Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
WO 91tlO466 ~ ~ ~ 3 j~ PCT/US91/00161
MICROCIDAL AGENT RE~SING CA~ER
FIELD OF THE INVENTION
The pres-nt invention relates to catheters for
insertion into body cavities or the like and having
means for killing microorganisms growing in regions or
adjacent to the exterior surface of the catheter. The
present invention also relates to methods for making the
same and products made by the inventive methods.
BACKGROUND OF THE_INVENTION
Most catheters can be described as some sort of
tube like device which is inserted into a portion of a
person~s body in order to transport fluids or gases in
or out of that particular portion of the body. In
passing through any particular portion of the body in
- order to reach its destination, the catheter will come -~
into contact with various tissues in the body. For ~ -
example, a catheter used to drain one's bladder (such as
a "Foley" catheter) must pass through the urethral tract
in ordex to reach the bladder. A nasogastric catheter
must pass through the nasal passageway and the esophagus
in order to reach the stomach. Some catheters, such as
these, are inserted through existing passageways in
order to reach their destinations, while others are
inserted through surgically created passageways.
In virtually every catheterization, there is a
significant potential for irritation of the tissues
which come into contact with the catheter as the
catheter is inserted and as it is withdrawn from the
respective body cavity, passageway or body portion, and
for microbial growth along the exterior surface of the ;
catheter which can lead to serious infections such as
urinary tract infections, bladder infections and the
35 like. These infections can lead to sepsis of the `
bladder which is often fatal for incontinent patients
who must be catheterized with an indwelling self-
retaining catheter such as a "Foley" catheter.
In addltion, there is a significant potential ~
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WO91/10466 ,~ PCT/US91/00161
for irritation of the tissues in contact wi-th the outer
surfaces of the catheter during the period of time when
the catheter resides within the respective passageway
occupied by the catheter. This can be a very painful
problem for the patient who must live with the
irritation caused by the catheter as it rubs against the
adjacent tissues in the respective passageway.
The rubbing and chafing which normally occurs
is usually caused by unavoidable slight movements of the
catheter tube resulting from movement of the patient.
It will be appreciated that various portions of the
catheter are often connected wi~h equipment outside of
the body which may or may not move in response to the
movement to the body. When the patient moves the
catheter must also move in reaction to the movement of
the portions of the body to which it is engaged. Such `
movements may conflict with the lack of movement of an
apparatus outside of the body to which the catheter is
connected, or movement of different body portions may
cause movement of the catheter with respect to one or
both of the respective body portions which is
inconsistent with the maintenance of relative spacial
contact with outer surfaces of the catheter in one or
both of the respective body portions. Simply put, body
movement generally causes slight twists, pulls and/or
pushes on the catheter which can rub, irr tate and chafe
against the tissues in the respective ad~acent
pas~ageway or body portion.
It will be appreciated that this creates a
great deal of discomfort for the patient who must be
catheterized. In many situations, the most
uncomortable aspect of being hospitalized can be the
fact that the patient must be catheterized for a
significant period of time during his or her hospital
stay. The catheter can be so irritating to one's
adjacent tissues that the patient may become relatively ;
tense and rigid because of their fear of movement which
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WO 91/10466 ~ ~ r~ PCl`/US91/00161
will result in further irritation of already irritated
and sore tissues in areas adjacent to the catheter.
This can virtually incapacitate a patient when the
tissues become so sore that any movement causes
significant pain and discomfort. It is also noted that
irritated tissues are believed to be more susceptible to
infection problems, so that irritation of the respective
tissues adjacent to the catheter can cause an increase
in the risk of infection which accompanies the patients -
10 discomfort. -
The use of a nasogastric catheter is an obvious
example of this latter problem. After the patient has
been catheterized for several days, the nasal passageway
and the throat invariably become sore. The slight
rubbing of the tube inside these passageways each time
the patient moves his or her head or body, causes
extreme discomfort once the tissues have become
irritated by previous rubbing and chafing against the ~ ~ -
catheter. Often, the passageway remains sore for a
significant period of time after the catheter has been
removed, and is a significant source of discomfort
during the hospitalization or treatment.
Accordingly, it will be appreciated that there
i9 a need for a catheter which will address these and
other problems associated with the prior art catheters.
The present invention provides advantages over the prior
art catheters and over the prior art methods for
manufacturing catheters, and also offers other
advantages over the prior art and solves other problems
associated therewith.
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SUNMARY OF TEIE INVENTION
Accordingly, it is an object of the present
invention to provide an elongated catheter comprising an
interior surface and an exterior surface. The interior
surface defines a lumen passing through the catheter.
The catheter further includes an enclosed sleeve cavity
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WO 91/1046~f~ PCT/US91/00161
between the interior and exterior surfaces which
encircles a portion of the lumen. The sleeve cavity has
an inner wall and an outer wall, wherein the outer wall
is a resilient sleeve which can stretch generally
independently of the inner wall and the cavity contains
an amount of suitable bactericidal agent in a suitable
carrier substance, wherein the inner wall and the outer
wall are joined together at distal and proximal ends of
the sleeve cavity. The resilient sleeve includes
diffusion permitting means for permitting the
bactericidal agent to di~fuse out of the cavity when the
sleeve is an aqueous environment, but otherwise
substantially restricting the bactericidal agent to the
sleeve cavity unless the contents of the sleeve cavity
are acted upon by a measurable mechanical or unless a
measurable pressure differential exists across the
resilient sleeve. In preferred embodiments said
diffusion permitting means will include a plurality of
micropores which permit the bactericidal agent to
diffuse across the resilient sleeve into suitable
aqueous environments from the sleeve cavity when the
aqueous environment lacks a concentration of
bactericidal agent equal to that of the carrier -
substance.
It will be appreciated that the microcidal or
bactericidal agent releasing catheter of the present
invention will provide significant advantages over the
prior art devices which provide no bactericidal
capability. In addition, the present invention also
provides advantages over catheters including
bactericidal agent containing carrier substances within
a cavity separated from the surrounding environment by a
wall having large openings for the transfer of the
carrier substance into the surrounding environment. The
use of these large openings will be appreciated to be
ineffective to provide appropriate release of the
bactericidal agent into the surrounding environment as
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~091/10466 '~ 3 PCT/US91/00161
this release is unrestricted. Furthermore, such a
device will be difficult to store and also difficult to
handle and/or insert in an appropriate environment such
as a urethral tract or the like. Because the present
5 invention provides significantly better control over the ~
transfer of the bactericidal agent into the environment --
surrounding ~he catheter, a transfer regulated by the ; -
natural forces generally associated ~ith diffusion into
an aqueous e~vironment, the present invention provides
new technology which is needed in the catheter art.
It will also be appreciated that the resilient
sleeve of the present catheter will allow the portion of
the cathe~er defining the lumen ~o move independently of
the exterior surface of the catheter proximate the
sleeve cavity, so that when the catheter is forced to
move in response to movement of a portion of the body,
the resilient sleeve of the catheter will not -
necessarily have to move with the movemant of the other --
portions of the catheter. When an end of the catheter
moves in response to the movement of a certain portion
of the body, for example, the resilient sleeve of the
outer wall can stretch and twist to stay in the same
relative contact with or adherence to proximate or
adjacent body tissues, while the inner wall and the
lumen are permitted to move in to the respective
adjacent body tissues without disrupting the relative
contact or adherence existing between the exterior
surface o~ the resilient sleeve and these adjacent body
tissues. Therefore, when the catheter is pulled, pushed
or twisted, the resilient sleeve can stretch so that the
movement of the rest of the catheter will not
necessitate relative displacement of the adjacent
tissues in respect to the exterior surface proximate the
sleeve, because the sleeve can stretch and stay in the
same position with respect to the adjacent tissues,
thereby reducing the potential for rubbing, chafing and
irritation of these tissues.
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WO91~1046S ~s~ PCT/US91/Ofl~C1
The present invention offers substantial
improvements over the prior art. Some of these
improvements relate to the comfort provided by the
sleeved catheters of the present invention, while others
have to do with the automated catheter manufacturing
methods, the preferred materials used to make the
catheters, the price of the present catheters in view of
the methods and materials used, and the like. Many of
the advantages of the automated manufacturing process
ar~ similar to those enumerated in co pending U.S.
Patent Application Serial No. 462,832 which is
incorporated herein by reference. The lubricated
sleeve, however, is disclosed in the present application
and is believed to provide significant advantages over
the prior art devices as will be evident from the
discussion below.
Foley-type self retaining catheters provide an
artificial conduit from the bladder to an external
collection device. Prior art Foley catheters generally
consist of a round bilumen tube which serves as a
"drainage pipe" from the bladder to the external
collection device. The urethral tract itself, which is ;
generally less than two inches long in women and several
inches long in men, is actually believed to be a fairly
flat ribbon-shaped passageway. When Foley catheters are
inserted into the bladder via the urethra, the catheter
is generally forced into the urethra so as to force the
ribbon-shaped passageway to open and to remain open for
as long as the patient is catheterized. To avoid the
problem of having urine drain down the outside of the
catheter within the urethral passageway, it is standard
practice to use a catheter of sufficient diameter so
that it will "fill" the passageway. Therefore, it is
common practice to pick a catheter which has a large ;~
enough outside diameter to hold the urethra "wide open~.
In order to do this, it is necesszry to pick a catheter
which has an outer diameter which is the same size as
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WO91/10~6 ~ ~ 7 3 ~ PCT/VS91/00161
the passageway when it is fully open. Unfortunately,the
tissues of the urethral tract include soft, sensitive
tissue which often becomes sore and irritated as the
catheter, which is formed to the human body, rubs and
chafes against it. Apart from the sheer discomfort
involved, it is also noted that the outer surfaces of ~
the irritated and sore tissues are more readily :-
colonized by bacteria than are healthy tissues. This
can result in more frequent bacterial infections from
catheterizations of the urethral passageway and the
bladder. Because long term catheterization is common,
particularly for elderly patients who are incontinent,
this is a significant problem. The present sleeved
catheters, which include a resilient sleeve which can
move independently of other portions of the catheter,
particularly the main portion of the catheter `
surrounding the interior lumen or lumens, can provide
significant relief in respect to the physical stress
upon the body tissues adjacent to the catheter,
20 particularly those of the urethral tract in contact with :
a sleeved Foley catheter of the present invention.
Instead of the stiff, unforgiving exterior surface of a
prior art catheter which is relatively unyielding in
respect to the adjacent body tissues, the present
invention includes an exterior surface which yields to
the ad~acent body tissues with which it is in contact
when other portions of the catheter are moved. The
exterior surace of the present invention includes a
xesilient sleeve which, in preferred embodiments,
surrounds a significant amount of a cushioning or a
lubricating substance which enables the resilient sleeve
to provide the surrounding adjacent body tissues with a
soft, "cushy" collar around the catheter which reduces
~echanical stress on these adjacent body tissues.
The present invention reduces stress on the
adjacent body tissues in the following ways. The
conduit portion of the catheter can be moved and twisted ;~
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WO91/104~6~ PCT/~S91/001~1
independently of the exterior surface of the resilient
sleeve portion of the sleeved catheter. Normal patient
activity will cause both external and internal pressures
on the catheter which will bias it toward movement in
S one direction or another. Since the thin resilient
sleeve is separated from the main conduit portion of the
catheter by a cushioning substance, preferably a
lubricating gel or the like, it can easily move,
stretch, compress and the like independently of the less
flexible main conduit portion of the catheter which
surrounds the lumen or lumens thereof. It is important
to appreciate that this works in two ways. If body
movements cause pressures or motion the comfort sleeve
will, with negligible resistance, adjust its shape and
position to conform to these movements without
resistance or movement of the main conduit portion of
the catheter. Conversely, external movement of the main
conduit portion of the catheter, such as twisting,
stretching, bending and the like, can take place
essentially independently of the thin resilient sleeve
of the exterior surface. Thus, the mechanical stresses
at the tissue/catheter interface are greatly reduced.
In addition, in preferred embodiments where the
thickness o~ the lubricating substance or gel is
maximized to increase khe volume of the sleeve cavity
between the resilient sleeve and the main conduit
portion of the catheter, the resilient sleeve is able to
conform to the actual shape of the passageway through
which it extends when inserted into the body. This is
preferred over the generally non-compliant cylindrical
tube which most catheters provide. For example, prior
art Foley catheters inserted into the urethra put
unnatural and unbalanced pressures on the tissues of the
urethral wall as it holds the urethra open. The
cushioned sleeve of the preferred embodiments of the
present invention, on the other hand, will provide an
exterior surface which is soft and compliant. This
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~O~1/10~6 ~ 7 ~ PCT/US91/00161
surface will confoxm to the surfaces of the adjacent
body tissues with which it comes into contact. In this
way, the preferred catheters of the present invention
will conform to the natural shape of the catheterized
passageway in which it resides. In addition, it is also
important to note that the present invention also -~
provides prefexred catheters which will enable health
care professionals to provide patients with catheters -
which are more accurately sized for the passageway in
which they are to be inserted. For instance, most women
are fitted with Foley-type self-retaining catheters
having outside diameters of 16, 18 and 20 French. On
the other hand, the compliance nature of the resilient
sleeve of preferred sleeved Foley catheters of the
lS present invention allows the displacement of a portion
of the volume in the sleeve cavity, which provides a
cushion to the resilient sleeve, to be displaced by
portions of the urethral track where it flattens out.
Therefore, the preferred embodiments of the present
invention will provide an exterior surface which can
have a variable outside diameter so as to accommodate
urethral tracts having different requirements.
Furthermoxe, the preferred embodiments of the present i `
invention will be more likely than the non-compliant
prior art devices to accommodate variations in the wall
of the urethral tract. Also, once properly itted with
a preferred embodiment o the present invention, the
conduit portion of the catheter will be able to slide
back and forth without disrupting the interface between
the exterior surface proximate the resilient sleeve and
the ad~acent body tissues of the passageway in which the
catheter resides.
It will be appreciated that catheters having
different sleeve cavity volumes will be needed for :
different applications. It will be extremely
advantageous fo~ the lubricating substance in the sleeve
cavity of certain preferred embodiments to be of
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WO 91/10466 ~ PCI'/l~S91/O~
!,i ~J
sufficient thickness that this substance significantly
separates the resilient outer sleeve from the outer wall
of the conduit portion of the catheter so that the outer
sleave, when inserted in or when residing in a body
5 passageway, will be soft and compliant such that the -
exterior surface proximate the resilient sleeve will
provide accommodation to the differences in the shape of
the orifice and the remaining portions of the passageway ;
and will provide a "cushioned", soft interface between
the adjacent body tissues and the preferred catheter.
It will also be appreciated that, even when the catheter
is pulled or twisted to such an extent that the outer
sleeve does move slightly in respect to the adjacent
body tissue, the resulting damage to those tissues will
be significantly less than would generally be the case
for prior art catheters. This is because the sleeve is
very soft and compliant in response to the cushioning
effect of the cushioning substance or lubricating gel in
the sleeve cavity, and is therefore cushioned from what
20 would be generally a harsher, more rigid surface of the ;
prior art catheters.
It will be appreciated from a further review of
the present invention that the methods of the present
invention provide great advantages over the prior art
methods of making catheters which generally employ
significant amounts of hand labor. These and various
other advantages and features of novelty which
characterize the present invention are pointed out with
particularity in the claims annexed hereto and forming a
part hereof. However, for a better understanding of the
present invention, its advantages and other objects
obtained by its use, reference should be made to the
drawings, which form a further part hereof, and to the
accompanying descriptive matter, in which there is
illustrated and described preferred embodiments of the
present invention.
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WO91/10466 ~ , PCT/US9l/0~161 ~;
BRIEF DESCRIPTION OF THE DRAWINGS
In the drawings, in which like reference
numerals indicate corresponding parts throughout the
several views,
Figure l is a transverse schematic view of an :
extruded tube in partial cross-section; .
Figure 2 is a transverse schematic view of an
intermediate tube formed ~rom the extruded tube shown in
Figure l; ~ .
Figure 3 is ~ schematic view of a portion of a
rack or pallet used to retain a plurality o~
intermediate tubes during a series of steps designed to :
provide the tubes with overcoat layers of polymeric
bonding composition, wherein a single intermediate tube ~.
is shown secured to a single support rod and following a
first dipping step wherein a portion of the outer '`:
surface of the intermediate tube is coating with a -
lubricating material; :. :
Figure 4 is a transverse schematic view of an
2~ intermediate tube similar to that shown in Figures 2
and 3, but following a second dipping step wherein the
coating of lubricating material on the outer surface of
the intermediate tube has been partially removed;
Figure 5 is a transverse sectional schematic
view of an intermediate tube similar to that shown in
Figure 4 following a subsequent dipping steps or steps .
in which an overcoat layer is formed over the outer .
surface thereof;
Figure 6 is a transverse sectional schematic l:
view of an elongated catheter in accordance with the
present invention;
Figure 7 is a transverse schematic view of an .
extruded double lumen tube in partial cross-section;
Figure 8 is a cross-sectional view of the
35 extruded double lumen tube as seen from the line 8-8 of ; :
Figure 7; .. :
Figure 9 is a transverse schematic view of the ~
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WO 91/10466 ~ ~ PCl`/VS91/OOt'l '
tube shown in Figure 7 after an opening is punched in
the outer surface;
Figure 10 is a cross-sectional view of the tube
as shown from the line 10-10 of Figure 9;
Figure ll is a transverse schematic view of the
double lumen tube shown in Figure 9 after a portion of
the first lumen has been filled with a polymeric bonding
composition;
Figure 12 is a cross-sectional view of the tube
as seen from the line 12-12 of Figure 11;
Figure 13 is a transverse schematic view of the
double lumen tube shown in Figure 11 after a tip is
affixed to a distal end of the tube;
Figure 14 is a schematic view of a portion of a
rack or pallet used to retain a plurality of tubes
during a series of steps designed to provide the tube
with an overcoat layer of a polymeric bonding
composition; ~`
Figure 15 is a transverse schematic view of an
intermediate tube similar to the tube shown in Figure 13
at.an intermediate stage of manufacture following to the
first of.a series of dipping steps;
Figure 16 is a transverse schematic view of an
intermediate tube similar to that shown in Figure 15,
but following A second dipping step wherein a coating o
bond preventing lubricating agent on the outer surface
has been partially removed;
Figure 17 is a cross-sectional view of the
intermediate tube of Figure 16 as shown from the line
17-17;
Figure 18 is a view of an intermediate tube
similar to that shown in Figure 16, but after a
subsequent dipping step or steps;
Figure 19 is a view of an intermediate tube
similar to that shown in Figure 18, but after yet
another dipping step or steps;
Figure 20 is a cross-sectional view of the
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WO91/10466 2 j ~ P~T/US91/00161
balloon catheter shown in Figure 19 from the line 20-20;
Figure 21 is a transverse schematic view of a
portion of a balloon catheter formed from the
intermediate tube shown in Figure 19, following a
5 further dipping step to create an overcoat layer; .
Figure 22 is a perspecti~e view of a portLon of
a balloon catheter similar to that shown in Figure 21,
but wherein the balloon catheter has been severed
through the sleeve cavity and the remaining portion of
the sleeve has been twisted to demonstrate its
independence of the outer surface of the extruded double
lumen tube used to make the balloon catheter;
Figure 23 is a transverse schematic view of a :
balloon catheter similar to that shown in Figure 21, but : :-
including an end piece and showing a sectional view of a
portion of catheter wherein the balloon portion of the
catheter is expanded;
Figure 24 is a cross-sectional view of an
alternate embodiment of the balloon catheter shown in .
Figure 23 as that embodiment would be seen from a line
similar to the line 24-2~ of Figure 23, were Figure 23
to show that embodiment; ::
Figure 25 is a transverse schematic view
similar to that shown in Figure 23, but showing another
alternate embodiment of a balloon catheter made in
accordance with the present invention and including a
plurality of first lumen access openings;
Figure 26 is a transverse schematic view of yet
another embodiment of the present invention similar to
the view shown in Figure 23;
Figure 27 is a partial side sectional view of
the catheter shown in Figure 21 being stamped by a:~:~
perforating device in a channel-like recess of a
stamping block; .
Figure 28 is a magnified sectional view from
the line 28-28 of Figure 27 showing a plurality of
pointed extension members which have passed through the
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WO91/1046-6~ " PCT/US91/00lfil
14
resilient sleeve of the catheter to form a plurality of
micropores;
Figure 29 is a transve.rse schematic view of yet
another embodiment of the present invention similar to
the view shown in Figure 26 but showing a third lumen in
communication with a sleeve cavity wherein the sleeve
includes a plurality of micropores (not shown);
Figure 30 is a sectional view of the catheter
shown in Figure 29 from the line 30-30;
Figure 31 is a transverse schematic sectional
view showing a portion of the catheter shown in Figure
26 when inserted in a urethral tract;
Figure 32 is a schematic illustration of
apparatus used to automate the production of catheters
15 in accordance with the present invention; and -
Figures 33A, 33B and 33C are flow charts
xepresenting certain steps in methods in accordance with
the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings, and specifically
to Figures 1-6, the present invention provides an
elongated catheter 5 (see Figure 6) having an interior
suxface 7 and an exterior surface 9. The interior
surface 7 deines a lumen 8. The elongated catheter 5
is preferably made from a tube 2 (see Figure 1) which is
eventually coated with an overcoat layer 42 of resilient
polymeric material which binds to an outer surface 14 of
the tube 2 unless the bonding of the polvmeric material
is prevented by other materials or means on the outer
surface 14.
The overcoat layer 42 of the elongated catheter
5 in accordance with the present invention, includes a
sleeve 44 wh.ich encircles a sleeve cavity 45 which
contains lubricating material 38. The lubricating
material or substance 38 is effective to permit the
sleeve 44 to slide along the outer surface 14 of the
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WO91/10~66 PCT/US91/00161
~ 3 ~
tube 2 proximate the sleeve 44 while in lubricated
contact with the outer surface 14. When applied in
sufficient thicknesses, the lubricating material serves
to separate the soft outer sleeve 44 from the tu~e 2,
such that the outer sleeve 44 provides a soft,
cushioned, compliant exterior sur~ace which can adapt :
and conform under slight pressures to the shape of the
passageway in which it is inserted or residing.
Depending on the catheter application and/or type, the
amount of the lubricating substance 38 and the sleeve
cavity ~5 can be minimized to provide for only a limited
increase in the outer diameter of the catheter proximate
the outer sleeve 44. In other cases, a soft, cushioned, ~ -
compliant sleeve which can adapt its shape is desirable.
In these embodiments, there is a relatively thick
coating of lubricant material 38 in the sleeve cavity 45
which will give the sleeve 44 a balloon-like feel and
appearance in the exterior surface proximate the sleeve
44. The elongated catheter 5 is preferably made of a
flexible elastomeric material such as latex, silicone
rubber or the like, most preferably silicone rubber. -;
The lubrica~ing material or substance 38 is preferably :
any biocompatible lubricating substance which is
effective to permit respective polymeric surfaces to
`25 slide with respect to one another when in lubricated
contact therewith. Preferably, the lubricating
substance 38 is a hydrophobic oil or other petroleum
based product or water-soluble soap, detergent, gel or
the like, either of which is effective to lubricate `
polymeric surfaces and to generally prevent bonding
thereto by other polymeric substances when coated ~ ;
thereby. In a preferred embodiment, the lubricating
substance 38 is petrolatum. In other embodiments the `
lubricating substance 38 can be a carrier substance 38
which includes a microcidal or bactericidal agent which
is effective to kill microorganisms or bacteria. The
carrier substance 38 can be a water-soluble lubricating
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WO91/10466 ~ ' PCT/US91/001~1
16
gel (eg. KY Jelly~, Hydrogel~, and the like), a coating
substance formulated to contain aqueous polyvinyl
alcohols and the like, petroleum jelly or petrolatum,
water-soluble soaps, de~ergents, bulking agents (such as
Glycerin, ~ethylcellulose, PVB, Sodium Carboxycellulose,
Xanthan Gum and the like) and the like, and of the
lubricating substances referenced above, and the like.
The first step in making an elongated catheter
5 in accordance with the method of the present invention
is to provide a tube 2 having an outer surface 14 and an
inner surface 7 defining a first lumen 8. The distal
end 16 of the tube 2 is preferably inserted into a
molding apparatus (not shown) designed to mould a tip 20
on the distal end 16 of the tube 2 to form the
lS intermediate tube 3 (see Figure 2). In a preferred
process of the present invention, the intermediate tube
3 is then secured on a support rod 26 of a rack or
pellet 24 which preferably includes a plurality of
support rods 26. Preferably, a plurality of
intermediate tubes 3 are secured on the plurality of
support rods prior to subjecting the intermediate tubes
3 secured on the support rods 26 to a series of dipping
steps in the preferred process.
After the intermediate tube 3 is formed from
the Lnitial tube 2, the outer surface is coated from the
lowest portion of the tip 20 up to a location on the
outer surface 14 designated by the dashed line A, as
shown in Figure 3, with the lubricating substance.
Subsequently, the lubricating substance coating the
outer sur~ace 14 of the tube below a location proximate
the dashed line designated B, as shown in Figures 3 and
4, is stripped from the outer surface 14 and the tip 20.
The intermediate tube 3 is then coated with a resilient
polymeric bonding composition which forms the overcoat
layer 42. The overcoat layer 42 bonds to the tip 20 and
a portion of the outer surface 14a below the dash line
designated B, and to a portion of the outer surface 14b
WO91/1~6 PCT/US91/00161
3, ,1 9
above the line designated A. In the area proxima~e to a
portion of the outer surface 14c between the dash lines
designated A and B, respectively, which remains coated
with lubricating material 38, the overcoat layer 42
forms a sleeve 44 which encircles the lubricating
material 38 coating the portion of the outer surface 14a
between the dash lines designated A and B, which
cooperates with the sleeve 44 to define the sleeve
cavity 45 in which the lubricating material 38 proximate
the sleeve 44 is contained. After the overcoat layer 42
is formed upcn the intermediate tube 3, a pair of fluid
conduit openings 56 are preferably created, most -
preferably punched, to permit fluid to pass into or out
of the lumen 8 proximate the distal end 16. It will be
15 appreciated that, although the overcoat layer 47 and the :
wall ll of the tube are shown in Figure 6 to be separate
elements, when made of identical polymeric materials, as
is the case with the most preferred embodiments of the
present invention which are made of silicone rubber, the
wall ll and the overcoat layer 42 will be bonded
together where they interface with one another so that
it is virtually impossible to distinguish between the
two and so that there is no part line in spite of the
fact that a part line is shown in Figures 5 and 6. In `
the preferred embodiments, where these elements are
~oined together, it will be appreciated that they form
an integral membrane or wall.
The ~pecific procedures used to form the
present elon~ated catheter 5 will include steps similar
to the steps used for similar purposes as described
hereinbelow.
Pre~erred embodiments of the elongated catheter
5 will include a plurality of micropores (too small to
be shown) in the resilient sleeve 44 which will permit a
carrier substance 38 including a microcidal or
bactericidal agent to diffuse out of the sleeve cavity
~5 when the catheter 5 is inserted into a suitable
WO91/10466 ~ PCT/US91/00161
18
aqueous environment which lacks the concentration of the
specific bactericidal agent or agents as are contained
in the carrier substance 38 within the cavity 45. It
will be appreciated, however, that some combinations of
carrier agent, bactericidal agent and sleeve material
will allow for diffusion across the resilient sleeve
simply by virtue of the structure of the sleeve material
and the characteristics of the carrier agent and/or the
bactericidal agent. In such an embodiment, the
bactericidal agent will be able to diffuse directly
through the resilient sleeve, and no micropores will be
required to permit this agent to pass across the barrier
the sleeve might otherwise present.
The microcidal or bactericidal agent or agents
contained within the carrier substance 38 may be any
agent which is effective to kill microorganisms or
bacteria killing in regions on or adjacent to the
exterior surface 9 of the catheter 5. These agents
include, but are not limited to, antibiotics, including
sulfa drugs and the like, and other microcidal and
bactericidal agents. Included among these agents are
nitrofurantoin, sulfamethoxazole, trimethoprim, mixtures
thereof such as Bactrim~ and the like, and other
equivalents. When enclosed within the sleeve cavity 45
by a resilient sleeve 44 which includes a plurality of
microporeq, the bactericidal agent can diffuse out of
the cavity 45 when the exterior suxface 9 proximate the
resilient sleeve 44 is located in an aqueous
environment. However, the micropores (not shown) are
also small enough to substantially restrict the
bactericidal agent to the sleeve cavity 45 when the
exterior surface 9 proximate the resilient sleeve 44 is
not located in a suitable aqueous environment unless the
contents of the sleeve cavity 44 are acted upon by
measurable mechanical force or unless a measurable
pressure differential exists across the resilient sleeve
44. As used herein, a pressure differential across the
;' ' `, '
.
: :. .. .
WO91/10466 PCT/US91/00161
~ ,3 ~
19 -,
~esilient sleeve 44 is a pressure differential across
the inside and outside surfaces of the resilient sleeve
44. In addition, as used in the present application, a
micropore is an orifice having a circumferential :.
5 diameter small enough so that it is effective to retain :
the carrier substance within a sleeve cavity 45 of an
embodiment of the present catheter unless the carrier -:
substance is vaporized or acted upon by forces resulting
from a pressure differential across the resilient sleeve :
44.
While any embodiment of the present invention
may include a bactericidal agent or agents and the
lubricating substance 38 or carrier substance 38
contained within the sleeve cavity 45 of that particular -
embodiment, and while any of the resilient sleeves 45 of
any of these embodiments may contain micropores in ::.
accordance with the description herein above, it will : .
be appreciated that these micropores will be so small as .
to be barely perceptible, if perceptible at all, to the -
naked eye. Further reference found here and below will
provide further description of the micropores discussed
herein abo~e (see discussion Figures 27 and 28 herein
below). It will be appreciated that the use of a
resilient sleeve 44 including a plurality of micropores
~not shown) to restrict the bactericidal agent to the
sleeve cavity ~5 except when the bactericidal agent is
able to diffuse out of the cavity 45 when the sleeve is
in a suitable aqueous environment as described herein
above, and except when the contents of the sleeve cavity
30 are acted upon by measurable mechanical force or unless .
a measurable pressure differential exists across the
resilient sleeve, provides a significant advantage over
a wall having large openings for the passage of a
bactericidal agent carrying substance contained within a
catheter cavity which would allow the bactericidal agent
carrying substance to pass across the wall simply when
acted upon by ordinary forces such as the force of
WO91/10466; ~ ! PCT/US91/001~1
gravity. In such a circumstance, it will be appreciated
that it would be very difficult to store and package a
catheter having such a wall including large openings as
described. Another disadvantage of such a catheter
would be appreciated upon inserting the catheter into a
passageway such as a urethral tract or the like. In
such a case, the force of the wall of the urethral tract
would provide pressure upon the wall of the catheter
which would tend to immediately force the bactericidal
agent carrying carrier substance out of the catheter
cavity via the large openings in the wall, resulting in
the immediate distribution of the bactericidal agent to
the urethral tract then causing a reduction of the
bactericidal agent carrying carrier substance remaining
in the catheter cavity for future transfer across the
wall. It will be appreciated that is can result in a
lack of bactericidal activity in the regions on and
ad~acent to the exterior surface of the catheter at a
point in time after the normal bodily functions reduce
and/or remove the quantities of bactericidal agent from
the vicinity of the catheter. Therefore, it will be
appreciated that the preferred embadiments of the
present invention which include a plurality of
micropores (not shown) in the resilient sleeve 44 will
provide advantages over a catheter having a wall
including large openings for the simple passage of
bactericidal agent carrying carrier substances located
within the catheter.
Referring now to Figures 7 and 8, the first
30 step in making a balloon catheter in accordance with the -
present invention is providing a double lumen tube 2',
which is preferably extruded and made of silicone
rubber. It will be appreciated, however, that the
double lumen tube 2' can be made by any known process
which yields a double lumen tube 2'. It will be further
appreciated that the tube ~' can be made of any
resilient polymeric material, preferably a biocompatible
WO91/10466 ~?~ J PCT/US91/00161
21
polymeric material which can be inserted into a human
body cavity. The double lumen tube 2~ includes a -
smaller capillary lumen 6/ and a larger fluid conduit
lumen 8'.
Referring now also to Figures 9 and 10, after -:
the double lumen tube 2' is cut to a desired size, a
capillary lumen access opening 12' is created in an :
outer surface 14' of the double lumen tube 2~. The
capillary lumen access opening 12' communicates with the
capillary lumen 6'.
Referring now also to Figures 11-13, an
intermediate tube 3' is subsequently prepared from the
double lumen tube 2r shown in Figure 9. In the first .
step of this process, a measured amount of polymeric
bonding composition, pre~erably silicone rubber or
another suitable polymeric bonding material, is injected
into the capillar~ lumen 6' from the distal end 16' of
the double lumen tube 2', so that the capillary lumen 6'
is filled with a polymeric fill material 18' up to a
point just below the capillary lumen access opening 12~.
A tip 20', preferably a rounded silicone rubber tip, is
then a~ixed to the distal end 16~ of the tube 2~ to
complete the formation of the intermediate tube 3' shown
in Figure 13. In a preerred method, the distal end 16'
25 of the tube 2' is inserted into a molding apparatus (not :
shown) designed to mold a tip 20' on the end of the tube
2'.
Re-erring now also to the Figures 14-21 and 32,
a preferred process of the present invention involves
securing a plurality of intermediate tubes 3', like the
intermediate tube 3' shown in Figure 13, to a rack or :
pallet 24'. The rack or pallet 24' will include a : ~:
plurality of support rods 26', each equipped with a
retaining clip 28'. The intermediate tubes 3' are
35 secured on the support rods 26' by engaging individual .::
support rods 26' in the larger of the two lumens 8', ::.
called the fluid conduit lumen 8', and sliding the
: .
.
WO91/10466 ~ J~ PCT/US91/001~1
, ls
22
intermediate tubes 3' up over the support rods 26~ until
the proximal ends 30' of the intermediate tubes 3~ abut
against the base of the retaining clips 28/ or,
preferably, the tip 20~ of each of the intermediate
tubes 3/ fits snugly against the distal tip 26a~ of each
of the support rods 26', as shown in Figures 15 and 16.
Although not shown, it is believed that the intermediate
tubes 3' can be secured on the support rods 26' without
the aid of the retaining clips 28~. This is because the
preferred extruded double lumen tubes 2' used to make
the intermediate tubes 3~ generally have a slight bend
in one direction or another when they are hung. This
results in a slight bend in the intermediate tubes 3~
that permits the intermediate tube 3~ to be secured on a
support rod 26' without the aid of a clip 28'. Because
of the nature of the polymeric materials gen~rally used
to maXe the intermediate tubes 3', they also have a
tendency to cling to other surfaces and to offer
resistance to movement of a surface along a surface of
this material as do most polymeric tubes including those
tubes 2 described hereinabove.
When the intermediate tubes 3' have been
secured on the support rods 26~, the pallet 24' can be
transferred from place to place, and the intermediate
tubes 3' on the pallet 24' can be dipped in a series of
baths (see Figure 26) prepared to accomplish a series of
process steps. In the preferred method of the present
invention, the intermediate tube 3' is made entirely of ;
silicone rubber and is secured upon a support rod 26'
made of spring steel. The tip 20' and the fill material
18' of the intermediate tube 3~ shown in Figure 13 are
made of the same material (silicone rubber) as the
double lumen 2'. Therefore, the tip 20' and the fill
material 18' preferably form integral portions of the
intermediate tube 3', which is shown in Figures 15-21.
The first step in the automated coating or
dipping process of forming the resilient sleeve 44' and
:' ~' :.
:': , .
O91/10466 PCT/US91/00161
~3~
23
the balloon portion 32~ of the balloon catheter 4~
(shown in Figure 21), after the intermediate tubes 3'
are secured to the pallet 24~, is to coat the
intermediate tubes 3' with a bond preventing lubricating
agent or substance 38 , preferably a removable bond
preventing lubricating agent. Preferably this is
accomplished by dipping each of the tubes 3' on the
pallet 24, simultaneously into a first dip tank 33
containing a bath 33a of a removable bond preventing
agen~, preferably a material which forms a semi-solid
film on surfaces when cooled on contact followed by an
opportunity for drying. Examples of such materials
include petroleum jelly or petrolatum, other oil base
substances which form a semi-solid upon cooling to room
lS temperature, liquid soaps which dry to form a semi-
solid, aqueous soap or detergent solutions, aqueous
polyvinyl alcohol solutions, emulsions, or suspensions,
lubricating gels, aqueous or oil based film forming
solids emulsions, and the like. In one embodiment
described herein, hot petrolatum is used, and in
another, a liquid soap is used, preferably Liquid Ivory
Soap from Proctor & Gamble, Cincinnati, Ohio. In other
embodiments of the present invention a lubricating gel
is used, pre~erabl~ a water-soluble formulation such as
KY Jelly~, Hydrogel~, and the like. It will be
appreciated that these bond preventing agents or
lubricating agents can also be used as a carrier
substance for any of the microcidal or bactericidal
agents reerenced herein above. When bactericidal
agents which are sensitive to variations in temperature
or the like are incorporated into the carrier substance,
appropriate modification of the procedure to avoid
limiting the effectiveness of the bactericidal agent c~n
be necessary in certain circumstances.
When the intermediate tubes 3' are removed from
this first bath 33a of removable bond preventing
lubricating agent 38', the agent or substance 38'
'. ' .' ' ' ' : ~ .'' ' ' ~ '' . ':
WO91/10466 ~ PCT/US91/00161
, . . .
24
adheres to the outer surface 14' of the intermedia~e
tube 3', and occupy the capillary lumen access opening
12' and the capillary lumen 6'. In one embodiment the
agent is petrolatum, which is heated to about 140-160F,
preferably about 150F. At these temperatures, the
petrolatum will run up into the capillary lumen 6'
through the capillary lumen access opening 12' with the
assistance of the "capillary effect", which draws the
fluid into the capillary lumen 6' to the level of the
petrolatum in this first tank 33. In other embodiments
the petrolatum is often heated to a lesser degree to
allow for a heavier, somewhat thicker coat of
lubricating agent on the outer surface 14'. As the
intermediate tubes 3' are withdrawn from the hot
15 petrolatum, petrolatum on each tube cools and solidifies .
to form a semi-solid coating 38' on the outer surface
14' and a semi-solid filling (not shown) in the -
capillary lumen 6' and the capillary lumen access :
opening 12' which cooperate to plug the capillary lumen :~
access opening 12'. In an alternate embodiment, the
bond preventing agent in the first tank 33 is liquid
soap at room temperature (about 62-74F). Nhen the : :: :
tubes 3 are withdrawn from the first dip tank 33, the ::
liquid soap forms a semi-solid ~ust as the hot ..
25 petrolatum did as it cooled. In another alternate ~ .
embodiment the bond preventing agent is a carrier :. ...
substance including a bactericidal agent preferably :
nitrofurantoin. The carrier can be petrolatum which is
preferably heated to about 60C for this purpo~e, or, : ... :~.
30 more preferably, is a water-soluble lubricating gel such :~
as the formulation of Hydrogel~ or the like which is :: .
maintained at room temperature or preferably about 20C. . :
In the preferred method of the present
invention, the intermediate tubes 3' are coated when ~ ..
they are dipped in a first bath 33a which contains
petrolatum which is maintained at a temperature ~
effective to permit the petrolatum to coat the outer .
.
WO91/10466 ` i3 i~ 3 PcT/us91/00161
surface 14 of the tube while limiting the degree to
which the petrolatum runs into the smaller lumen 6'.
The petrolatum will run into the first lumen access
opening 12', but, preferably, will not run very far into
the smaller lumen 6/. The temperature of the petrolatum
in the first tank 33 is preferably maintained at about
40-80~, more preferably about 50-70, even more
preferably about 55-65, and most preferably about 60C
for this purpose. As shown in Figure 15, the
inter~3ediate tube 3~ is coated with the bond preventing
lubricating agent 38' up to a location on the surface
14' of the intermediate tube 3~ proximate the dashed
line A shown in Figure 15 by dipping the intermediate
tube 3' into the first dip tank 33 up to that point.
Following this step, the outqr surface 14~ of
the intermediate tube 3~ is stripped of the bond
preventing lubricating agent 38' up to a location
proximate the dashed line designated B in Figures 15 - -
and 16. This is preferably accomplished by one or more
dipping steps in accordance with the methods for
stripping particular lubricating agents as described
hereinbelow. The intermsdiate tube is then preferably
coated as shown in Figure 16 between the locations ;
proximate the dashed lines A and B. The intermediate
tube 3'' shown in Figure 16 is then dipped in a
subsequent dip tank holding a second bond preventing
agent. In this step the liquid soap can be preferred,
although petrolatum and other agents will also work.
During this step, the intermediate tube 3' shown in
Figure 16 is dipped into the tank up to a point on the
outer surface 14' of the intermediate tube 3' proximate
the dashed line C so as to coat the portion of the
intermediate tube 3' from the lowest portion of the tip
20' up to the location proximate the dashed line
designated C. In preferred embodiments of the present
invention, any of the bond preventing lubricating agents ;
enumerated above may be used. Preferably, however, the
.. ..
WO91/10466 ;~ PCT/US9l/001~l
26
bond p.reventing lubricating agent is hot petrolatum
heated to about 130-150F, preferably about 140F (about
60OC), or liquid soap at room temperature (about 62-
74F). When the intermediate tubes 3~ are withdrawn
from the hot petrolatum, petrolatum will cool and
solidify to form a semi-solid coat 39 on the outer
surface 14' and a semi-solid filling 34' in the
capillar~ lumen 6' and the capillary lumen access :
opening 12' which cooperate to plug the capillary lumen : .
10 access opening 12~ as shown in Figure 18. As stated ~ .
above, soap at room temperature will provide the same : ..
function as the petrolatum. The intermediate tube is -
then subjected to a further dipping step wherein the ~ :
intermediate tube shown in Figure 18 is dipped in one or ; ~.
more dip tanks so as to strip the coating of bond
preventing agent 39 from the portion of the intermediate : ~ -
tube 3~ below a location on the outer surface 14'
proximate the dashed line designated D in Figures 18
and 19 so as to strip the tube of bond preventing agent ..
20 below that location. .::
After the intermediate tubes 3' are coated in :.:
this manner and the capillary lumen access openings 12' :. .
are plugged with a bond preventing agent 40, the tubes
3' aro then dipped in a series of dip tanks (see Figure : : .
25 26) provided to coat the intermediate tube 3I with a .::
polymeric bonding composition, preferably silicone . ..... .
rubber, in a step or steps provided to form the overcoat
layer 42', including both the resilient sleeve 44' and
balloon portion 58' of the balloon catheter 5' shown in
30 Figure 21. In the preferred methods, the intermediate ~
tube 3' is dipped in silicone rubber in two or more :
successive dipping steps so that the resulting overcoat ;
layer 42' includes underlying and an overlying layers :. .
(not shown), which form an integral part of the balloon .
catheter 5' and are bonded together, and to the outer
surface 14~ in the portions thereof, 14a', 14b' and
14d', which are located below the dashed line designated :
WO91/10466 PCT/US91/00161
J ~
27
D, between the dashed lines designated B and C, and
above the dashed line designated At respectively. The
portion 14d' above line A was not coated prior to the
final dipping steps designed to provide the overcoat
layer 42', and the portion 14a' below line D was
stripped of its coating prior to those steps.
In subsequent steps, the proximal end 30~ of
the balloon catheter 5' is secured to an end piece 46~
to form a completed Foley catheter 4~ (shown in Figure;;
23). The end piece 46' can include a cap 48' for
closing a proximal end access opening 49' to the fluid
conduit lumen 8' and can be equipped with a luer value
50' for engagement in and closure of the proximal
capillary lumen access upper opening 52~ communicating
lS with the capillary lumen 6'. Prior to the attachment of
the end piece 46' to the sleeved balloon catheter 5~ to
form the completed sleeved Foley catheter 4', the
sleeved balloon catheter 5' is preferably allowed to air :
dry to permit solvents in the overcoat layer 42' to
evaporate and is subsequently cured at an elevated
temperature. Care is taken to keep the curing
temperature below the boiling temperatures of the
solvent so as to prevent unsightly bubbling of the
t~olvent within the overcoat layer 42'. Because the
overcoat layer 42' is preferably made of the same
polymeric bonding composition, even though it may be
created in a plurality of dipping steps, it is
represented in Figures 21-25 as a single overcoat layer
42'. It will be appreciated, however, that this single
overcoat layer 42' may or may not represent an integral
layer formed in a series of dipping steps wherein there
may be any number of underlying or overlying layers.
The completed Foley catheter 4' also includes a fluid ;
conduit access opening 56' in an exterior surface 62' of
the completed Foley catheter 4'. The fluid conduit
access opening 56' communicates with the fluid conduit
lumen 8'.
WO91/1~66 PCT/US91/001~1
;`, ;'~ ~J ~i
Referring now also to Figures 27 and 28, a
phase of stamping operation is illustrated. In steps
subsequent to the formation of the sleeve 44~ of the ~ - -
alternate embodiment of the catheter 5~ shown in Figure
5 21, or preferably, after completion of the completed - -
Foley catheter 4~ shown in Figure 23, a portion of the
catheter 5' or 4' proximate the resilient sleeve 44' is
placed in an elongated, channel-like recess 84 in a
stamping block 86. The catheter 5~ or 4' is preferably
cooled first to a temperature below about 3~F. A
perforating or stamping device 90 having a plurality of
very small, pointed extension members 92 (see Figure 28)
is then used to create a plurality of micropores 8l' in ;
the resilient sleeve 44~ by stamping the resilient
lS sleeve 44~ when it is held within the channel-like
recess 84. The elongated, channel-like recess 84 is
configured to hold the catheter 4' or 5' proximate the
resilient sleeve 44~ such that, upon impact, the ~ ~-
stamping device 90 perforates only the resilient sleeve
44' in preferred embodiments. It will be appreciated
that the polymeric material of the catheter 41 or 5' is `~
not compressible so that the impact of the stamping
device 90 is unable to significantly displace the
catheter 4' or 5' once it has been pressed to the bottom `
of the channel-like recess 84 as shown in Figure 27.
Depending on the kind of lubricant/carrier contained in
the sleeve cavity 45', it is sometimes necessary to cool
or even freeze the lubricant/carrier prior to the step
of perforating the resilient sleeve 44' so as to
minimize the flowability of the lubricant, and reduce or
eliminate the loss of lubricant/carrier through
micropores which could otherwise result from the
mechanical pressure of the stamping device 90 during the
perforation step.
Referring now also to Figure 22, the
independence and s~retchability of the resilient sleeve
44' is illustrated. The resilient slee~e 44~, not only
.,,, . .:, . .
."'
-.
', ' . ' ' " . ' . , ', ' ' ' ' . , . ", . ' , "'' " ', . ,. ', ~ ~
WO91/10~66 PCT/US91/00161
~ i3 ~ j J~ .`'j
has a narrower thickness than the inner wall 21' of the
catheter 5', but it is also more flexible, more
stretchable, and preferably less rigid than the inner
wall 21~. The lubricating substance 38' contained in ~-
the sleeve cavity 45/ permits the sleeve 44~ to slide
along and in respect to the outer surface 14' while in
lubricated contact therewith and when stretched
independently thereof. As illustrated in Figure 22, the -
resilient sleeve 44~ can be twisted in respect to the
inner wall 21' without twisting the inner wall 21' or
the respective lumens, 6~ and 8~. The resilient sleeve -
44' can also be stretched without stretching the inner
wall 2l' of the catheter 5~. As stated hereinabove,
this enables the resilient sleeve 44~ to stay in
relative contact with or in adherence to adjacent body
tissues (not shown) with which the resilient sleeve 44
is in con~act with even when the remaining portions of
the sleeved balloon catheter 5', such as the inner wall
21', are forced to move in response to forces impacting -
on the catheter 5' at other points along its length.
The resilient sleeve 44 can also change from its initial ;
circumferential shape to a more ribbon-like oval shape
in order to match the shape or contour of the passageway ~'
in which it resides. The volume of the sleeve càvity 45
will preferably increase the outside diameter of the
catheter proximate the sleeve portion at l~ast about 5%,
preferably about 10%, more preferably about 20%, even
more preferably about 25%, even more preferably about
35%, and even more preferably about 50%. It is
conceivable that applications will also be found where
the thickness of the lubricating substance in the sleeve
cavity 45 is increased so as to increase the volume of
the sleeve cavity such that the outside diameter of the
catheter proximate the sleeve 44 will be increased from
about 50 to lO0, or 50 to 200% or more depending on the
particular application. The important factor is that
the sleeve be soft and compliant so that it can conform
WO 91/104~6, o~'~ PCI'/US91/001 ~1
to the shape of the particular passageway in which it -
resides and, at the same time fill the passageway so as
to limit the passage of fluids along either the wall of
the passageway or the exterior surface of the catheter,
and at the same time, to allow the inner conduit portion
of the catheter move relatively independently of the
exterior surface of the sleeve 44 of the catheter.
In preferred methods in accordance with the
present invention, the end piece 46' is made by a
process of injection molding. Preferably, the proximal
end 30' of the sleeved balloon catheter 5~ is inserted
into an injection molding apparatus (not shown) after
the overcoat layer 42~ has been cured. However, it will
be appreciated that the end piece 46~ can be added to
the interme;~iate tube 3' prior to the initiation of the
dipping process. A polymeric bonding composition,
preferably silicone rubber, is injected into the mold
~not shown) and the end piece 46' is molded onto the
proximal end 30' of the balloon catheter 5' to make the
completed Foley catheter 4' shown in Figure 23.
Following further drying, curing steps, where deemed
necessary given the type of polymeric bonding
composition or compositions used to make the completed
Foley catheter 4'/ micropores (too small to be shown)
are created in the resilient sleeve 44' so that
bacterial agent in the carrier substance 38' can diffuse
out in appropriate aqueous environment, and the
completed catheter 4' is tested to see if it is
functional and if it has any leaks. This testing can be
30 done before or after the fluid conduit access opening , ;
56' is created in the exterior surface 62' to -
communicate with the fluid conduit lumen 8~.
In order to test the integrity of the completed
catheter 4', prior to engaging the plug 50' in the
proximal capillary lumen access opening 52' in the end
piece ~6', the proximal capillary lumen access opening
52' is slipped over a hot water nozzle (not shown), and ~;
, . ~ ., .. . ~... .... . :.. , .. - : -
WO91/10466 PCT/US91/~16]
31
a measured amount of a hot aqueous solution, preferably
water or water containing a trace o~ surfactant, at a
temperature of between about 120-160F, preferably about
140F, is pumped into the capillary lumen 6~ from a
standard hot water heater (not shown) by a commercially
available water pump (not shown) such that the balloon
portion 58' is expanded. It will be appreciated that
higher or lower temperatures can be used so long as the
desired coating properties for the particular
application desired can be obtained. The balloon
portion 58' of the overcoat layer 42' is the portion of
the overcoat layer 42' which is not bonded to the outer
surface 14' of the intermediate tube 3' proximate a -
balloon cavity 54'. The balloon portion 58' of the
overcoat layer 42' coopexates with the portion l4c~ of
the outer surface 14~ which remained coated with the ~ :
bond preventing agent prior to the step of dipping the
intermediate tube 3' in the polymeric bonding
composition, to define the balloon cavity 54'. The
balloon cavity 54' communicates with the capillary lumen
6' via the capillary lumen access opening 12'. When the
hot water solution is pumped or injected into the
capillary access lumen 6' to test the completed catheter
4' and the balloon portion 58', the balloon portion 58'
and the balloon cavity 54' are expanded. If there is a
significant lack of integrity in the balloon portion 58'
it will be exposed when the water is introduced in this
manner. In addition to testing the balloon portion 58',
the water solution will also remove the remaining bond
preventing agent in the balloon lumen 54~ and the
capillary lumen 6' when it is removed. Although some of
the bond preventing agent may come out of the capillary
lumen 6 via the proximal capillary lumen access opening
52' during the step of curing the overcoat layer 42',
the hot aqueous solution is generally believed to remove
most of the bond preventing agent, although a residue
may remain.
- . ...................................... .
.. ... . ., , .. . , . , ~.... . , . , -
WO91/10466 ,~ PCT/US91/00161
~ ~ i 2,~ ~
32
Following the preliminary test, which relies on
a visual observation to determine whether there is any
lack of integrity, a further test is used to obtain :~
further assurance that there are no leaks in the balloon - :
portion 58. This further test is accomplished by
engaging the proximal capillary lumen accessing opening
52~ to the nozzle of a commercially available leak
tester (not shown). One such device is a Model No. 6510
Caps Tester from Caps Himmelstein (Hoffman Estates, IL
60195). Once the completed catheter 4' is tightly
secured over the nozzle, an electrical switch, such as a
hand switch or, preferably, a foot pedal, is used to
release a measured blast of air into the capillary lumen
6'. When the air is introduced into the capillary lumen
6' it also enters the balloon cavity 54~ via the
capillary 'umen access opening 12' and inflates the
balloon portion 58' and, thereby, expands the balloon
cavity 54'. The leak tester is designed to sense any ~;
loss of pressure once the balloon portion 58' is
inflated, and will given an indication, therefore, if
there are any measurable leaks. After this test is
completed, the completed sleeved Foley catheters 4' that ..
have passed all tests, are then packaged, preferably in
. a material which breathes such as Tyvek~ (from DuPont),
and boxed. The boxes are then sterilized with ETO
(Ethylene Oxide) and then stored for shipment.
In a preferred embodiment of the present .:
invention, the extruded double lumen tube 2' used to
make the intermediate tube 3' is a tube (not shown)
30 which has a series of generally parallel undulations .
running generally parallel with ~he longitudinal axis of
the tube (see Figure 24). When such a tube is used, a
sleeved Foley catheter 4'' having a ribbed inner surface
60 on the balloon portion 58'' of the completed Foley
catheter 4'' will result because the bond preventing
coating 40' (not shown) on the intermediate tube 3'' : :
will reciprocate the undulations in the outer surface
,'' ~
' .
. ' ' ~ .
WO91/10466 PCT/US91/00161
J' ,.~ IJ~ '.)
33
14'' of the intermediate tube 3~. Therefore, when the
balloon portion 58'' of the overcoat layer is created,
the inner surface 60 will have ribs 59 which reciprocate
the undulations in the bond preventing coating material
40~ coating the coated portion 14c'' of the outer
surface 14''.
Referring now also to Figure 25, another
embodiment of the present invention provides a completed
sleeved Foley catheter 4~ which has a plurality of
lO capillary openings 12''' that permit greater access to -
the balloon lumen 54~ from the capillary lumen 6~''
and vice versa. This can be very important-when wishing
to ensure that the access to the capillary lumen 6'''
from the balloon lumen 54''' is not blocked once the
balloon portion 58''' of the overcoat layer 42~ is
expanded.
In the Applicants' use of the preferred methods
of the present invention, balloon and sleeve fabrication
is almost completely automated. Entire sets of sleeved
balloon catheters 5' are manufactured simultaneously.
The preferred pallet 24 has 400 spring steel support
rods 26 attached to a pallet in 20 rows of 20 rods,
wherein each of the rods 26 is about 1 inch from each
ad~acent rod. Single and double lumen tubing (not
shown) is preerably made by extrusion processes known
to those of skill in the art. The tubes 2 and 2~ are
cut to length as the tubing leaves the extruder (not
shown~. An opening 12~ is created in the outer surface
14' o the double lumen tubes 2', preferably with a
hollow drill bit or drill tube (not shown), so as to
communicate with the capillary lumen 6' in those tubes
2'. The distal portion 6a' of the capillary lumen 6',
located between the distal end 16' of the tube 2' and
the capillary lumen access opening 12', is then injected
with a measured amount of a polymeric bonding
composition, preferably silicone rubber, so that the
distal portion 6a~ is filled and sealed. A rounded tip
. - -- - . . .
WO91/10466 ~ PCT/US91/00161
~ ;Aj (~ O ~ ,
20' is then formed at the distal end 16' of the double
lumen tube 2', preferably by inserting the tube 2' in a
molding device (not shown).
Referring now also to Figure 26, another
preferred embodiment of the present invention is
illustrated in this embodiment of the present invention
as sleeved Foley catheter 4''''. It is very similar to
the catheter shown in Figure 23 except that the space
between the balloon cavi~y 54'''' and the sleeve cavity
45'''' has been decreased so that it will accommodate
the urethral sphincter of the bladder. In addition, the
volume of the lubricating substance 38~ in the sleeve -
cavity 45'''' is significantly more than that shown in
Figure 23. This is accomplished by increasing the
thickness of the lubricating substance 38 which is
coated onto the intermediate tube carrying the
manufac~-.uring process. The increase in the thickness of
the lubricating substance 38'''' allows the sleeved
Foley catheter 4'''' to provide a very soft, "cushy", ~-
conforming exterior surface 9'''' proximate the sleeve
44'''' which can accommodate variations in the surfaces
with which the catheter 4'''' comes into contact.
~ eferring now also to Figures 29 and 30, and
alternate embodiment of the sleeve Foley catheter 4'''',
similar to th~ catheter 4'''' shown in Figure 23, is
shown. This catheter 4'''' differs from the catheter
4'''' shown in Figure 23 in that it includes a third
lumen 97 which communicates with the sleeve cavity
45''''. The sleeve 44'''' also includes a plurality of
micropores (too small to be shown) which enable the
bactericidal agent in the carrier substance 38'''' to
diffuse out of the cavity 45'''' when the resilient
sleeve 44'''' is located in an aqueous environment
wherein the concentration of the bactericidal agent in
the aqueous environment is less than the concentration
of the bactericidal agent in the sleeve cavity 45''''. ;
This particular catheter 5'''' is useful for long term ~ .
.
. ,:
WO91/10466 ~ "l 3 PCT/US91/00161
catheterization where it is desirable to replenish the -
supply of carrier substance 38'''' located within the ;~
sleeve cavity 45''''. In Figure 30, a cross-sectional
view of the catheter 5'''' is shown.
Referring now also to Figure 31, the sleeved
Foley catheter 4'''' shown in Figure 26 is shown when
inserted into a urethral tract 74 of a woman 70. The
balloon portion 58'''' of the catheter 4'''' resides
within the bladder 72 of the woman 70. The balloon
portion 58'''' is expanded to retain the catheter 4
in the urethral tract 74. The larger volume of
lubricating substance 38'''' in the sleeve cavity
45~ , as compared to that for other embodiments of the
present invention, helps provide an exterior surface .
9~ proximate the sleeve 44~ which is cushioned so
that it can conform to the wall of the urethral tract
74. The lubricating substance 38'''' also allows the
inner ~7''~11 2l'''~ or conduit portion 2l~ of the
catheter 4~''' to move back and forth within the
urethral tract 74'''' to a limited degree without
disrupting the interface between the exterior surface
9'''' proximate the sleeve 44'''' and the adjacent body
tissues of the urethral tract 74. This allows the
catheter 4'''' to move in all directions to a limited
degree without disrupting this interface, thereby
increasing the comfort of the patient in which the
catheter 4'''' resLdes. In this embodiment, the
lubricating substance 38'''' is a carrier substance
38'''' which lncludes a bactericidal agent. The
catheter 4'''' also includes a plurality of micropores
(not shown, too small to be shown) in the resilient
slee~e 44'''' which are created using a device 90 like
that shown in Figures 27 and 28. It will be
appreciated, that the catheter 4'''' has been rotated in
the channel-like recess 84 so that micropores can be
: created around the entire circumference of the catheter
4'''' in a series of stamping steps similar to those
.. : ,
., ' . '. ' , ' . . , ' ~ ' , ~ ' '
WO91/10466 ~3'~`. PCT/US91/00161
... I;i ,'. ,, J
36
described herein above (see prior discussion in
reference to Figures 27 and 28). It will be
appreciated, that when the catheter 4/~' is inserted in
the urethral tract 74 as shown in Figure 31, the aqueous
environment common to the urethral tract 74 will
encourage the diffusion of any bactericidal agent -
contained in the lubricating or carrier substance 38
contained in the sleeve cavity 45~'''. Diffusion is
believed to be a process wherein there is a net flow of
matter, in this particular instance, bactericidal agent,
from a region of high concentration from a region of low
concentration. Unless otherwise medicated, the aqueous
environment of the urethral tract will be a region of ~
low bactericidal concentration and will, therefore, due :
to the aqueous nature of this environment, enable the
bactericidal agent in the sleeve cavity 45~' to -
diffus~ out of the sleeve cavity 45'''~, across the
resilient sleeve 44~ and into the urethral tract 74.
This will result in a reduction of elimination of
bacteria coming on or adjacent to the exterior surface
9'''' proximate the resilient sleeve 44''''.
Although not relied upon, it is believed that
diffusion results from a number of phenomena including
~orces commonly associated with osmosis and diffusion as
well as capillary action. It is also noted that the
rate of dif~usion is believed to be proportional to the
concentrati~n gradient across the resilient sleeve
44'''' when concentration gradient is understood to be
defined in The Encyclopedia Britannica (15th edition,
30 copyright 1985) which is incorporated herein by ;:~
reference.
In the most preferred embodiments of the
present method, 400 of the intermediate tubes 3' are
then mounted vextically on rigid spring steel support
rods 26~ on a pallet 24' in the manner previously
described. The pallet 24' is then moved via a
transporting mechanism 22 (see Figure 28) over a series
.... . . . ,.... , ~ . . . , .. ~ . ,, .. .. . : , .
`
WO91/1~66 PCT/US91/00161
37
of dip tanks as follows in the following example which
will further disclose preferred elements of the present
invention.
Example 1.
(A) The pallet 24' is stopped over a first
tank 33, which contains white USP petrolatum contain
nitrofurantoin. The nitrofurantoin containing
petrolatum is heated to about 60C (about 140F).
The tank is raised so as to immerse the intermediate
tubes 3' into the petrolatum to such a depth that
the petrolatum reaches the proximal end of the
desired sleeve location. The dip tank 33 is then
lowered and a portion of the outer surface 14' of
the intermediate tubes 3' are coated with the
nitrofurantoin containing petrolatum. This portion
e~s.ends fxom the general point at which the proximal
end of the resilient sleeve 44/ will begin, to the
distal end 20a' of the tip 20' of the intermediate
tube 3'. This step is repeated when it is
desireable to build up the thickness of the
lubricating substance and the resulting volume of
the sleeve cavity so as to increase the resulting
increase in the outside diameter of the particular
catheker over the circumferential diameter of the
conduit portion or tube 2 or 2' of this present
invention.
(B) The pallet 24' is then automatically
advanced and stopped over a second dip tank 35 which
contains white USP petrolatum heated to about 120C
~about 250F). The second dip tank 35 is raised so
as to immerse the intermediate tubes 3' into the
super-heated petrolatum so that the super-heated
petrolatum comes into contact with the petrolatum
coating 38' on outer surface 14' of the intermediate
tube 3' from the prior dipping step up to a general
location where a distal end of the resilient sleeve
- . . , .. , .. - . . .. ,... ,-~ ,. ~. . . ..
WO91/10466 ~ PCT/US91/00161
, --~,,;j' l ~ '
44~ will end. The second dip tank 35 is then
lowered. This dipping step causes the coating of
the petrolatum from the prior dipping step to be
largely removed from the portions 14a the outer -~ :
surface 14' below a location where the distal end of
the resilient sleeve 44' will be generally located
(designated by dashed line B) to the distal end 20a' - ;
of the tip 20' of the intermediate tube 3'. Some
residual petrolatum may remain on the outer surface
14' of the intermediate tube 3~ in this area of the
outer surface 14'. However, most of the petrolatum
is removed.
(C) The pallet 24' is then automatically
advanced and stopped over a third dip tank 37
containing mineral spirits heated to about 200F.
The third dip tank 37 is then raised so as to
im~r~rse the intermediate tubes 3~ into the mineral
spirits to the same depth as they were immersed in
the super-heated petrolatum in the second dip tank
35. The tank 37 is then lowered and all but a trace
amount of the petrolatum is removed from the outer
surface 14 located generally below the dashed line
B, which will eventually be proximate the sleeve ;:
44'.
(D) The pallet 24' is then automatically
advanced and stopped over a fourth dip tank 40
containing a volatile organic solvent such as
toluene, trichloroethane or the like. The fourth
tank 40 i9 then raised to immerse the intermediate
catheters 3 to the same depth as previously immersed
in the second and third tanks 35 and 37, thereby
removing essentially all traces of the petrolatum
from this portion of the outer surface 14'. The
intermediate catheter tube 3' now has a band 38' of
semi-solid petrolatum located around the axial
circumference of the intermediate tube 3' in the
location where the sleeve cavity 45' will be
WO91/10466 PCT/US91/~0~61
39
created.
(E) The pallet 24' is then stopped over a
fifth, sixth, seventh and eighth dip tank, 41, 43,
47 and 49, respectively, where the steps enumerated
in steps A, B, C, and D, respectively, are repeated
with the following variation. When the pallet 24
is stopped over the fifth dip tank 41, the
intermediate tubes 3' are immersed only up to a
location proximate the dashed line designated C as :: :
shown in Figures 18 and 19. When ~he pallet ~4' is
subsequently stopped in series over dip tanks 43, 47
and 49, the intermediate tubes 3~ on the pallet 24~ :
are only immersed up to a location proximate the
dashed line D as shown in Figures 18 and 19.
Following these steps , the petrolatum is stripped ::
from the portion 14a' of the outer surface 14'
located below the location proximate the dashed line
de.q!_gnated D. The petrolatum not only coats the
portion 14c' of the outer surface 14' located in
this area, but also fills a portion of the capillary
lumen 6' and plugs the capillary lumen access
opening 12', which will eventually be used to
inflate the balloon portion 58' of the completed
Foley catheter 4'.
(F) The pallet 24' is then lowered and
automatically advanced to a ninth dip tank 51
containing a low-solids silicone rubber/solvent
dispersion which is effective to minimize any
disruption of the integrity of the petrolatum
coatings 38' and 40' remaining on the intermediate
tube 3'`proximate the portions 14e and 14c of the
outer surface 14' where the sleeve cavity 45'
balloon cavity 54' will be created during subsequent
dipping steps. The ninth tank 51 is then raised to
immerse the intermediate tube 3' in the solution up
to a location above the dashed line designated in A
in Figure 19. This step can be subsequently
t
i- ' '. i ., . '. ' . ,
WO91/10~6~ PCT/US91/00161
I'J ~`'
repeated at intervals, preferably allowing time for
significant solvent evaporation, either in the same
~ank or in a subsequent tank containing a greater
concentration of silicone rubber, until the overcoat
layer 42 and the balloon portion 58 of the overcoat
layer 42 have a desired balloon thickness. However, ~-
in the present embodiment, the tank 5l is lowered,
the pallet 24' is advanced to a tenth dip tank 53
containing a silicone rubber dispersion having a
higher silicone rubber concentration than the
dispersion in the ninth dip tank 51, and the tubes
3/ are completely immersed again. The pre~erred
thickness over the overcoat layer 42', the resilient
sleeve 44' and the balloon portion 58~ is 17.5
thousandths of an inch (plus or minus 2.5
thousandths of an in~ch). Where subsequent silicone
rubber dip tanks are provided, the concentration of
silicone rubber in the subsequent tanks are
preferably greater than the concentration of the
silicone rubber in the ninth tank 51. It is also
desirable to alter the silicone rubber used in a
final coating to provide greater sheen and a
smoother finish, however, the concentration and the
solvent may be adjusted as deemed appropriate~
(G) The pallet 24' is then advanced through a
drying area where solvents are allowed to evaporate,
and then through a heat cure step, where the sleeved
balloon catheters 5' formed by this process are
cured at a temperature just below the boiling point
of any solvent used in any of the silicone rubber
dip dispersions. For toluene this temperature is
about 200F.
(H) After the heat cure, the sleeved balloon
catheters 5' are allowed to cool and are then
removed from the support rods 26'. The proximal
ends 30' of each of the balloon catheters 4 is then
inserted into an injection molding apparatus (not
' :
. ,, ~,
wog1/10466 j~ ) 3 PCT/US9~/00161
41
shown), which forms the end piece 46' of the
completed sleeved Foley catheter 4~.
(I) The completed Foley catheters 5 are then
finish~d by punching a fluid conduit access opening
56' in the exterior surface 62' such that it
communicates with the fluid conduit lumen 8' in a
location below or distal to the balloon portion 58
of the overcoat layer 42~ and by stamping a
plurality of micropores (not shown) in the resilient
sleeve 44' to permit the nitrofurantoin to diffuse
into aqueous environments such as a urethral tract,
thereby minimizing or eliminating bacterial growth
therein. The micropores are created by perforating
the resilient sleeve 44~ with a plurality of very
small, pointed extending members 92 on a stamping
device 90. The catheter 5' is first cooled to a
temperature below 32F and then placed in an
el~ngated, channel-like recess 84 and stamped with
the stamping device 90, to create the micropores.
tJ) The completed Foley catheters 4' are then
sent through the test sequence described
hereinabove, during which the balloon portion 58' of
each completed Foley catheter 4' is inflated and the
petrolatum band 40' within the balloon cavity 54' is
largely removed.
Referring now also to Figures 33A, 33B and 33C,
the present invention provides a method of making
sleeved Foley catheters 4' including the following ~:
steps:
tA) Provfding a tube having an outer surface and
first and second lumens;
tB) Cutting the tube to a desired length;
tC) Creating a first lumen access opening in the
outer surface to communicate with the first lumen;
tD) Filling the first lumen with a polymeric ;
bonding composition up to the first lumen access : .
', ' ..... ' .:
.
:~: '; '
';'''~ ' .'
WO91~ 6 ~ . PCT/US91/00161
r ~ 1
42
opening from an end nearest the first lumen access
opening; :~
(E) Sealing the end of the tube nearest the first
lumen access opening; and
(F) Securing the tube to a movable pallet.
.. . .
These steps are followed by the following
steps: . .
(A) Coating a first portion of the outer surface
and plugging the first lumen access opening with a
removable bond preventing lubrica-ting agent or
carrler substance containing a bactericidal agent; :
(B) Stripping the coating of removable bond -~
preventing lubricating agent away from a second .
portion of the outer surface adjacent to the first ~ .
portion; ::
(C) Simultaneously coating a third portion of the :`
ou~S~r surface adjacent to the second portion thereof ~ .
and plugging the first lumen access opening with a . .
removable bond preventing agent; .
(D) Stripping the coating of removable bond
preventing agent away from a fourth portion of the
outer surface ad~acent to and below the third
portion thereof;
(E) Coating the outer surface and the remaining :
coating of removable bond preventing agent with an
overcoat layer of a suitable film forming polymeric
bonding composition; and
(F) Curing the overcoat layer.
Following those steps, methods of the present
invention include the following steps~
(A) Securing an end piece to the end of the tube
furthest from the first lumen access opening;
(B) Stamping a plurality of micropores around the
entire circumference of the exterior surface of the
res~lient sleeve in a series of stamping steps; ~ ;
: ~' ,'
.. :
:. '
......... , ~ ..
WO 91/10466 h j3 ~ 3 ~ , Pcr/lJsgl/0ol6l
43
(C) Simultaneously testing the balloon portion of
the resulting catheter and substantially removing
the removable preventing bond agent from the first
portion of the outer surface and the first lumen
S access opening;
(D) Further testing the catheter capillary lumen
and the balloon portion for leaks;
(E) Punching a second lumen access opening in an
exterior surface of the catheter to communicate with
the second lumen;
(F) Packaging the resulting sleeved Foley
catheters; and
(G) Sterilizing the sleeved Foley catheters.
In another preferred embodiment of the present
invention, following the securing of a plurality of
intermediate tubes 3' to the transportable pallet 24',
balloon catheters are produced as follows:
(A) the pallet 24' is stopped over a first tank 33,
which contains white USP petrolatum contain an
effective amount of nitrofurantoin to prevent
bacterial growth on the exterior surface of the
resilient sleeve when inserted into a suitable
aqueous environment. The petrolatum is heated to
about 60C. That tank 33 is then raised so as to
immerse the intermediate tubes 3' into the
petrolatum to such a depth that the petrolatum
reaches the proximal end of the desired resilient
sleeve location proximate the dashed line designated
A in Figure 15. The dip tank 33 is then lowered and
a portion of the outer surface 14' of the
intermediate tubes 3' are coated with petrolatum.
This portion extends from the general point at which ; -
the proximal end of the resilient sleeve 44' will
begin, to the distal end 2a' of the tip 20' of each
intermediate tube 3'. In other embodiments, this ~,~
step can be repeated to increase the thickness of
:. " ''"'"
. ::
.'. :
WO91/1046~ PCT/US91/001~1
- ~.3
~he lubricant coating 38', as well as the ultimate
volume of the sleeve cavity 45' and the size of the ;:
outside diameter of the catheter 5I proximate the
sleeve 44l.
tB) The steps outlined in paragraphs B, C and D of
Example I presented hereinabove, are then followed -~
generally as outlined in Example I. -
(C) The pallet 24' is then stopped over a fifth dip
tank 41, which contains a liquid soap (Liquid Ivory
Soap from Proctor ~ Gamble Co., Cincinnati, OH
45202). The soap is held at room temperature
(between about 60-80F, preferably 65-72F). The
fifth dip tank 41 is raised so as to immerse the
intermediate tubes 3' into the liquid soap so that
the soap coats the tubes 3~ up to the dashed line
designated by the letter ~ in Figure 18. The dip
tank 41 is then lowered and the liquid soap forms a
semi-solid coating 40' on the outer surface 14' of
each of the intermediate tubes 3' extending from
line designated C to the distal end 20a' of the tip
20' of each of the intermediate tubes 3'.
(D) The pallet 24 is then automatically advanced
and stopped over a sixth dip tank 43 which contains
an aqueous solution containing a trace of a suitable
wetting agent or surfactant. In a preferred
embodimen~, three gallons of water i9 mixed with two
ounces of a suitable surfactant. The surfactant
wiLl generally be less than one percent of the total
volume of the solution. A sixth dip tank 43 is then
raised 80 as to immerse the intermediate tubes 3~ in
the aqueous fluid up to the dashed line designated
by the letter D in Figures 18 and 19. The sixth dip
tank 43 is then lowered and the semi-solid liquid
soap coating the poxtion 14a' of the outer surface ;
14' below the dashed line designated D is
substantially removed.
(E) The pallet 24' is then automatically advanced
. .
WO91/10466 ~ s9, PCT/US91/00161
and stopped over a seventh dip tank 47 containing
water. The seventh dip tank 47 is then raised and
the intermediate tubes 3~ are immersed in the water
up to the line designated D as in the prior dipping
step. The seventh dip tank 47 is then lowered and
virtually all of the liquid soap is removed from the
portion l4a~ of the outer surface l4' below the line
designated D.
(F) The pallet 24' is then automatically advanced
and stopped over a eighth dip tank 49 containing a
low-solids silicone rubber/solvent dispersion which
is effective to minimize any disruption of the
integrity o the liquid soap coating 40~ remaining
on each of the intermediate tubes proximate the
portion 14c~ of the outer surface 14' where the
balloon cavity 54 will be created during subsequent
dipping steps (the portion between the dashed lines
designated C and D). The eighth tank 49 is then
raised to immerse intermediate tubes 3' in the
silicone rubber dispersion. It will be appreciated
that any suitable solvent for providing a suitable
dispersion of silicone rubber and coating the
particular lubricating agent may be used. It is
also believed to be possible to use aqueous
solvents, however, they are not preferred at
present. It will also be appreciated that this step
can be repeated at subsequent intervals, preferably
long enough to permit significant solvent
evaporation, to add to the thickness of the overcoat
layer 42 and the balloon portion 58 of the overcoat
layer 42. However, further steps, involving -~
different solutions can also follow. ~ -~
(G) The fourth dip tank 39 is then lowered and the
silicone rubber, coating portions of the outer ~ -
surface 14' as well as the coating of petrolatum 38'
and the coating of soap 40', is allowed to dry. The
pallet 24' is then advanced again to a ninth dip
~ '"'' ' .''
W091/tO466 PCT/US91/001~1
46
tank 51 containing a different silicone rubber
dispersions having a solids content which is higher
than the solids content in the eighth dip tank 49. `
The intermediate tubes 3l are immersed again in the
subsequent silicone rubber dispersion when the ninth
dip ~ank Sl is raised. The ninth dip tank 51 is
then lowered, and the silicone rubber, coating the
tubes 3~ is allo~ed to dry.
(H) The pallet 24' is then automatically advanced
again to a tenth dip tank 53 containing a silicone
rubber dispersion including a silicone rubber which
provides a high sheen and a smooth texture surf~ce.
The tubes 3' are dipped again as before and the
tenth dip tank 53 is then lowered and the silicone
rubber coating the tubes 3~ is allowed to dry.
(G) The pallet 24~ is then advanced through a
drying step followed by a heat cure step, and each
completed sleeved balloon catheter 5~ is then
secured to an end piece 46', provided with a fluid
conduit access opening 56', cooled to below
free~ing, stamped to provide a plurality of
micropores (too small to be shown) in the resilient
sleeve, tested, packaged and sterilized.
The automated system that Applicants claim will
permit completed sleeved Foley catheters 4' to be
manufactured at the rate of about l.600 catheters per
hour. Because virtually no handwork is involved in the
balloon and sleeve construction, the catheters 4
produced will be consistent and of very high quality.
The exterior surface 62' is smoother than hand-glued
balloons, and the outside diameter of the balloon
portion 58' is qssentially identical to the outside
diameter of other portions of the completed Foley
catheters 4~. It will be appreciated that larger
outside diameter balloon portions are undesirable since
they are somewhat more difficult to insert and withdraw,
.
. ~ .. . .... . .. . . . ..... . . . ... . . . .. . . . . . . ..... . .. . . . .. .
, : .. , : , .. . ~ . . . .
WO91/10~6 PCT/VS91/0016]
w i,~? 7 ~ ~ ~j 3
47
and cause additional trauma upon withdrawal. In
addition, by eliminating the hand labor involved in
adhering the balloon portion 58' to the intermediate
tube 3' in the manufacture of silicone rubber balloon
catheters 5', by specifically eliminating the separate
s~ep of fabricating the balloon portion, which also
requires hand labor, and by eliminating the significant
impact on yield resulting from hand processing errors,
the applicants' new process will permit direct
production cost for silicone rubber balloon catheters of
all types to be reduced by about 25-50% over the cost
estimated for the prior art silicone rubber balloon
catheters.
It is to be understood, however, that even
though numerous characteristics and advantages of the
present invention have been set forth in the foregoing
description, together with details of the structure and : ~ .
function of the invention, the sequence or order of the
specific steps, or the actual compositions, solvents, :~.
20 temperatures, environmental conditions and the like .
employed for each step, it will be appreciated the
disclosure is illustrative only, and that changes may be ~ :
made in detail, especially in matters of shape, size,
arrangement of parts or sequence or elements of events
25 within the principles of the invention to the full : : ~ .
extent indicated by the broad general meaning of the :
terms in whlch the appended claims are expressed.
` ~ '', ~
,
- :
!, . ' , ~ ,i
