DEVICES, SYSTEMS AND PROCEDURES FOR ADMINISTERING INSTRUMENTS FOR EXTENSION THROUGH A THROMBUS

Abstract

The procedure may comprise attaching a first delivery device to a catheter assembly, which may include a catheter lodged within a patient's vasculature. The first delivery device may include a first tubular instrument. When the first tubular instrument is in a distal position, the distal surface of the first tubular instrument may be positioned a first distance beyond the distal tip of the catheter. The procedure may also include attaching a second delivery device to the catheter assembly after detaching the first delivery device from the catheter assembly. The second delivery device may include a second tubular instrument. When the second tubular instrument is in a distal position, the distal surface of the second tubular instrument may be positioned a second distance beyond the distal tip of the catheter.The second distance can be greater than the first distance.

Description

A catheter is commonly used to infuse fluids into a patient's blood vessels. For example, the catheter can be used to infuse normal saline, various medications, or total parenteral nutrition. The catheter can also be used to draw blood from the patient. The catheter may include a peripheral intravenous (“IV”) catheter over the needle. In this case, the catheter may be mounted on an introducer needle with a sharp distal tip. The catheter and introducer needle may be assembled so that the distal tip of the introducer needle extends beyond the distal tip of the catheter, with the bevel of the needle facing upward, away from the patient's skin. The catheter and introducer needle are generally inserted at a shallow angle through the skin and into the patient's vasculature. To verify the correct placement of the introducer needle and / or catheter in the blood vessel, the physician typically checks for blood backflow in the catheter assembly's return chamber. Once needle placement is confirmed, the physician can temporarily occlude blood flow in the vessel and withdraw the needle, leaving the catheter in place for future blood draws or fluid infusions. Blood collection using a catheter can be difficult for several reasons, particularly when the catheter remains in the vasculature for more than a day. When a catheter is left in place for an extended period, the catheter or vein may be more prone to narrowing, collapse, kinking, obstruction with debris (e.g., fibrin clots or platelets), or adhesion of the catheter tip to the vasculature. For this reason, a blood sample is often obtained at the time of insertion, but less frequently while the catheter is in place. Therefore, when a blood sample is required, an additional needle puncture is often necessary to access the vein for blood collection, which can be painful for the patient and incur additional material costs. In some cases, to avoid an additional needle stick, a tubular instrument can be used to access the patient's vasculature through the catheter. The tubular instrument can be inserted through the catheter and into the vasculature to extend the catheter's lifespan and allow blood to be drawn through the catheter without the need for additional needle sticking. IVIA / a / ZUZZ / UI 1 UO4 additional needle puncture. The subject matter claimed herein is not limited to implementations that solve a problem or that function only in environments such as those described above. Rather, this background information is provided only to illustrate an example of a technological area in which some of the implementations described herein can be put into practice. BRIEF DESCRIPTION This disclosure generally relates to one or more delivery devices that provide access to a patient's vasculature, as well as related systems and procedures. In some embodiments, each delivery device can deliver a tubular instrument through a catheter. In some embodiments, the tubular instrument can facilitate a longer dwell time of the catheter within the patient's vasculature. In some embodiments, the delivery devices can be used to advance the tubular instrument within the catheter and / or beyond the distal tip of the catheter when the catheter is deteriorated or nearing the end of its useful life in order to overcome obstructions such as thrombi, valves, and / or a fibrin sheath within or around the catheter that might otherwise prevent blood withdrawal. In some embodiments, the delivery devices may allow needle-free delivery of the tubular instrument to the patient's vasculature for blood collection, fluid administration, patient or device monitoring, or other clinical needs by utilizing an existing catheter within the vasculature. In some embodiments, the tubular instruments of the delivery devices may be of different lengths, allowing delivery devices with longer tubular instruments to be used after delivery devices with shorter tubular instruments in order to increase the likelihood of the tubular instruments passing through a thrombus, which may increase in size over time. In some embodiments, a procedure may comprise attaching a first delivery device to a catheter assembly. In some embodiments, the catheter assembly may comprise a catheter lodged within the patient's vasculature. In some embodiments, the first delivery device may comprise a first housing and a first tubular instrument. In some embodiments, the first tubular instrument may comprise a distal end, a proximal end, and a lumen, extending between the distal end of the first tubular instrument and the proximal end of the first tubular instrument. In some embodiments, the proximal end of the first tubular instrument may be secured within the first housing. In some embodiments, the first tubular instrument may be configured to advance distally from a proximal to a distal position relative to the first housing and the catheter assembly. In some embodiments, when the first tubular instrument is in the proximal position, it may be proximal to the catheter assembly. In some embodiments, when the first tubular instrument is in the distal position, the distal surface of the distal end of the first tubular instrument may be positioned distal to the distal tip of the catheter and a first distance beyond the distal tip of the catheter. In some embodiments, the first tubular instrument may advance completely relative to the first housing when it is in the distal position. In some embodiments, after transferring a first volume of blood through the first tubular instrument to a first blood collection container and moving the tubular instrument from the distal to the proximal position, the procedure may comprise detaching the first delivery device from the catheter assembly. In some embodiments, after detaching the first delivery device from the catheter assembly, the procedure may comprise attaching a second delivery device to the catheter assembly. In some embodiments, the second delivery device may comprise a second housing and a second tubular instrument. In some embodiments, the second tubular instrument may comprise a distal end, a proximal end, and a lumen extending between the distal end of the second tubular instrument and the proximal end of the second tubular instrument. In some embodiments, the proximal end of the second tubular instrument may be secured within the second housing. In some embodiments, the second tubular instrument may be configured to advance distally from the proximal to the distal position relative to the second housing and the catheter assembly. In some embodiments, the second tubular instrument may advance completely relative to the second housing when the second tubular instrument is in the distal position. In some embodiments, when the second tubular instrument is in a proximal position, it may be proximal to the catheter assembly. In some embodiments, when the second tubular instrument is in a distal position, the distal surface of the distal end of the second tubular instrument may be positioned distal to the distal tip of the catheter and a second distance beyond the distal tip of the catheter. In some embodiments, the second distance may be greater than the first distance. In some embodiments, after transferring a second volume of blood through the second tubular instrument into a second blood collection container and moving the second tubular instrument from the distal to the proximal position, the procedure may comprise detaching the second delivery device from the catheter assembly. In some embodiments, after detaching the second delivery device from the catheter assembly, the procedure may comprise attaching a third delivery device to the catheter assembly. In some embodiments, the third delivery device may comprise a third housing and a third tubular instrument. In some embodiments, the third tubular instrument may comprise a distal end, a proximal end, and a lumen extending between the distal end of the third tubular instrument and the proximal end of the third tubular instrument. In some embodiments, the proximal end of the third tubular instrument may be secured within the third housing. In some embodiments, the third tubular instrument may be configured to advance distally from the proximal to the distal position relative to the third housing and the catheter assembly. In some embodiments, the third tubular instrument may advance completely relative to the third housing when the third tubular instrument is in the distal position. In some embodiments, when the third tubular instrument is in a proximal position, it may be proximal to the catheter assembly. In some embodiments, when the third tubular instrument is in a distal position, the distal surface of the distal end of the third tubular instrument may be positioned distal to the distal tip of the catheter and a third distance beyond the distal tip of the catheter. In some embodiments, the third distance may be greater than the second distance. In some embodiments, after transferring a third volume of blood through the third tubular instrument to a third blood collection container and moving the third tubular instrument from the distal to the proximal position, the procedure may involve detaching the third delivery device from the catheter assembly. In some implementations, the difference between the first and second distances can be 0.5 inches, which may facilitate extension through a thrombus that may form near the distal tip of the catheter and the establishment of a fluid pathway through the catheter assembly. More specifically, in some implementations, the size of the thrombus may increase over time, so the second distance may be greater than the first to increase the likelihood of passing through the thrombus when the second The IVIA / a / ZUZZ / UI 1 UO4 delivery device is attached to the catheter assembly, which is attached to the catheter assembly after the first delivery device. In some embodiments, the first distance may be 1 inch or less. In some embodiments, the second distance may be 1.5 inches or less. In some embodiments, the third distance may be 2 inches or less. In some embodiments, the difference between the first and second distances may be 0.25 inches, 0.33 inches, 0.75 inches, 1 inch, or another suitable distance. In some embodiments, the difference between the first and second distances may be greater than 0.25 inches. In some embodiments, the first delivery device may be attached to the catheter assembly on day one, and the second delivery device may be attached to the catheter assembly on day two, which may be after day one.In some implementations, the second day may be immediately after the first day. In some embodiments, the difference between the second and third distances can be 0.5 inches, facilitating extension through any thrombus that may form near the distal tip of the catheter and establishing a fluid pathway through the catheter assembly. More specifically, in some embodiments, the thrombus size may increase over time, so the third distance may be greater than the second distance to increase the likelihood of passing through the thrombus when the third delivery device is attached to the catheter assembly, which may occur after the second delivery device is attached. In some embodiments, the difference between the second and third distances may be 0.25 inches, 0.33 inches, 0.75 inches, 1 inch, or another suitable distance. In some embodiments, the difference between the second and third distances may be greater than 0.25 inches. In some embodiments, the second delivery device may be attached to the catheter assembly on the second day, and the third delivery device may be attached to the catheter assembly on the third day, which may be after the second day. In some embodiments, the third day may be immediately after the second day. In some embodiments, the first blood volume can be transferred to the first blood collection container via the first tubular instrument on the first day. In some embodiments, the second blood volume can be transferred to the second blood collection container via the second tubular instrument on the second day. In some embodiments, the third blood volume can be transferred to the third blood collection container via the third tubular instrument on the third day. In some embodiments, one or more of the first blood volume, the second blood volume, and the third blood volume may be transferred to the second blood collection container via the third tubular instrument on the third day. UO4 blood can be the same or different from each other. In some embodiments, the distal end of one or more of the first tubular instrument, the second tubular instrument, and the third tubular instrument may comprise one or more lateral holes, which can facilitate blood flow to the catheter proximal to the thrombus. In some embodiments, the distal end of one or more of the first tubular instrument, the second tubular instrument, and the third tubular instrument may be closed and / or may comprise a slit. In some embodiments, one or more of the first tubular instrument, the second tubular instrument, and the third tubular instrument may be resistant to occlusion and thrombosis since the slit can be closed and blood is not permitted to diffuse into the corresponding tubular instrument under normal physiological pressure conditions. In some embodiments, the difference between the first and second distances, and the difference between the second and third distances, may increase the likelihood of extension through the thrombus and the establishment of a fluid pathway through the catheter assembly. In some embodiments, one or more specific delivery devices, in addition to the first, second, and third delivery devices, may be attached to the catheter assembly without removing the catheter from the patient. In some embodiments, the specific tubular instruments inserted through the indwelling catheter over time may be progressively longer, which may increase the likelihood of establishing a fluid pathway through the catheter assembly to allow blood withdrawal and / or may reduce thrombosis. In some embodiments, the first delivery device may comprise a first mark. In some embodiments, the second delivery device may comprise a second mark. In some embodiments, the third delivery device may comprise a third mark. In some embodiments, one or more of the first, second, and third marks may indicate a time of use of the corresponding delivery device. For example, the first mark may indicate Day 1 or First Blood Draw. As another example, the second mark may indicate Day 2 or Second Blood Draw. As a further example, the third mark may indicate Day 3 or Third Blood Draw. In some embodiments, the first, second, and / or third marks may indicate a time of use of the corresponding delivery devices. In some embodiments, the first delivery device may comprise another brand. In some embodiments, the first delivery device may comprise a slider, which can be coupled to the first tubular instrument. In some embodiments, the The UO4 slider can be aligned with the other mark when the distal surface of the first tubular instrument is level with the distal tip of the catheter. Therefore, in some embodiments, the other mark can indicate to a clinician that, in response to further distal advancement of the first tubular instrument, the first tubular instrument will extend distally to the distal tip. In some embodiments, the second delivery device may include the other mark. In some embodiments, the second delivery device may include the slider that can be coupled to the second tubular instrument. In some embodiments, the slider can be aligned with the other mark when the distal surface of the second tubular instrument is level with the distal tip of the catheter. Similarly, in some embodiments, the third delivery device may include the other mark. In some embodiments, the third delivery device may include the slider, which can be coupled to the third tubular instrument. In some embodiments, the slider can be aligned with the other mark when the distal surface of the third tubular instrument is level with the distal tip of the catheter. In some embodiments, the catheter assembly may comprise a catheter adapter, which may include a distal end, a proximal end, and a lumen extending through the distal end of the catheter adapter and the proximal end of the catheter adapter. In some embodiments, the catheter assembly may include the catheter, which may be secured within the catheter adapter. In some embodiments, the distal end of the housing may include a connector, which may be configured to engage with a connector on the catheter adapter. In some embodiments, another delivery device may comprise the housing, which may include one or more of the following: the first mark, the second mark, the third mark, and a groove. In some embodiments, the first mark is proximal to the second mark. In some embodiments, the delivery device may comprise a tubular instrument, which may comprise a distal end, a proximal end, and a lumen, extending between the distal end of the tubular instrument and the proximal end of the tubular instrument. In some embodiments, the proximal end of the tubular instrument may be secured within the housing. In some embodiments, the slider may be attached to the tubular instrument and slide along the groove in the housing. In some embodiments, the slider may comprise an advance tab, which the clinician may grasp to advance and / or retract the tubular instrument. In some embodiments, in response to the distal advancement of the slider from a position proximal to the first mark, the distal surface of the distal end of the tubular instrument may UO4 may be positioned at a first distance beyond the distal end of the housing. In some embodiments, in response to the distal advancement of the slider from the proximal position to the second mark, the distal surface of the distal end of the tubular instrument may be positioned at a second distance beyond the distal end of the housing. In some embodiments, the second distance beyond the distal end of the housing may be greater than the first distance beyond the distal end of the housing. In some embodiments, in response to the distal advancement of the slider from the proximal position to the third mark, the distal surface of the distal end of the tubular instrument may be positioned at a third distance beyond the distal end of the housing. In some embodiments, the third distance beyond the distal end of the housing may be greater than the second distance beyond the distal end of the housing. It should be understood that both the preceding general description and the following detailed description constitute examples and explanations and do not limit the invention as claimed. It should be understood that the various embodiments are not limited to the arrangements and tubular instruments shown in the drawings. Furthermore, the drawings are not necessarily to scale. It should also be understood that the embodiments may be combined, or that other embodiments may be used, and that structural changes, unless otherwise claimed, may be made without departing from the scope of the various embodiments of the present invention. The following detailed description should therefore not be taken in a limiting sense. BRIEF DESCRIPTION OF THE VARIOUS VIEWS OF THE DRAWINGS The example embodiments will be described and explained in greater specificity and detail by means of the accompanying drawings in which: Figure 1A is a top perspective view of an example delivery device with an example anterior catheter assembly, illustrating an example tubular instrument in a proximal position, according to some embodiments; Figure 1B is a top perspective view of the delivery device of Figure 1A with the attached catheter assembly, illustrating the tubular instrument in a distal position, according to some embodiments; Figure 2A is a top perspective view of a first delivery device, illustrating a first example tubular instrument in a proximal position, according to some embodiments; Figure 2B is a top perspective view of a second delivery device, illustrating a second example tubular instrument in a proximal position, according to some embodiments; UO4 Figure 2C is a perspective top view of a third delivery device, illustrating a third example tubular instrument in a proximal position, according to some embodiments; Figure 3A is a top perspective view of the first delivery device of Figure 2A, illustrating the first tubular instrument in a distal position, according to some embodiments; Figure 3B is a top perspective view of the second delivery device of Figure 2B, illustrating the second tubular instrument in a distal position, according to some embodiments; Figure 3C is a top perspective view of the third delivery device of Figure 20, illustrating the third tubular instrument in a distal position, according to some embodiments; and Figure 4 is a top perspective view of an elongated delivery device, according to some embodiments. DESCRIPTION OF ACHIEVEMENTS With reference now to Figures 1A-1B, in some embodiments, a delivery device 10 for administering a tubular instrument 12 into the catheter 14 can facilitate a longer dwell time of the catheter 14. More specifically, the delivery device 10 can be used to advance the tubular instrument 12 into the catheter 14 and / or beyond the distal tip 16 of the catheter 14 for fluid infusion or blood withdrawal when the catheter 14 is deteriorated or nearing the end of its service life. In some embodiments, the delivery device 10 may comprise a housing 18 configured to engage a catheter adapter 19. In some embodiments, the delivery device 10 may comprise the tubular instrument 12. In some embodiments, the delivery device 10 may comprise any suitable delivery device. Non-limiting examples of delivery devices that may be used with the tubular instrument 12 are described in more detail in U.S. Patent Application No. 16 / 037,246, filed July 17, 2018, entitled “EXTENSION HOUSING A PROBE OR INTRAVENOUS CATHETER,” U.S. Patent Application No. 16 / 388.650, filed on April 18, 2019, entitled “INSTRUMENT DELIVERY DEVICE HAVING A ROTARY ELEMENT,” U.S. Patent Application No. 16 / 037,319, filed on July 17, 2018, entitled “MULTI-DIAMETER CATHETER AND RELATED DEVICES AND METHODS,” U.S. Patent Application No. 16 / 502,541, filed on July 3, 2019, entitled “DELIVERY DEVICE FOR A VASCULAR ACCESS INSTRUMENT,” and U.S. Patent Application No. 16 / 691,217, filed on November 21, 2019, entitled “SYRINGE-BASED DELIVERY DEVICE FOR A VASCULAR ACCESS INSTRUMENT' (Syringe-based delivery device for a vascular access instrument), U.S. Patent Application No. 16 / 742.013, filed on January 14, 2020, entitled “CATHETER DELIVERY DEVICE AND RELATED SYSTEMS AND METHODS” (Catheter delivery device and related systems and methods), and United States patent application no. 16 / 838,831, filed on April 2, 2020, entitled “VASCULAR ACCESS INSTRUMENT HAVING A FLUID PERMEABLE STRUCTURE AND RELATED DEVICES AND METHODS” (Vascular access instrument having a fluid permeable structure and related devices and methods), each of which is incorporated by reference in its entirety. In some embodiments, when the tubular instrument 12 is advanced distally relative to the housing 18, the delivery device 10 may be configured to introduce the tubular instrument 12 into the catheter assembly 20, which may comprise the catheter adapter 19 and the catheter 14. In some embodiments, when the tubular instrument 12 is introduced into the catheter assembly 20, the tubular instrument 12 may access a fluid pathway of the catheter assembly 20 and / or the tubular instrument 12 may be extended through the catheter assembly 20 to access the patient's vasculature. In some embodiments, catheter assembly 20 may comprise or correspond to any suitable catheter assembly, such as, for example, the BD NEXIVA® Closed IV Catheter System, the BD CATHENA® Catheter System, the BD VENFLON® Pro Safety Shielded IV Catheter System, the BD NEOFLON® IV Cannula System, the BD INSYTE® AUTOGUARD® BC Shielded IV Catheter System, or another suitable catheter assembly. In some embodiments, catheter assembly 20 may be integrated with an integrated extension tube 22. In other embodiments, catheter assembly 20 may not be integrated. In some embodiments, catheter 14 may comprise a peripheral intravenous catheter (PIVC), a peripherally inserted central catheter (PICC), or a midline catheter. In some embodiments, the catheter 14 may be secured within and extend distally from the catheter adapter 19. In some embodiments, the catheter adapter 19 may comprise a distal end 24, a proximal end 26, and a lumen 28 extending between and / or through the distal end 24 and the proximal end 26. In some embodiments, a septum may be disposed within the lumen of the catheter adapter 19. In some embodiments, the tubular instrument 12 may be delivered to the vasculature through the septum or proximal to the septum. In some embodiments, the delivery device 10 may comprise a connector 30, which may be coupled to the proximal end 26 or to another portion of the catheter assembly 20, such as, for example, a Y-adapter. In some embodiments, the connector 30 may comprise a male sliding, threaded, or clip-on luer adapter. In some embodiments, the connector 30 may comprise a female sliding, threaded, or clip-on luer adapter. In some embodiments, the connector 30 may comprise an introducer or cannula that can be inserted into the proximal end 26 of the catheter adapter 19. In some embodiments, the housing 18 may comprise a distal end 32 and a proximal end 34. In some embodiments, the distal end 32 may comprise the connector 30. In some embodiments, the delivery device 10 may comprise a blood collection device 36. In some embodiments, the blood collection device 36 may comprise or correspond to a blood collection container. In some embodiments, the blood collection container may comprise a syringe, a vacuum blood collection tube 38, a small sample collection device, or any other container. In some embodiments, the blood collection device 36 may be attached to the delivery device 10 after the distal advancement of the tubular instrument 12. In some embodiments, the blood collection device may comprise a needle assembly, which may include a 40 needle configured to receive the blood collection container. In some embodiments, the proximal tip of the 40 needle may be disposed within an elastomeric sheath. In some embodiments, when the blood collection container pushes the elastomeric sheath distally, the 40 needle may pierce the elastomeric sheath and be inserted into the blood collection container. In these and other embodiments, the blood collection container may include the 38 vacuum blood collection tube. In some embodiments, the blood collection device may comprise a holder 42, which may be configured to receive the vacuum blood collection tube 38. In some embodiments, the blood collection device may comprise the VACUTAINER® single-use holder, available from Becton, Dickinson and Company of Franklin Lakes, New Jersey. In some embodiments, the blood collection device 36 may be coupled to and in fluid communication with the proximal end 43 of the tubular instrument 12. In some embodiments, the blood collection device 36 may be coupled to and in UO4 fluid communication with the proximal end 43 of the tubular instrument 12 through a fluid pathway extending through the needle 40 and the tubular instrument 12. In some embodiments, the blood collection device 36 can be coupled to the proximal end 43 of the tubular instrument 12 in any number of suitable ways, such as by integration, a luer connection, etc. In some embodiments, the delivery device 10 may comprise a forwarder. In some embodiments, the forwarder may comprise a tab or handle, which the physician can move to advance the tubular instrument 12 distally and / or retract the tubular instrument 12 proximally. In some embodiments, the forwarder may be coupled to the tubular instrument 12. In some embodiments, the forwarder may be rotatable. In some embodiments, the forwarder may comprise a slider 41, which can be slid along a groove 45 arranged within the housing 18, as illustrated in Figures 1A-1B. In some embodiments, the tubular instrument 12 can be extended and moved through the proximal end 26 of the housing 18. In some embodiments, in response to significant dwell time within the vasculature, catheter 14 of catheter assembly 20 may be susceptible to narrowing, collapse, kinking, obstruction with debris (e.g., fibrin clots or platelets), and the distal tip 16 of catheter 14 may adhere to the vasculature. Therefore, blood collection using catheter 14 may be difficult. In some embodiments, tubular instrument 12 may comprise or act as another catheter that can provide access to the patient's vasculature without additional needle punctures. Therefore, in some embodiments, tubular instrument 12 can be used for needle-free blood collection and / or fluid infusion. With reference to Figures 2A and 3A, in some embodiments, a first delivery device 44 may be coupled to the catheter assembly 20. In some embodiments, the first delivery device 44 may be similar or identical to the delivery device 10 of Figures 1A-1B, respectively, in terms of one or more included features and / or operation. In some embodiments, the catheter 14 may remain within the patient's vasculature when the first delivery device 44 is coupled to the catheter assembly 20. More specifically, the catheter 14 may remain within the patient's vasculature before the first delivery device 44 is coupled to the catheter assembly 20. In some embodiments, the first delivery device 44 may comprise a first housing 46 and a first tubular instrument 48. In some embodiments, the first housing 46 and the first tubular instrument 48 may be similar or identical to the housing 18 and the tubular instrument 12 of Figures 1A-1B in terms of one or more included features and / or operation. In some embodiments, the first tubular instrument 48 may comprise a distal end 50, a proximal end 43, and a lumen extending between the distal end 50 of the first tubular instrument 48 and the proximal end 43 of the first tubular instrument 48. In some embodiments, the lumen may extend through the distal end 50 and the proximal end 43. In some embodiments, the proximal end 43 of the first tubular instrument 48 may be secured within the first housing 46. In some embodiments, the first tubular instrument 48 may be configured to advance distally from a proximal to a distal position with respect to the first housing 46 and the catheter assembly 20. In some embodiments, when the first tubular instrument 48 is in a proximal position, the first tubular instrument 48 may be proximal to the catheter assembly 20. More specifically, the distal end 50 of the first tubular instrument 48 or the distal surface 56 of the first tubular instrument 48 may be proximal to the catheter assembly 20 and / or within the first housing 46. In some embodiments, when the first tubular instrument 48 is in the distal position, the distal surface 56 of the distal end 50 of the first tubular instrument 48 may be disposed distal to a distal tip 16 of the catheter 14 and a first distance beyond the distal tip 16 of the catheter 14. In some embodiments, the distal surface 56 may comprise a more distal surface of the distal end 50. In some embodiments, the first tubular instrument 48 may advance completely relative to the first housing 46 when the first tubular instrument 48 is in the distal position. For example, the slider 41 may come into contact with a distal end of the groove 45, which may act as a stop. In some embodiments, after transferring a first volume of blood through the first tubular instrument 48 to a first blood collection container and moving the first tubular instrument 48 from the distal position to the proximal position, the first delivery device 44 can be detached from the catheter assembly 20. With reference to Figures 2B and 3B, in some embodiments, after detaching the first delivery device 44 from the catheter assembly 20, a second delivery device 58 may be attached to the catheter assembly 20. In some embodiments, the second delivery device 58 may be similar or identical to the delivery device 10 of Figures 1A-1B in terms of one or more included features and / or operation. In some embodiments, the catheter 14 may remain within the patient's vasculature when the second delivery device 58 is attached to the catheter assembly 20 and may not have been removed from the patient since its insertion into the vasculature. In some embodiments, the catheter 14 may remain within the patient's vasculature before the second delivery device 58 is attached to the catheter assembly 20. In some embodiments, the second delivery device 58 may comprise a second housing 60 and a second tubular instrument 62. In some embodiments, the second housing 60 and the second tubular instrument 62 may be similar or identical to housing 18 and tubular instrument 12 of Figures 1A-1B, respectively, in terms of one or more included features and / or operation. In some embodiments, the second tubular instrument 62 may comprise the distal end 50, the proximal end 43, and the lumen extending between the distal end 50 of the second tubular instrument 62 and the proximal end 43 of the second tubular instrument 62. In some embodiments, the lumen may extend through the distal end 50 and the proximal end 43. In some embodiments, the proximal end 43 of the second tubular instrument 62 may be secured within the second housing 60. In some embodiments, the second tubular instrument 62 may be configured to advance distally from the proximal to the distal position relative to the second housing 60 and the catheter assembly 20. In some embodiments, the second tubular instrument 62 may advance completely relative to the second housing 60 when the second tubular instrument 62 is in the distal position. For example, the slider 41 may contact a distal end of the groove 45, which may act as a stop. In some embodiments, when the second tubular instrument 62 is in a proximal position, it may be proximal to the catheter assembly 20. More specifically, the distal end 50 of the second tubular instrument 62 or the distal surface 56 of the second tubular instrument 62 may be proximal to the catheter assembly 20 and / or within the second housing 60. In some embodiments, when the second tubular instrument 62 is in a distal position, the distal surface 56 of the distal end 50 of the second tubular instrument 62 may be positioned distal to the distal tip 16 of the catheter 14 and a second distance beyond the distal tip 16 of the catheter 14. In some embodiments, the distal surface 56 may comprise a more distal surface of the distal end 50. In some embodiments, the second distance may be greater than the first distance. In some embodiments, after transferring a second volume of blood through the second tubular instrument 62 to a second blood collection container and moving the UO4 second tubular instrument 62 from the distal position to the proximal position, the second delivery device 58 can be detached from the catheter assembly 20. In some embodiments, the difference between the first and second distances may be 0.5 inches, which may facilitate extension through a thrombus that may form near the distal tip 16 of catheter 14 and the establishment of a fluid pathway through catheter assembly 20. More specifically, in some embodiments, the size of the thrombus may increase over time, so the second distance may be greater than the first distance to increase the likelihood that the second tubular instrument 62 will pass through the thrombus when the second delivery device is attached to catheter assembly 20, after the first delivery device is attached to catheter assembly 20. In some embodiments, the first distance may be 1 inch or less. In some embodiments, the second distance may be 1.5 inches or less. In some embodiments, the difference between the first and second distances may be 0.25 inches, 0.33 inches, 0.75 inches, 1 inch, or another suitable distance. In some embodiments, the difference between the first and second distances may be greater than 0.25 inches. In some embodiments, the first delivery device may be attached to the catheter assembly 20 on day one, and the second delivery device may be attached to the catheter assembly 20 on day two, which may be after day one. In some embodiments, day two may be immediately after day one. With reference to Figures 2C and 3C, in some embodiments, after detaching the second delivery device 58 from the catheter assembly 20, a third delivery device 64 may be attached to the catheter assembly 20. In some embodiments, the third delivery device 64 may be similar or identical to the delivery device 10 in Figures 1A-1B in terms of one or more included features and / or operation. In some embodiments, the catheter 14 may remain within the patient's vasculature when the third delivery device 64 is attached to the catheter assembly 20 and may not have been removed from the patient since its insertion into the vasculature. In some embodiments, the catheter 14 may remain within the patient's vasculature before the second delivery device 58 is attached to the catheter assembly 20. In some embodiments, the third delivery device 64 may comprise a third housing 66 and a third tubular instrument 68. In some embodiments, the third housing 66 and the third tubular instrument 68 may be similar or identical to housing 18 and tubular instrument 12 of Figures 1A-1B, respectively, in terms of one or IVIA / a / ZUZZ / UII UO4 plus included features and / or operation. In some embodiments, the third tubular instrument 68 may comprise the distal end 50, the proximal end 43 and the lumen extending between the distal end 50 and the proximal end 43. In some embodiments, the lumen may extend through the distal end 50 and the proximal end 43. In some embodiments, the proximal end 43 of the third tubular instrument 68 may be secured within the third housing 66. In some embodiments, the third tubular instrument 68 may be configured to advance distally from the proximal to the distal position relative to the third housing 66 and the catheter assembly 20. In some embodiments, the third tubular instrument 68 may advance completely relative to the third housing 66 when the third tubular instrument 68 is in the distal position. For example, the slider 41 may contact a distal end of the groove 45, which may act as a stop. In some embodiments, when the third tubular instrument 68 is in a proximal position, it may be proximal to the catheter assembly 20. More specifically, the distal end 50 of the third tubular instrument 68 or the distal surface 56 of the third tubular instrument 68 may be proximal to the catheter assembly 20 and / or within the third housing 66. In some embodiments, when the third tubular instrument 68 is in a distal position, the distal surface 56 of the distal end of the third tubular instrument 68 may be disposed distal to the distal tip 16 of the catheter 14 and a third distance beyond the distal tip 16 of the catheter 14. In some embodiments, the distal surface 56 may comprise a more distal surface of the distal end 50. In some embodiments, the third distance may be greater than the second distance. In some embodiments, after transferring a third volume of blood through the third tubular instrument 68 to a third blood collection container and moving the third tubular instrument 68 from the distal position to the proximal position, the third delivery device 64 can be detached from the catheter assembly 20. In some embodiments, the third distance may be 2 inches or less. In some embodiments, the difference between the second and third distances may be 0.5 inches, facilitating extension through any thrombus that may form near the distal tip of the catheter and establishing a fluid pathway through the catheter assembly 20. More specifically, in some embodiments, the size of the thrombus may increase over time, so the third distance may be greater than the second distance to increase the likelihood that the third tubular instrument 68 will pass through the thrombus when the third delivery device is attached to the catheter assembly 20, which may occur after the second delivery device is attached to the catheter assembly 20. In some embodiments, the difference between the second and third distances may be 0.25 inches, 0.33 inches, 0.75 inches, 1 inch, or another suitable distance. In some embodiments, the difference between the second and third distances may be greater than 0.25 inches. In some embodiments, the second delivery device 58 may be attached to the catheter assembly 20 on the second day, and the third delivery device 64 may be attached to the catheter assembly 20 on the third day, which may be after the second day. In some embodiments, the third day may be immediately after the second day. With reference to Figures 2A-3C, in some embodiments, the first blood volume can be transferred to the first blood collection container 70a via the first tubular instrument 48 on the first day. In some embodiments, the second blood volume can be transferred to the second blood collection container 70b via the second tubular instrument 62 on the second day. In some embodiments, the third blood volume can be transferred to the third blood collection container 70c via the third tubular instrument 68 on the third day. In some embodiments, one or more of the first blood volume, the second blood volume, and the third blood volume may be the same or different from each other. In some embodiments, one or more of the first blood collection container 70a, the second blood collection container 70b, and the third blood collection container 70c may be the same or different blood collection containers. In some embodiments, the first blood volume may be collected in the first blood collection container 70a and / or in one or more blood collection containers. In some embodiments, the second blood volume may be collected in the second blood collection container 70b and / or in one or more blood collection containers. In some embodiments, the third blood volume may be collected in the third blood collection container 70c and / or in one or more blood collection containers. In some embodiments, the distal end 50 of one or more of the first tubular instrument 48, the second tubular instrument 62, and the third tubular instrument 68 may comprise one or more lateral holes 72, which may facilitate blood flow to the catheter 14 proximal to the thrombus. In some embodiments, the distal end 50 of one or more of the first tubular instrument 48, the second tubular instrument 62, and the third tubular instrument 68 may be closed and / or may comprise a slit. In some embodiments, the side holes 72 in the first tubular instrument 48 may be within the first distance or at a certain distance from which the tip Distal UO4 16 extends beyond catheter 14. In some embodiments, the lateral holes 72 in the second tubular instrument 62 may be within the second distance or at a specified distance at which the distal tip 16 extends beyond catheter 14. In some embodiments, the lateral holes 72 in the third tubular instrument 68 may be within the second distance or at a specified distance at which the distal tip 16 extends beyond catheter 14. In some embodiments, one or more of the first tubular instrument 48, the second tubular instrument 62, and the third tubular instrument 68 may be resistant to occlusion and thrombosis because the slit can be closed, preventing blood from diffusing into the corresponding tubular instrument under normal physiological pressure. In some embodiments, the distal end 50 may include a distal opening. In some embodiments, the difference between the first and second distances, and the difference between the second and third distances, may increase the likelihood of extension through the thrombus and the establishment of a fluid pathway through catheter assembly 20. In some embodiments, one or more particular delivery devices, in addition to the first delivery device 44, the second delivery device 58, and the third delivery device 64, may be attached to catheter assembly 20 without removing catheter 14 from the patient. In some embodiments, the particular tubular instruments inserted through the housed catheter 14 over time may be progressively longer, which may increase the likelihood of establishing a fluid pathway through catheter assembly 20 to allow blood withdrawal and / or may reduce thrombosis. In some embodiments, the first dispensing device 44 may comprise a first mark 74a, which may be arranged on the outer surface of the first housing 46. In some embodiments, the second dispensing device may comprise a second mark 74b, which may be arranged on the outer surface of the second housing 60. In some embodiments, the third dispensing device 64 may comprise a third mark 74c, which may be arranged on the outer surface of the third housing 66. In some embodiments, the first mark 74a, the second mark 74b, and the third mark 74c may comprise one or more of a line, notch, groove, text, color, or other suitable mark. In some embodiments, one or more of the first mark 74a, the second mark 74b, and the third mark 74c may represent a period of use of the corresponding delivery device. For example, the first mark 74a may indicate Day 1 or First Blood Draw. As another example, the second mark 74b may indicate Day 2 or Second Blood Draw. IVIA / a / ZUZZ / UI 1 UO4 blood collection. As an additional example, the third mark 74c may indicate Day 3 or Third blood collection. In some embodiments, the first mark 74a, the second mark 74b, and / or the third mark 74c may indicate a time of use of the corresponding delivery devices. In some embodiments, the first housing 46 may comprise another mark 76a. In some embodiments, the first delivery device 44 may comprise the slider 41, which can be coupled to the first tubular instrument 48. In some embodiments, the slider 41 may be aligned with the other mark 76a when the distal surface 56 of the first tubular instrument 48 is level with the distal tip 16 of the catheter 14. Therefore, in some embodiments, the other mark 76a may indicate to the clinician that, in response to further distal advancement of the first tubular instrument 48, the first tubular instrument 48 will extend distally to the distal tip 16 of the catheter 14. In some embodiments, the second housing 60 may comprise the other mark 76b. In some embodiments, the second delivery device 58 may comprise the slider 41, which can be coupled to the second tubular instrument 62. In some embodiments, the slider 41 can be aligned with the other mark 76b when the distal surface 56 of the second tubular instrument 62 is level with the distal tip 16 of the catheter 14. Similarly, in some embodiments, the third delivery device 64 may comprise the other mark 76c. In some embodiments, the third delivery device may comprise the slider 41, which can be coupled to the third tubular instrument 68. In some embodiments, the slider 41 can be aligned with the other mark 76c when the distal surface 56 of the third tubular instrument 68 is level with the distal tip 16 of the catheter 14. In some embodiments, the third housing 66 may be longer than the second housing 60, which may be longer than the first housing 46. Therefore, the third tubular instrument 68, which may be longer than the second tubular instrument 62 and the first tubular instrument 48, may be contained within the third housing 66 before distal advancement. Similarly, in some embodiments, the second tubular instrument 62 may be contained within the second housing 60 before distal advancement, and the first tubular instrument 48 may be contained within the first housing 46 before distal advancement. With reference now to Figure 4, in some embodiments, a dispensing device 80 may comprise a housing 82 and a tubular instrument 84. In some embodiments, the housing 82 may comprise one or more of the following: a first mark 86, a second mark 88, a third mark 90, and the groove 45. In some IVIA / a / ZUZZ / UI 1 UO4 realizations, the first mark 86, the second mark 88 and the third mark 90 may comprise one or more of a line, notch, groove, text, color or other suitable mark. In some embodiments, the first mark 86 may be proximal to the second mark 88. In some embodiments, the delivery device 80 may comprise the tubular instrument 84, which may comprise the distal end 50, the proximal end 43, and the lumen. In some embodiments, the proximal end of the tubular instrument may be secured within the housing 82. In some embodiments, the slider 41 may be coupled to the tubular instrument 84 and be slidable along the groove 45 of the housing 82. In some embodiments, the slider 41 may comprise an advance tab, which the physician may grasp to advance and / or retract the tubular instrument. In some embodiments, in response to the distal advancement of slider 41 from a position proximal to the first mark 86, the distal surface 56 of the distal end 50 of the tubular instrument 84 may be positioned at a first distance beyond the distal end 32 of the housing 82 or at a first distance beyond the distal tip 16 of the catheter 14. In some embodiments, in response to the distal advancement of slider 41 from the position proximal to the second mark 88, the distal surface 56 of the distal end 50 of the tubular instrument may be positioned at a second distance beyond the distal end of the housing or at a second distance beyond the distal tip 16 of the catheter 14. In some embodiments, the second distance beyond the distal end 50 of housing 82 may be greater than the first distance beyond the distal end 32 of housing 82. As mentioned above, in some embodiments, the second distance beyond the distal tip 16 of catheter 14 may be greater than the first distance beyond the distal tip 16 of catheter 14. In some embodiments, in response to the distal advancement of slider 41 from the proximal position to the third mark 90, the distal surface 56 of the distal end of the tubular instrument 84 may be positioned a third distance beyond the distal end 32 of the housing 82. In some embodiments, the third distance may be greater than the second distance. As mentioned above, in some embodiments, the third distance beyond the distal tip 16 of the catheter 14 may be greater than the second distance beyond the distal tip 16 of the catheter 14. In some embodiments, different blood collection containers or the same blood collection container may be used to collect blood through delivery device 80 or any of the other delivery devices herein UO4 Disclosure. In some embodiments, slider 41 may advance distally from the proximal position to the first mark 86 in a first time interval for a first blood draw. In some embodiments, slider 41 may advance distally from the first mark 86 to the second mark 88 in a second time interval following the first time interval. In some embodiments, slider 41 may advance distally from the second mark 88 to the third mark 90 in a third time interval following the second time interval. In some embodiments, the first time interval may correspond approximately to one day. In some embodiments, the second and third time intervals may correspond approximately to two days and three days, respectively.In some embodiments, the first time duration, the second time duration, and the third time duration may correspond to any suitable time duration from the insertion of the catheter 14 into the vasculature. All examples and conditional language presented herein are intended for pedagogical purposes to assist the reader in understanding the invention and the concepts contributed by the inventors to the development of the technique, and should be considered as not limiting the examples and conditions specifically indicated. Although embodiments of the present invention have been described in detail, it should be understood that various changes, substitutions, and alterations may be made without departing from the spirit and scope of the invention.

Claims

1. A method comprising: attaching a first delivery device to a catheter assembly, the catheter assembly comprising a catheter housed within the vasculature of a patient and the first delivery device comprising: a first housing;and a first tubular instrument comprising a distal end, a proximal end and a lumen, extending between the distal end of the first tubular instrument and the proximal end of the first tubular instrument, wherein the proximal end of the first tubular instrument is secured within the first housing, wherein the first tubular instrument is configured to advance distally from a proximal position to a distal position with respect to the first housing and the catheter assembly, wherein, when the first tubular instrument is in a proximal position, the first tubular instrument is proximal to the catheter assembly and when the first tubular instrument is in a distal position, the distal surface of the first tubular instrument is disposed distal to the distal tip of the catheter and a first distance beyond the distal tip of the catheter;after transferring a first volume of blood through the first tubular instrument to a first blood collection container and moving the tubular instrument from the distal position to the proximal position, detach the first delivery device from the catheter assembly; after detaching the first delivery device from the catheter assembly, attach a second delivery device to the catheter assembly, the second delivery device comprising: a second housing;a second tubular instrument comprising a distal end, a proximal end and a lumen, extending between the distal end of the second tubular instrument and the proximal end of the second tubular instrument, wherein the proximal end of the second tubular instrument is secured within the second housing, wherein the second tubular instrument is configured to advance distally from another proximal position to another distal position with respect to the second housing and the catheter, wherein, when the second tubular instrument is in the proximal position, the second tubular instrument is proximal to the catheter assembly and when the second tubular instrument is in the distal position, the distal surface of the second tubular instrument is disposed distal to the distal tip of the catheter and a second distance from the distal tip of the catheter, the second distance being greater than the first distance;and 1 UO4 after transferring a second volume of blood through the second tubular instrument to a second blood collection container and moving the second tubular instrument from the distal position to the proximal position, detach the second delivery device from the catheter.; 2. Method according to claim 1, wherein the difference between the first distance and the second distance is 0.5 inches.

3. Method according to claim 1, wherein the first distance is 1 inch or less.

4. Method according to claim 3, wherein the second distance is 1.5 inches or less.

5. Method according to claim 1, further comprising transferring the first volume of blood, through the first tubular instrument, to the first blood collection container on a first day and transferring the second volume of blood, through the second tubular instrument, to the second blood collection container on a second day.

6. Method according to claim 1, wherein the distal end of the first tubular instrument and the second tubular instrument are closed.

7. Method according to claim 1, wherein the distal end of the first tubular instrument and the distal end of the second tubular instrument comprise a plurality of lateral holes.

8. Method according to claim 1, further comprising: attaching a third administration device to a catheter disposed within the patient's vasculature, the third administration device comprising: a third housing;a third tubular instrument comprising a distal end, a proximal end, and a lumen extending between the distal end of the third tubular instrument and the proximal end of the third tubular instrument, wherein the proximal end of the third tubular instrument is secured within the third housing, wherein the third tubular instrument is configured to advance distally from another proximal position to another distal position with respect to the third housing and the catheter, wherein, when the third tubular instrument is in the other proximal position, the third tubular instrument is proximal to the catheter assembly, and when the third tubular instrument is in the other distal position, the distal surface of the third tubular instrument is disposed distal to the distal tip of the catheter and a third distance from the distal tip of the catheter, the third distance being greater than the second distance. 1 UO4; 9. Method according to claim 8, wherein the third distance is 2.0 inches or less.

10. Method according to claim 9, wherein the difference between the second distance and the third distance is 0.5 inches.

11. Blood collection kit, comprising: a first administration device, comprising: a first housing, wherein a distal end of the first housing comprises a first adapter configured to couple to a catheter assembly;and a first tubular instrument comprising a distal end, a proximal end, and a lumen, extending between the distal end of the first tubular instrument and the proximal end of the first tubular instrument, wherein the proximal end of the first tubular instrument is secured within the first housing, wherein the first tubular instrument is configured to advance distally from a proximal position to a distal position with respect to the first housing and the catheter assembly, wherein, in response to the distal advancement of the first tubular instrument from the proximal position to the distal position with respect to the first housing, the distal surface of the distal end of the first tubular instrument is disposed at a first distance beyond the distal end of the first housing;a second delivery device, comprising: a second housing, wherein a distal end of the second housing comprises a second adapter configured to couple to a catheter assembly;and a second tubular instrument comprising a distal end, a proximal end, and a lumen, extending between the distal end of the second tubular instrument and the proximal end of the second tubular instrument, wherein the proximal end of the second tubular instrument is secured within the second housing, wherein the second tubular instrument is configured to advance distally from a proximal position to a distal position with respect to the second housing and the catheter assembly, wherein, in response to the distal advancement of the second tubular instrument from the proximal position to the distal position with respect to the second housing, the distal surface of the distal end of the second tubular instrument is disposed at a second distance beyond the distal end of the second housing, the second distance being greater than the first distance.

12. Blood collection kit according to claim 11, wherein the distal end of the first tubular instrument and the second tubular instrument are closed. 1 UO4 13. Blood collection kit according to claim 11, wherein the distal end of the first tubular instrument and the distal end of the second tubular instrument comprise a plurality of side holes.

14. Blood collection kit according to claim 11, further comprising: a third administration device, comprising: a third housing, wherein a distal end of the third housing comprises a third adapter configured to couple to a catheter assembly;and a third tubular instrument comprising a distal end, a proximal end, and a lumen, extending between the distal end of the third tubular instrument and the proximal end of the third tubular instrument, wherein the proximal end of the third tubular instrument is secured within the third housing, wherein the third tubular instrument is configured to advance distally from a proximal position to a distal position with respect to the third housing and the catheter assembly, wherein, in response to the distal advancement of the third tubular instrument from the proximal position to the distal position with respect to the third housing, the distal surface of the distal end of the third tubular instrument is disposed at a third distance beyond the distal end of the third housing, the third distance being greater than the second distance.

15. Delivery device for administering a tubular instrument through a catheter of a catheter assembly, the delivery device comprising: a housing comprising a first mark, a second mark and a groove, wherein the first mark is proximal to the second mark;a tubular instrument comprising a distal end, a proximal end and a lumen, extending between the distal end of the tubular instrument and the proximal end of the tubular instrument, wherein the proximal end of the tubular instrument is secured within the housing, a slider coupled to the tubular instrument and sliding along the groove of the housing, wherein, in response to distal advancement of the slider from a position proximal to the first mark, the distal surface of the distal end of the tubular instrument is disposed at a first distance beyond the distal end of the housing, wherein, in response to distal advancement of the slider from the position proximal to the second mark, the distal surface of the distal end of the tubular instrument is disposed at a second distance beyond the distal end of the housing, the second distance being greater than the first distance.

16. Administration device according to claim 15, wherein the difference between the first distance and the second distance is 0.5 inches. 1 UO4 17. Administration device according to claim 15, wherein the first distance is 1 inch or less.

18. Delivery device according to claim 17, wherein the second distance is 1.5 inches or less.

19. Delivery device according to claim 15, wherein the housing comprises a third mark distal to the second mark, wherein, in response to distal advancement of the slider from the proximal position to the third mark, the distal surface of the distal end of the tubular instrument is disposed at a third distance beyond the distal end of the housing, the third distance being greater than the second distance.

20. Delivery device according to claim 15, wherein, when the slider is aligned with the first mark, the second mark, the third mark, or another mark of the housing, the distal surface of the tubular instrument is level with the distal tip of the catheter.

Images