Abstract: A gas extraction device for a fluid delivery apparatus includes a first layer and a vent membrane coupled to the first layer. The vent membrane enables a gas to pass through the vent membrane and prevents a fluid from passing through the vent membrane. The gas extraction device also includes a second layer coupled to the vent membrane opposite the first layer. The second layer has a first channel formed therethrough. In addition, the gas extraction device includes an impermeable membrane coupled to the second layer opposite the vent membrane. The first channel is configured to receive a fluid having a gas dispersed therein. The fluid is pressurized to move the fluid through the first channel against the vent membrane and to move the gas through the vent membrane.

Abstract: A fluid delivery device comprising a fluid reservoir; a transcutaneous access tool fluidly coupled to the fluid reservoir, the transcutaneous access tool including a needle or a trocar; and a transcutaneous access tool insertion mechanism for deploying the transcutaneous access tool, wherein the insertion mechanism is configured to insert and retract the needle/trocar in a single, uninterrupted motion.

Abstract: The present invention relates to a drug delivery device for dispensing a liquid medicament, comprising: a housing (12) having at least one feeder member (100), a disposable injector (60) comprising an injection needle (65), a flexible tube (64) and an injector fluid coupling (68), wherein the injection needle (65) is in fluid communication with the fluid coupling (68) via the flexible tube (64), a disposable cartridge (70) comprising a reservoir (80) at least partially filled with the liquid medicament and comprising a cartridge fluid coupling (90) in fluid communication with the reservoir (80), wherein the injector (60) and the cartridge (70) are releasably attachable to the housing (12) and arrestable to the housing (12) in an undeployed configuration (4), in which the injector fluid coupling (68) and the cartridge fluid coupling (90) are disconnected, and wherein one of injector (60) and cartridge (70) is displaceable relative to the other one of injector (60) and cartridge (70) from the undeployed configu

Abstract: A cannula for transferring a substance to and/or from a patient includes a tubular support sleeve and a transfer tube. The support sleeve includes a rigid tubular member defining a lumen extending from a proximal end to a distal end of the tubular member. The transfer tube is positioned in the lumen and extends beyond each of the proximal end and the distal end of the tubular member. The tubular member includes a rigid, MRI-compatible material.

Abstract: The present invention provides devices and methods for establishing aseptic connections between two or more components or subassemblies. The devices may be used in medical devices such as drug delivery pumps (10). In some embodiments, a connection is made between a drug container (50, 1050, 2050) and a fluid pathway connection assembly (300, 1300, 2300). The fluid pathway connection assembly may include a connection hub (312, 1312, 2312), a piercing member (316, 1316, 2316), and a piercing member retainer (314, 1314, 2314). The assembly may further include a first film (318, 1318, 2318) covering a cavity (312A, 1312A, 2312A), thereby maintaining the aseptic condition of the cavity. The drug container may hold a fluid drug and include a pierceable seal (326, 1326, 2326). A second film (322, 1322, 2322) may cover a recess (328, 1328, 2328) formed by the seal and thereby maintain the aseptic condition of the interior of the chamber.

Abstract: Some embodiments of an infusion pump system may be configured to allow the user to communicate with the infusion pump system using voice or image input. Optionally, particular embodiments can interpret the voice or image input using speech or image recognition capabilities. By incorporating speech or image recognition equipment within the infusion pump system, user interactions with the pump system can be enhanced and simplified.

Abstract: An infusion pump system providing therapy to a patient in a closed-loop or semi-closed loop mode can safely automatically revert to open-loop therapy. The system stores a default open-loop basal rate profile in memory. The system also continually tracks the insulin on board for the patient over a plurality of closed-loop therapy intervals. When an error or event occurs requiring reversion to open-loop therapy, the system automatically provides therapy according to the open-loop basal rate profile and the tracked insulin on board amount.

Abstract: A telescoping portable drug mixing and delivery device configured to store a dry medication separately from a liquid component, wherein a tensile force applied between the housing and a cap opens a valve and causes displacement of a fluid from a first chamber to a second chamber while simultaneously mixing the fluid with a dry medicament prior to injection. An extendable needle guard is provided over the delivery assembly which prevents premature injection as well as inadvertent sticks or other cross contamination of a needle. The needle guard can also form part of a secondary trigger mechanism which injects the reconstituted drug after the mixing stage is complete.

Abstract: Vial dosing systems and methods are disclosed. A vial dosing device includes a connecting body coupleable to a vial, a cannulated plunger having a proximal end coupled to the connecting body, a dose chamber adapted to slidably receive a distal end of the cannulated plunger and to expel medicament through a distal end of the dose chamber, and a plunger tip check valve coupled to the cannulated plunger and adapted for fluid flow from the cannulated plunger through the plunger tip check valve into the dose chamber.

Abstract: Device for dispensing a substance having: a dispensing element through which the substance can be dispensed, a displaceable protective element for the dispensing element, a drive element that is coupled with the protective element and a feedback element which can generate a signal when or after a predefined quantity or the entire quantity of the substance to be dispensed has been dispensed characterized in that the feedback device is coupled with the drive element.

Abstract: A method of administering subcutaneous treatment to a patient is provided. The method includes delivering, by a needle-free injection device, a first volume of a treatment at a first location on a surface of a body of the patient; detecting a movement of the needle-free injection device relative to the first location; determining, from the movement of the needle-free injection device relative to the first location, a second location of the needle-free injection device relative to the first location; determining a second volume of the treatment to deliver at the surface of the body of the patient at the second location; and delivering, by the needle-free injection device, the second volume of the treatment at the second location on the surface of the body of the patient.

Abstract: It is possible to feed an injection objective substance to a depth of a skin structure of an objective living body without using any injection needle. A syringe having no injection needle comprises an enclosing unit which encloses the injection objective substance, a pressurizing unit which pressurizes the injection objective substance enclosed in the enclosing unit, and a flow passage unit which defines a flow passage so that the injection objective substance, which is pressurized by the pressurizing unit, is allowed to inject to an injection target area.

Abstract: The invention relates to a supply system having at least one outlet for connecting to an applicator instrument, and having a controller (51) that controls at least one valve (50, 50?, 50?, 50??) such that, within an application time interval of less than 4 s, in particular less than 2 s: a) a first fluid during at least a first delivery interval (T1) with a first pressure (ph) is conveyed in a first feed line (11); b) a second fluid during a second delivery interval (T2) following the first conveying interval (T1) is conveyed with a second pressure (pz) in a second feed line (23); and c) the first fluid, during at least a third delivery interval (T3), is conveyed with a third pressure (pl) in the first feed line (11).

Abstract: In a conventional laminated gasket production method, when a product of a laminated gasket is demolded from a mold, the product is rubbed against the mold and, therefore, minute scratches are formed on a surface of the laminated gasket. These minute scratches are liable to prevent reliable sealing of a liquid drug. The present invention is a method for producing a gasket to be used for a medical syringe and is characterized by including the steps of: preparing a gasket molding mold; molding a gasket having a circumferential surface portion in the mold with the gasket being laminated with a lamination film; and demolding the gasket from the mold, and then forming a groove only in the lamination film circumferentially of the circumferential surface portion of the gasket.

Abstract: An assembly includes a cartridge containing doses of a drug and a piston rod adapted and arranged to expel drug from the cartridge, the piston rod including a thread. The assembly further includes a nut member adapted and arranged to be rotated with respect to the piston rod about a rotational axis. The assembly further comprises a last dose stop mechanism adapted including at least one first interaction member and at least one second interaction member provided by the piston rod and at least one first stop member and at least one second stop member provided by the nut member. The interaction members and the stop members are configured to mechanically cooperate with one another such that further relative movement of the nut member and the piston rod for setting a dose of the drug is prevented.

Abstract: An injection device for dosing and for releasing a defined dose of a liquid product includes: a threaded rod with a thread that includes teeth; a rotating sleeve with an engaging element that can engage with the teeth of the threaded rod; a guide sleeve having an engaging element that can engage with the teeth of the threaded rod; and a dosing sleeve arranged in an axially moveable manner in relation to the rotating sleeve and the guide sleeve, the dosing sleeve in a threaded engagement with the rotating sleeve.

Abstract: The present disclosure is generally directed to a resettable drug delivery device for selecting and dispensing a number of user variable doses of a medicament. The drug delivery device comprises a housing, a cartridge holder releasably attached to the distal end of the housing, a piston rod engaging a housing insert and a drive member, a dose setting member guided within the housing to allow rotation of the dose setting member during dose setting and dose dispensing, a clutch for rotationally coupling the drive member and the dose setting member, and a locking element which is rotationally constrained to the housing and is axially movable relative to the housing between a proximal dose setting position and a distal resetting position.

Abstract: An epidural needle assembly including an epidural needle assembly and an injection needle assembly. The injection needle assembly is slidably mounted on the needle of the epidural needle assembly between extended and retracted positions. The injection needle assembly includes an injection hub having an injection needle secured thereto which extends forwardly therefrom. When the injection needle assembly is in its retracted position, the forward end of the injection needle is positioned rearwardly of the forward end of the epidural needle. When the injection needle assembly is in its extended position, the forward end of the injection needle is positioned forwardly of the forward end of the epidural needle. When in its extended position, the injection needle is able to create a hole in the skin of a person or animal to permit the epidural needle to be inserted therein.

Abstract: A drug dispensing-tracking device configured in the form of at least one of a cover, a sleeve, and a cap, and configured to connect with a drug-injection or storage device. The tracking device may comprise at least one or more of: an acoustic sensor, a vibration sensor, an optical sensor, an optical-navigation sensor, and a magnetic sensor, and any combination thereof. At least one sensor may be configured to produce at least one respective signal in response to sensing a vibration, a sound, light, movement, and a magnetic field, respectively, produced by the drug-injection device due to an activity of the drug-injection device.

Abstract: The present invention relates to a safety device (100) for preventing needlestick injury with a needle (20), comprising: a protective cap (130) and a shield (120) capable of pivoting from a storage position where it is interlocked with the protective cap (130), a retracted position where it gives access to the needle (20) and a safety position where it covers the needle (20), wherein a cam surface (127) of the shield and an engaging peg (137) of the protective cap are arranged so that, when the safety device (100) is mounted around the tip (14) of a medical device (10), removing the protective cap (130) from the tip (14) by a distal movement displaces the shield (120) from the storage position to the retracted position. Furthermore, the present invention relates to a medical device (10) comprising a tip (14) provided with a needle (20) comprising a needle point (22), wherein the medical device (10) further comprises a safety device (100).

Abstract: A piston for use in an injector comprising a cylinder having a longitudinal axis and an inner wall, which piston has a deformable sealing element with a convex surface, which deformable sealing element when the piston is inserted in the cylinder abuts the inner wall of the cylinder at an abutting interface and seals an annular gap between the piston and the inner wall of the cylinder. The abutting interface and the deformable sealing element have axial dimensions parallel with the longitudinal axis. The ratio between the axial dimension of the abutting interface and the axial dimension of the deformable sealing element is in the range between 0.01 and 0.2. In another aspect, an injector includes the piston and is used in a disposable syringe of the piston. The piston can prevent refilling of a syringe.

Abstract: A needle-bearing hub for a pen needle is provided with a distal patient-facing side having an enlarged surface for contact with the subject's skin. The enlarged surface is provided with a radius of curvature that increases the likelihood that the needle reaches full injection depth when an injection is performed at an inclined angle with respect to the surface of the skin and with to the desired depth less discomfort to the patient.

Abstract: A non-combustion type flavor inhaler comprises: a reservoir storing an aerosol source; a transfer unit transferring the aerosol source from upstream of the liquid surface forming location to a liquid surface forming location at which a liquid surface of the aerosol source is formed, the transfer unit being configured to form the liquid surface; a suction port arranged downstream of the liquid surface forming location; a first atomizer atomizing the aerosol source located upstream of the liquid surface forming location; and a second atomizer atomizing a droplet generated from the liquid surface formed at the liquid surface forming location, the droplet being located downstream of the liquid surface forming location.

Abstract: A dispenser for supplying a metered volume of a liquid medicament to an aerosolizing device. The dispenser may include a container having a proximal end and a distal end, wherein the container is configured to store a volume of liquid medicament. The dispenser may also include a dispensing mechanism coupled to the distal end of the container. The dispensing mechanism may have a distal end terminating in a tip through which the liquid medicament is dispensed. The dispensing mechanism operates to dispense a metered volume of the liquid medicament from the tip each time the dispensing mechanism is operated. The distal end of the dispensing mechanism includes an interface that interacts with a housing of an inhaler to limit an insertion depth of the tip into an opening the housing.

Abstract: A compliance monitoring module for a breath-actuated inhaler comprising: a miniature pressure sensor, a sensor port of said sensor being pneumatically coupled to a flow channel through which a user can inhale; a processor configured to: receive a signal originating from a dosing mechanism of the inhaler indicating that medication has been released; receive data from a sensing element of the sensor; and based on said signal from said dosing mechanism and said data from said sensing element, make a determination that inhalation of a breath containing medication through said flow channel complies with one or more predetermined requirements for successful dosing; and a transmitter configured to, responsive to said determination, issue a dosing report.

Abstract: A respiratory apparatus evaluates accuracy of a pressure sensor, such as when only a single pressure sensor is provided. The accuracy of the pressure sensor may be assessed based on pressure measurement obtained from the pressure sensor and a subordinate or secondary characteristic of the respiratory device such as altitude or atmospheric pressure. A controller or processor may calculate the altitude of the respiratory device based in part on the pressure measurement. In some embodiments, the assessment of the pressure sensor may involve an evaluation of the calculated altitude. In some cases, the assessment of the pressure sensor may involve determining an estimated pressure based on a calculated altitude, and comparing the pressure measurement obtained from the pressure sensor with the estimated pressure.

Abstract: A system and method is disclosed for performing diagnostics on patient devices (720). The patient devices (720) may include respiratory therapy devices that operate in accordance with instruction sets, such as software or firmware. A server (710) may maintain a database of diagnostic data (718) indicating faults in one or more of a plurality of patient devices (720). The server (710) may transmit this diagnostic data (718) to one or more computing devices (760), including identification of faults that have occurred. The server (710) may also transmit service data to the plurality of patient devices (720) in order to address the identified faults.

Abstract: The system and method for reducing or eliminating obstructive sleep apnea in patients with the use of a nasopharyngeal device. The nasopharyngeal device has at least one cup and a balloon-cuff located at opposing ends of a semi-rigid, solid-walled tube. The balloon-cuff is reversibly inflatable and is located adjacent to the soft palate of a patient when installed. The inflation of the balloon-cuff opens the airway in a patient thereby reducing obstructive sleep apnea. The one or more cups have perforations, holes, slots or the like for increasing air intake. The cups may also contain clips for securing the nasopharyngeal device in place.

Abstract: The present invention provides improved dual lumen endobronchial tube devices. The dual lumen endobronchial tube devices feature a universal design for left or right mainstem bronchus insertion. The dual lumen endobronchial tube devices also feature enhanced balloon cuff designs to minimize dislodgement while maintaining proper airway sealing. The present invention also includes water activated lubricious coating inside the shaft to reduce friction during insertion of a bronchoscope into the airway. The present invention also provides improved double clamps that prevent the accidental clamping of both tubes of a Y-adapter.

Abstract: An introducer for tracheal tube intubation has a proximal section connected to a distal section having an angled bougie tip. The introducer is configurable (i) for use as a bougie in which a tracheal tube is railroaded over the introducer's back end and into a trachea and (ii) for use as a stylet in which a tracheal tube is pre-loaded onto the introducer for insertion into a trachea. In certain embodiments, the introducer has one or more flexible or malleable sections that enable the introducer to bend into different configurations. The flexible/malleable sections have directional bending such that the sections bend in roughly the same plane as the angled bougie tip. This enables an operator always to know the orientation of the bougie tip even after it has been inserted into the trachea. The flexible/malleable sections enable the introducer to be configured with a handle or other type of grip.

Abstract: A method and apparatus can be used in the selection of correctly sized respiratory interfaces. The method includes the use of light beams to project sizing markers onto a patient's face, which enables the size of the patient's facial features to be measured relative to a set of interface sizes. A sizing apparatus can include a light source and beam splitters that will refract and project the light source into a series of beams that can be aligned on a patient's face in order to measure the features of the patient.

Abstract: A mask system for use between a patient and device to deliver a breathable gas to the patient includes a mouth cushion, a pair of nasal prongs, an elbow, and a headgear assembly. The mouth cushion is structured to sealingly engage around an exterior of a patient's mouth in use, and the pair of nasal prongs are structured to sealingly communicate with nasal passages of a patient's nose in use. The elbow delivers breathable gas to the patient. The headgear assembly maintains the mouth cushion and the nasal prongs in a desired position on the patient's face. The headgear assembly provides a substantially round crown strap that cups the parietal bone and occipital bone of the patient's head in use.

Abstract: A breathing arrangement for use between a patient and a structure to deliver a breathable gas to the patient includes a patient interface including a mouth covering assembly including a cushion structured to sealingly engage around an exterior of a patient's mouth in use, a nozzle assembly including a pair of nozzles structured to sealingly engage within nasal passages of a patient's nose in use without forming a seal on a nasal bridge region of a patient's face, each of the nozzles including a dual wall construction including an inner wall and an outer wall that surrounds the inner wall, and a flexible element connecting the mouth covering assembly and the nozzle assembly.

Abstract: A nasal interface uses asymmetrical nasal delivery elements to deliver an asymmetrical flow through the interface to both nares or to either nare, and a mouthpiece may be inserted to maintain a leak, to improve dead space clearance in the upper airways, decrease peak expiratory pressure, reduce noise, increase safety of the therapy for smaller patients and reduce resistance in the interface allowing desired flow rates to be achieved at reduced motor speeds of associated flow generating devices. Different forms of fittings, such as sleeves or inserts can be attached to nasal delivery elements to improve or optimise the therapeutic effects of nasal high flow. It may allow high pressures to be achieved at lower flow rates, reduce noise, improve patient comfort and efficiently clear anatomical dead space.

Abstract: A headgear or headgear segments are manufactured to shape thereby producing little or no waste material. Techniques such as knitting, braiding, crocheting, and 3D printing can be used produce the headgear.

Abstract: An assembly for modifying airflow into a nasopharyngeal airway of a patient. A valve assembly is adapted to attach to an airflow generator. A solenoid including a piston is mounted exterior to a feed tube. A butterfly valve is within the feed tube at the inlet. A pin is within the piston, and a shaft of the butterfly valve is bent to connect to the pin such that the solenoid can drive the butterfly valve. An exhalation valve is within the feed tube at the outlet, the exhalation valve adapted to slide axially within the feed tube and incrementally cover the outlet. Upon rotation of the butterfly valve, the exhalation valve thereby slides towards the mask side, wherein upon activation of both the airflow generator and a controller circuit, pressurized air from the airflow generator continuously enters the feed tube but is converted to a single, repeatable burst or rush.

Abstract: A medical device assembly is disclosed, comprising a medical device, such as a urinary catheter, and preferably having a hydrophilic surface coating, and a package forming a closed compartment around the catheter. The package is formed of at least one sheet of tearable material and comprises a first weld extending along a first side in a first direction of the package and a second weld extending along a second side in a second direction of the package. The first and second directions are different and preferably orthogonal to each other. A tear line is provided in the second weld, and arranged to direct a subsequent tear towards the first weld. Further, the first weld is provided with an inward protrusion, protruding inwardly towards the closed compartment, at a distance from the second weld. A corresponding method of production is also disclosed.

Abstract: A water disintegratable catheter having a barrier layer disposed on an outer surface and/or inner surface of the catheter wherein the barrier layer comprises a hydrophobic component.

Abstract: Provided is a junction structure between a first tubular member and a second tubular member, and a catheter including the junction structure. An interface between the first tubular member and the second tubular member has an uneven shape in the longitudinal direction of the junction structure along a circumferential direction of the first tubular member and the second tubular member. At least one of the first tubular member and the second tubular member includes a protruding portion that protrudes into the other tubular member only between an inner periphery of the other tubular member and an outer periphery of the other tubular member. The joining strength of the junction structure is improved against a pressure in the radial direction.

Abstract: A system of devices for treating an artery includes an arterial access sheath adapted tointroduce an interventional catheter into an artery and an elongated dilator positionable within the internal lumen of the sheath body. The system also includes a catheter formed of an elongated catheter body sized and shaped to be introduced via a carotid artery access site into a common carotid artery through the internal lumen of the arterial access sheath. The catheter has an overall length and a distal most section length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.

Abstract: A wire assembly having a pre-shaped, flexible distal configuration deliverable through a vascular catheter, that assumes the pre-shaped distal configuration upon exiting the vascular catheter thereby permitting an operator to stabilize the position of a separate vascular guide catheter during a coronary interventional procedure.

Abstract: A grip designed for sliding movement over a urinary catheter shaft, and a urinary catheter system including a urinary catheter and the grip. The grip includes a body designed to surround the urinary catheter shaft, a first flare, and a second flare. The body includes a proximal end, a distal end, and a gripping area between the proximal end and the distal end, the gripping area designed to contact the urinary catheter shaft upon the application of force to the gripping area. The first flare increases in cross-sectional area from the gripping area to the proximal end of the body. The second flare increases in cross-sectional area from the gripping area to the distal end of the body.

Abstract: A device is provided for preventing buckling of a flexible elongate member during insertion of the flexible elongate member. The device includes a support frame comprising a first end, a second end, and multiple pairs of support members. The support frame is configured to reversibly move from a collapsed configuration to an expanded configuration when the first and second ends are moved away from each other. The device also includes multiple open channels coupled to the multiple pairs of support members of the support frame. The multiple open channels are configured to allow the flexible elongate member to be top loaded into the multiple open channels. Also, the multiple open channels are maintained in an axial alignment as the support frame is moved between the expanded and collapsed configurations.

Abstract: An improved bi-directional steerable catheter is provided. The catheter generally comprises a catheter body, tip section and control handle. The catheter further comprises first and second puller wires extending from the control handle, through the catheter body and into the tip section. The control handle has deflection means for each puller wire that include a gear, and a carrier to which the proximal end of a puller wire is anchored. The gear is rotatably coupled to a lever controlled by an operator and the gear engages the carrier such that rotation of the gear by the lever results in longitudinal movement of the carrier, which results in deflection of the tip section.

Abstract: Embodiments include a catheter anchoring device for securing a percutaneous medical catheter inserted at a skin puncture site to a skin of a body. The catheter anchoring device may include a catheter capture portion coupled to a skin attachment portion. The catheter capture portion may be configured to engage with a portion of the catheter protruding from the skin when the catheter is subcutaneously placed in a body. The skin attachment portion may be configured to adhesively attach the anchoring device to the skin, wherein the skin attachment portion is primarily attached to the skin overlaying and lateral to the subcutaneously located catheter.

Abstract: A tubing management apparatus that is operable to provide management of a medical tube. The tubing management apparatus includes a cord having a coiling device coupled to the first end of the cord and a clip secured to the second end of the cord. A plurality of couplers are slidably coupled to the cord intermediate the first end and second end. The plurality of couplers include a body having an upper portion and a lower portion. The upper portion of the body is configured to be slidably secured to the cord. The upper portion of the body of each of the plurality of couplers has an embedded magnet so as to assist in maintaining the couplers adjacent to each other. The lower portion of the body of the plurality of couplers includes various alternative embodiments that are configured to receive and retain a portion of a tube.

Abstract: A catheter assembly including a catheter; a catheter hub fixed to a proximal end portion of the catheter; an inner needle disposed inside the catheter; and a housing supporting the inner needle, the housing accommodating the catheter hub when in an initial state in which a distal end of the inner needle is protruding from a distal end of the catheter. The catheter hub is configured to rotate with respect to the inner needle and the housing when accommodated inside the housing.

Abstract: An integrated vascular delivery system and method of use, the system including: a frame having a catheter hub that provides a first anchoring point on the patient and receives a catheter insertable in the patient to transfer fluid at an insertion site, a stabilization hub that provides a second anchoring point on the patient, at least one lateral member extending between the catheter and stabilization hubs, and a fluidic channel. The frame operates in a folded configuration in which the hubs are coupleable and an unfolded configuration in which the anchoring points are distributed around the insertion site to anchor the frame to the patient, thereby stabilizing the catheter. In some embodiments, the system further includes a septum that helps prevent fluid leakage from the catheter hub, or a needle shield that covers the distal end of a needle used during catheter insertion.

Abstract: Introducer sheaths are described. In one embodiment, an introducer sheath comprises a sheath hub, a fixed housing coupled to the sheath hub, a rotating element rotatably coupled to the fixed housing, a sheath tube fixedly coupled to the rotating element, and a lock coupled to the rotating element. The lock is capable of preventing the rotating element and the sheath tube from rotating with respect to the sheath hub.

Abstract: The device includes a dilator having a locking mechanism configured to limit a distance a guidewire can be advanced out of a distal end of the dilator.