Rapid insertion central venous catheter insertion assembly and introducer needle assembly

Abstract

Disclosed herein is a coupler and assembly thereof for a rapid insertion central venous catheter (RICC). For example, an introducer needle assembly for a RICC may include an introducer needle and a coupler coupled to the introducer needle. The introducer needle includes a needle having a needle slot extending longitudinally from a proximal portion of the needle shaft to a distal needle tip. A sheath covers the needle shaft sealing the needle slot below, except for a portion of the needle slot below a sheath opening at a proximal portion of the sheath. The needle hub may include a needle hub extension arm extending distally on the needle shaft and the proximal portion of the sheath. The needle hub may include a needle hub portion of a RICC clip configured to hold a portion of the RICC therein. The coupler may include a complementary coupler portion of a RICC clip connected to a coupler housing.

Description

[Background technology]

[0001] Central venous catheters (CVCs) are typically introduced into a patient's body and advanced through the patient's vasculature by the Seldinger technique. The Seldinger technique involves many steps and medical devices (e.g., needles, scalpels, guidewires, introducer sheaths, dilators, CVCs, etc.). Although the Seldinger technique is effective, many of the steps are time consuming and the handling of numerous medical devices is cumbersome, all of which may cause trauma to the patient. In addition, the number of medical devices that need to be replaced during the Seldinger technique makes contamination by contact relatively high. Therefore, there is a need to reduce the number of steps and medical devices involved in introducing a catheter such as a CVC into a patient's body and advancing the catheter through its vasculature.

[0002] Disclosed herein is a coupler and assembly for a rapidly insertable central catheter (RICC) that addresses the above. Summary of the Invention

[0003] Disclosed herein, in some embodiments, is a RICC insertion assembly including a RICC, an introducer needle, an access guidewire, and a coupler coupling the RICC, the introducer needle, and the access guidewire together. The introducer needle includes a needle shaft, a sheath, and a needle hub covering a proximal portion of the needle shaft and a proximal portion of the sheath. The needle shaft includes a needle slot extending longitudinally from the proximal portion of the needle shaft to a distal needle tip. The sheath covers the needle shaft sealing the needle slot therebelow, except for the needle slot below a sheath opening in the proximal portion of the sheath. The needle hub includes a needle hub extension arm extending distally. Additionally, the needle hub includes a needle hub portion of a RICC clip configured to hold a portion of the RICC therein at least in a ready-to-deploy state of the RICC insertion assembly. The access guidewire includes a proximal portion including a proximal end and a distal portion including a distal end. The distal end of the access guidewire is disposed within the introducer needle just proximal to a needle tip in at least the ready-to-deploy state of the RICC insertion assembly. The coupler includes a coupler housing and a coupler portion of the RICC clip connected to the coupler housing. The proximal and distal ends of the access guidewire form a loop on the access guidewire such that the RICC is disposed over the loop in at least the ready-to-deploy state of the RICC insertion assembly.

[0004] In some embodiments, the coupler housing includes a proximally extending coupler housing support, and at least the needle hub extension arm is slidably disposed on the coupler housing support in at least the ready-to-deploy state of the RICC insertion assembly.

[0005] In some embodiments, the coupler portion of the RICC clip is a first "C" shaped portion of the RICC clip suspended from a proximal portion of the coupler housing support. The needle hub portion of the RICC clip is a second "C" shaped portion of the RICC clip suspended from a proximal portion of the needle hub. The first and second "C" shaped portions of the RICC clip open toward one another such that the RICC clip completes at least the ready-to-deploy state of the RICC insertion assembly.

[0006] In some embodiments, the RICC clip is configured to retain one or more extension legs of the RICC therein such that the RICC is suspended from the RICC insertion assembly in at least the ready-to-deploy state of the RICC insertion assembly.

[0007] In some embodiments, the RICC clip is configured to release the one or more extension legs of the RICC therefrom when the introducer needle is withdrawn from the coupler.

[0008] In some embodiments, the coupler housing further comprises a needle hub receptacle at a proximal portion of the coupler housing, and a distal portion of the needle hub comprises the needle hub extension arm disposed within the needle hub receptacle in at least the ready-to-deploy state of the RICC insertion assembly.

[0009] In some embodiments, the coupler further includes a valve module disposed within a valve module chamber of the coupler housing distal to the needle hub receptacle. The valve module seals around the proximal portion of the sheath and the distal portion of the access guidewire that extends through the sheath opening in at least the ready-to-deploy state of the RICC insertion assembly. The seal around the sheath and the access guidewire enables leak-free aspiration through the introducer needle.

[0010] In some embodiments, the valve module includes an integral blade disposed in a needle slot beneath a distal end of the sheath opening, the blade including a distally facing blade edge configured to decouple the sheath from the needle shaft when the introducer needle is withdrawn from the coupler, allowing the access guidewire to pass through the needle slot of the needle shaft and exit the needle shaft.

[0011] In some embodiments, the coupler includes a pair of locking buttons extending through opposite sides of the coupler housing, the pair of locking buttons mounted respectively on a pair of shafts captively retained within the coupler housing, each button of the pair of locking buttons pivoting on a corresponding shaft.

[0012] In some embodiments, each locking button of the pair of locking buttons has a protrusion extending from a cross arm connecting the protrusion to an exterior depressible portion of the locking button, and each locking button of the pair of locking buttons has a gap facing the cross arm between the protrusion and the exterior depressible portion of the locking button.

[0013] In some embodiments, the pair of locking buttons are biased away from the centerline of the coupler such that the protrusion of each locking button of the pair of locking buttons is positioned within one of a pair of notches in the walls of the needle hub extension arm on either side of the needle hub extension arm in a default state of the pair of locking buttons.

[0014] In some embodiments, when the pair of locking buttons are pressed toward the centerline of the coupler, the walls of the needle hub extension arm on either side of the needle hub extension arm pass through a gap between the protrusion and the outer depressible portion of each of the pair of locking buttons.

[0015] In some embodiments, the needle hub includes a proximally extending needle hub cradle with gripping pads on either side of the needle hub cradle to facilitate holding the RICC insertion assembly when the introducer needle is withdrawn from the coupler.

[0016] In some embodiments, the RICC insertion assembly further includes a syringe fluidly connected to the introducer needle in at least the ready-to-deploy state of the RICC insertion assembly, the barrel of the syringe being disposed within the needle hub cradle with a gripping pad located on a side of the barrel of the syringe.

[0017] In some embodiments, a separate RICC integrated into a plunger flange extension extends from a plunger flange of the syringe plunger, and a further RICC clip is configured to retain a catheter hub of the RICC therein such that the RICC is suspended from the RICC insertion assembly in at least the ready-to-deploy state of the RICC insertion assembly.

[0018] In some embodiments, the needle hub includes an access guidewire channel formed by a notch in the needle shaft and a distally extending needle hub extension on the proximal portion of the sheath.

[0019] In some embodiments, the access guidewire channel includes a transversely extending bar and a needle hub pad between the bar and the access guidewire channel, the bar and the needle hub pad configured to press and hold the access guidewire in place when establishing a puncture pathway from an area of ​​the patient's skin to a vascular lumen.

[0020] In some embodiments, the coupler housing includes a longitudinally extending coupler housing slot on the same side of the coupler housing as the coupler portion of the RICC clip, the coupler housing slot opening in an opposite direction to the needle slot of a needle shaft, the coupler housing slot configured to allow the access guidewire to exit the coupler housing when the introducer needle is withdrawn from the coupler.

[0021] In some embodiments, the coupler housing slot includes a narrow portion and a wider portion proximal to the narrow portion, the wider portion of the coupler housing slot configured to align at least a needle hub alignment rail of the needle hub during assembly of the RICC insertion assembly.

[0022] In some embodiments, the access guidewire includes an access guidewire hub on a distal end of the access guidewire configured to prevent over-advancement of the access guidewire.

[0023] Disclosed herein, in some embodiments, is an introducer needle assembly including an introducer needle and a coupler coupled to the introducer needle. The introducer needle includes a needle shaft, a sheath, and a needle hub covering a proximal portion of the needle shaft and a proximal portion of the sheath. The needle shaft includes a needle slot extending longitudinally from the proximal portion of the needle shaft to a distal needle tip. The sheath covers the needle shaft sealing the needle slot therebelow, except for the needle slot below a sheath opening in the proximal portion of the sheath. The needle hub includes a needle hub extension arm extending distally. Additionally, the needle hub includes a needle hub portion of a RICC clip configured to hold a portion of the RICC therein. The coupler includes a coupler housing and a coupler portion of the RICC clip connected to the coupler housing.

[0024] In some embodiments, the coupler housing includes a proximally extending coupler housing support, and at least the needle hub extension arm is slidably disposed on the coupler housing support.

[0025] In some embodiments, the coupler portion of the RICC clip is a first "C" shaped portion of the RICC clip suspended from a proximal portion of the coupler housing support. The needle hub portion of the RICC clip is a second "C" shaped portion of the RICC clip suspended from a proximal portion of the needle hub. The first and second "C" shaped portions of the RICC clip open toward each other to complete the RICC clip.

[0026] In some embodiments, the coupler housing further includes a needle hub receptacle at a proximal portion of the coupler housing, the distal portion of the needle hub including the needle hub extension arm disposed within the needle hub receptacle.

[0027] In some embodiments, the coupler further includes a valve module disposed within a valve module chamber of the coupler housing distal to the needle hub receptacle. The valve module seals around the proximal portion of the sheath and, if present, a distal portion of an access guidewire extending through the sheath opening. The seal around the sheath and the access guidewire allows for leak-free aspiration through the introducer needle.

[0028] In some embodiments, the valve module includes an integral blade disposed in a needle slot beneath a distal end of the sheath opening, the blade including a distally facing blade edge configured to decouple the sheath from the needle shaft when the introducer needle is withdrawn from the coupler.

[0029] In some embodiments, the coupler includes a pair of locking buttons extending through opposite sides of the coupler housing, the pair of locking buttons mounted respectively on a pair of shafts captively retained within the coupler housing, each button of the pair of locking buttons pivoting on a corresponding shaft.

[0030] In some embodiments, each locking button of the pair of locking buttons has a protrusion extending from a cross arm connecting the protrusion to an exterior depressible portion of the locking button, and each locking button of the pair of locking buttons has a gap facing the cross arm between the protrusion and the exterior depressible portion of the locking button.

[0031] In some embodiments, the pair of locking buttons are biased away from the centerline of the coupler such that the protrusion of each locking button of the pair of locking buttons is positioned within one of a pair of notches in the walls of the needle hub extension arm on either side of the needle hub extension arm in a default state of the pair of locking buttons.

[0032] In some embodiments, when the pair of locking buttons are pressed toward the centerline of the coupler, the walls of the needle hub extension arm on either side of the needle hub extension arm pass through a gap between the protrusion and the outer depressible portion of each of the pair of locking buttons.

[0033] Also disclosed herein is a method for inserting a RICC into a blood vessel lumen of a patient. In some embodiments, the method includes the steps of obtaining a RICC insertion assembly, establishing a puncture path, advancing an access guidewire, withdrawing an introducer needle, and advancing a RICC. The obtaining RICC insertion assembly includes obtaining a RICC insertion assembly including the RICC, an introducer needle including a sheath covering a needle shaft, and an access guidewire, which are coupled together by a coupler. In addition, a proximal portion of the access guidewire is disposed within a primary lumen of the RICC, and a distal end of the access guidewire is disposed within the introducer needle by a valve module disposed within a coupler housing of the coupler. The proximal and distal ends of the access guidewire form a loop on the access guidewire, and the RICC is disposed above the loop at least in the ready-to-deploy state of the RICC insertion assembly. The establishing puncture path includes establishing a puncture path from an area of ​​skin to a blood vessel lumen using the introducer needle. The access guidewire advancing step includes advancing the distal end of the access guidewire within the needle shaft from its initial position just proximal to the needle tip of the needle shaft into the vessel lumen. The introducer needle withdrawing step includes withdrawing the introducer needle from the coupler while leaving the access guidewire in place within the vessel lumen. The RICC clip formed between a needle hub portion and a coupler portion of the RICC clip separates to release a portion of the RICC held therein upon withdrawal of the introducer needle from the coupler portion. The introducer needle includes a needle slot extending longitudinally from a proximal portion of the needle shaft to a needle tip, the access guidewire being allowed to escape therethrough upon withdrawal of the introducer needle from the coupler portion.The RICC advancing step includes advancing a catheter tube of the RICC over the access guidewire to insert the RICC into a blood vessel lumen.

[0034] In some embodiments, the coupler portion of the RICC clip is a first "C" shaped portion of the RICC clip suspended from a proximal portion of a proximally extending coupler housing support, and the needle hub portion of the RICC clip is a second "C" shaped portion of the RICC clip suspended from a proximal portion of a proximally extending needle hub cradle, and the first and second "C" shaped portions of the RICC clip open toward one another such that the RICC clip completes at least the ready-to-deploy state of the RICC insertion assembly.

[0035] In some embodiments, the method further includes a needle hub release step that includes releasing the needle hub prior to withdrawing the introducer needle from the coupler in the introducer needle withdrawal step. Releasing the needle hub includes depressing a pair of locking buttons that extend into the coupler housing through opposing sides of an arm of the coupler housing to allow a wall of a distally extending needle hub extension arm to pass through a gap between the protrusion and an outer depressible portion of a locking button for each locking button of the pair of locking buttons.

[0036] In some embodiments, the establishing a puncture path step includes pressing and holding the access guidewire in place against a transversely extending bar or needle hub pad of the needle hub between the bar and the access guidewire channel formed by a notch in a distally extending needle hub extension tube.

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

[0038] [Figure 1] FIG. 1 illustrates a side view of a RICC insertion assembly according to some embodiments. [Diagram 2] 1 illustrates a perspective view of another RICC insertion assembly according to some embodiments. [Diagram 3] 1A and 1B show top perspective views of an introducer needle assembly according to some embodiments. [Figure 4] FIG. 1 illustrates a perspective view of the bottom of an introducer needle assembly and a syringe according to some embodiments. [Diagram 5] FIG. 1 illustrates a side view of an introducer needle assembly according to some embodiments. [Figure 6] FIG. 1 illustrates a top view of an introducer needle assembly according to some embodiments. [Figure 7] 1 illustrates a bottom view of an introducer needle assembly according to some embodiments. [Figure 8] 1 illustrates a side view of an introducer needle assembly with the introducer needle withdrawn from the coupler, according to some embodiments. [Figure 9] 1 illustrates a top view of an introducer needle assembly with the introducer needle withdrawn from the coupler, according to some embodiments. [Figure 10] 14A-14C show bottom views of the introducer needle assembly with the introducer needle withdrawn from the coupler, according to some embodiments. [Figure 11] 1A-1C show perspective views of an introducer needle assembly according to some embodiments with half of the coupler housing and half of the needle hub removed to aid in visualizing certain features of the introducer needle assembly. [Figure 12] 1A-1C show perspective views of an introducer needle assembly according to some embodiments with the coupler housing removed to aid in visualizing certain features of the introducer needle assembly. [Figure 13] 14A-14C show side views of valve modules of both sheaths of an introducer needle and a coupler on the needle shaft according to some embodiments. [Figure 14] 13A-13C show longitudinal cross-sectional views of both sheaths of an introducer needle and a valve module of a coupler on the needle shaft according to some embodiments. [Figure 15] 1 illustrates a side view of an introducer needle, according to some embodiments. [Figure 16] 1 illustrates a top view of an introducer needle, according to some embodiments. [Figure 17] 1 illustrates a sheath over a needle shaft of an introducer needle, according to some embodiments. [Figure 18] 1 illustrates a top view of a sheath according to some embodiments. [Figure 19] 1 illustrates a top view of a needle shaft according to some embodiments. [Figure 20] 1 illustrates a RICC of a RICC insertion assembly, according to some embodiments. [Figure 21] FIG. 13 shows details of a distal portion of a catheter tube of a RICC according to some embodiments. [Figure 22] 1 shows a cross-section of a distal portion of a catheter tube according to some embodiments. [Figure 23] 13 illustrates another cross-section of a distal portion of a catheter tube according to some embodiments. [Figure 24] 1 shows a longitudinal cross-section of a distal portion of a catheter tube according to some embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

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

[0040] With regard to the terms used herein, it should also be understood that the terms are intended to describe certain embodiments, and that the terms do not 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. In addition, any of the aforementioned features or steps may further include one or more features or steps, unless otherwise specified. Labels such as "left", "right", "upper", "lower", "front", "rear", etc. are used for convenience and do not imply a particular fixed position, orientation, or direction, for example. Instead, such designations are used to reflect a relative position, orientation, or direction, for example. The singular forms "one", "one", and "said" include plural references unless the context clearly dictates otherwise.

[0041] With respect to "proximal," for example, a "proximal portion" or "proximal end portion" of a catheter includes the portion of the catheter that is intended to be near the clinician when the catheter is used with a patient. Similarly, for example, a "proximal length" of a catheter includes the length of the catheter that is intended to be near the clinician when the catheter is used with a patient. For example, the "proximal end" of a needle includes the end of the catheter that is intended to be near the clinician when the catheter is used with a patient. Although a proximal portion, proximal end portion, or proximal length of a catheter can include the proximal end of the catheter, a proximal portion, proximal end portion, or distal length of a catheter need not include the distal end of the catheter. That is, unless otherwise indicated by context, a proximal portion, proximal end portion, or proximal length of a catheter is not a terminal portion or terminal length of a catheter.

[0042] With respect to "distal," for example, a "distal portion" or "distal end portion" of a catheter includes a portion of the catheter that is intended to be near or within a patient when the catheter is used with a patient. Similarly, for example, a "distal length" of a catheter includes a length of the catheter that is intended to be near or within a patient when the catheter is used with a patient. For example, the "distal end" of a needle includes the end of the catheter that is intended to be near or within a patient when the catheter is used with a patient. Although a distal portion, distal end portion, or distal length of a catheter can include the distal end of the catheter, a distal portion, distal end portion, or distal length of a catheter need not include the distal end of the catheter. That is, unless otherwise suggested by context, a distal portion, distal end portion, or distal length of a catheter is not a terminal portion or terminal length of a catheter.

[0043] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art. As discussed above with respect to the Seldinger technique, the many steps are time consuming and the handling of numerous medical devices is cumbersome, all of which can be traumatic for the patient. In addition, the large number of medical devices that need to be replaced during the Seldinger technique increases the likelihood of contamination through contact. There is therefore a need to reduce the number of steps and medical devices involved in introducing a catheter, such as a CVC, into a patient's body and advancing the catheter through its vasculature.

[0044] Disclosed herein is a coupler for a RICC and an assembly thereof. For example, an introducer needle assembly for a RICC may include an introducer needle and a coupler coupled to the introducer needle. The introducer needle includes a needle having a needle slot extending longitudinally from a proximal portion of the needle shaft to a distal needle tip. A sheath covers the needle shaft sealing the needle slot below, except for a portion of the needle slot below a sheath opening at a proximal portion of the sheath. The needle hub may include a needle hub extension arm extending distally on the needle shaft and the proximal portion of the sheath. The needle hub may include a needle hub portion of a RICC clip configured to hold a portion of the RICC therein. The coupler may include a complementary coupler portion of a RICC clip connected to a coupler housing.

[0045] The foregoing features, as well as other features of couplers and assemblies for RICCs, will become more apparent to those skilled in the art in view of the accompanying drawings and the following description, which describe certain embodiments of the foregoing in the context of a RICC insertion assembly. In particular, the RICC insertion assembly includes only one type of catheter that may be incorporated into a catheter insertion assembly, for example. It should be understood that peripherally inserted central catheters (PICCs), dialysis catheters, and the like, may be incorporated into a catheter insertion assembly, such as the following catheter insertion assemblies:

[0046] RICC Insertion Assembly FIG. 1 illustrates a RICC insert assembly 100 according to some embodiments. FIG. 2 illustrates another RICC insert assembly 200 according to some embodiments. For simplicity, generic features within a RICC insert assembly 100, 200 or subassembly thereof (e.g., the needle hub 160 of the introducer needle 104) are referred to herein with a single reference number. Each RICC insert assembly 100, 200 or subassembly thereof includes generic features that differentiate the particular feature from features of another RICC insert assembly or subassembly (e.g., the bar 198 of the needle hub 160 shown in FIG. 1 for the RICC insert assembly 100 and the pinch holder 204 of the needle hub 160 shown in FIG. 2 for the RICC insert assembly 200 relative to the needle hub pad 202). In addition, while the RICC insert assembly 100 is referred to first herein for convenience, it should be understood that the description of the RICC insert assembly 100 continues through the RICC insert assembly 200 unless the context suggests otherwise.

[0047] As shown, the RICC insertion assembly 100 includes a RICC 102, an introducer needle 104, an access guidewire 106, and a coupler 108 that couples the RICC 102, the introducer needle 104, and the access guidewire 106 together in at least a ready-to-deploy state of the RICC insertion assembly 100. In the ready-to-deploy state of the RICC insertion assembly 100, the proximal end of the access guidewire 106 is disposed within an access guidewire hub 250 that is coupled to a luer connector of the RICC 102, and the distal end of the access guidewire 106 is disposed within a needle lumen 174 of the introducer needle 104, as described below. This forms a loop in the access guidewire 106. The RICC 102 is disposed over the loop in the ready-to-deploy state of the RICC insertion assembly 100, keeping the RICC insertion assembly 100 in a relatively compact configuration.

[0048] The RICC insertion assembly 100 may further include a syringe 110 that is fluidly connected to the introducer needle 104, at least in the ready-to-deploy state of the RICC insertion assembly 100. As described below, the sheath 164 seals the needle slot 168 of the needle shaft 162. In particular, the sheath 164 seals the needle slot 168 outside of the valve module 218. The valve module 218 then seals over a sheath opening 178 of the sheath 164 that opens to the needle slot 168. The valve module 218 also seals around the access guidewire 106. Such a seal allows the syringe 110 to aspirate blood in accordance with the blood aspirating steps of the method described below.

[0049] In particular, in addition to or as an alternative to the RICC clip 186 described below, the RICC clip 112 may be incorporated into the syringe 110 with a suitably configured plunger flange extension 114 for retaining the catheter hub 132 of the RICC 102 therein. As shown in FIG. 2, the plunger flange extension 114 may extend from a plunger flange 116 of a plunger stopper 118 inserted into a proximal portion of the tubular plunger 120. In an alternative embodiment to that described above, the plunger flange extension 114 may instead extend from a plunger flange integral with the plunger as commonly found in disposable syringes having plungers with orthogonal longitudinally extending support members. In an alternative embodiment to that described above, the plunger flange extension 114 may instead extend from an optionally textured plunger flange 122 incorporated into a plunger connecting barrel cap 124 slidably disposed on the barrel 126 of the syringe 110. (See FIG. 3 for plunger flange 122 of barrel cap 124.) In any event, plunger flange extension 114 includes plunger flange extension slot 128 therein to form RICC clip 112 configured to retain catheter hub 132 of RICC 102 therein such that RICC 102 is suspended from RICC insertion assembly 100 or 200 in at least the ready-to-deploy state of RICC insertion assembly 100 or 200.

[0050] Finally, any component of the RICC insertion assembly 100 selected from at least the RICC 102, the introducer needle 104, the access guidewire 106, the coupler 108, and the syringe 110, or any portion of a component selected from the above components, can include an antimicrobial agent thereon or therein. In one example, the catheter tube 130 of the RICC 102 can include an antimicrobial coating on the abluminal surface of the catheter tube 130, the luminal surface of the catheter tube 130, or both surfaces. In another example, the pre-extrusion material of the catheter tube 130 can include an antimicrobial agent mixed into the material such that the antimicrobial agent is incorporated into the catheter tube 130 when extruded, and the antimicrobial agent protects both the abluminal surface of the catheter tube 130 and the luminal surface of the catheter tube 130 from microbial contamination.

[0051] FIG. 20 illustrates a RICC 102 of the RICC insertion assembly 100, according to some embodiments. As shown, the RICC 102 includes a catheter tube 130 , a catheter hub 132 , one or more extension legs 134 , and one or more extension leg connectors 136 .

[0052] 21-24 show various views of the catheter tube 130 of the RICC 102, according to some embodiments. The catheter tube 130 includes a first section 138 at a distal portion of the catheter tube 130, a second section 140 at a distal portion of the catheter tube 130 proximal to the first section 138, and a tapered junction 142 between the first section 138 and the second section 140 of the catheter tube 130.

[0053] The first section 138 of the catheter tube 130 includes a catheter tip 144 having a relatively short taper from an outer diameter of the distal portion of the first section 138 distal to the junction 142 to an outer diameter of the distal end of the first section 138. The taper of the catheter tip 144 is configured to immediately dilate tissue surrounding the puncture path established by the introducer needle 104 to the outer diameter of the distal portion of the first section 138 of the catheter tube 130. As best shown in FIG. 24, the first section 138 of the catheter tube 130 also includes a proximal portion that is disposed within a lumen of the distal portion of the junction 142 and fixedly coupled thereto, such as by solvent bonding, adhesive bonding, or heat welding.

[0054] The second section 140 of the catheter tube 130 includes a constant outer diameter over its length from the distal end of the second section 140 to the proximal end of the second section 140. The constant diameter of the second section 140 of the catheter tube 130 is configured for smooth insertion into the puncture tract and target vasculature after any expansion by the first section 138 of the catheter tube 130 and the junction 142. The distal end of the second section 140 of the catheter tube 130 has a flat surface that is flush with the flat surface proximal end of the junction 142 and is fixedly coupled thereto, such as by solvent bonding, adhesive bonding, or heat welding.

[0055] The junction 142 includes a taper over its length from the proximal end of the junction 142 to the distal end of the junction 142. The taper of the junction 142 is configured to immediately expand the tissue surrounding the puncture path from the outer diameter at the proximal portion of the first section 138 of the catheter tube 130 to the outer diameter of the second section 140 of the catheter tube 130. The abluminal surface of the junction 142 smoothly transitions from the abluminal surface of the first section 138 of the catheter tube 130 to the abluminal surface of the second section 140 of the catheter tube 130 without creating an edge that may catch on the skin when the catheter tube 130 is inserted into the puncture path. In addition to having minimal or negligible edges, the edges may include solvent interdiffusion polymeric material of the polymeric material forming the catheter tube 130, which provides a smooth transition from the first section 138 of the catheter tube 130 to the junction 142 and from the junction 142 to the second section 140 of the catheter tube 130. In particular, the junction 142 has a length that is approximately equal to the length of the exposed portion of the first section 138 of the catheter tube 130 or a length between the lengths of the exposed portions of the first section 138 and the second section 140 of the catheter tube 130. Thus, the length of the exposed portion of the first section 138 of the catheter tube 130 is less than the length of the junction 142 and at most approximately equal to the length of the junction 142.

[0056] The first section 138 of the catheter tube 130 is formed from a first polymeric material (e.g., polytetrafluoroethylene, polypropylene, or polyurethane) having a first durometer hardness. The second section 140 of the catheter tube 130 is formed from a second polymeric material (e.g., polyvinyl chloride, polyethylene, another polyurethane, or silicone) having a second durometer hardness less than the first durometer hardness. For example, the first section 138 of the catheter tube 130 can be formed from a first polyurethane having a first durometer hardness, and the second section 140 of the catheter tube 130 can be formed from a second, different polyurethane (e.g., the same or different diisocyanates or triisocyanates reacted with different diols or triols, different diisocyanates or triisocyanates reacted with the same or different diols or triols, different diisocyanates or triisocyanates reacted with the same diols or triols under different conditions or with different additives, etc.) having a second durometer hardness less than the first durometer hardness. Indeed, polyurethanes are advantageous for the catheter tube 130 in that they can be relatively stiff at room temperature, but can become more flexible in vivo at body temperature, thereby reducing irritation to the vessel wall as well as phlebitis. Polyurethanes are also advantageous in that they can be less thrombogenic than some other polymers. The joint 142 is formed from a second polymeric material or a third polymeric material (e.g., yet another polyurethane) having a third durometer hardness less than the first durometer hardness and greater than, approximately equal to, or less than the second durometer hardness.

[0057] It should be understood that the first durometer hardness of the first polymeric material, the second durometer hardness of the second polymeric material, and the third durometer hardness of the third polymeric material may be of different scales (e.g., Type A or Type D). With this understanding, the second durometer hardness of the second polymeric material or the third durometer hardness of the third polymeric material may not be less than the first durometer of the first polymeric material in absolute terms when the second durometer hardness or the third durometer hardness is less than the first durometer. In fact, the hardness of the second polymeric material or the third polymeric material may still be less than the hardness of the first polymeric material, because the different scales, each ranging from 0 to 100, are designed to characterize different materials in a group of materials having similar hardness.

[0058] With the first section 138 of the catheter tube 130, the second section 140 of the catheter tube 130, and the junction 142 between the first section 138 and the second section 140 of the catheter tube 130 described above, the catheter tube 130 has sufficient column strength to prevent buckling of the catheter tube 130 when inserted into the puncture path established by the introducer needle 104. The column strength of the catheter tube 130 is also sufficient to prevent buckling of the catheter tube 130 when advanced through the patient's vasculature without pre-dilating the tissue surrounding the puncture path or any of the vessels of the vasculature with a separate dilator.

[0059] The catheter tube 130 includes one or more catheter tube lumens extending therethrough. However, typically in a multi-lumen RICC (e.g., a two-lumen RICC, a three-lumen RICC, a four-lumen RICC, a five-lumen RICC, a six-lumen RICC, etc.), there is only one catheter tube lumen extending from the proximal end of the catheter tube 130 to the distal end of the catheter tube 130. (See FIGS. 21-24.) In fact, the first section 138 of the catheter tube 130 typically includes a single lumen therethrough, as best shown in FIG. 24.

[0060] A catheter hub 132 is coupled to a proximal portion of the catheter tube 130. The catheter hub 132 includes one or more catheter hub lumens that correspond in number to the one or more catheter tube lumens. The one or more catheter hub lumens extend entirely through the catheter hub 132 from a proximal end of the catheter hub 132 to a distal end of the catheter hub 132.

[0061] Each of the one or more extension legs 134 is coupled by its distal portion to the catheter hub 132. Each of the one or more extension legs 134 includes one or more extension leg lumens, the number of which corresponds to the number of the one or more catheter hub lumens. Each of the one or more extension leg lumens extends entirely through the extension leg from a proximal end of the extension leg to a distal end of the extension leg.

[0062] Each of the one or more extension leg connectors 136 is on a proximal portion of one of the one or more extension legs 134. For example, each of the one or more extension leg connectors 136 can be a luer connector on a proximal portion of one of the one or more extension legs 134. Through such an extension leg connector, a corresponding extension leg and its extension leg lumen can be connected to another medical device and its lumen. However, at least in the ready-to-deploy state of the RICC insertion assembly 100, at least one extension leg connector (e.g., an extension leg connector including a portion of the primary lumen 146 of the RICC 102) is connected to an extension arm clip of an extension arm of the coupler 108 to form a loop around the access guidewire 106 and the RICC 102 thereon.

[0063] As shown, the RICC 102 is a tri-lumen RICC including a set of three lumens. However, the RICC 102 is not limited to the set of three lumens described above. The set of three lumens includes a primary lumen 146, a secondary lumen 148, and a tertiary lumen 150 formed from fluidly connected portions of three catheter tube lumens, three catheter hub lumens, and three extension leg lumens. The primary lumen 146 has a primary lumen opening 152 at the distal end of the first section 138 of the catheter tube 130, which corresponds to the distal end of the catheter tube 130 and the distal end of the RICC 102. The secondary lumen 148 has a secondary lumen opening 154 at the side of the distal portion of the catheter tube 130. The tertiary lumen 150 has a tertiary lumen opening 156 at the side of the distal portion of the catheter tube 130 proximal to the secondary lumen opening 154.

[0064] 3-12 show various views of the introducer needle assembly 158, according to some embodiments. As shown, the introducer needle assembly 158 is a subassembly of the RICC insertion assembly 100. In effect, the introducer needle assembly 158 includes an introducer needle 104 and a coupler 108 interconnected together.

[0065] 15-19 show various views of the introducer needle 104 or parts thereof, according to some embodiments. As shown, the introducer needle 104 includes an elongate portion and a needle hub 160 that covers a proximal portion of the elongate portion of the introducer needle 104. As shown, the elongate portion of the introducer needle 104 includes a needle shaft 162 and a sheath 164 that covers the needle shaft 162 such that the needle hub 160 covers both the proximal portion of the needle shaft 162 and the proximal portion of the sheath 164. At least in the ready-to-deploy state of the RICC insertion assembly 100, the needle shaft 162 and the sheath 164 extend from the needle hub 160, through the valve module 218 of the coupler 108, and out the distal end of the coupler housing 212 of the coupler 108.

[0066] The needle shaft 162 includes a needle tip 166 at a distal portion of the needle shaft 162 and a needle slot 168 extending longitudinally from at least a proximal portion of the needle shaft 162 to the needle tip 166 .

[0067] The needle tip 166 includes a bevel 170 having a tip bevel and a primary bevel proximal to the tip bevel. Although not shown, the tip bevel angle of the tip bevel is greater than the primary bevel angle of the primary bevel such that the bevel 170 provides a smooth transition across the needle tip 166. Such a needle tip is thus configured to establish a puncture path from an area of ​​skin into a vascular lumen of a patient in accordance with the puncture path establishment steps of the method described below.

[0068] The needle slot 168 extends from at least a proximal portion of the needle shaft 162 to the needle tip 166. In fact, the needle slot 168 optionally extends from the proximal end of the needle shaft 162 to the needle tip 166. In any event, the needle channel 172 extends along the length of the needle shaft 162 corresponding to the needle slot 168. The needle slot 168 has a width dimensioned according to the outer diameter of the access guidewire 106, which allows the access guidewire 106 to pass from at least a proximal portion of the needle shaft 162 to the needle tip 166 when the introducer needle withdrawal step of the method described below is performed.

[0069] It should be appreciated that the needle shaft 162 includes a needle slot 168, while the introducer needle 104 includes a needle lumen 174. However, the needle lumen 174 is provided by a combination of the needle shaft 162 and the sheath 164 covering the needle shaft 162. In effect, the sheath 164 covering the needle shaft 162 seals off the needle slot 168 therebelow to form the needle lumen 174 of the introducer needle 104 and enable the syringe 110 to aspirate blood in accordance with the blood aspirating steps of the method described below.

[0070] The sheath 164 includes a sheath tip 176 at a distal portion of the sheath 164 and a sheath opening 178 on a side of a proximal portion of the sheath 164 . The sheath tip 176 includes a relatively short taper from the outer diameter of the distal portion of the sheath 164 to the outer diameter of the distal end of the sheath 164, which corresponds to the outer diameter of the distal portion of the needle shaft 162. The taper has a taper angle that is less than the primary bevel angle of the primary bevel of the needle tip 166, which in turn is less than the tip bevel angle of the tip bevel of the needle tip 166. Such a taper of the sheath tip 176 is configured to provide a smooth transition from the needle tip 166 to the sheath body for the puncture path establishment step of the method described below.

[0071] The sheath opening 178 is open to the needle slot 168 of the needle shaft 162 and allows the access guidewire 106 to pass through the sheath opening 178 and into the needle channel 172 or the formed needle lumen 174, at least in the ready-to-deploy state of the RICC insertion assembly 100. Thus, the sheath opening 178 has a width approximately corresponding to the width of the needle slot 168, which in turn is sized according to the diameter of the access guidewire 106. Also, the sheath opening 178 has a length sufficient to allow the access guidewire 106 to pass through the sheath opening 178 and into the needle slot 168 or the formed needle lumen 174, and to accommodate the blade 236 of the valve module 218 below the distal end of the sheath opening 178. In particular, the sheath 164 covering the needle shaft 162 seals the needle slot 168 below it, except below the sheath opening 178. However, the valve module 218 covers and seals the needle slot 168 exposed by the sheath opening 178 by sealing the needle shaft 162 and the proximal portion of the sheath 164 therein, thereby enabling the syringe 110 to aspirate blood in accordance with the blood aspirating steps of the method described below.

[0072] The sheath 164, or sheath body thereof, is formed from a polymeric material configured to facilitate smooth and consistent insertion of the introducer needle 104 from an area of ​​the patient's skin into the vascular lumen in accordance with the puncture path establishment step of the method described below. In addition, the polymeric material has sufficient mechanical properties at the thickness of the sheath 164 to resist collapse of the sheath 164 into the needle slot 168 of the needle shaft 162 when the blood aspiration step of the method described below is performed, and also facilitates detachment of the sheath 164 from the needle shaft 162 in accordance with the introducer needle withdrawal step of the method described below. Such polymeric materials may include, but are not limited to, polyethylene, polypropylene, or polytetrafluoroethylene.

[0073] The needle hub 160 includes a needle hub extension arm 180 extending distally at a distal portion of the needle hub 160, a needle hub cradle 182 extending proximally, and a needle hub portion 184 of a RICC clip 186 connected or suspended from a proximal portion of the needle hub 160, specifically the proximal portion of the needle hub cradle 182. Additionally, the needle hub 160 may further include an access guidewire channel 188, a retaining means for holding the access guidewire 106 in place, if desired, and a needle hub alignment rail 190.

[0074] The needle hub extension arm 180 is configured to be locked into the needle hub receptacle 224 at least in the ready-to-deploy state of the RICC insertion assembly 100. The needle hub extension arm 180 includes one or more walls 192 depending on the configuration of the needle hub extension arm 180. In one example, the needle hub extension arm 180 can include one wall when the needle hub extension arm 180 is configured to approximate a half right cylindrical surface or an elliptical cylindrical surface. In one example, the needle hub extension arm 180 can include three walls when the needle hub extension arm 180 is configured to approximate a sluice box. Such an example of the needle hub extension arm 180 is shown in FIG. 12, where the three walls include a bottom wall and two side walls adjacent to the bottom wall. Notably, the bottom wall may be curved, but instead the bottom wall may be flat. Regardless of the number of the one or more walls 192, the needle hub extension arm 180 includes up to a pair of notches 194 in the one or more walls 192. 12, for example, the needle hub extension arm 180 may include a pair of notches 194 on both sides of the needle hub extension arm 180, such as on two side walls of the needle hub extension arm 180 adjacent to the bottom wall. The protrusions 242 of each of the pair of lock buttons 220 described below are disposed in corresponding notches of the pair of notches 194 in the needle hub extension arm 180 in the default state of the pair of lock buttons 220. Thus, the needle hub extension arm 180 disposed in the needle hub receptacle 224 of the coupler housing 212 at least in the ready-to-deploy state of the RICC insertion assembly 100 is also locked in the needle hub receptacle 224 at least in the ready-to-deploy state of the RICC insertion assembly 100.

[0075] The needle hub cradle 182 is configured to receive the barrel 126 of the syringe 110, thereby supporting the syringe 110 in at least the ready-to-deploy state of the RICC insertion assembly 100. Advantageously, the needle hub cradle 182 optionally includes textured gripping pads 196 on either side of the needle hub cradle 182 configured to facilitate holding the RICC insertion assembly 100 when establishing a puncture path from an area of ​​the patient's skin into a blood vessel lumen in accordance with the puncture path establishment step of the method described below. In addition, the gripping pads 196 are also configured to facilitate holding the needle hub 160 when withdrawing the introducer needle 104 from the coupler 108 during the introducer needle withdrawal step of the method described below. If the gripping pad 196 is textured, the gripping pad 196 may be textured, for example, with ridges, bumps, or conversely, depressions, which may make it easier to hold the RICC insertion assembly 100 or needle hub 160 in environments where stray fluids may make it difficult to hold the RICC insertion assembly 100 or needle hub 160.

[0076] The RICC clip 186 is configured to hold a portion of the RICC 102 therein, at least in the ready-to-deploy state of the RICC insertion assembly 100. The needle hub portion 184 of the RICC clip 186 will also be configured to hold said portion of the RICC 102 therein, at least in the ready-to-deploy state of the RICC insertion assembly 100. If the coupler portion 216 of the RICC clip 186 is a first "C" shaped portion of the RICC clip 186, described below, the needle hub portion 184 of the RICC clip 186 is a second "C" shaped portion of the RICC clip 186 suspended from a proximal portion of the needle hub 160, specifically a proximal portion of the needle hub cradle 182. The first "C" shaped portion and the second "C" shaped portion of the RICC clip 186 open toward each other to complete the RICC clip 186, optionally overlapping, at least in the ready-to-deploy state of the RICC insertion assembly 100. Upon completion of the RICC insertion assembly 100 in at least the ready-to-deploy state, the RICC clip 186 may, for example, retain one or more extension legs 134 of the RICC 102 therein such that the RICC 102 is suspended from the RICC insertion assembly 100 as shown in FIG. 1. In particular, the RICC clip 186 is configured to release a portion of the RICC 102 therefrom (e.g., one or more extension legs 134) when the introducer needle 104 is withdrawn from the coupler 108 in an introducer needle withdrawal step of the method described below. Indeed, withdrawal of the introducer needle 104 from the coupler 108 separates the coupler portion 216 and the needle hub portion 184 of the RICC clip 186, such that the RICC clip 186 opens to release a portion of the RICC 102 therefrom (e.g., one or more extension legs 134).

[0077] The access guidewire channel 188 is configured to guide a distal portion of the access guidewire 106 from the distal end of the RICC 102, through the access guidewire conduit 234, and into the valve module 218, at least in the ready-to-deploy state of the RICC insertion assembly 100. As shown, the access guidewire channel 188 is defined by a notch in a distal portion of the needle hub extension tube 189, which portion of the needle hub extension tube 189 is above the proximal portion of the needle shaft 162 and sheath 164, either immediately proximal to or slightly above the sheath opening 178 of the sheath 164. Notably, the access guidewire channel 188 passes through the distal portion of the needle hub extension tube 189, although it may alternatively be configured as a separate access guidewire conduit.

[0078] The retaining means for holding the access guidewire 106 in place may optionally include a laterally extending bar 198 and a needle hub pad 202 between the bar 198 and the access guidewire channel 188, as best shown in Figures 8, 9, 11 and 12. In particular, both the bar 198 and the needle hub pad 202 are between the sides of the coupler housing 212, at least in the ready-to-deploy state of the RICC insertion assembly 100. The bar 198 and the needle hub pad 202 are configured to press (with a thumb) and hold the access guidewire 106 in place, such as when establishing a puncture path from an area of ​​the patient's skin to a blood vessel lumen. However, the retaining means for holding the access guidewire 106 in place is not limited to the bar 198 and the needle hub pad 202 for manually holding the guidewire in place, as required. In fact, the retaining means for holding the access guidewire 106 in place may alternatively be a pinch holder 204 as shown in Figure 2, as required. Such a pinch holder may include a pair of closely spaced or contiguous elastomeric right circular solid cylinders 206 oriented longitudinally along the needle hub 160 such that the access guidewire 106 is forced into the pinch holder 204 and automatically held therein by compression on the access guidewire 106 by the elastomeric cylinders 206; The needle hub alignment rail 190 extends from the needle hub cradle 182 on the same side as the needle hub portion 184 of the RICC clip 186, but distal thereto, and is configured to at least align the needle hub 160 with the coupler 108 when a distal portion of the needle hub 160 is inserted into the needle hub receptacle 224 of the coupler housing 212 during assembly of the RICC insertion assembly 100 or its introducer needle assembly 158. In particular, the coupler housing slot 226 of the coupler housing 212 includes a widened portion 230 of the coupler housing slot 226 configured to receive the needle hub alignment rail 190 for aligning the needle hub 160 with the coupler 108 during assembly of the RICC insertion assembly 100 or its introducer needle assembly 158, as described below. Advantageously, the needle hub alignment rail 190 located within the wide portion 230 of the coupler housing slot 226 ensures that the needle hub extension arm 180 of the needle hub 160 can be locked and unlocked from the needle hub receptacle 224 of the coupler 108 without problems (e.g., jamming) using, for example, a pair of locking buttons 220, by minimizing or eliminating any relative rotation between the needle hub 160 and the coupler 108, and therefore any misalignment.

[0079] The needle hub connector includes a needle hub bore 208 and an optional needle hub flange 210 around the periphery of the needle hub connector 208 . The needle hub bore 208 of the needle hub connector is configured to receive therein a syringe tip (not shown) of the syringe 110 to fluidly connect the introducer needle 104 to the syringe 110. (See FIGS. 1-4 for a fluidly connected introducer needle 104 and syringe 110.) In fact, the needle hub bore 208 can have a luer taper (e.g., a 6% taper) configured to receive the syringe tip therein, and the syringe tip can be complementarily configured with the luer taper.

[0080] If present, needle hub flange 210 around needle hub bore 208 is configured to threadably mate with the female threads of a threaded collar around the syringe tip of syringe 110. While the threaded collar of syringe 110 is optional, needle hub flange 210 advantageously provides a so-called luer lock type connection with the female threads of the threaded collar, if both are present, which provides greater security against inadvertent separation of introducer needle 104 and syringe 110 than an otherwise luer slip type connection would provide.

[0081] 8-10 show various views of coupler 108 according to some embodiments. As shown, the coupler 108 includes a coupler housing 212, a coupler housing support 214 extending proximally from the coupler housing 212, and a coupler portion 216 of the RICC clip 186 connected or suspended from a proximal portion of the coupler 108, specifically the proximal portion of the coupler housing support 214. Although not shown in FIGS. 8-10, the coupler 108 further includes a valve module 218 disposed within the coupler housing 212, specifically within a valve module chamber 222 of the coupler housing 212 distal to the needle hub receptacle 224. Such a valve module is alternatively shown in FIGS. 13 and 14 over the sheath opening 178 of the sheath 164 of the introducer needle 104. Finally, the coupler 108 may further include up to a pair of locking buttons 220 extending through opposite sides of the coupler housing 212. However, it should be understood that in some embodiments, the coupler 108 may alternatively include a single locking button extending through a side of the coupler housing 212 .

[0082] FIG. 11 shows a perspective view of the introducer needle assembly 158, according to some embodiments, with half of the coupler housing 212 removed to aid in visualizing certain features.

[0083] The coupler housing 212 includes two molded pieces that are coupled together (e.g., fixed or screwed or bolted together) to form a bullet-shaped body configured to be comfortably held underhand (e.g., cradle-like) in the left hand for left-handed venipuncture or in the right hand for right-handed venipuncture using the RICC insertion assembly 100. The inside of each of the two molded pieces includes a number of recesses that, when the two molded pieces are coupled together, form a valve module chamber 222 in the distal portion of the coupler housing 212 and a needle hub receptacle 224 on its distal side in the proximal portion of the coupler housing 212. Also, although not explicitly shown, each of the two molded pieces includes a lock button through-hole configured to receive one of a pair of lock buttons 220 that extend through opposite sides of the coupler housing 212, as described below. However, in an embodiment of the introducer needle assembly 158 that utilizes a single locking button to lock the needle hub 160 within the coupler 108 instead of a pair of locking buttons 220, only a single locking button through-hole is required between the two molded pieces of the coupler housing 212. Finally, the coupler housing 212 includes a longitudinally extending coupler housing slot 226 that is formed between the two molded pieces when the two molded pieces are joined together.

[0084] The valve module chamber 222 is configured to retain the valve module 218 therein. In particular, the valve module chamber 222 is further configured to have sufficient space to allow the valve module 218 to separate to allow the access guidewire 106 to exit when the introducer needle 104 is withdrawn from the coupler 108 during an introducer needle withdrawal step of the method described below.

[0085] The needle hub receptacle 224 is configured to receive both the needle hub extension tube 189 and the needle hub extension arm 180 of the needle hub 160 when the distal portion of the needle hub 160 of the introducer needle 104 is inserted therein. In fact, the needle hub receptacle 224 includes the needle hub extension tube 189 and the needle hub extension arm 180 inserted therein, at least in the ready-to-deploy state of the RICC insertion assembly 100 or its introducer needle assembly 158. In particular, the needle hub extension arm 180 of the needle hub 160, having a pair of notches 194 in one or more walls 192 of the needle hub extension arm 180, is configured to be locked in the needle hub receptacle 224 by a pair of locking buttons 220, at least in the ready-to-deploy state of the RICC insertion assembly 100 or its introducer needle assembly 158.

[0086] The coupler housing slot 226 is configured to allow the access guidewire 106 to exit the coupler housing 212 when the introducer needle 104 is withdrawn from the coupler 108 during an introducer needle withdrawal step of the method described below. The coupler housing slot 226 is formed on the same side of the coupler housing 212 as the coupler portion 216 of the RICC clip 186 when the two molded pieces of the coupler housing 212 are coupled together. In addition, the coupler housing slot 226 opens in the opposite direction to the needle slot 168 of the needle shaft 162. The coupler housing slot 226 is configured to allow the access guidewire 106 to drop and exit the coupler housing 212 when the introducer needle 104 is withdrawn from the coupler 108 during an introducer needle withdrawal step of the method described below. Notwithstanding the above, it should be understood that coupler housing slot 226 may alternatively be located at other locations than those shown in Figures 4, 7, and 10 discussed above. For example, coupler housing slot 226 may alternatively be located opposite or orthogonal to that shown in Figures 4, 7, and 10 discussed above, with other modifications such as, among other things, relocating a pair of lock button through holes.

[0087] The coupler housing slot 226 is also configured to at least align the needle hub 160 with the coupler 108 when a distal portion of the needle hub 160 (e.g., the needle hub extension arm 180) is inserted into the needle hub receptacle 224 of the coupler housing 212 during assembly of the RICC insertion assembly 100 or its introducer-needle assembly 158. As best shown in FIG. 10 , the coupler housing slot 226 has a narrow portion 228 and a wide portion 230 proximal to the narrow portion 228, the wide portion 230 of the coupler housing slot 226 being within the coupler housing support 214. The wide portion 230 of the coupler housing slot 226 is configured to receive the needle hub alignment rail 190 of the needle hub 160 to at least align the needle hub 160 with the coupler 108 during assembly of the RICC insertion assembly 100. Advantageously, the wide portion 230 of the coupler housing slot 226, when the needle hub alignment rail 190 is positioned therein, ensures that the needle hub extension arm 180 of the needle hub 160 can be locked and unlocked from the needle hub receptacle 224 of the coupler 108 without problems (e.g., jamming) using, for example, a pair of locking buttons 220, by minimizing or eliminating any relative rotation, and thus any misalignment, between the needle hub 160 and the coupler 108.

[0088] The coupler housing support 214 is configured to support the introducer needle 104 by the needle hub extension arm 180 and the needle hub cradle 182 of the needle hub 160 when the introducer needle 104 is coupled with the coupler 108. In particular, at least the needle hub extension arm 180 of the needle hub 160 is slidably disposed on the coupler housing support 214 at least in the ready-to-deploy state of the RICC insertion assembly 100. Indeed, the needle hub cradle 182 of the needle hub 160 is slidably disposed on the coupler housing support 214 at least in the ready-to-deploy state of the RICC insertion assembly 100, while the needle hub alignment rail 190 extending from the needle hub cradle 182 is slidably disposed within the widened portion 230 of the coupler housing slot 226 in the coupler housing support 214.

[0089] The RICC clip 186 is also configured to hold a portion of the RICC 102 therein, at least in the ready-to-deploy state of the RICC insert assembly 100. The coupler portion 216 of the RICC clip 186 is configured to hold the aforementioned portion of the RICC 102 therein, at least in the ready-to-deploy state of the RICC insert assembly 100. The coupler portion 216 of the RICC clip 186 is a first "C" shaped portion of the RICC clip 186 suspended from a proximal portion of the coupler housing support 214, and the needle hub portion 184 of the RICC clip 186 is a second "C" shaped portion of the RICC clip 186 as described above. The first "C" shaped portion and the second "C" shaped portion of the RICC clip 186 open toward each other to complete the RICC clip 186, optionally overlapping, at least in the ready-to-deploy state of the RICC insert assembly 100. Upon completion of the RICC insertion assembly 100 in at least the ready-to-deploy state, the RICC clip 186 may, for example, retain one or more extension legs 134 of the RICC 102 therein such that the RICC 102 is suspended from the RICC insertion assembly 100 as shown in FIG. 1. In particular, the RICC clip 186 is configured to release a portion of the RICC 102 therefrom (e.g., one or more extension legs 134) when the introducer needle 104 is withdrawn from the coupler 108 in an introducer needle withdrawal step of the method described below. Indeed, withdrawal of the introducer needle 104 from the coupler 108 separates the coupler portion 216 and the needle hub portion 184 of the RICC clip 186, such that the RICC clip 186 opens to release a portion of the RICC 102 therefrom (e.g., one or more extension legs 134).

[0090] 13 and 14 show different views of the valve module 218 of the coupler 108 covering both the sheath 164 and the needle shaft 162 of the introducer needle 104, according to some embodiments.

[0091] As shown, the valve module 218 is configured to seal around a proximal portion of the sheath 164 and a distal portion of the access guidewire 106 that extends through the sheath opening 178 in at least the ready-to-deploy state of the RICC insertion assembly 100. Such a seal around the sheath 164 and the access guidewire 106 allows for leak-free aspiration through the introducer needle 104 during the blood aspiration step of the method described below. The valve module 218 includes an introducer needle 232, an access guidewire conduit 234, and an integral braid 236.

[0092] The introducer needle conduit 232 is configured to direct the elongate portion of the introducer needle 104 (i.e., the needle shaft 162 and the sheath 164 covering it) through both the valve module 218 and the coupler housing 212. In effect, the introducer needle conduit 232 includes the elongate portion of the introducer needle 104 disposed therein at least in a ready-to-deploy state of the RICC insertion assembly 100 or its introducer needle assembly 158. Although not shown, the introducer needle conduit 232 further includes a seal therein (e.g., two halves of an elastomeric sleeve) configured to seal around the elongate portion of the introducer needle 104 when the introducer needle 104 is disposed within the introducer needle conduit 232 and optionally compressed.

[0093] The access guidewire conduit 234 is configured to guide the access guidewire 106 from the coupler housing slot 226 of the coupler housing 212 to both the sheath opening 178 of the sheath 164 and the needle channel 172 of the needle shaft 162 or the needle lumen 174 of the introducer needle 104. In fact, the access guidewire conduit 234 contains the access guidewire 106 disposed therein, at least in the ready-to-deploy state of the RICC insertion assembly 100. Although not shown, the access guidewire conduit 234 further includes a seal therein (e.g., two halves of an elastomeric sleeve) configured to seal around a distal portion of the access guidewire 106 when the access guidewire 106 is disposed within the access guidewire conduit 234 and optionally compressed.

[0094] The blade 236 extends from an attachment point in the valve module 218 into the needle slot 168 of the needle shaft 162 such that the blade 236 is disposed in the needle slot 168 below the distal end of the sheath opening 178 of the sheath 164. The blade 236 includes a distally facing blade edge 238 configured to decouple the sheath 164 from the needle shaft 162 when the introducer needle 104 is withdrawn proximally from the coupler 108 during an introducer needle withdrawal step of the method described below. Decoupling the sheath 164 from the needle shaft 162 allows the access guidewire 106 to both exit the needle shaft 162 via the needle slot 168 and exit the coupler 108 via the coupler housing slot 226 of the coupler housing 212.

[0095] A pair of locking buttons 220 extending through a pair of locking button through-holes on either side of the coupler housing 212 are configured to lock the needle hub 160 of the introducer needle 104 within the coupler 108. Specifically, the pair of locking buttons 220 are configured to lock the needle hub extension arm 180 of the needle hub 160 within the needle hub receptacle 224 of the coupler 108. To this end, the pair of locking buttons 220 are respectively mounted on a pair of shafts 240 that are captively retained within the coupler housing 212, with each locking button 220 of the pair of locking buttons rotating on a corresponding shaft. Notably, the pair of shafts 240 may pass through proximal portions of the pair of locking buttons 220 as shown, or the pair of shafts 240 may be repositioned within the coupler housing 212 such that the pair of shafts 240 pass through distal portions of the pair of locking buttons 220. Each lock button of the pair of lock buttons 220 has a protrusion 242 extending from a cross arm 244 connecting the protrusion 242 to an outer depressible portion 246 of the lock button. Additionally, each lock button of the pair of lock buttons 220 has a gap 248 facing the cross arm 244 between the protrusion 242 and the outer depressible portion 246 of the lock button. Finally, although not shown, the pair of lock buttons 220 may be biased away from the centerline of the coupler 108 by a pair of compression springs, respectively, or by a single compression spring between the pair of lock buttons 220. In any case, the pair of lock buttons 220 are biased such that the protrusion 242 of each lock button of the pair of lock buttons 220 is disposed within one of a pair of notches 194 in the one or more walls 192 of the needle hub extension arm 180 in the default state of the pair of lock buttons 220. However, the protrusions 242 of each of the pair of lock buttons 220 are displaced from the above-mentioned positions when the pair of lock buttons 220 are pressed into the coupler housing 212 .In fact, when the pair of locking buttons 220 are pressed into the coupler housing 212, one or more walls 192 of the needle hub extension arm 180 on either side of the needle hub extension arm 180 can pass through the gap 248 between the protrusion 242 and the outer depressible portion 246 of each of the pair of locking buttons 220, thereby enabling the introducer needle 104 to be withdrawn from the coupler 108 in the introducer needle withdrawal step of the method described below.

[0096] 1 and 2 show an access guidewire 106 as part of a RICC insertion assembly 100, 200, according to some embodiments. The access guidewire 106 includes a proximal portion including a proximal end optionally disposed within an access guidewire hub 250, and a distal portion including a distal end. In at least the ready-to-deploy state of the RICC insertion assembly 100, the proximal end of the access guidewire 106 extends from the proximal end of the RICC 102, optionally within the access guidewire hub 250 coupled to a luer connector of the RICC 102. In any event, the proximal portion of the access guidewire 106 extends from the proximal end of the RICC 102, through said luer connector, and along the primary lumen 146 of the RICC 102, in at least the ready-to-deploy state of the RICC insertion assembly 100. Additionally, a distal portion of the access guidewire 106 extends along the primary lumen 146 of the RICC 102, but the distal portion of the access guidewire 106 also extends out the distal end of the RICC 102, into the valve module 218 via the access guidewire conduit 234, into the needle shaft 162 through both the sheath opening 178 of the sheath 164 and the needle slot 168 of the needle shaft 162, and along the needle channel 172 of the needle shaft 162 or the needle lumen 174 of the introducer needle 104, at least in the ready-to-deploy state of the RICC insertion assembly 100. As shown in FIGS. 1 and 2, the distal end of the access guidewire 106 is disposed within the needle lumen 174 of the introducer needle 104 just proximal to the needle tip 166, at least in the ready-to-deploy state of the RICC insertion assembly 100. Additionally, the proximal and distal ends of the access guidewire 106 form a loop on the access guidewire 106, at least when the RICC insertion assembly 100 is in a ready-to-deploy state, over which the RICC 102 is positioned, thereby keeping the RICC insertion assembly 100 in a relatively compact configuration.

[0097] The access guidewire hub 250 on the distal end of the access guidewire 106 is configured to provide a convenient handle by which the access guidewire 106 may be withdrawn from the RICC insertion assembly 100 or a subassembly thereof during the access guidewire withdrawal step described below. In addition, the access guidewire hub 250 advantageously prevents over-advancement of the access guidewire 106 during the access guidewire advancement step of the method described below, thus obviating loss of the proximal end of the access guidewire 106 within the primary lumen 146 of the RICC 102. Although the access guidewire hub 250 may be of any convenient shape, the access guidewire hub 250 in FIGS. 1 and 2 is shown as a tab having a relatively flat major surface. While flat, such major surface may be textured, for example, with ridges, bumps, or conversely, indentations, to facilitate holding the access guidewire hub 250 in an environment where stray fluids may make it difficult to hold the access guidewire hub 250.

[0098] The access guidewire 106 can include a guidewire tip 252 at a distal portion of the access guidewire 106 that adopts a "J" shape configured to prevent puncturing the posterior wall of a blood vessel. Such a guidewire tip assumes a straight state in at least a ready-to-deploy state of the RICC insertion assembly 100 and assumes a curved state when the guidewire tip 252 is advanced beyond the needle tip 166 (e.g., advanced into the blood vessel lumen) in the deployed state of the RICC insertion assembly 100.

[0099] The access guidewire 106 may further include a bare section and a wound section proximal to the bare section. Although not shown, the bare section, if present, extends distally through the access guidewire conduit 234 of the valve module 218 in at least the ready-to-deploy state of the RICC insertion assembly 100 such that the valve module 218 forms a fluid-tight seal around the bare section of the access guidewire 106. Notably, the aforementioned bare section may instead be a flat-wrapped or ground-wrapped section of the access guidewire 106, where the flat-wrapped section includes windings of tape instead of round wire and the ground-wrapped section includes windings of round wire that are grounded to make the windings flat.

[0100] method The method includes a method for inserting a RICC 102 into a blood vessel lumen of a patient, the method including one or more steps selected from obtaining a RICC insertion assembly, establishing a puncture path, aspirating blood, advancing an access guidewire, releasing a needle hub, withdrawing an introducer needle, advancing a RICC, withdrawing an access guidewire, advancing a steering guidewire, advancing another RICC, and withdrawing a steering guidewire.

[0101] The RICC insertion assembly obtaining step includes obtaining a RICC insertion assembly 100. As described above, the RICC insertion assembly 100 includes a RICC 102, an introducer needle 104 including a sheath 164 covering a needle shaft 162, and an access guidewire 106, which are coupled together by a coupler 108. In addition, a proximal portion of the access guidewire 106 is disposed within the primary lumen 146 of the RICC 102, and a distal end of the access guidewire 106 is disposed within the introducer needle 104 by a valve module 218 disposed within a coupler housing 212 of the coupler 108. The proximal and distal ends of the access guidewire 106 form a loop on the access guidewire 106, and the RICC 102 is disposed over the loop at least in the ready-to-deploy state of the RICC insertion assembly 100.

[0102] The puncture path establishment step includes establishing a puncture path from the area of ​​skin to the vascular lumen with the introducer 104. Additionally, the puncture path establishment step may include pressing and holding the access guidewire 106 in place against the bar 198, the needle hub pad 202 of the needle hub 160, or both. Again, the needle hub pad 202 is between the bar 198 and the access guidewire channel 188 formed by a notch in the distally extending needle hub extension tube 189. Finally, the puncture path establishment step may include ensuring blood reflux while establishing the puncture path. Ensuring blood backflow while establishing the puncture path includes ensuring blood backflows into the needle hub 160 of the introducer needle 104, the syringe tip of the syringe 110 fluidly connected to the introducer needle 104, the barrel 126 of the syringe 110, or a combination thereof, particularly if the needle hub 160 is clear and colorless. Once the puncture path is established, a slight vacuum can be drawn using the syringe 110 while establishing the puncture path such that blood backflows into at least the needle hub 160 of the introducer needle 104. Ensuring blood backflow as described above confirms that the puncture path extends into the vessel lumen.

[0103] The blood drawing step includes drawing blood using a syringe 110 connected to the needle hub 160 to ensure that the puncture path extends into the vessel lumen, particularly before withdrawing the introducer needle 104 from the coupler 108 in the introducer needle withdrawal step. The sheath 164 also covers the needle shaft 162 and seals the needle slot 168 of the needle shaft 162 below it. In particular, the sheath 164 seals the needle slot 168 outside the valve module 218. The valve module 218 then covers and seals the sheath opening 178 of the sheath 164, which allows the access guidewire 106 to pass through the needle slot 168 into the needle shaft 162 in the ready-to-deploy state of the RICC insertion assembly 100. The valve module 218 also seals around the distal portion of the access guidewire 106. Such a seal allows the syringe 110 to draw blood during the blood drawing step.

[0104] The access guidewire advancement step includes advancing the distal end of the access guidewire 106 within the needle shaft 162 from an initial position just proximal to the needle tip 166 of the needle shaft 162 into the vascular lumen, thereby ensuring vascular lumen access for the RICC 102 during the RICC advancement step.

[0105] The needle hub release step includes releasing the needle hub 160 prior to withdrawing the introducer needle 104 from the coupler 108 in the introducer needle withdrawal step. Releasing the needle hub 160 includes depressing a pair of locking buttons 220 that extend into the coupler housing 212 through opposite sides of the arms of the coupler housing 212 to allow the walls 192 of the distally extending needle hub extension arms 180 to pass through the gaps 248 between the projections 242 and the locking button outer depressible portions 246 for each locking button of the pair of locking buttons 220.

[0106] The introducer needle withdrawal step involves withdrawing the introducer needle 104 from the coupler 108 by the needle hub 160 while leaving the access guidewire 106 in place within the vascular lumen. The introducer needle withdrawal step involves simultaneously decoupling the sheath 164 from the needle shaft 162 using a blade 236 of a valve module 218 disposed within a valve module chamber 222 of the coupler housing 212 as the introducer needle 104 is withdrawn from the coupler 108. Decoupling the sheath 164 from the needle shaft 162 allows the access guidewire 106 to exit the needle shaft 162 via a needle slot 168. In particular, the valve module 218 around the needle shaft 162 and sheath 164 separates to allow the access guidewire 106 to further exit the valve module 218 when the introducer needle 104 is withdrawn from the coupler 108 in an introducer needle withdrawal step. In addition, the coupler housing 212 includes a coupler housing slot 226 configured to allow the access guidewire 106 to further exit the coupler housing 212 when the introducer needle 104 is withdrawn from the coupler 108 in an introducer needle withdrawal step. Finally, the introducer needle withdrawal step includes simultaneously separating the RICC clip 186 formed between the needle hub portion 184 and the coupler portion 216 of the RICC clip 186. In effect, the RICC clip 186 separates as the introducer needle 104 is withdrawn from the coupler 108, exposing a portion of the RICC 102 held therein (eg, one or more of the extension legs 134).

[0107] The RICC advancement step involves inserting the RICC 102 into the vessel lumen by advancing the catheter tube 130 of the RICC 102 over the access guidewire 106 into the vessel lumen.

[0108] The access guidewire withdrawal step involves withdrawing the access guidewire 106 while leaving the catheter tube 130 within the vessel lumen. The steering guidewire advancement step involves advancing a steering guidewire through the primary lumen 146 of the RICC 102, into the vessel lumen, and into the lower third of the superior vena cava (SVC) of the patient's heart.

[0109] Another RICC advancement step involves advancing the distal portion of the catheter tube 130 further into the vessel lumen over the steering guidewire to the lower third of the superior vena cava (SVC) of the patient's heart.

[0110] The steering guidewire withdrawal step involves withdrawing the steering guidewire, leaving the catheter tube 130 in the lower third of the SVC. Although some specific embodiments are disclosed herein and the specific embodiments are disclosed in some detail, the specific embodiments are 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 the broader aspects of the invention encompass these adaptations or modifications as well. Thus, departures from the specific embodiments disclosed herein may be made without departing from the scope of the concepts provided herein.

Claims

1. 1. A rapid insertion central catheter (RICC) insertion assembly comprising: RICC and An introducer needle, a needle shaft including a needle slot extending longitudinally from a proximal portion of the needle shaft to a distal needle tip; a sheath covering the needle shaft except for the needle slot below a sheath opening at a proximal portion of the sheath and sealing the needle slot therebelow; a needle hub covering the needle shaft and the proximal portion of the sheath, the needle hub including a needle hub extension arm extending distally; a needle hub portion of a RICC clip configured to retain a portion of the RICC therein at least in a ready-to-deploy state of the RICC insertion assembly; an introducer needle comprising:

1. An access guidewire, comprising: a proximal portion including a proximal end; a distal portion including a distal end disposed within the introducer needle just proximal to the needle tip in at least the ready-to-deploy state of the RICC insertion assembly; an introducer needle comprising: a coupler connecting the RICC, the introducer needle, and the access guidewire together, A coupler housing; a coupler portion of the RICC clip connected to the coupler housing, the proximal and distal ends of the access guidewire forming a loop on the access guidewire and the RICC being positioned over the loop in at least the ready-to-deploy state of the RICC insertion assembly; Including coupler and RICC insertion assembly comprising:

2. 2. The RICC insertion assembly of claim 1, wherein the coupler housing includes a proximally extending coupler housing support, and wherein at least the needle hub extension arm is slidably disposed on the coupler housing support when the RICC insertion assembly is in at least the ready-to-deploy state.

3. 3. The RICC insertion assembly of claim 2, wherein the coupler portion of the RICC clip is a first "C" shaped portion of the RICC clip suspended from a proximal portion of the coupler housing support, and the needle hub portion of the RICC clip is a second "C" shaped portion of the RICC clip suspended from a proximal portion of the needle hub, and the first and second "C" shaped portions of the RICC clip open toward each other such that the RICC clip completes at least the ready-to-deploy state of the RICC insertion assembly.

4. 4. The RICC insertion assembly of claim 2 or 3, wherein the RICC clip is configured to hold one or more extension legs of the RICC therein such that the RICC is suspended from the RICC insertion assembly in at least the ready-to-deploy state of the RICC insertion assembly.

5. The RICC insertion assembly of claim 4 , wherein the RICC clip is configured to release the one or more extension legs of the RICC therefrom when the introducer needle is withdrawn from the coupler.

6. 6. The RICC insertion assembly of claim 1, wherein the coupler housing includes a needle hub receptacle at a proximal portion of the coupler housing, and a distal portion of the needle hub including the needle hub extension arm is disposed within the needle hub receptacle at least in the ready-to-deploy state of the RICC insertion assembly.

7. 7. The RICC insertion assembly of claim 6, wherein the coupler further includes a valve module disposed within a valve module chamber of the coupler housing of the needle hub receptacle, the valve module sealing around the proximal portion of the sheath and the distal portion of the access guidewire extending through the sheath opening in at least the ready-to-deploy state of the RICC insertion assembly to enable leak-free aspiration through the introducer needle.

8. 8. The RICC insertion assembly of claim 7, wherein the valve module includes an integral blade disposed within the needle slot beneath a distal end of the sheath opening, the blade including a distally facing blade edge configured to decouple the sheath from the needle shaft when the introducer needle is withdrawn from the coupler, thereby allowing the access guidewire to exit the needle shaft via the needle slot.

9. 9. The RICC insertion assembly of claim 1, wherein the coupler includes a pair of locking buttons extending through opposite sides of the coupler housing, the pair of locking buttons respectively mounted on a pair of shafts captively retained within the coupler housing, each button of the pair of locking buttons pivoting on a corresponding shaft.

10. 10. The RICC insertion assembly of claim 9, wherein each locking button of the pair of locking buttons has a protrusion and a gap, the protrusion extending from a cross arm connecting the protrusion to an outer depressible portion of the locking button, the gap facing the cross arm between the protrusion and the outer depressible portion.

11. 11. The RICC insertion assembly of claim 10, wherein the pair of locking buttons are biased away from a centerline of the coupler such that the protrusion of each locking button of the pair of locking buttons is disposed within one of a pair of notches in a wall of the needle hub extension arm on either side of the needle hub extension arm in a default state of the pair of locking buttons.

12. 12. The RICC insertion assembly of claim 11, wherein in some embodiments, when the pair of locking buttons are pressed toward the centerline of the coupler, the walls of the needle hub extension arm on either side of the needle hub extension arm pass through a gap between the protrusion and the outer depressible portion of each of the pair of locking buttons.

13. 13. The RICC insertion assembly of claim 1, wherein the needle hub includes a proximally extending needle hub cradle having gripping pads on either side of the needle hub cradle to facilitate holding the RICC insertion assembly when the introducer needle is withdrawn from the coupler.

14. 14. The RICC insertion assembly of claim 13, further comprising a syringe fluidly connected to the introducer needle at least in the ready-to-deploy state of the RICC insertion assembly, the barrel of the syringe being disposed within the needle hub cradle with a gripping pad located on a side of the barrel of the syringe.

15. 15. The RICC insertion assembly of claim 14, wherein another RICC clip is integrated into a plunger flange extension extending from a plunger flange of the syringe, the another RICC clip configured to hold a catheter hub of the RICC therein such that the RICC is suspended from the RICC insertion assembly in at least the ready-to-deploy state of the RICC insertion assembly.

16. 16. The RICC insertion assembly of claim 1, wherein the needle hub includes an access guidewire channel formed by a notch in the needle shaft and a distally extending needle hub extension tube on a proximal portion of the sheath.

17. 17. The RICC insertion assembly of claim 16, wherein the needle hub includes a laterally extending bar and a needle hub pad between the bar and the access guidewire channel, the bar and the needle hub pad configured to press and hold the access guidewire in place when establishing a puncture path from an area of ​​a patient's skin to a vascular lumen.

18. 18. The RICC insertion assembly of claim 1, wherein the coupler housing includes a longitudinally extending coupler housing slot on the same side of the coupler housing as the coupler portion of the RICC clip, the coupler housing slot opening in the opposite direction to the needle slot of the needle shaft, and the coupler housing slot configured to allow the access guidewire to exit the coupler housing when the introducer needle is withdrawn from the coupler.

19. 20. The RICC insertion assembly of claim 18, wherein the coupler housing slot includes a narrow portion and a wider portion proximal to the narrow portion, the wider portion of the coupler housing slot configured to align at least a needle hub alignment rail of the needle hub during assembly of the RICC insertion assembly.

20. 20. The RICC insertion assembly of claim 1, wherein the access guidewire includes an access guidewire hub on a distal end of the access guidewire, the access guidewire configured to prevent over-advancement of the access guidewire.

21. 1. An introducer needle assembly, comprising: An introducer needle, a needle shaft including a needle slot extending longitudinally from a proximal portion of the needle shaft to a distal needle tip; a sheath covering the needle shaft except for the needle slot below a sheath opening at a proximal portion of the sheath and sealing the needle slot therebelow; a needle hub covering the needle shaft and the proximal portion of the sheath, the needle hub including a needle hub extension arm extending distally; a needle hub portion of a rapid insertion central catheter (RICC) clip configured to retain a portion of the RICC therein; an introducer needle comprising: a coupler coupled to the introducer needle, A coupler housing; a coupler portion of the RICC clip connected to the coupler; A coupler including 1. An introducer needle assembly comprising:

22. The introducer needle assembly of claim 21 , wherein the coupler housing includes a proximally extending coupler housing support, and at least the needle hub extension arm is slidably disposed on the coupler housing support.

23. 23. The introducer needle assembly of claim 22, wherein the coupler portion of the RICC clip is a first "C" shaped portion of the RICC clip suspended from a proximal portion of the coupler housing support, and the needle hub portion of the RICC clip is a second "C" shaped portion of the RICC clip suspended from a proximal portion of the needle hub, and the first and second "C" shaped portions of the RICC clip open toward each other to complete the RICC clip.

24. 24. The introducer needle assembly of claim 21, wherein the coupler housing includes a needle hub receptacle at a proximal portion of the coupler housing, and a distal portion of the needle hub including the needle hub extension arm is disposed within the needle hub receptacle.

25. 25. The introducer needle assembly of claim 24, wherein the coupler further includes a valve module disposed within a valve module chamber of the coupler housing distal to the needle hub receptacle, the valve module sealing around the proximal portion of the sheath and, if present, a distal portion of an access guidewire extending through the sheath opening, thereby enabling leak-free aspiration through the introducer needle.

26. 26. The introducer needle assembly of claim 25, wherein the valve module includes an integral blade disposed in a needle slot beneath a distal end of the sheath opening, the blade including a distally facing blade edge configured to decouple the sheath from the needle shaft when the introducer needle is withdrawn from the coupler.

27. 27. The introducer needle assembly of claim 21, wherein the coupler includes a pair of locking buttons extending through opposite sides of the coupler housing, the pair of locking buttons respectively mounted on a pair of shafts captively retained within the coupler housing, each button of the pair of locking buttons rotating on a corresponding shaft.

28. 28. The introducer needle assembly of claim 27, wherein each lock button of the pair of lock buttons has a projection and a gap, the projection extending from a cross arm connecting the projection to an exterior depressible portion of the lock button, the gap facing the cross arm between the exterior depressible portion of the lock button.

29. 29. The introducer needle assembly of claim 28, wherein the pair of locking buttons are biased away from a centerline of the coupler such that the protrusion of each locking button of the pair of locking buttons is disposed within one of a pair of notches in a wall of the needle hub extension arm on either side of the needle hub extension arm in a default state of the pair of locking buttons.

30. 30. The introducer needle assembly of claim 29, wherein when the pair of locking buttons are pressed toward the centerline of the coupler, the walls of the needle hub extension arm on either side of the needle hub extension arm pass through a gap between the protrusion and the outer depressible portion of each of the pair of locking buttons.

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