Magnetically trackable stylet and method thereof

Abstract

Disclosed herein are magnetically trackable stylets and methods thereof. The magnetically trackable stylets may include a stylet body including a core wire, a magnetic assembly, and an outer structure on the core wire and the magnetic assembly. The magnetic assembly may include one or more magnetic field generating elements disposed alongside the core wire within a magnetically trackable distal portion of the stylet body. The outer structure, which may be an overmolding layer, a reflow layer, a potting layer, or a shrink wrap layer, may be located around the core wire and the magnetic assembly. The stylet body may be configured to be disposed within a lumen of a medical device, such as a catheter, for magnetically tracking a tip of a medical layer in vivo without bending-related fatigue-related fracture of the stylet body. Methods of such magnetically trackable stylets may include methods of using the stylet.

Description

[Technical field]

[0001] SUMMARY The present disclosure relates to magnetically trackable stylets and methods thereof. [Background technology]

[0002] The Sherlock 3CG™ Tip Confirmation System and Sherlock 3CG+ TCS (collectively, “TCS”) are indicated for peripherally inserted central catheter (“PICC”) guidance and positioning. The TCS provides real-time location information of the PICC tip using passive patient-specific magnet tracking and cardiac electrical activity for such guidance and positioning. Thus, the TCS is an advantageous alternative to chest x-rays and fluoroscopy for placing PICCs in adult patients, especially when relying on the patient's electrocardiogram (“ECG”) signal. The TCS continues to be important for PICC guidance and positioning, as PICCs can be positioned up to five times faster with fewer malpositions and reduced x-ray exposure using the TCS. Summary of the Invention

[0003] Disclosed herein is a magnetically trackable stylet and method for use with a TCS or other such system for placement of a medical device utilizing at least magnetic tracking for placement of the medical device.

[0004] Disclosed herein, in some embodiments, is a magnetically trackable stylet that includes a stylet body that includes a core wire, a flexible magnetic assembly, and a casing. The magnetic assembly includes one or more magnetic field generating elements disposed alongside the core wire within a magnetically trackable distal portion of the stylet body. The casing is positioned around the core wire and the magnetic assembly. The stylet body is configured to be disposed within a lumen of a catheter to magnetically track a catheter tip in vivo without bending-related fatigue-related breakage of the stylet body.

[0005] In some embodiments, the core wire is tapered within a distal portion of the stylet body alongside the one or more magnetic field generating elements. In some embodiments, the stylet further comprises a sealed stylet tip that includes a seal that seals the one or more magnetic field generating elements within a distal portion of the stylet body.

[0006] In some embodiments, the one or more magnetic field generating elements include one or more polymer-bonded magnets that are configured to bend and thereby allow the stylet to bend and conform to the patient's anatomy without breaking.

[0007] In some embodiments, the one or more polymer-bonded magnets include a single cylindrical polymer-bonded magnet. In some embodiments, the one or more polymer-bonded magnets include a plurality of cylindrical polymer-bonded magnets.

[0008] In some embodiments, the one or more magnetic field generating elements include one or more sintered magnets. In some embodiments, the one or more sintered magnets include a plurality of cylindrical sintered magnets having rounded ends configured to allow the cylindrical magnets to bend relative to one another and thereby allow the stylet to bend to conform to the patient's anatomy without breakage.

[0009] In some embodiments, the one or more sintered magnets include a plurality of cylindrical sintered magnets alternating with a plurality of spherical sintered magnets, the alternating cylindrical and spherical magnets forming an articulated joint therebetween that is configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with the patient's anatomy without breakage.

[0010] In some embodiments, the one or more sintered magnets include a plurality of cylindrical sintered magnets alternating with a plurality of non-metallic spheres, the alternating cylindrical magnets and non-metallic spheres forming an articulated joint therebetween that is configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with a patient's anatomy without breakage.

[0011] In some embodiments, the one or more sintered magnets include a plurality of cylindrical sintered magnets arranged in alternating fashion with a plurality of partitions that define grooves in the magnet holder in which the sintered magnets are disposed, the partitions forming articulating joints between the cylindrical magnets, the joints being configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with the patient's anatomy without breakage.

[0012] In some embodiments, the one or more sintered magnets include a plurality of cylindrical sintered magnets disposed within a plurality of magnet holders forming an articulating joint therebetween configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with the patient's anatomy without breakage.

[0013] In some embodiments, each of the magnet holders includes a ball end and a socket end, and the connection between the magnet holders is a ball and socket connection. In some embodiments, the magnet holder includes a ball-end type magnet holder having a pair of ball ends and a socket-end type magnet holder having a pair of socket ends, the interface between the magnet holders being a ball and socket interface.

[0014] In some embodiments, the magnet holders are links and the connectors are link loops between the links chained together. In some embodiments, the one or more magnetic field generating elements include one or more magnetic wires twisted or braided with a core wire, the one or more magnetic wires being configured to bend and thereby allow the stylet to bend and conform to the patient's anatomy without breaking.

[0015] Disclosed herein, in some embodiments, is a magnetically trackable stylet that includes a stylet body that includes a flexible magnet assembly and a casing. The magnetic assembly includes one or more magnetic wires within a magnetically trackable distal portion of the stylet body. A casing is positioned about the magnetic assembly. The stylet body is configured to be disposed within a lumen of a catheter to magnetically track a catheter tip in vivo without bending-related fatigue-related breakage of the stylet body.

[0016] In some embodiments, the one or more magnetic wires include a single magnetic wire. In some embodiments, the stylet further comprises a core wire, the magnetic wire being twisted together with the core wire within the distal portion of the stylet body.

[0017] In some embodiments, the stylet further comprises a core wire, the magnetic wire being helically wound around the core wire within the distal portion of the stylet body.

[0018] In some embodiments, the one or more magnetic wires comprises a plurality of magnetic wires. In some embodiments, the stylet further comprises a core wire, the magnetic wire being twisted or braided with the core wire within the distal portion of the stylet body.

[0019] In some embodiments, the stylet further comprises a core wire, the magnetic wire being twisted or braided around the core wire within the distal portion of the stylet body.

[0020] In some embodiments, the stylet further comprises a sealed stylet tip. The stylet tip comprises a seal that seals the magnetic wire within a distal portion of the stylet body.

[0021] Disclosed herein, in some embodiments, is a magnetically trackable stylet including a stylet body including a core wire, a magnetic assembly, and an outer structure on the core wire and the magnetic assembly. The magnetic assembly includes one or more magnetic field generating elements disposed alongside the core wire within a magnetically trackable distal portion of the stylet body. The outer structure is selected from the group consisting of an overmold layer, a reflow layer, a potting layer, and a shrink wrap layer. The stylet body is configured to be disposed within a lumen of a catheter to magnetically track a catheter tip in vivo without bending-related fatigue-related failure of the stylet body.

[0022] In some embodiments, the outer structure is a single layer outer structure. In some embodiments, the outer structure includes an overmolded layer that is molded around the core wire and the magnetic assembly.

[0023] In some embodiments, one or more gaps between any two or more magnetic field generating elements include a polymer material of an overmolded layer therebetween, the one or more gaps having polymer material therebetween forming one or more articulation joints in the magnetic assembly.

[0024] In some embodiments, the outer structure includes a reflow layer that is reflowed around the core wire and the magnetic assembly. In some embodiments, one or more gaps between any two or more magnetic field generating elements include a reflow layer of polymer material therebetween, the one or more gaps having polymer material forming one or more articulation joints in the magnetic assembly.

[0025] In some embodiments, the outer structure includes a potting layer that is potted around the core wire and the magnetic assembly. In some embodiments, one or more gaps between any two or more magnetic field generating elements include potting material of a potting layer therebetween, the one or more gaps having potting material therebetween forming one or more articulation joints in the magnetic assembly.

[0026] In some embodiments, the outer structure includes a shrink wrap layer that is shrunk around the core wire and the magnetic assembly. In some embodiments, one or more gaps between any two or more magnetic field generating elements form one or more articulation joints in the magnetic assembly.

[0027] In some embodiments, the outer structure is a multi-layer outer structure. In some embodiments, the outer structure includes an overmolded layer and one or more other layers on the overmolded layer, The overmolded layer is molded around the core wire and the magnetic assembly.

[0028] In some embodiments, one or more gaps between any two or more magnetic field generating elements include a polymer material of an overmolded layer therebetween, the one or more gaps having polymer material therebetween forming one or more articulation joints in the magnetic assembly.

[0029] In some embodiments, the one or more other layers include a casing disposed on the overmold layer. In some embodiments, the outer structure includes a reflow layer and one or more other layers over the reflow layer, The reflow layer is reflowed around the core wire and the magnetic assembly.

[0030] In some embodiments, one or more gaps between any two or more magnetic field generating elements include a reflow layer of polymer material therebetween, the one or more gaps having polymer material forming one or more articulation joints in the magnetic assembly.

[0031] In some embodiments, the one or more other layers include a braided layer over the reflow layer and an outer casing over the braided layer. The reflow layer is reflowed into the braided layer.

[0032] In some embodiments, the outer structure includes a potting layer and one or more other layers over the potting layer, The potting layer is potted around the core wire and the magnetic assembly.

[0033] In some embodiments, one or more gaps between any two or more magnetic field generating elements include potting material of a potting layer therebetween, the one or more gaps having potting material therebetween forming one or more articulation joints in the magnetic assembly.

[0034] In some embodiments, the one or more other layers include a casing disposed over the potting layer. In some embodiments, the outer structure includes a shrink wrap layer and one or more other layers over the shrink wrap layer, where the shrink wrap layer is shrunk around the core wire and the magnetic assembly.

[0035] In some embodiments, one or more gaps between any two or more magnetic field generating elements form one or more articulation joints in the magnetic assembly. In some embodiments, the one or more other layers include a casing disposed over the shrink wrap layer.

[0036] In some embodiments, the core wire is tapered within a distal portion of the stylet body alongside the one or more magnetic field generating elements. In some embodiments, the stylet further comprises a sealed stylet tip that includes a seal that seals the one or more magnetic field generating elements within a distal portion of the stylet body.

[0037] These and other features of the concepts presented herein will become apparent to those of ordinary skill in the art in view of the following description and accompanying drawings, which describe in greater detail certain embodiments of such concepts. [Brief description of the drawings]

[0038] [Figure 1] 1 shows a block diagram depicting various elements of a first integrated system for placement of a medical device, such as a catheter, within a patient, according to some embodiments. [Diagram 2] 1 shows a schematic diagram of a patient and a catheter being placed within the patient using a first integrated system, according to some embodiments. [Diagram 3] 1 illustrates an ultrasound image on a display of a first integrated system according to some embodiments. [Figure 4] 1 illustrates a perspective view of a first stylet of a first integrated system according to some embodiments. [Figure 5A] 13 illustrates a graphical representation on a display of the first integrated system during placement of a catheter before a signal is received by the tip location sensor according to some embodiments. [Figure 5B] 1 illustrates a graphical representation on a display of a first integrated system having signals received in the vicinity of a tip location sensor according to some embodiments. [Figure 5C] 1 illustrates a graphical representation on a display of a first integrated system having a signal received below a tip location sensor according to some embodiments. [Figure 6]1 shows a block diagram depicting various elements of a second integrated system for placement of a medical device, such as a catheter, within a patient, according to some embodiments. [Figure 7] 1 shows a schematic diagram of a patient and a catheter being placed within the patient using a second integrated system, according to some embodiments. [Figure 8] 13 shows a perspective view of a second stylet of a second integrated system according to some embodiments. [Figure 9] 1 shows a schematic diagram of a patient's ECG tracing in accordance with some embodiments. [Figure 10] 13 illustrates a graphical representation on a display of a second integrated system having a signal received below a tip location sensor according to some embodiments. [Figure 11] 1 illustrates a stylet body of a first or second stylet according to some embodiments. [Figure 12] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 13] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 14] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 15A] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 15B] 15B shows a detailed cross-sectional view of a tip portion of the stylet of FIG. 15A rotated 90° along the axis of the stylet in accordance with some embodiments. [Figure 16] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 17] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet according to some embodiments. [Figure 18] 1 shows a detailed cutaway view of a tip portion of a first or second stylet according to some embodiments. [Figure 19] 1 shows a detailed cutaway view of a tip portion of a first or second stylet according to some embodiments. [Figure 20A] 1 shows a detailed cross-sectional view of a distal portion of a first and second stylet including a first outer structure according to some embodiments. [Figure 20B] 1 shows a detailed cross-sectional view of a distal portion of a first and second stylet including a second outer structure according to some embodiments. [Figure 20C] 1 shows a detailed cross-sectional view of a distal portion of a first or second stylet including a third outer structure according to some embodiments. [Figure 21A] 13 shows a detailed cross-sectional view of a distal portion of the first and second stylets including a fourth outer structure according to some embodiments. [Figure 21B] 13 shows a detailed cross-sectional view of a distal portion of the first and second stylets including a fifth outer structure according to some embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0039] Before a more detailed disclosure of some specific embodiments, it should be understood that the specific embodiments disclosed herein do not limit the scope of the concepts provided herein, and that the specific embodiments disclosed herein may have features that can be easily separated from the specific embodiment and that can optionally be combined with or substituted for features of any of some of the other embodiments disclosed herein.

[0040] Also, in relation to the terms used herein, it should be understood that the terms are intended to describe some particular embodiments, and that the terms are not intended to limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps within a group of features or steps, and do not provide sequential or numerical limitations. For example, the "first", "second", and "third" features or steps do not necessarily have to appear in that order, and a particular embodiment including such features or steps is not necessarily limited to three features or steps. And, in addition, any of the above features or steps may further include one or more features or steps, unless otherwise indicated. Labels such as "left", "right", "upper", "lower", "front", "rear", and the like are used for convenience, and are not intended to imply any particular fixed location, orientation, or direction, for example. Instead, such labels are used, for example, to reflect relative location, orientation, or direction. The singular forms "a," "an," and "the" include plural references unless the context clearly dictates otherwise.

[0041] For example, in the context of "proximal," "proximal portion," or "proximal section," a catheter includes the portion of the catheter that is intended to be located near the clinician when the catheter is in use on a patient. Similarly, for example, the "proximal length" of a catheter includes the length of the catheter that is intended to be located near the clinician when the catheter is in use on a patient. For example, the "proximal end" of a catheter includes the end of the catheter that is intended to be located near the clinician when the catheter is in use on a patient. Although the proximal portion, portion, or length of a catheter can include the proximal end of the catheter, the proximal portion, portion, or length of a catheter does not necessarily include the proximal end of the catheter. That is, unless the context suggests otherwise, the proximal portion, portion, or length of a catheter is not a distal portion or length of a catheter.

[0042] For example, in the context of a "distal," "tip portion," or "tip section," a catheter includes the portion of the catheter that is intended to be located near or within a patient when the catheter is in use on a patient. Similarly, for example, the "tip length" of a catheter includes the length of the catheter that is intended to be located near or within a patient when the catheter is in use on a patient. For example, the "tip" of a catheter includes the end of the catheter that is intended to be located near or within a patient when the catheter is in use on a patient. A tip portion, tip portion, or tip length of a catheter can include the tip of the catheter, but a tip portion, tip portion, or tip length of a catheter need not include the tip of the catheter. That is, unless the context suggests otherwise, a tip portion, tip portion, or tip length of a catheter is not a terminal portion or terminal length of a catheter.

[0043] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art.

[0044] As discussed above, TCS continues to be an advantageous alternative to chest x-ray and fluoroscopy for placement of PICCs in adult patients, particularly when relying on the patient's electrocardiogram ("ECG") signal. Disclosed herein are magnetically trackable stylets and methods for use with TCS or other such systems for placement of medical devices that utilize at least magnetic tracking for placement of the medical device.

[0045] The drawings depict features of various embodiments of an integrated system for placing a medical device, such as a catheter, within a patient's vasculature. In some embodiments, the integrated system utilizes at least two modes to improve the accuracy of the placement of the medical device: 1) an ultrasound ("US") mode for introducing the medical device (e.g., catheter 72) into the patient's vasculature under US visualization, and 2) a tip location sensor ("TLS") mode for TLS or magnetic tracking of the tip of the medical device (e.g., distal tip 76A of catheter 72) during its advancement through the tortuous vasculature, thereby allowing detection and correction of any malpositioning of the medical device during such advancement. The US visualization and TLS tracking of the integrated system are, in some embodiments, integrated into a single integrated device that is used by the clinician placing the medical device. The integration of features of these two modes into the integrated device simplifies the placement of the medical device and results in relatively fast placement of the medical device. For example, the integrated system allows US guidance and TLS tracking to be viewed from a single display of the integrated system. Additionally, controls located on the US probe of the integrated device, whose probe remains within the patient's sterile field during placement of the medical device, can be used to control the functions of the integrated system, thereby eliminating the need for the clinician to reach out from the sterile field to control the integrated system.

[0046] In some embodiments, a third mode, i.e., an ECG mode, is included within the integrated system to enable ECG confirmation of the tip of the medical device in a desired location relative to the patient's cardiac node from which the ECG signal is originating.

[0047] The combination of the features of the three modes described above allows the integrated system to facilitate placement of a medical device within a patient's vasculature with a relatively high level of accuracy. Furthermore, due to ECG confirmation for the medical device tip, correct tip placement can be confirmed without the need for a confirmatory x-ray. This reduces patient exposure to potentially harmful x-rays, the cost and time associated with transporting patients to and from x-ray departments, costly and inconvenient repositioning procedures, etc.

[0048] 1 and 2, which depict various components of an integrated system 10 for placing a medical device, such as a catheter 72. As shown, the integrated system 10 generally includes a console 20, a display 30, a probe 40, and a TLS 50, each of which is described in further detail below.

[0049] FIG. 2 illustrates the general relationship of various components to a patient 70 during a procedure for placing a catheter 72 (e.g., a PICC, central venous catheter ("CVC"), or other suitable catheter) into the patient's vasculature through an insertion site 73 in the patient's skin. FIG. 2 illustrates that the catheter 72 generally includes a proximal portion 74 that remains outside the patient 70 after placement is complete, and a distal portion 76 that resides within the patient's vasculature. The integrated system 10 is utilized to ultimately position the distal tip 76A of the catheter 72 at a desired location within the patient's vasculature. In some embodiments, the desired location for the distal tip 76A of the catheter 72 is near the patient's heart, such as in the lower third of the superior vena cava ("SVC"). However, the integrated system 10 can be utilized to place the distal tip 76A of the catheter 72 at other locations as needed. The proximal portion 74 of the catheter 72 further includes a hub 74A that provides fluid communication between one or more lumens of the catheter tube 71 and one or more extension legs 74B extending proximally from the hub 74A.

[0050] An example implementation of the console 20 is shown in Figure 5C, however, it should be understood that the console 20 may have any of a variety of forms. As shown in Figure 1, a processor 22 including non-volatile memory such as an electrically erasable programmable read only memory ("EEPROM") may be included within the console 20 to control system functions during operation of the integrated system 10, thereby acting as a control processor. Also included within the console 20 is a digital controller / analog interface 24. The digital controller / analog interface 24 is in communication with both the processor 22 and other system components to control interfacing between the probe 40, the TLS 50, and other system components.

[0051] The integrated system 10 further includes a port 52 for connection between the TLS 50 and optional components 54, including a printer, storage media, keyboard, etc. In some embodiments, the port 52 is a USB port, although other port types or combinations of port types may be used for this and other interface connections described herein. A power connection 56 is included with the console 20 to allow for operative connection to an external power source 58. An internal power source 60 (e.g., a battery) may also be utilized, with or without the external power source 58. A power management circuit 59 is included with the digital controller / analog interface 24 of the console 20 to regulate power usage and distribution.

[0052] The display 30 may be integrated within the console 20. The display 30 is used to display information to the clinician during the placement procedure. In some embodiments, the display 30 may be separate from the console 20. The content depicted by the display 30 changes according to one or more modes (e.g., US mode, TLS mode, ECG mode, or combinations thereof) during use on the integrated system 10. In some embodiments, the console button interface 32 (see FIGS. 1 and 5C) and buttons included on the probe 40 may be used to quickly invoke a desired mode on the display 30 by the clinician to assist in the placement procedure. In some embodiments, information from multiple modes, such as TLS and ECG modes, may be displayed simultaneously (see FIG. 10). Thus, the display 30 of the console 20 may be utilized for US visualization to access the patient's vasculature, TLS tracking during advancement of the catheter 72 through the vasculature, and ECG confirmation to confirm placement of the distal tip 76A of the catheter 72 in relation to the patient's cardiac nodes. In some embodiments, the display 30 is an LCD device.

[0053] 2 is utilized in connection with a first mode (i.e., US mode) for US visualization of a blood vessel, such as a vein, in preparation for insertion of a catheter 72 into the vasculature. Such visualization provides real-time assistance for introducing the catheter 72 into the vasculature of the patient 70 and helps reduce complications typically associated with such introduction, including inadvertent arterial puncture, hematoma, pneumothorax, etc.

[0054] The probe 40 includes a head housing a piezoelectric array for generating ultrasonic pulses and receiving the echoes after reflection by the patient's body when the head is placed in pressure contact with the patient's skin near the expected insertion site (see FIG. 2). The probe 40 further includes a number of control buttons, which may be included on a button pad as shown in FIG. 2. The modes of the integrated system 10 can be controlled by the control buttons, thereby eliminating the need for the clinician to reach out from the sterile field established around the insertion site 73 prior to placement of the catheter 72 to change modes via use of the console button interface 32.

[0055] Thus, in some embodiments, the clinician utilizes a first mode (i.e., US mode) to determine an appropriate insertion site for establishing vascular access, first with a needle or introducer and then with catheter 72. The clinician can then seamlessly switch to a second mode (i.e., TLS mode) via the depression of a control button on the control button pad of probe 40 without the need to reach out from the sterile field. The TLS mode can then be used to aid in the advancement of catheter 72 through the vasculature toward its intended destination.

[0056] 1 shows that the probe 40 further includes control buttons and a button and memory controller 42 for controlling probe operation. The button and memory controller 42 may include non-volatile memory such as an EEPROM in some embodiments. The button and memory controller 42 is in operative communication with a probe interface 44 of the console 20, which includes a piezoelectric input / output component 44A for interfacing with the probe piezoelectric array, and a button and memory input / output component 44B for interfacing with the button and memory controller 42.

[0057] 3 illustrates an exemplary screen shot 88 depicted on the display 30 while the integrated system 10 is in its first mode (i.e., US mode). An image 90 of a subcutaneous area of ​​a patient 70 is shown depicting a cross-section of a vein 92. The image 90 is generated by operation of the piezoelectric array of the probe 40. Also included on the screen shot 88 is a depth scale indicator 94 that provides information regarding the depth of the image 90 below the patient's skin, a lumen size scale 96 that provides information regarding the size of the vein 92 in relation to the lumen size of a standard catheter, and other indicia 98 that provide information regarding the status of the integrated system 10 or possible actions to be performed with the integrated system 10 (e.g., freeze frame, image template, save data, print image, power state, image brightness, etc.).

[0058] It should be noted that while a vein 92 is depicted in the image 90, in other embodiments, other body lumens or portions may be imaged. It should be noted that the US mode depicted in FIG. 3 may be simultaneously depicted on the display 30 along with other modes, such as a TLS mode, if desired. In addition to the display 30, auditory information, such as beeps, tones, and the like, may also be utilized by the integrated system 10 to assist the clinician in the placement of the catheter 72. Furthermore, the control buttons included on the probe 40 and console button interface 32 may be configured in various manners for user or clinician input. Indeed, slide switches, toggle switches, electronic or touch sensitive pads, or the like may be implemented for user or clinician input. Additionally, both US visualization and TLS tracking may occur simultaneously or exclusively during use of the integrated system 10.

[0059] The probe 40 may be utilized as part of the integrated system 10 to enable US visualization of the peripheral vasculature of the patient 70 in preparation for percutaneous introduction of the catheter 72. However, the probe 40 may also be utilized to control the TLS mode functions of the integrated system 10 as the catheter 72 is navigated within the vasculature to its desired destination. Again, as the probe 40 is used within the sterile field of the patient 70, this feature allows the TLS tracking to be controlled entirely from within the sterile field. Thus, the probe 40 is a dual purpose device, thereby allowing convenient control of both the US visualization and TLS tracking of the integrated system 10 from the sterile field. In some embodiments, the probe 40 may also be utilized to control some or all of the ECG-related functions for the third mode of the integrated system 10.

[0060] The integrated system 10 further includes a second mode, i.e., a TLS mode. The TLS 50 allows a clinician to quickly locate and confirm the position or orientation of the catheter 72 during initial placement and advancement through the vasculature of the patient 70. Specifically, the TLS mode detects magnetic fields generated by a magnetic field generating tip of the stylet 100, which in some embodiments has been pre-inserted into a longitudinally defined lumen of the catheter 72, thereby allowing the clinician to identify the general location and orientation of the distal tip 76A of the catheter within the patient's body for tracking. In some embodiments, the magnetic field generating tip of the stylet 100 can be tracked using the teachings of one or more of the following patents: U.S. Pat. No. 5,775,322; U.S. Pat. No. 5,879,297; U.S. Pat. No. 6,129,668; U.S. Pat. No. 6,216,028; and U.S. Pat. No. 6,263,230, each of which is incorporated herein by reference in its entirety. The TLS 50 also allows for an indication of the direction in which the distal tip 76A of the catheter 72 is pointing, thereby further assisting in accurate placement of the catheter 72. The TLS 50 further assists the clinician in determining when malposition of the distal tip 76A of the catheter 72 has occurred, such as when the distal tip 76A has deviated from the desired venous route into another vein. Examples of the TLS 50 and systems incorporating the TLS 50 are disclosed in U.S. Patent Nos. 8,388,541, 8,781,555, 8,849,382, 9,636,031, and 9,649,048, each of which is incorporated herein by reference in its entirety.

[0061] As mentioned above, the TLS 50 utilizes a stylet 100 to enable the distal tip 76A of the catheter 72 to be tracked during its advancement through the vasculature. FIG. 4 provides an example of a stylet 100, which includes a proximal end 100A and a distal end 100B. A handle 102 is included on the stylet body 1000 at the proximal end 100A of the stylet 100, with a core wire 104 extending distally from the handle 102 through the stylet body 1000 (see FIG. 11 ). As shown in FIG. 11 , a magnetic assembly 1002 is located at or alongside the distal end of the core wire 104. The magnetic assembly 1002 includes one or more magnetic field generating elements 106. For example, the magnetic field generating elements 106 may be disposed adjacent to one another near the distal end 100B of the stylet 100 and may be encapsulated by a flexible outer structure 108 (e.g., a flexible casing) as shown in FIG. 4. In fact, each of the one or more magnetic field generating elements 106 may include a solid cylindrically shaped permanent magnet (e.g., a composite or ferrite magnet, a rare earth magnet, a rare earth-free magnet, etc.) stacked end-to-end with the other magnetic field generating elements 106. The stylet tip 110 may be sealed by a filler material 1004 (e.g., a conductive slug, a conductive epoxy, or the like) within the distal tip of the outer structure 108 of the one or more magnetic field generating elements 106, thereby sealing the one or more magnetic field generating elements 106 within the distal portion of the stylet 100 of its stylet body 1000 (see FIG. 11). Advantageously, therefore, the one or more magnetic field generating elements 106 are capable of moving relative to the outer structure 108, thereby improving the flexibility of the stylet 100 with respect to directly adhering the one or more magnetic field generating elements 106 to the outer structure 108.Indeed, by directly adhering one or more of the magnetic field generating elements 106 to the outer structure 108, the one or more magnetic field generating elements 106 are maintained in a fixed position relative to the outer structure 108.

[0062] Notwithstanding the above, the magnetic field generating element(s) 106 may vary from those described above in number, shape, size, or in relation to one or more dimensions, composition, magnet type, or location within the distal portion of the stylet 100. Indeed, other examples of the magnetic field generating element(s) 106 are described below. For example, the magnetic assembly 1002 or its magnetic field generating element(s) 106 may be a flexible electromagnetic assembly 1006, such as that described below in relation to FIG. 19, which generates a magnetic field for detection by the TLS 50. Another example of a magnetic assembly usable herein may be found in U.S. Patent No. 5,099,845, entitled "Medical Instrument Location Means," which is incorporated herein by reference in its entirety. Still other examples of stylets including magnetic assemblies that may be utilized with the TLS 50 include U.S. Patent No. 8,784,336, U.S. Patent No. 9,901,714, U.S. Patent No. 10,004,875, U.S. Patent Application Publication No. 2018 / 0304043, and U.S. Patent Application Publication No. 2018 / 0169389, each of which is incorporated herein by reference in its entirety. It should be understood that "stylet," as used herein, may include any of a variety of devices configured for releasable placement within the lumen of the catheter 72 to assist in positioning the distal tip 76A of the catheter 72 within a desired location within the patient's vasculature.

[0063] 2 illustrates the placement of the stylet 100 substantially within the lumen of the catheter 72, such that a proximal portion of the stylet 100 extends proximally from the lumen of the catheter tube 71, through the hub 74A, and out through one or more extension legs 74B. Thus positioned within the lumen of the catheter 72, the distal end 100B of the stylet 100 is substantially co-terminal with the distal tip 76A of the catheter 72, such that detection by the TLS 50 of the distal end 100B of the stylet 100 indicates the location of the distal tip 76A of the catheter 72 in a corresponding manner.

[0064] The TLS 50 is utilized by the integrated system 10 during operation to detect the magnetic field generated by the one or more magnetic field generating elements 106 of the stylet 100. As seen in FIG. 2, the TLS 50 is positioned on the chest of the patient 70 during insertion of the catheter 72. The TLS 50 is positioned at a predetermined location on the chest of the patient 70, such as through the use of external body landmarks, to allow the magnetic field of the one or more magnetic field generating elements 106 disposed within the catheter 72 to be detected during movement of the catheter 72 through the patient's vasculature. Again, the one or more magnetic field generating elements 106 of the magnetic assembly 1002 may be in a common termination with the distal tip 76A of the catheter 72 (see FIG. 2). Detection of the magnetic field of the one or more magnetic field generating elements 106 by the TLS 50 provides the clinician with information about the position and orientation of the distal tip 76A of the catheter 72 during its movement.

[0065] More specifically, the TLS 50 is operatively connected to the console 20 of the integrated system 10 via one or more of the ports 52 as shown in FIG. 1. It should also be noted that other connection schemes between the TLS 50 and the console 20 may be used without limitation. As mentioned above, one or more magnetic field generating elements 106 may be utilized within the stylet 100 to allow the position of the distal tip 76A of the catheter 72 (see FIG. 2) to be observed relative to the TLS 50 positioned on the patient's chest. The detection of the one or more magnetic field generating elements 106 by the TLS 50 is graphically displayed on the display 30 of the console 20 in the TLS mode. As a result, the clinician placing the catheter 72 can roughly determine the location of the distal tip 76A of the catheter 72 within the patient's vasculature relative to the TLS 50 and can detect when a malposition of the catheter 72 occurs, such as, for example, the advancement of the catheter 72 along an undesired vein.

[0066] 5A-5C depict screen shots taken from the display 30 of the integrated system 10 while in TLS mode, showing the manner in which the magnetic assembly 1002 of the stylet 100 is depicted. Screen shot 118 of FIG. 5A shows a representative image 120 of the TLS 50. Other information is provided on the screen shot 118, including a depth scale indicator 124, a status or action indicator 126, and a button icon 128 (see FIG. 5C) that corresponds to the console button interface 32 included on the console 20. Although the button icon 128 is shown as a relatively simple indicator to guide the user in identifying the purpose of the corresponding button of the console button interface 32, in some embodiments the display 30 can be touch-sensitive such that the button icon 128 itself can function as a button interface and can change according to the mode of the integrated system 10.

[0067] During the initial stages of advancement of the catheter 72 through the patient's vasculature after insertion therein, the distal tip 76A of the catheter 72, having the distal end 100B of the stylet 100 substantially co-terminous therewith, is relatively far from the TLS 50. Thus, the screen shot 118 indicates "no signal," thereby indicating that a magnetic field from the magnetic assembly 1002 of the stylet 100 is not being detected. In FIG. 5B, the magnetic assembly 1002 adjacent the distal end 100B of the stylet 100 has advanced sufficiently close to the TLS 50 to be detected by it, but it is not yet below the TLS 50. This is indicated by the half icon 114A representing the distal portion of the stylet 100 or the magnetic assembly 1002 of the stylet 100 being positioned to the right of the TLS 50 from the perspective of the patient 70.

[0068] In FIG. 5C, the magnetic assembly 1002 near the tip 100B of the stylet 100 is advanced below the TLS 50 so that its position and orientation relative to the TLS 50 is detected by the TLS 50. This is indicated by the icon 114 on the image 120. Note that the button icon 128 provides an indication of an action that may be performed by pressing a corresponding button on the console button interface 32. Thus, the button icon 128 can change according to the mode of the integrated system 10, thereby providing flexibility in the use of the console button interface 32. Note further that since the control button pad of the probe 40 includes control buttons similar to some of the buttons on the console button interface 32, the button icon 128 on the display 30 provides a guide to the clinician to control the integrated system 10 with the control buttons of the probe 40 while remaining within the sterile field. For example, if the clinician needs to leave the TLS mode and return to the US mode, the appropriate control button on the probe's control button pad can be pressed and the US mode can be instantly invoked, thereby refreshing the display 30 to accommodate the visual information required for the US mode, such as that shown in Figure 3. This is accomplished without the need for the clinician to reach out from the sterile field.

[0069] 6 and 7, an integrated system 10 according to some embodiments will be described. As before, the integrated system 10 includes a console 20, a display 30, a probe 40 for US visualization, and a TLS 50 for TLS tracking. It should be noted that the integrated system 10 depicted in FIGS. 6 and 7 is similar in many respects to the integrated system 10 depicted in FIGS. 1 and 2. Therefore, only selected differences will be described below. The integrated system 10 of FIGS. 6 and 7 includes an additional function for determining the proximity of the distal tip 76A of the catheter 72 relative to the sinoatrial ("SA") node or other electrical impulse emitting node of the patient's 70 heart, thereby providing an improved ability to precisely position the distal tip 76A of the catheter 72 at a desired location near the node. Additionally, a third mode of the integrated system 10, i.e., an ECG mode, allows for detection of an ECG signal from the SA node in order to position the distal tip 76A of the catheter 72 at a desired location within the patient's vasculature. It should be noted that the US mode, TLS mode, and ECG mode are seamlessly combined within the integrated system 10 of FIG. 6 and may be utilized in concert or individually to assist in the placement of the catheter 72.

[0070] 6 and 7 show the addition of a stylet 130 to the integrated system 10. In summary, the stylet 130 is removably pre-disposed within the lumen of the catheter 72, which is inserted into the patient 70 via the insertion site 73. In addition to the magnetic assembly 1002 of the stylet 100 for the TLS mode, the stylet 130 includes an ECG sensor assembly near its distal end 130B for sensing ECG signals generated by the SA node. In contrast to the stylet 100, the stylet 130 further includes a tether 134 extending from its proximal end that is operatively connected to the TLS 50. The tether 134 allows ECG signals detected by the ECG sensor assembly of the stylet 130 to be transmitted to the TLS 50 upon confirmation of the location of the distal tip 76A of the catheter 72 as part of the ECG mode. As shown in FIG. 7, reference and ground ECG leads are attached to the body of the patient 70 and to the TLS 50, allowing the integrated system 10 to filter out high levels of electrical activity not related to the SA node electrical activity of the heart, thereby enabling ECG-based tip confirmation. The ECG signal sensed by the ECG sensor assembly of the stylet 130, along with the reference and ground signals received from the ECG leads placed on the patient's skin, are received by the TLS 50 positioned on the patient's chest (see FIG. 7). The TLS 50 or the processor 22 can process ECG data corresponding to the ECG signal to generate an ECG waveform on the display 30. In the case where the TLS 50 is processing ECG data, a processor is included therein to perform the intended functions. In the case where the console 20 is processing ECG data, the processor 22, the digital controller / analog interface 24, or other processors can be utilized within the console 20 to process the data.

[0071] Thus, as the catheter 72 with the stylet 130 is advanced through the patient's vasculature, the catheter 72 may be advanced beneath the TLS 50 positioned on the chest of the patient 70 as shown in FIG. 7. This allows the TLS 50 to detect the position of the magnetic assembly 1002 of the stylet 130 in substantial co-termination with the distal tip 76A of the catheter 72 located within the patient's vasculature. The detection of the magnetic assembly 1002 of the stylet 130 by the TLS 50 is depicted on the display 30 in the ECG mode. The display 30 further depicts an ECG waveform generated as a result of the electrical activity of the patient's heart detected by the ECG sensor assembly of the stylet 130 in the ECG mode. More specifically, the electrical activity of the SA node, including the P-wave of the waveform, is detected by the ECG sensor assembly of the stylet 130 and transferred to the TLS 50 and the console 20. The electrical activity of the SA node is then processed for depiction on the display 30. As a result, a clinician placing the catheter 72 can observe the ECG data to determine optimal placement of the distal tip 76A of the catheter 72, such as near the SA node. In some embodiments, the console 20 includes the electronic components, such as a processor 22 (see FIG. 6 ), required to receive and process signals detected by the ECG sensor assembly of the stylet 130. However, in some embodiments, the TLS 50 may include the electronic components required to receive and process signals detected by the ECG sensor assembly of the stylet 130.

[0072] As mentioned above, the display 30 is used to display information to the clinician during placement of the catheter 72. The content of the display 30 changes according to the mode of the integrated system 10, i.e., US mode, TLS mode, ECG mode, or any combination of the above modes. Any of the three modes can be instantly invoked by the clinician on the display 30, and in some cases, information from multiple modes, such as TLS and ECG modes, can be displayed simultaneously. In some embodiments, as before, the mode of the integrated system 10 can be controlled by a control button on the probe 40, thereby eliminating the need for the clinician to reach out from the sterile field to touch the console button interface 32 of the console 20 to change modes. Thus, the probe 40 can also be utilized to control some or all of the ECG-related functions of the integrated system 10. It should also be noted that the console button interface 32 or other input configurations can also be used to control system functions. In addition to the display 30, auditory information, such as beeps, tones, and the like, can also be utilized by the integrated system 10 to assist the clinician during placement of the catheter 72.

[0073] 8, various details of several embodiments of a stylet 130 that is removably disposed within the catheter 72 and utilized during insertion to position the distal tip 76A of the catheter 72 at a desired location within the patient's vasculature will be described. As shown, the stylet 130 includes a proximal end 130A and a distal end 130B. A tether connector 132 is included at the proximal end 130A of the stylet 130, and a tether 134 extends distally from the tether connector 132 and is attached to a handle 136. A core wire 138 extends distally from the handle 136. In some embodiments, the stylet 130 is pre-positioned within the lumen of the catheter 72 such that the distal end 130B is substantially flush or co-terminous with an opening at the distal tip 76A of the catheter 72 (see FIG. 7). Additionally, the core wire 138, handle 136, and proximal portion of the tether 134 extend proximally from one of the extension legs 74B in such an embodiment. It should be noted that although described here as a stylet, in other embodiments a guidewire or other medical device guiding device may include certain operational features of the stylet 130.

[0074] The core wire 138 defines an elongated shape and is constructed from suitable stylet materials, including memory materials such as stainless steel or nickel, and a titanium-containing alloy commonly referred to as "nitinol." Although not shown here, fabrication of the core wire 138 from nitinol allows the portion of the core wire 138 corresponding to the distal segment of the stylet 130 to have a pre-formed (e.g., bent) configuration to bias the distal portion 76 of the catheter 72 into a similar configuration. In other embodiments, the core wire 138 does not include a pre-form. Additionally, the nitinol construction provides torqueability to the core wire 138 to allow at least the distal segment of the stylet 130 to be manipulated by the core wire 138 while the stylet 130 is disposed within the lumen of the catheter 72, thereby allowing the distal portion 76 of the catheter 72 to be navigated through the vasculature during insertion of the catheter 72.

[0075] A handle 136 is provided to allow for insertion or removal of the stylet 130 from the catheter 72. In embodiments in which the corewire 138 has torque capabilities, the handle 136 further allows the corewire 138 to be rotated within the lumen of the catheter 72 to aid in navigating the tip section 76 of the catheter 72 through the vasculature of the patient 70.

[0076] The handle 136 is attached to the distal end of the tether 134, which may be a flexible shielded cable containing one or more conductive wires electrically connected to both a core wire 138 that functions as an ECG sensor assembly and a tether connector 132. The tether 134 thus provides a conductive path from the distal portion of the core wire 138 to the tether connector 132 at the proximal end 130A of the stylet 130. The tether connector 132 is configured for operable connection to the TLS 50 on the patient's chest to aid in navigation of the distal tip 76A of the catheter 72 to a desired location within the patient's vasculature.

[0077] As described above for the stylet 100, the outer structure 108 (e.g., a casing) encapsulates at least a portion of the core wire 138 as well as a magnetic assembly 1002 disposed near the distal end 130B of the stylet 130 used during the TLS mode of the integrated system 10. The magnetic assembly 1002 includes one or more magnetic field generating elements 106 that may be interposed between an outer surface of the core wire 138 and an inner surface of the outer structure 108 near the distal end 130B of the stylet 130. The one or more magnetic field generating elements 106 may include up to at least 20 permanent magnets of solid cylindrical shape stacked end-to-end in a manner similar to the stylet 100 of FIG. However, in other embodiments, the one or more magnetic field generating elements 106 may vary in number, shape, size, or one or more dimensions, composition, magnet type, or location within the distal portion of the stylet 130. For example, in some embodiments, the one or more magnetic field generating elements 106 of the magnetic assembly 1002 are replaced by electromagnets that generate a magnetic field for detection by the TLS 50.

[0078] One or more magnetic field generating elements 106 are utilized within a distal portion of the stylet 130 to enable the position of the distal end 130B of the stylet 130 to be observable relative to the TLS 50 positioned on the patient's chest. As discussed above, the TLS 50 is configured to detect the magnetic fields generated by the one or more magnetic field generating elements 106 as the stylet 130 advances with the catheter 72 through the patient's vasculature. As a result, a clinician placing the catheter 72 can generally determine the location of the distal tip 76A of the catheter 72 within the patient's vasculature and can detect when the catheter 72 is malpositioned.

[0079] The stylet 130 further includes the ECG sensor assembly described above. The ECG sensor assembly enables the stylet 130, disposed within the lumen of the catheter 72 during insertion, to be utilized in detecting intra-atrial ECG signals generated by the SA or other nodes of the patient's heart, thereby permitting navigation of the distal tip 76A of the catheter 72 to a predetermined location within the vasculature proximate the patient's heart. The ECG sensor assembly thus serves as an aid in verifying proper placement of the distal tip 76A of the catheter 72.

[0080] In the embodiment shown in FIG. 8, the ECG sensor assembly includes a distal portion of a core wire 138 disposed near the distal end 130B of the stylet 130. The conductive core wire 138 allows ECG signals to be detected by the distal end and transmitted proximally along the core wire 138. A filler 1004 (e.g., a metal slug or an epoxy containing metal particles) may fill a distal portion of the outer structure 108, including the stylet tip 110 (see FIG. 4), adjacent the distal terminus of the core wire 138 so as to be in conductive communication with the distal end of the core wire 138, thereby increasing the conductive surface area of ​​the distal end 130B of the stylet 130 to improve its ability to detect ECG signals.

[0081] Prior to placement of the catheter 72, the stylet 130 is placed within the lumen of the catheter 72. Note that the stylet 130 may come from the manufacturer pre-placed within the catheter 72, or may be placed within the catheter 72 by the clinician prior to placement of the catheter 72. The stylet 130 is disposed within the catheter 72 such that the distal end 130B of the stylet 130 is substantially co-terminous with the distal tip 76A of the catheter 72, thereby placing the distal tips of both the stylet 130 and the catheter 72 in substantial alignment with one another. The co-terminous nature of the catheter 72 and stylet 130 allows the magnetic assembly 1002 to function with the TLS 50 in TLS mode to track the position of the distal tip 76A of the catheter 72 as the catheter is advanced within the patient's vasculature. However, for purposes of the tip confirmation function of the integrated system 10, the distal end 130B of the stylet 130 does not need to be co-terminated with the distal tip 76A of the catheter 72. Rather, all that is required is that a conductive path be established between the vasculature and the ECG sensor assembly of the corewire 138 such that electrical impulses of the SA node or other nodes of the patient's heart may be detected. This conductive path may include a variety of components including saline, blood, etc.

[0082] Once the catheter 72 has been introduced into the patient's vasculature via the insertion site 73 (see FIG. 7 ), the TLS mode of the integrated system 10 can be utilized to advance the distal tip 76A of the catheter 72 toward its intended destination in the vicinity of the SA node, as previously described. Upon approaching said destination, the integrated system 10 can be switched to an ECG mode to allow the ECG emitted by the SA node to be detected. As the catheter 72, with the stylet disposed therein, advances toward the patient's heart, the conductive ECG sensor assembly, including the distal end of the corewire 138 and the conductive material in the stylet tip 110, begins to detect electrical pulses generated by the SA node. Thus, the ECG sensor assembly functions as an electrode for detecting ECG signals. The corewire 138 near the distal end of the stylet 130 functions as a conductive pathway for transmitting electrical impulses generated by the SA node and received by the ECG sensor assembly to the tether 134.

[0083] The tether 134 conveys the ECG signal to the TLS 50, which is temporarily placed on the patient's chest. The tether 134 is operably connected to the TLS 50 via a tether connector 132 or other suitable direct or indirect connection. The ECG signal can then be processed and depicted on the display 30 as described (see FIGS. 6 and 7). Monitoring the ECG signal received by the TLS 50 and displayed on the display 30 allows the clinician to observe and analyze changes in the ECG signal as the distal tip 76A of the catheter 72 advances toward the SA node. When the received ECG signal matches a desired profile, the clinician can determine that the distal tip 76A of the catheter 72 has reached a desired position relative to the SA node. As discussed above, in some embodiments, this desired position is located within the lower third of the SVC.

[0084] The ECG sensor assembly and the magnetic assembly 1002 can function in concert to assist the clinician in the placement of the catheter 72 within the patient's vasculature. In general, the magnetic assembly 1002 of the stylet 130 assists the clinician in generally navigating the vasculature, from the initial insertion of the catheter 72 to the placement of the distal tip 76A of the catheter 72 within the desired general region of the patient's heart. The ECG sensor assembly can then be utilized to guide the distal tip 76A of the catheter 72 to a desired location within the SVC by allowing the clinician to observe changes in the ECG signal generated by the patient's heart as the ECG sensor assembly of the stylet 130 approaches the SA node. Again, once the ECG signal matches the desired profile, the clinician can determine that the tips of both the stylet 130 and the catheter 72 have reached the desired location in relation to the patient's heart. Once properly positioned, the catheter 72 can be secured in place, and the stylet 130 can be removed from the catheter 72. It should be noted here that the stylet 130 may include one of a variety of configurations in addition to those explicitly described herein. In some embodiments, the stylet 130 may be attached directly to the console 20 instead of indirectly attached via the TLS 50. In some embodiments, the structure of the stylet 130 that enables its TLS and ECG related functions may be integrated within the catheter 72 itself. For example, the magnetic assembly 1002 or ECG sensor assembly may be built into the wall of the catheter 72 in some embodiments.

[0085] 9 illustrates a typical ECG waveform 176 including P waves and QRS complexes. In general, the amplitude of the P waves varies as a function of the distance of the ECG sensor assembly from the SA node generating the ECG waveform 176. A clinician can use this relationship in determining when the distal tip 76A of the catheter 72 is properly positioned near the heart. For example, in one implementation, the distal tip 76A of the catheter 72 is desirably positioned within the lower one-third (1 / 3) of the superior vena cava. The ECG detected by the ECG sensor assembly of the stylet 130 is used to reconstruct a waveform such as the ECG waveform 176 for depiction on the display 30 of the integrated system 10 in ECG mode.

[0086] 10, the manner in which ECG data is displayed on the display 30 when the integrated system 10 is in ECG mode according to some embodiments. Screenshot 178 of the display 30 includes elements of the TLS mode, such as an image 120 of the TLS 50 and an icon 114 corresponding to the position of the tip 130B of the stylet 130 as it travels through the patient's vasculature. Screenshot 178 also includes a window 180 in which the current ECG waveform captured by the ECG sensor assembly of the stylet 130 is displayed. Window 180 is continually refreshed as new waveforms are detected.

[0087] Window 182 includes a continuous depiction of the most recently detected ECG waveform as well as a refresh bar 182A that moves laterally to refresh the waveform as it is detected. For purposes of comparison, window 184A is used to display a baseline ECG waveform captured before the ECG sensor assembly is in close proximity to the SA node to assist the clinician in determining when the desired location of the distal tip 76A of catheter 72 has been achieved. Windows 184B and 184C may display user-selected ECG waveforms from those detected when the user presses a predefined control button on the probe 40 or console button interface 32. The waveforms in windows 184B and 184C remain until overwritten by a new waveform as a result of user selection via a button press or other input. A depth scale indicator 124, a status or action indicator 126, and a button icon 128 are also included on display 30. An integrity indicator 186 is also included on the display 30 to provide indication of whether a reference or ground ECG lead is operably connected to the TLS 50 .

[0088] Thus, the display 30, in some embodiments, depicts elements of both TLS and ECG modes simultaneously on a single screen, thereby providing the clinician with a wealth of data to assist in placing the distal tip 76A of the catheter 72 in the desired location. It is further noted that the screen shot 178 or selected ECG or TLS data may be saved, printed, or otherwise maintained by the integrated system 10 to enable documentation of proper placement of the catheter 72.

[0089] Figures 4 and 8 show stylets 100 and 130, respectively, according to some embodiments. Figure 11 shows a stylet body 1000 of the stylets 100 and 130, according to some embodiments.

[0090] As shown, each of the magnetically trackable stylets 100 and 130 includes a stylet body 1000 configured to be disposed within a lumen of a medical device, such as one or more lumens of a catheter 72, for magnetically tracking the tip of the medical device in vivo. The stylet body 1000 generally includes a magnetic assembly 1002 including a core wire 104 or 138, one or more magnetic field generating elements 106, and an outer structure 108. Again, the core wire 104 or 138 may be disposed alongside the one or more magnetic field generating elements 106 within a distal portion of the stylet body 1000, thereby enabling magnetic tracking of the stylet 100 or 130. However, the core wire 104 or 138 may instead be disposed through the one or more magnetic field generating elements 106 (e.g., through the axial center of the one or more magnetic field generating elements 106) within a distal portion of the stylet body 1000. In particular, these are different configurations than those described above in connection with Figure 4, in which the one or more magnetic field generating elements 106 are disposed distally of the core wire 104 or 138. Regardless of the manner in which the core wire 104 or 138 is disposed between the one or more magnetic field generating elements 106, the core wire 104 or 138 may be tapered in a distal portion of the stylet body 1000, as shown in Figure 11, to allow the one or more magnetic field generating elements 106 to be sized as needed. While certain embodiments of the magnetic assembly 1002, outer structure 108 of the stylet body 1000, or the like, have been described above with respect to the stylets 100 and 130, further embodiments of at least the magnetic assembly 1002 and outer structure 108 of the stylet body 1000 are described below in relation to Figures 12-14, 15A, 15B, and 16-19, as well as Figures 20A-20C, 21A, and 21B, respectively.

[0091] FIG. 12 shows a detailed cross-sectional view of a distal portion of the stylet 100 or 130 according to some embodiments. The one or more magnetic field generating elements 106 may include one or more polymer-bonded magnets. The one or more polymer-bonded magnets may include a single polymer-bonded magnet molded as a cylindrical body. Alternatively, the one or more polymer-bonded magnets may include multiple polymer-bonded magnets molded as cylindrical bodies. Such polymer-bonded magnets may include, without limitation, polymer-bonded neodymium magnets. The one or more polymer-bonded magnets are configured to improve the bending capabilities of the stylet body 1000 and the stylet 100 or 130. Indeed, the one or more polymer-bonded magnets are configured to bend and thus allow the stylet body 1000 to bend in accordance with the patient's anatomy (e.g., vasculature) without kinking or breaking of the stylet body 1000.

[0092] Advantageously, the shape, dimensions (e.g., length), material (e.g., magnetic material, polymer, etc.), magnetic saturation, or placement of the single polymer-bonded magnet or each polymer-bonded magnet of the multiple polymer-bonded magnets can be optimized to provide a desired balance between the magnetic field strength of the magnetic assembly 1002 and the flexibility (e.g., bend radius) of the distal portion of the stylet body 1000. In addition, the outer structure 108 can also be optimized for overall support, tensile strength, and flexibility.

[0093] 13 and 14 show detailed cross-sectional views of the distal portion of the stylet 100 or 130 according to some embodiments. The one or more magnetic field generating elements 106 may include one or more sintered magnets. The one or more sintered magnets may include a plurality of sintered magnets cut or finished as cylinders or possibly cones with flat or rounded ends, as shown in FIG. 13 or FIG. 14. Optionally, the plurality of cylindrical or conical sintered magnets may be arranged alternately with a plurality of spherical sintered magnets 1406 or a plurality of non-metallic spheres 1410 and thus non-magnetic spheres, as shown in FIG. 14. Such sintered magnets may include, without limitation, sintered neodymium magnets. Regardless of whether the plurality of cylindrical or conical sintered magnets includes only rounded ends or flat or rounded ends arranged alternating with the plurality of spherical sintered magnets 1406 or non-metallic spheres 1410 (e.g., thermoplastic spheres, elastomer spheres, etc.), the distal portion of the stylet body 1000 configured in this manner includes an articulating joint 1308 or 1408 between at least the cylindrical magnets for improved bending capabilities of the stylet 100 or 130. In fact, the joint 1308 or 1408 is configured to allow at least the cylindrical magnets to bend relative to one another, which allows the stylet body 1000 to bend in accordance with the patient's anatomy (e.g., vasculature) without kinking or breaking of the stylet body 1000.

[0094] 15A, 15B, 16, and 17 show detailed cross-sectional views of a distal portion of the stylet 100 or 130 according to some embodiments. In this case, the one or more magnetic field generating elements 106 may also include one or more sintered magnets, which may be arranged in one or more magnet holders 1510, 1610, or 1710, as shown in Figs. 15A, 15B, 16, and 17. The one or more sintered magnets may include sintered magnets cut and finished as cylinders with flat or rounded ends. As shown in Figs. 15A and 15B, the sintered magnets may be arranged in the grooves of a single magnet holder 1510, which includes a number of partition walls 1512 arranged in the grooves that separate the magnet holder 1510. In fact, the sintered magnets are arranged in alternating fashion with a number of partition walls 1512 in the grooves of the magnet holder 1510, which partition walls form articulated joints 1508 between the sintered magnets. Alternatively, as shown in Fig. 16 and Fig. 17, the sintered magnets can be arranged in a plurality of magnet holders 1610 or 1710, thereby forming an articulated joint 1608 or 1708 therebetween. As shown in Fig. 16, each magnet holder of the plurality of magnet holders 1610 can accommodate one of the sintered magnets. Furthermore, each magnet holder of the plurality of magnet holders 1610 can also include a ball end and a socket end such that the joint 1608 between the magnet holders 1610 is a ball and socket joint. However, the plurality of magnet holders 1610 can have ball end type magnet holders having a pair of ball ends alternating with socket end type magnet holders having a pair of socket ends, also providing a ball and socket joint between the magnet holders 1610. Alternatively, as shown in Figure 17, each magnet holder of the multiple magnet holders 1710 can be a link or chain link, and the connector 1708 can be a link between the chained links. Whether it is the single magnet holder 1510 of Figures 15A and 15B, or the multiple magnet holders 1610 or 1710 of Figures 16 or 17, the connectors 1508, 1608, and 1708 improve the bending ability of the stylet 100 or 130.In fact, the coupling portions 1508, 1608, and 1708 are configured to allow the multiple sintered magnets to bend relative to one another, thereby allowing the stylet 100 or 130 to bend in accordance with the patient's anatomy without breakage.

[0095] Advantageously, the shape, size (e.g., length), magnetic material, magnetic saturation, or arrangement of each of the plurality of cylindrical, conical, or spherical sintered magnets can be optimized to provide a desired balance between the magnetic field strength of the magnetic assembly 1002 and the flexibility (e.g., bending radius) of the distal portion of the stylet body 1000. Similarly, the arrangement or ratio of the plurality of non-metallic spheres 1410 to the plurality of cylindrical or conical sintered magnets can be optimized to provide a desired balance between the magnetic field strength of the magnetic assembly 1002 and the flexibility (e.g., bending radius) of the distal portion of the stylet body 1000. In addition, the outer structure 108 can be optimized for overall support, tensile strength, and flexibility.

[0096] 18 and 19 show detailed cutaway views of a distal portion of the stylet 100 or 130 according to some embodiments. As shown, the one or more magnetic field generating elements 106 include one or more magnetic wires around the core wire 104 or 138, if present. The one or more magnetic wires may include a single magnetic wire twisted with or helically wrapped around the core wire 104 or 138, as shown in FIG. 19. Alternatively, the one or more magnetic wires may include multiple magnetic wires twisted or braided around i) the core wire 104 or 138, ii) one of the multiple magnetic wires, or iii) each other, as shown in FIG. 18. Such magnetic wires may include, without limitation, neodymium magnet wires. By being flexible, the one or more magnetic wires are configured to improve bending ability and allow the stylet 100 or 130 to bend in accordance with the patient's anatomical structure (e.g., vasculature) without kinking or breaking of the stylet body 1000.

[0097] Alternatively, as shown in FIG. 19, the one or more magnetic field generating elements 106 may include one or more electromagnets around the core wire 104 or 138. The one or more electromagnets may include a single electromagnet formed from a conductive wire helically wound around the core wire 104 or 138 to generate a magnetic field when a current is applied thereto. Alternatively, the one or more electromagnets may include multiple electromagnets formed from multiple conductive wires helically wound around the core wire 104 or 138 to generate a magnetic field when a current is applied thereto. Each of the conductive wires may be helically wound around a dedicated section of the core wire 104 or 138 and may be electrically insulated from the core wire 104 or 138 as well as from other conductive wires for linear arrays of multiple electromagnets. By being flexible, the one or more conductive wires are configured to improve bending ability and allow the stylet 100 or 130 to bend in accordance with the patient's anatomical structure (e.g., vasculature) without kinking or breaking of the stylet body 1000.

[0098] Advantageously, the dimensions (e.g., diameter, length, etc.) of the single or multiple conductive wires, the magnetic or conductive materials (e.g., a mixture of the same magnetic or conductive material or different magnetic or conductive materials for the multiple magnetic or conductive wires), the magnetic saturation, windings, or the twisting or braiding of the multiple magnetic or conductive wires can be optimized to provide a desired balance between the magnetic field strength of the magnetic assembly 1002 and the flexibility (e.g., bend radius) of the distal portion of the stylet body 1000. In addition, the outer structure 108 can be optimized for overall support, tensile strength, and flexibility.

[0099] 20A-20C, 21A, and 21B show various detailed cross-sectional views of a distal portion of a stylet 100 or 130 including various outer structures according to several embodiments.

[0100] The outer structure 108 can have a single layer (i.e., a single-layer outer structure) as shown in FIG. 20A and FIG. 21A or multiple layers (i.e., a multiple-layer outer structure) as shown in FIG. 20B, FIG. 20C, and FIG. 21B. For a single-layer outer structure 108, such an outer structure can include at least a first layer 1206 of an overmolding layer, a reflow layer, a potting layer, or a shrink-wrap layer. For a multiple-layer outer structure 108, such an outer structure can include the first layer 1206 with one or more other layers, such as a second layer 1208, a third layer 1210, etc., on its top or bottom. If the outer structure 108 includes two or more other layers, such as the second layer 1208 and the third layer 1210, in addition to the first layer 1206, the two or more other layers can be on top, bottom, or any combination of top and bottom of the first layer 1206.

[0101] For the first layer 1206, which is an overmolded layer, the overmolded layer can be molded around the core wire 104 or 138 and the magnetic assembly 1002 as shown in FIG. 20A. If present, one or more gaps between any two or more magnetic field generating elements 106 can include a polymer material of the overmolded layer therebetween, thereby forming one or more articulation joints 1212 in the magnetic assembly 1002. The polymer material can be an elastomeric or thermoplastic polymer, such as acrylic, acrylonitrile butadiene styrene ("ABS"), polyamide (e.g., nylon), polylactic acid, polybenzimidazole, polycarbonate, polyethersulfone, polyoxymethylene, polyetheretherketone ("PEEK"), polyetherimide, polyethylene, polyphenylene oxide, polyphenylene sulfide, polypropylene, polystyrene, polyvinyl chloride, polyvinylidene fluoride, or polytetrafluoroethylene ("PTFE"). Because one or more gaps between two or more magnetic field generating elements 106 can be adjusted in relation to their width prior to molding (e.g., injection molding) on ​​the magnetic assembly 1002, one or more articulating joints 1212 can be optimized to achieve a desired balance between the flexibility (e.g., bending radius) and magnetic field strength of the magnetic assembly 1002 within the tip portion of the stylet body 1000.

[0102] For the first layer 1206, which is the reflow layer, the reflow layer can be molded around the core wire 104 or 138 and the magnetic assembly 1002 and then reflowed around the core wire 104 or 138 and the magnetic assembly 1002, as shown in FIG. 20A. If present, one or more gaps between any two or more magnetic field generating elements 106 can include the polymer material of the reflow layer therebetween, thereby forming one or more articulation joints 1212 in the magnetic assembly 1002. The polymeric material may be a thermoplastic polymer such as acrylic, acrylonitrile butadiene styrene ("ABS"), polyamide (e.g., nylon), polyether block amide ("PEBA"), polyurethane, polylactic acid, polybenzimidazole, polycarbonate, polyethersulfone, polyoxymethylene, polyetheretherketone ("PEEK"), polyetherimide, polyethylene, fluorinated ethylene propylene ("FEP"), polyphenylene oxide, polyphenylene sulfide, polypropylene, polystyrene, polyvinyl chloride, polyvinylidene fluoride ("PVDF"), or polytetrafluoroethylene ("PTFE"). Because one or more gaps between two or more magnetic field generating elements 106 can be adjusted in relation to their width prior to molding (e.g., injection molding) and reflow of the thermoplastic polymer on the magnetic assembly 1002, one or more articulating joints 1212 can be optimized to achieve a desired balance between the flexibility (e.g., bending radius) and magnetic field strength of the magnetic assembly 1002 within the tip portion of the stylet body 1000.

[0103] For the first layer 1206, which is the potting layer, the potting layer can be potted around the core wire 104 or 138 and the magnetic assembly 1002 as shown in FIG. 20A. If present, one or more gaps between any two or more magnetic field generating elements 106 can include the potting material of the potting layer therebetween, thereby forming one or more articulating joints 1212 in the magnetic assembly 1002. The potting material can be a thermosetting polymer such as epoxy, polyurethane, or silicone. The one or more gaps between the two or more magnetic field generating elements 106 can be adjusted in relation to their width prior to potting the potting material on the magnetic assembly 1002, so that the one or more articulating joints 1212 can be optimized to achieve a desired balance between the flexibility (e.g., bend radius) and magnetic field strength of the magnetic assembly 1002 in the distal portion of the stylet body 1000.

[0104] For the first layer 1206, which is a shrink wrap layer, the shrink wrap layer can be shrunk around the core wire 104 or 138 and the magnetic assembly 1002 as shown in FIG. 21A. If present, the gap or gaps between any two or more magnetic field generating elements 106 can include air or spacers therebetween, optionally with some conformable shrink wrap layer shrunk to the outer diameter of the gap or gaps, thereby forming one or more articulation joints 1212 in the magnetic assembly 1002. The shrink wrap layer can be a thermoplastic polymer such as polyolefin (e.g., polyethylene, polypropylene, polybutene), fluoropolymer (e.g., PTFE), or polyvinyl chloride ("PVC"). Because one or more gaps between two or more magnetic field generating elements 106 can be adjusted in relation to their width prior to shrinking of the shrink-wrap layer on the magnetic assembly 1002, one or more articulating joints 1212 can be optimized to achieve a desired balance between the flexibility (e.g., bending radius) and magnetic field strength of the magnetic assembly 1002 within the tip portion of the stylet body 1000.

[0105] Again, the outer structure 108 can have a single layer (i.e., a single-layer outer structure) as shown in FIG. 20A and FIG. 21A or multiple layers (i.e., a multiple-layer outer structure) as shown in FIG. 20B, FIG. 20C, and FIG. 21B. For multiple-layer outer structures 108, such outer structures can include a first layer 1206 with one or more other layers, such as a second layer 1208, a third layer 1210, etc., on top or bottom thereof. For example, FIG. 20B and FIG. 21B show the first layer 1206 (an overmolding layer, a reflow layer, a potting layer, or a shrink-wrap layer) with the second layer 1208 on top thereof. In such an embodiment, the second layer 1208 can be a casing or a tube on the first layer 1206. In another example, FIG. 20C shows the first layer 1206 with the second layer 1208 and the third layer 1210 on top thereof. In such an embodiment, the second layer 1208 can be a casing or tube over the third layer 1210, which can be a braided layer. When the first layer 1206 is a reflow layer, the polymer material of the reflow layer can reflow into the braided layer as well as into one or more gaps between any two or more of the magnetic field generating elements 106, thereby forming the composite outer structure 108.

[0106] Finally, methods include those using a magnetically trackable stylet. For example, such methods may include catheter insertion, catheter advancement, and catheter placement steps. The catheter insertion step includes inserting a catheter 72 into an insertion site 73 of a patient 70. The catheter 72 includes a stylet 100 or 130 disposed within a lumen of the catheter 72 such that a distal end 100B or 130B of the stylet 100 or 130 is substantially co-terminous with a distal tip 76A of the catheter 72. The catheter advancement step includes advancing the catheter 72 through the vasculature of the patient 70 without breaking the stylet body 1000 of the stylet 100 or 130 due to bending-related fatigue. As described above, the stylet 100 or 130 includes an outer structure 108 around a magnetic assembly 1002 of one or more magnetic field generating elements 106 disposed within a magnetically trackable distal portion of the stylet body 1000 alongside the core wire 104 or 138. The catheter placement step includes positioning the distal tip 76A of the catheter 72 within a desired general region near the patient's heart according to the magnetic tracking of the TLS 50 of the integrated system 10 to position the catheter 72.

[0107] Although some specific embodiments have been disclosed herein, and the specific embodiments have been disclosed in a certain degree of detail, this is not intended to limit the scope of the concepts provided herein. Further adaptations or modifications may become apparent to those skilled in the art, and in the broader aspects, these adaptations or modifications are likewise encompassed. Thus, departures from the specific embodiments disclosed herein may be made without departing from the scope of the concepts provided herein.

Claims

1. A magnetically trackable stylet comprising: a stylet body having a magnetically trackable tip portion; The stylet body includes: A core wire; a flexible magnetic assembly including one or more magnetic field generating elements disposed alongside the core wire within the distal portion of the stylet body; a casing positioned around the core wire and the magnetic assembly; Including, the stylet body is configured to be disposed within a lumen of a catheter for magnetically tracking a catheter tip in vivo without fracture of the stylet body due to bending-related fatigue. Stylet.

2. The stylet of claim 1 , wherein the core wire is tapered within the distal portion of the stylet body in line with the one or more magnetic field generating elements.

3. The stylet of claim 1 or 2, further comprising a sealed stylet tip, the stylet tip including a seal that seals the one or more magnetic field generating elements at the distal portion of the stylet body.

4. 4. The stylet of claim 1, wherein the one or more magnetic field generating elements comprise one or more polymer-bonded magnets configured to bend and thereby allow the stylet to bend according to a patient's anatomy without breaking.

5. The stylet of claim 4 , wherein the one or more polymer-bonded magnets include a single cylindrical polymer-bonded magnet.

6. The stylet of claim 4 , wherein the one or more polymer-bonded magnets include a plurality of cylindrical polymer-bonded magnets.

7. The stylet of claim 1 , wherein the one or more magnetic field generating elements include one or more sintered magnets.

8. 8. The stylet of claim 7, wherein the one or more sintered magnets comprise a plurality of cylindrical sintered magnets having rounded ends, the rounded ends of the cylindrical magnets configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend according to a patient's anatomy without breakage.

9. 8. The stylet of claim 7, wherein the one or more sintered magnets include a plurality of cylindrical sintered magnets arranged alternating with a plurality of spherical sintered magnets forming an articulated joint therebetween, the joint being configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with a patient's anatomy without breakage.

10. 8. The stylet of claim 7, wherein the one or more sintered magnets include a plurality of cylindrical sintered magnets arranged alternating with a plurality of non-metallic spheres forming an articulated joint therebetween, the joint being configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with a patient's anatomy without breakage.

11. 8. The stylet of claim 7, wherein the one or more sintered magnets include a plurality of cylindrical sintered magnets arranged in alternating fashion with a plurality of partitions that separate grooves in a magnet holder in which the sintered magnets are disposed, the partitions forming articulated joints between the cylindrical magnets configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with a patient's anatomy without breakage.

12. 8. The stylet of claim 7, wherein the one or more sintered magnets include a plurality of cylindrical sintered magnets disposed within a plurality of magnet holders forming an articulated joint therebetween, the joint being configured to allow the cylindrical magnets to bend relative to one another, thereby allowing the stylet to bend in accordance with a patient's anatomy without breakage.

13. The stylet of claim 12, wherein each of the magnet holders includes a ball end and a socket end, and the coupling is a ball and socket coupling.

14. The stylet of claim 12, wherein the magnet holder includes a ball-end type magnet holder having a pair of ball ends and a socket-end type magnet holder having a pair of socket ends, and the coupling portion is a ball and socket coupling portion.

15. The stylet of claim 12, wherein the magnet holders are links and the couplings are link loops between the links chained together.

16. 4. The stylet of claim 1, wherein the one or more magnetic field generating elements include one or more magnetic wires twisted or braided with the core wire, the one or more magnetic wires configured to bend and thereby allow the stylet to bend according to the patient's anatomy without breakage.

17. A magnetically trackable stylet comprising: a stylet body having a magnetically trackable tip portion; The stylet body includes: a flexible magnetic assembly of one or more magnetic wires within the distal portion of the stylet body; a casing positioned around the magnetic assembly; Including, the stylet body is configured to be disposed within a lumen of a catheter for magnetically tracking a catheter tip in vivo without fracture of the stylet body due to bending-related fatigue. Stylet.

18. The stylet of claim 17 , wherein the one or more magnetic wires include a single magnetic wire.

19. The stylet of claim 18, further comprising a core wire within the distal portion of the stylet body, the magnet wire being twisted with the core wire.

20. The stylet of claim 18, further comprising a core wire within the distal portion of the stylet body, the magnetic wire being helically wound around the core wire.

21. The stylet of claim 17 , wherein the one or more magnetic wires comprise a plurality of magnetic wires.

22. 22. The stylet of claim 21, further comprising a core wire within the distal portion of the stylet body, the magnetic wire being twisted or braided with the core wire.

23. 22. The stylet of claim 21, further comprising a core wire within the distal portion of the stylet body, the magnetic wire being twisted or braided around the core wire.

24. 20. The stylet of any one of claims 17 to 19, further comprising a sealed stylet tip including a seal that seals the magnet wire within the distal portion of the stylet body.

25. A magnetically trackable stylet comprising: a stylet body having a magnetically trackable tip portion; The stylet body includes: A core wire; a magnetic assembly including one or more magnetic field generating elements disposed alongside the core wire within the distal portion of the stylet body; an outer structure on the core wire and the magnetic assembly selected from the group consisting of an overmold layer, a reflow layer, a potting layer, and a shrink wrap layer; Including, the stylet body is configured to be disposed within a lumen of a catheter for magnetically tracking a catheter tip in vivo without fracture of the stylet body due to bending-related fatigue. Stylet.

26. The stylet of claim 25, wherein the outer structure is a single layer outer structure.

27. 27. The stylet of claim 26, wherein the outer structure includes the overmolded layer molded around the core wire and the magnetic assembly.

28. The stylet of claim 27, wherein one or more gaps between any two or more magnetic field generating elements include polymer material of the overmolded layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

29. The stylet of claim 26, wherein the outer structure includes a reflow layer reflowed around the core wire and the magnetic assembly.

30. The stylet of claim 29, wherein one or more gaps between any two or more magnetic field generating elements include polymer material of the reflow layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

31. The stylet of claim 26, wherein the outer structure includes a potting layer potted around the core wire and the magnetic assembly.

32. The stylet of claim 31 , wherein one or more gaps between any two or more magnetic field generating elements include potting material of the potting layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

33. 27. The stylet of claim 26, wherein the outer structure includes the shrink wrap layer shrunk around the core wire and the magnetic assembly.

34. 34. The stylet of claim 33, wherein the one or more gaps between any two or more magnetic field generating elements form one or more articulation joints within the magnetic assembly.

35. The stylet of claim 25 , wherein the outer structure is a multi-layer outer structure.

36. 36. The stylet of claim 35, wherein the outer structure includes the overmolded layer molded around the core wire and the magnetic assembly and one or more other layers on the overmolded layer.

37. The stylet of claim 36, wherein one or more gaps between any two or more magnetic field generating elements include polymer material of the overmolded layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

38. 38. The stylet of claim 36 or 37, wherein the one or more other layers include a casing disposed on the overmolded layer.

39. 36. The stylet of claim 35, wherein the outer structure includes the reflow layer reflowed around the core wire and the magnetic assembly and one or more other layers on the reflow layer.

40. The stylet of claim 39, wherein one or more gaps between any two or more magnetic field generating elements include polymer material of the reflow layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

41. The stylet of claim 39 or 40, wherein the one or more other layers include a braided layer over the reflow layer and an outer casing over the braided layer, the reflow layer being reflowed into the braided layer.

42. 36. The stylet of claim 35, wherein the outer structure includes the potting layer potted around the core wire and the magnetic assembly and one or more other layers on the potting layer.

43. The stylet of claim 42, wherein one or more gaps between any two or more magnetic field generating elements include potting material of the potting layer therebetween, thereby forming one or more articulating joints within the magnetic assembly.

44. 44. The stylet of claim 42 or 43, wherein the one or more other layers include a casing disposed on the potting layer.

45. 36. The stylet of claim 35, wherein the outer structure includes the shrink wrap layer shrunk around the core wire and the magnetic assembly and one or more other layers on the shrink wrap layer.

46. 46. ​​The stylet of claim 45, wherein one or more gaps between any two or more magnetic field generating elements form one or more articulation joints within the magnetic assembly.

47. 47. The stylet of claim 45 or 46, wherein the one or more other layers include a casing disposed over the shrink wrap layer.

48. 48. The stylet of any one of claims 25 to 47, wherein the core wire is tapered within the distal portion of the stylet body in line with the one or more magnetic field generating elements.

49. 49. The stylet of any one of claims 25 to 48, further comprising a sealed stylet tip, the stylet tip including a seal that seals the one or more magnetic field generating elements within the distal portion of the stylet body.

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