Septum Feature for Identification of an Access Port
A power-injectable access port, and a method of identifying a subcutaneously implanted power-injectable access port. The power-injectable access port includes a body capturing a septum that covers a cavity defined by the body, and a pattern of protrusions extending from an outer surface of the septum away from the cavity, the pattern of protrusions detectable through palpation to identify the access port as a power-injectable access port.
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This application is a continuation of U.S. patent application Ser. No. 13/471,219, filed May 14, 2012, now U.S. Pat. No. 8,608,713, which is a continuation of U.S. patent application Ser. No. 11/320,223, filed Dec. 28, 2005, now U.S. Pat. No. 8,177,762, which claims the benefit of priority to U.S. Provisional Patent Application No. 60/658,518, filed Mar. 4, 2005, and which is a continuation-in-part of U.S. patent application Ser. No. 10/374,000, filed Feb. 25, 2003, now U.S. Pat. No. 7,713,251, which is a continuation of U.S. patent application Ser. No. 09/582,406, filed Jun. 23, 2000, now U.S. Pat. No. 6,527,754, which is a U.S. national stage application under 35 USC §371 of International Application No. PCT/US99/28695, filed Dec. 3, 1999, which claims the benefit of priority to U.S. Provisional Patent Application No. 60/111,257, filed Dec. 7, 1998, the disclosure of each of which is incorporated, in its entirety, by this reference.BACKGROUND
Access portals, or ports, provide a convenient method to repeatedly deliver medicants to remote areas of the body without utilizing surgical procedures. The port is totally implantable within the body, and permits the infusion of medications, parenteral solutions, blood products, and other fluids. The port may also be used for blood sampling
Known ports typically include a chamber accessible through a self-sealing septum. Septums of the prior art vary in shape, from a wafer-like cylindrical block of silicone to a pre-molded septum of U.S. Pat. No. 4,802,885 to Weeks et al. The pre-molded septum of U.S. Pat. No. 4,802,885 includes opposed convex surfaces and a peripheral ledge.
In common practice, a caregiver locates the septum of the port by palpation. Port access is accomplished by percutaneously inserting a needle, typically a non-coring needle, perpendicularly through the septum of the port and into the chamber. The drug or fluid is then administered by bolus injection or continuous infusion. Ordinarily the fluid flows through the chamber, into a catheter and finally to the site where the fluid is desired. Except for the septum, traditional ports are constructed from all-metal or all-plastic. Each type of construction has unique advantages and disadvantages.
All-metal constructions have the advantages that they maintain a septum in a self-sealing fashion after repeated percutaneous injections. Additionally, all-metal constructions, such as titanium, or stainless steel provide a port which is both biocompatible and compatible with the injected fluid.
However, all-metal constructions present the disadvantages that they are relatively heavy, difficult to fabricate and relatively expensive. Additionally, all-metal ports produce large Magnetic Resonance Imaging (MRI) artifacts. On the other hand, all-plastic ports have the advantages that they are inexpensive to construct, light in weight, and do not create an MRI artifact. However, ports constructed from plastic have the disadvantage that infused fluids may react with the plastic body of the port. All-plastic ports contain the disadvantage that they cannot maintain a sealing engagement with the septum after repeated percutaneous injections. Additionally, all-plastic ports are susceptible to nicks and scratches on the interior surface by the accessing needle. These nicks and scratches could lead to nidus, blood clots, or precipitation formations.
Efforts have been made to combine the advantages of all-metal ports with all-plastic ports. For example, in U.S. Pat. No. 4,802,885 to Weeks et al., a metal reservoir having a chamber sealed by a pre-formed silicone septum is jacketed by a single piece of a silicone elastomer. However, all-metal ports jacketed by a single piece of elastomer have significant shortcomings. These shortcomings include quality control problems during manufacturing, and expensive molding processes.
Other efforts have focused on providing a multiple piece all-plastic housing in cooperation with an open metal cup to sealingly engage a septum. For example, see U.S. Pat. No. 5,213,574 to Tucker. This design has shortcomings associated with it, including defects in the plastic housing which may cause an improperly sealed septum. Once the septum is improperly sealed the entire port must be discarded.
Therefore a need has arisen for an access port device which addresses the problems of prior port devices.
A variety of implantable devices, known as subcutaneous access ports, are utilized to deliver fluids to or to withdraw fluids from the bloodstream of a patient. Such access ports typically include a needle-impenetrable housing which encloses one or more fluid cavities and defines for each such fluid cavity an access aperture communicating through the housing on the side thereof which is adjacent to the skin of the patient when the access port is implanted in the body. A needle-penetrable septum is received in and seals each access aperture. Exit passageways located in an outlet stem communicate with each of the fluid cavities for dispensing medication therefrom to a predetermined location in the body of the patient through an implanted catheter attached to the access port.
Once the access port and the catheter have been implanted beneath the skin of a patient, quantities of medication or blood may be dispensed from one such fluid cavity by means of a non-coring needle passed through the skin of the patient and penetrating the septum into one of the respective fluid cavities. This medication is directed through the distal end of the catheter to an entry point into the venous system of the body of the patient.
Blood may also be withdrawn for sampling from the body of a patient through such an access port. This is accomplished by piercing the skin of the patient and one of the respective septums with a non-coring needle and applying negative pressure thereto. This causes blood to be drawn through the catheter into the fluid cavity corresponding to the pierced septum and then out of the body of the patient through the needle.
To prevent clotting thereafter, the withdrawal route is flushed with a saline solution or heparin using again a non-coring needle piercing the skin of the patient and the septum in the same manner as if a medication were being infused.
Both intermittent and continual injections of medication may be dispensed by the access port. Continual access involves the use of a non-coring needle attached to an ambulatory-type pump or a gravity feed IV bag suspended above the patient. The ambulatory-type pump or the IV bag continually feeds the medication or fluid through the needle to the fluid cavity in the access port and from there through the catheter to the entry point into the venous system.
To facilitate locating each respective septum once the access port has been implanted, some access ports incorporate a raised circular ring located about the outer perimeter of the septum. This raised ring enhances the tactile sensation afforded by the subcutaneous septum to the palpating fingertip of a medical practitioner. Alternatively, other access ports have utilized palpation ridges rather than a raised circular ring for substantially the same purpose. The palpation ridges allow the location of the septum to be accurately determined when the access port is subcutaneously implanted.
To preclude reaction with the tissues in the body of the patient, access ports are constructed of nonreactive materials, such as titanium or stainless steel. Although these materials are nonreactive, access ports constructed utilizing titanium or stainless steel materials produce an interfering or blurred image of the body of the patient in the vicinity of the implanted access port when diagnostic imaging techniques such as magnetic resonance imaging (“MRI”), CAT scans, or computerized tomography are used. The blurred region caused by the presence of a metallic access port in the body of a patient extends beyond the access port itself. Therefore, the use of metallic access ports limits the diagnostic imaging techniques that may be used relative to those areas of the body in which an access port is implanted. In place of metallic materials some access ports have been fabricated at least in part from biocompatible plastics.
A further problem relating to the materials for and manufacture of access ports is the deleterious impact of some manufacturing procedures on the fluids which flow through the fluid cavities and related structures located between the fluid cavities and the catheter. During the manufacture of an access port, whether the port is comprised of metallic or plastic materials, it becomes necessary to form the fluid cavities and exit passageways through which the fluid will be directed into the attached catheter. This manufacturing process often leaves sharp edges, seams and corners in the areas where the fluid cavity is to direct the flow of the fluid through an exit passageway. As blood or other fluids are injected through the septum into the fluid cavity, pressure developed within the fluid cavity tends to cause fluid to flow through the exit passageway. As the fluid in the fluid cavity flows past the sharp edges and corners produced in the manufacture of the access port, turbulence arises, taking the form of a vortex, adjacent to the sharp edges and corners. Some fluids, such as blood, are sensitive to this turbulence, and lysing of the red blood cell component of the injected blood can occur in these turbulent areas.
In addition, the production of the circular fluid cavities often results in the creation of areas within the housing in which fluid flow is retarded. These areas are referred to as dead spaces and usually occur in areas of transition, such as where the bottom of the septum interfaces with the walls of the fluid cavity and where the floor of the fluid cavity meets the exit passageway through which the fluid must flow. As the flow of fluids through dead spaces is retarded, stagnation occurs, resulting in some fluid being trapped within these dead spaces. If the access port is used to withdraw or transfuse blood, blood trapped in these dead spaces may form clots and block the flow of fluid through the fluid cavity.
Moreover, in some prior vascular access ports the internal reservoirs are formed by two plastic parts with are bonded together. This results in an undesirable seam being formed where the adjacent parts abut one another. The inside of the reservoir should be as smooth as possible to help prevent damage to blood cells or the initiation of blood clotting during infusion or withdrawal of blood through the port.
A further problem encountered in the design and construction of access port relates to the positioning of the septums within the housing of the access port. The positioning of the septums within the housing is a compromise between two conflicting objectives. These are the need to separate the septums to such a distance so that the septums may be easily differentiated for the purpose of injection and the need to restrict the overall dimensions of the access port for patient comfort and aesthetics. The distancing of the septums to facilitate their differentiation, however, results in a corresponding distancing of the fluid cavities. This result is at odds with another structural requirement for access ports with plural cavities, namely that the exit passageways from each fluid cavity be closely spaced at the point where the implanted catheter is to be coupled to the access port.
To guide the flow of a fluid from each of the spatially separated fluid cavities into the side-by-side configuration of fluid outflow necessitated by the dimensions of a plural lumen catheter, intermediate structural members have been required. Naturally, this complicates the process of manufacture and increases its cost, as well as the changes of structural failure.
There are several examples of such intermediate members used to resolve the manufacturing constraints imposed upon the construction of a passageway flowing from spatially separate fluid cavities into a side-by-side configuration acceptable by a catheter. One is to produce passageways in the form of bent metal tubes which are then insert molded or welded into the larger body of the access port. The use of such a metal component will interfere with the production of an access port which is free of limits as to the diagnostic imaging techniques that may be used relative to those areas of the body in which an access port is implanted. In addition, the integral nature of such metal outlet passageways raises the possibility of leakage of medication through the interstices between the metal tubes and the body of the access port.
Alternatively, to produce fluid flow from spatially separated fluid cavities into the closely spaced lumens of a catheter, each fluid cavity has been designated with its own spatially separated outlet stem. These outlet stems are then coupled by a hub structure for permanent attachment to the closely spaced lumens of a catheter. This type of arrangement increases the size of the overall access port and its cost of manufacture by adding thereto the necessity of fabricating and assembling of the hub element. Port connections to catheters in this manner are permanent. Accordingly, if the catheter is to be shortened by trimming, that trimming must occur at the distal end of the catheter, and this precludes the use of any type of specially designed tip or valve.
An additional set of problems encountered in the use of access ports relates to the actual connection of the catheter to the access port. This is most commonly effected by securing the catheter to an outlet stem protruding from the housing of the access port. In an attempt to lock the catheter to the outlet stem of the access port, thread-type systems have been developed wherein the catheter is attached to an outlet stem, and the outlet stem is then threaded into the access port. When utilizing this system, however, it is difficult to determine the amount of engagement of the catheter onto the outlet stem. Some catheter connection systems do not allow visual verification of attachment. As a result, leakage and failure can occur.
To overcome this problem, access ports are produced in which the catheter is pre-attached at the factory. While this practice alleviates many of the problems with leakage and failure due to catheter slippage, this system severely limits the type of the catheter usable with the access port. This precludes the use of catheters having specialized distal tips, as the distal end of the catheter is the only end that can then be trimmed to effect its ultimate sizing. For example, catheters utilizing a Groshong® slit valve at their distal end may not have any of the distal tip of the catheter removed without compromising the catheter.
Thus, there has been a need for an improved vascular access port which overcomes the above-noted problems, and which can be manufactured economically. The present invention fulfills these needs and provides other related advantages.SUMMARY
One aspect of the instant disclosure relates to access port for providing subcutaneous access to a patient. More particularly, an access port may comprise a body configured for capturing a septum for repeatedly inserting a needle therethrough into a cavity defined within the body. Further, the septum may include at least one topographical feature configured for identification of the septum. Also, a septum for an access port for providing subcutaneous access to a patient is encompassed by the instant disclosure, wherein the septum may comprise a body exhibiting at least one topographical feature configured for identification of the septum.
A further aspect of the instant disclosure relates to an access port for providing subcutaneous access to a patient including a body configured for capturing a septum for repeatedly inserting a needle therethrough into a cavity defined within the body, and a means for identification of the septum. In one embodiment, the means for identification may comprise at least one topographical feature of a surface of the septum. In another embodiment, means for identification may comprise a visually perceivable feature selected from the group consisting of: a color, a symbol, a letter, a pattern, and indicia. In a further embodiment, means for identification may comprise an x-ray detectable feature or an ultrasound detectable feature. In yet an additional embodiment, means for identification may comprise an RFID tag.
Another aspect of the instant disclosure relates to a method of identifying a subcutaneously implanted access port. More particularly, an access port including a septum may be provided. Further, at least one topographical feature of the septum of the access port may be perceived. In addition, the subcutaneously implanted access port may be identified in response to perceiving the at least one feature of the septum of the access port.
Features from any of the above mentioned embodiments may be used in combination with one another in accordance with the instant disclosure. In addition, other features and advantages of the instant disclosure will become apparent to those of ordinary skill in the art through consideration of the ensuing description, the accompanying drawings, and the appended claims.
Advantages of the instant disclosure will become apparent upon review of the following detailed description and drawings, which illustrate representations (not necessarily drawn to scale) of various aspects of the instant disclosure, wherein:
The septums 16 are formed with a generally circular shape, and, as shown in the drawings, may include a nipple 26 or a concave portion 28 on the outer surface thereof. The nipple is advantageous for visual and/or tactile location of the port device 10, and as a locator for needle insertion. Likewise, concave portion 28 provides similar features, but may be used in areas where a protruding nipple is undesirable. The septums 16A and 16B and housing 12 are preferably formed with mated tongue and groove portions, as shown in the side view drawings of
As opposed to plastic materials used in the prior art, the cup portion 14 is preferably formed of titanium or stainless steel to resist scratches and/or debris from being introduced into the chambers, as a result of needle impacts thereon. Preferably, cup 14A and 14B is attached to housing 12 via insert molding, interference fit, ultrasonic weld, biocompatible glue, and/or other attachment means.
FIGS. 4 and 5A-5B depict alternative embodiments for the cup member described above in
As discussed above, access ports may provide percutaneous access to a patient. In further detail, referring to
One aspect of the instant disclosure contemplates that a septum of an access port may include at least one perceivable or identifiable feature for identifying the septum and, optionally, the access port. Of course, the identifiable feature may be perceivable after the access port is implanted within a patient. For example, at least one or perhaps multiple identifiable feature(s) of a septum of an access port may be correlative to information (e.g., a manufacturer's model or design) pertaining to the access port. Thus, an identifiable feature from an access port of a particular model may be unique in relation to most, if not all, other identifiable features of another access port of a different model or design. Of course, the at least one identifiable feature of an access port may be further correlative with any information of interest, such as type of port (e.g., power-injectable port), catheter type, date of manufacture, material lots, part numbers, etc. In this way, once at least one identifiable feature of an access port is observed or otherwise determined, correlation of such at least one feature of an access port may be accomplished, and information pertaining to the access port may be obtained. Accordingly, “identification,” as used herein and in connection with a septum, means to provide the ability to correlate selected information of interest with a perceivable feature of a septum.
In one embodiment, at least one feature may be perceived by palpation (i.e., to examine by touch), by way of other physical interaction, or by visual observation. Accordingly, a person may touch or feel the septum of the access port to perceive at least one identifying characteristic of the septum. In another embodiment, at least one identifiable feature may be perceived via x-ray or ultrasound imaging. In yet a further embodiment, at least one identifiable feature may be perceived through magnetic, light, or radio energy interaction or communication with the septum.
Turning to the embodiment wherein at least one feature may be perceived through palpation, other physical interaction, or visual observation, a topography or exterior surface feature of a septum of an access port may be configured for perception. For example, the instant disclosure contemplates that a septum may include at least one topographical feature configured for identifying the access port after it is implanted. More particularly,
The instant disclosure further contemplates that a septum may include a plurality of protrusions that, collectively, are structured for perception and identification of the septum. For example,
As mentioned above, the instant disclosure contemplates that a septum may include at least one protrusion and that the protrusion may be configured, as desired, for perception and identification of the septum. For example, a protrusion extending from a surface of a septum may include at least one substantially planar surface.
As mentioned above, at least protrusion of a septum may be sized, shaped, and structured as desired. For example, in another embodiment, a septum may include at least one protrusion that is elongated. For example,
In a further aspect of the instant disclosure, a septum may include at least one recess that is structured for perception and identification of the septum. For example,
In another embodiment, a septum may include a plurality of recesses configured for perception (e.g., visual or by palpation) and identification of the septum. For example,
The instant disclosure also contemplates that at least one recess formed in a septum may comprise of at least one elongated recess. Thus, the instant disclosure contemplates that a septum may include at least one elongated recess configured for identifying the septum, an access part in which the septum is assembled, or both. For example,
In other embodiment contemplated by the instant disclosure, a septum may include at least one protrusion and at least one recess configured for perception and identification of the septum. For example,
The instant disclosure contemplates various configurations of a septum including at least one protrusion and at least one recess. For example,
Accordingly, the instant disclosure contemplates that at least one protrusion, protruding region, recess, recessed region, undulation, or adjacent features of different elevation may comprise a feature for identifying a septum of an access port. For example, in a further embodiment, a plurality of protrusions 80 may be spaced about a selected center or other point on a septum surface of a septum.
Further, in another embodiment, a topography of a septum may comprise elongated protrusions and elongated recesses.
It should also be understood that the instant disclosure contemplates access ports having a septum with an exposed surface defined, at least in part, by a periphery that is not circular in nature. Rather, the instant disclosure contemplates that an access port may have a periphery which is generally quadrilateral, generally rectangular, generally triangular, generally elliptical, generally oval, generally polygonal, or otherwise configured. It should also be understood from the discussion of the above-described various embodiments of a septum of an access port that variations, additions, combinations, or different features are encompassed by the instant disclosure. Thus, the instant disclosure is not limited to the above-described exemplary embodiments.
Generally, the instant disclosure contemplates that means for identifying a septum may be provided. In one embodiment, as described above, at least one topographical feature may comprise means for identifying a septum. In another embodiment, at least one visual feature may be perceived and used to identify a septum. For example, a color, a pattern, one or more letters, one or more numbers, symbols, any indicia, or combinations thereof, may be formed upon or as a portion of a septum. Such a configuration may allow for visual perception and identification of a septum. In addition, the instant disclosure also contemplates that at least one feature of an access port of the instant disclosure may not be observable visually or by palpation but, rather, may be otherwise observable. For example, means for identifying a septum may comprise at least one feature observable through interaction with an imaging technology such as x-ray or ultrasound. For instance, a metal feature (e.g., a plate or other metal geometry) may be included within a septum of an access port. As may be appreciated, such a metal feature may be represented on an x-ray generated by exposure of the access port to x-ray energy while simultaneously exposing x-ray sensitive film to x-ray energy passing through the access port. Further, the instant disclosure contemplates that a size, shape, or both size and shape of a metal feature of an access port may be configured for enhancing identification of an access port. For example, assuming that a metal feature comprises a metal plate, a size, shape, or both may be selectively tailored for identification of a septum. Similarly, a feature of an access port of the may be tailored for detection via ultrasound interaction. Such a feature may comprise an exterior topographical feature. In another embodiment, such a feature may comprise a composite structure including two or more materials that form an interface (i.e., an interior feature or surface) that may be identified by ultrasound imaging. In a further aspect of the instant disclosure, it is contemplated that a communicative technology may be utilized wherein information is encompassed by an access port of the instant disclosure. Generally, a communication device (e.g., a radio beacon, a light-emitting element, an ultrasound emitting transducer, etc.) may be imbedded or otherwise affixed to a septum of the instant disclosure. Such a communication device may be configured for transmitting information in response to a given impetus. More specifically, a septum may be exposed to a request signal (e.g., a sound, an impact or an acceleration, light, radio waves, etc.). Such a request signal may cause the communication device to transmit information therefrom via sound, light, radio waves, or as otherwise known in the art. Such information may be employed for identifying an access port of the instant disclosure. Thus, a wide variety of means for identifying a septum may be employed for identifying a septum.
In one exemplary example, radio frequency identification technology may be employed for identification of a septum of an access port. Particularly, so-called active RFID tags are powered by an internal battery and are typically read/write devices. Currently, a suitable cell coupled to suitable low power circuitry can ensure functionality for as long as ten or more years, depending upon the operating temperatures and read/write cycles and usage. So-called passive RFID tags operate without a separate external power source and obtain operating power generated from the reader. Passive RFID tags are typically programmed with a unique set of data (usually 32 to 128 bits) that cannot be modified. Read-only tags may operate as an identifier comparable to barcodes, which may contain selected product-specific information. Thus, passive RFID tags may be much lighter than active RFID tags, less expensive, and may offer a substantially unlimited operational lifetime. In one embodiment, an RFID tag may be affixed to an exterior surface of a septum. In another embodiment, an RFID tag may be imbedded within a septum. One advantage of RFID approach is the noncontact, non-line-of-sight nature of the technology. RFID tags can be read through a variety of visually and environmentally challenging conditions, where other optically related technologies may be less effective.
As will be appreciated by those skilled in the art, any septum configured according to the above described aspects of the instant disclosure may be incorporated within a housing or body to form an access port. For example,
In further detail,
While certain representative embodiments and details have been shown for purposes of illustrating aspects of the instant disclosure, it will be apparent to those skilled in the art that various changes in the methods and apparatus disclosed herein may be made without departing from the scope of the instant disclosure, which is defined in the appended claims. For example, other access port sizes and shapes may be employed; and various other embodiments and structures may be employed for forming at least one identifiable feature of an access port of the instant disclosure.
1. A power-injectable access port, comprising:
- a body capturing a septum that covers a cavity defined by the body; and
- a pattern of protrusions extending from an outer surface of the septum away from the cavity, the pattern of protrusions detectable through palpation to identify the access port as a power-injectable access port.
2. A power-injectable access port according to claim 1, wherein the pattern of protrusions comprises three substantially identical protrusions.
3. A power-injectable access port according to claim 2, wherein the three substantially identical protrusions are positioned substantially equidistantly from a central axis of the septum in a triangular pattern.
4. A power-injectable access port according to claim 1, wherein the pattern of protrusions comprises protrusions that are elongated and extend linearly or arcuately.
5. A power-injectable access port according to claim 4, wherein the elongated protrusions form a plurality of substantially linear ridges.
6. A power-injectable access port according to claim 5, wherein the substantially linear ridges are parallel to each other.
7. A power-injectable access port according to claim 6, wherein the parallel substantially linear ridges are formed equidistant from a central axis.
8. A power-injectable access port according to claim 4, wherein the elongated protrusions intersect substantially near the center of the septum and extend at least partially toward a periphery thereof.
9. A power-injectable access port according to claim 8, wherein the elongated protrusions extend to the periphery of the septum.
10. A power-injectable access port according to claim 4, wherein the elongated protrusions form a pattern of intersecting lines.
11. A power-injectable access port according to claim 1, wherein the protrusions comprise frustoconical circumferential sides and a flat top surface.
12. A power-injectable access port according to claim 1, further comprising at least one recess extending into the outer surface of the septum.
13. A power-injectable access port according to claim 12, further comprising three recesses extending into the outer surface of the septum positioned substantially equidistant from the central axis of the septum.
14. A power-injectable access port according to claim 1, further comprising a plurality of recesses on the outer surface of the septum extending into the septum.
15. A power-injectable access port according to claim 14, wherein the plurality of recesses and the pattern of projections are positioned equidistant from an axis of the access port, such that an elongated recess is separated from an adjacent elongated recess by a projection.
16. A power-injectable access port according to claim 15, wherein the recesses and the projections are curved to create a generally circular pattern.
17. A power-injectable access port according to claim 1, wherein each of the protrusions includes a surface remote from the outer surface of the septum that is rounded.
18. A power-injectable access port according to claim 1, wherein a side periphery of the access port is generally triangular.
19. A method of identifying a subcutaneously implanted power-injectable access port, comprising:
- providing a power-injectable access port including a septum having a pattern of protrusions extending from an outer surface thereof, the pattern of protrusions detectable through palpation to identify the access port as a power-injectable port;
- detecting the protrusions through palpation; and
- identifying the access port as a power-injectable port.
Filed: Dec 12, 2013
Publication Date: Apr 10, 2014
Applicant: C. R. BARD, INC. (Murray Hill, NJ)
Inventors: Jim C. Beasley (Phoenix, AZ), Eddie K. Burnside (Bountiful, UT), Jay Gerondale (Longmont, CO), Steven Tallarida (Mansfield, MA), Kelly B. Powers (North Salt Lake, UT)
Application Number: 14/104,354
International Classification: A61M 39/04 (20060101); A61M 39/02 (20060101);