves to the extended position.

Abstract: A system can include a handle and a needle fixedly secured to the handle. The needle can include a distal tip that can be inserted through a sidewall of a vessel of a patient. The system can further include a catheter that defines a lumen through which the needle extends and includes an engagement surface at an interior thereof. A cannular stiffener can be positioned within the lumen of the catheter at an exterior of the needle and can include an engagement surface that can press distally on the engagement surface of the catheter to advance the catheter distally over the needle and through a lumen of the vessel when the stiffener is advanced distally over the needle. The system can further include a stiffener hub attached to the stiffener, the stiffener hub being movably coupled with the handle so as to translate relative thereto.