Devices for endovascular access through extracorporeal life support circuits

Abstract

Adaptors, cannulas, caps, tube couplers, and systems thereof provide endovascular access through an established ECLS system. Adaptors having curved or angled shafts navigate right angle side ports of standard bypass cannulas and permit hemostatic introduction and direction of an intervention device to the axial flow path of the cannula lumen and bypass system. A modified cannula having an angled side port is also provided for use as an arterial cannula. A cap having an occluding surface may be inserted into the angled side port to prevent blood from stagnating in the angled side port. A tube coupler is also provided having an access port, such as an angled access port, and may be spliced into an established bypass system for vascular access point. Multiple couplers can be used to provide multiple access points. The adaptors and occlusive cap are interchangeable with each other and with secondary circuits.

What is claimed is: 
     
       1. An occlusive cap for a cannula side port having an angled cannula side port channel with a terminal opening in a wall of a cannula lumen, said side port channel disposed at an acute angle relative to said cannula lumen, said occlusive cap comprising:
 a cap connector threadably received on the exterior of said side port for selectively retaining said occlusive cap on said cannula side port; and   an occluding member extending from said cap into said cannula side port channel and extending to and filling said terminal opening when said occlusive cap connector is fully retained on said cannula side port for thereby preventing inflow of fluid into said terminal opening and said cannula side port channel;   said occluding member terminating in an occluding surface at said terminal opening that is disposed at an acute angle relative to the direction of extension of said occluding member and flush with said cannula lumen wall whereby laminar flow through said cannula lumen is not disrupted, edges of said occluding surface being adjacent to and abutting interior surfaces of said side port channel to thereby form a tight fit therewith;   said occluding member further including a locking member disposed between said occluding member and said side port channel for retaining the orientation of said occluding surface flush with said terminal opening when said occlusive cap connector is fully retained on said cannula side port, and   said cap connector including a floating Luer connection securing said occlusive member to said cannula side port.   
     
     
       2. The occlusive cap according to  claim 1 , wherein said occluding member has a diameter corresponding to said cannula side port channel. 
     
     
       3. A method, comprising:
 providing endovascular access through an extracorporeal life support system, which includes providing an access port having a port opening at its terminal end and a port channel extending through it for the introduction of an intervention device to a flow path of the extracorporeal life support system; and   when endovascular access through the extracorporeal life support system is not in use, inserting and securing an occlusive cap having an occluding surface into the access port, thereby sealing off the port channel by way of the occluding surface,   wherein a perimeter of the occluding surface is positioned adjacent to a wall defining the port channel and a wall defining the flow path.    
     
     
       4. The method of  claim 3 , further comprising removing the occlusive cap from the access port when endovascular access through the extracorporeal life support system is in use.  
     
     
       5. The method of  claim 3 , wherein the extracorporeal life support system is an extracorporeal membrane oxygenation circuit.  
     
     
       6. The method of  claim 3 , wherein providing endovascular access through the extracorporeal life support system includes providing access into a patient's cardiovascular system.  
     
     
       7. The method of  claim 6 , further comprising introducing one or more intervention devices into the patient's cardiovascular system.  
     
     
       8. The method of  claim 3 , wherein providing endovascular access through the extracorporeal life support system includes establishing secondary perfusion for distal perfusion.  
     
     
       9. The method of  claim 3 , wherein providing the access port includes splicing a tube coupler into the extracorporeal life support system.  
     
     
       10. The method of  claim 9 , further comprising restricting the flow path of the extracorporeal life support system at a location upstream of the splice location prior to splicing the tube coupler into the extracorporeal life support system.  
     
     
       11. The method of  claim 9 , wherein splicing the tube coupler into the extracorporeal life support system includes coupling a first end of the tube coupler adjacent a proximal end of a cannula and coupling a second end of the tube coupler to tubing of the extracorporeal life support system.  
     
     
       12. The method of  claim 11 , wherein the first and second ends of the tube coupler include one or more ribs, barbs, serrations, or bevels.  
     
     
       13. The method of  claim 3 , wherein providing the access port includes providing multiple access ports by splicing two or more tube couplers, each having an access port, into the extracorporeal life support system.  
     
     
       14. The method of  claim 3 , wherein providing the access port includes providing multiple access ports by splicing a single tube coupler having a plurality of access ports into the extracorporeal life support system.  
     
     
       15. The method of  claim 3 , wherein providing the access port includes providing a cannula having an angled side port.  
     
     
       16. The method of  claim 3 , wherein inserting and securing the occlusive cap in the access port includes locking an orientation of the occluding surface.  
     
     
       17. The method of  claim 16 , wherein, in the locked orientation, the occluding surface is flush or coextensive with the wall defining the flow path of the extracorporeal life support system.  
     
     
       18. The method of  claim 16 , wherein locking the orientation of the occluding surface includes engaging a locking projection located at the perimeter of the occlusive surface with a locking recess located in the port channel.  
     
     
       19. The method of  claim 3 , wherein securing the occlusive cap in the access port includes engaging a luer lock connection between the occlusive cap and the access port.  
     
     
       20. The method of  claim 19 , wherein a connector of the occlusive cap is threadably received by an exterior rim of the port opening.  
     
     
       21. The method of  claim 3 , wherein inserting and securing the occlusive cap in the access port includes simultaneously forming an occlusion arrangement configured to prevent-blood stagnation or thrombus formation in the port channel.  
     
     
       22. The method of  claim 3 , wherein inserting and securing the occlusive cap in the access port includes simultaneously forming an occlusion arrangement configured to maintain-laminar blood flow in the flow path of the extracorporeal life support system.  
     
     
       23. The method of  claim 3 , wherein the flow path of the extracorporeal life support system is maintained open for 6 hours or more, regardless of whether the endovascular access is in use or not.  
     
     
       24. A method, comprising:
 providing endovascular access through an extracorporeal life support system, which includes providing an access port having a port opening at its terminal end and a port channel extending through it for the introduction of an intervention device to a flow path of the extracorporeal life support system; and   when endovascular access through the extracorporeal life support system is not in use, inserting and securing an occlusive cap having an occluding surface into the access port, thereby sealing off the port channel by way of the occluding surface,   wherein inserting and securing the occlusive cap includes locking an orientation of the occluding surface in the access port, and wherein, in the locked orientation, the occluding surface is flush or coextensive with a wall defining the flow path of the extracorporeal life support system.    
     
     
       25. The method of  claim 24 , wherein locking the orientation of the occluding surface includes engaging a locking projection of the occlusive cap with a locking recess in the port channel.  
     
     
       26. An occlusive cap for a cannula side port having an angled cannula side port channel with a terminal opening in a wall of a cannula lumen, said side port channel disposed at an acute angle relative to said cannula lumen, said occlusive cap comprising:
 a cap connector threadably received on the exterior of said side port for selectively retaining said occlusive cap on said cannula side port; and   an occluding member extending from said cap into said cannula side port channel and extending to and filling said terminal opening when said occlusive cap connector is fully retained on said cannula side port for thereby preventing inflow of fluid into said terminal opening and said cannula side port channel;   said occluding member terminating in an occluding surface at said terminal opening that is disposed at an acute angle relative to the direction of extension of said occluding member and flush with said cannula lumen wall whereby laminar flow through said cannula lumen is not disrupted, edges of said occluding surface being adjacent to and abutting interior surfaces of said side port channel to thereby form a tight fit therewith;   said occluding member further including a locking member disposed between said occluding member and said side port channel for retaining the orientation of said occluding surface flush with said terminal opening when said occlusive cap connector is fully retained on said cannula side port; and   said cap connector including a floating Luer connection securing said occlusive member to said cannula side port.    
     
     
       27. The occlusive cap according to  claim 26 , wherein said occluding member has a diameter corresponding to said cannula side port channel.