Instrument Advancement Device

Abstract

The instrument advancement device includes an access connector configured to connect to a vascular access device, a primary lumen in fluid communication with the access connector, an instrument received within the primary lumen and having a retracted position and an extended position, an advancement member configured to move the instrument between the retracted position and the extended position, and a lumen seal received within the primary lumen and connected to the instrument. The lumen seal defines a space between the lumen seal and the primary lumen when the instrument is in the retracted portion. The lumen seal engages the primary lumen when the instrument is in the advanced position.

Description

[Technical Field]

[0001] The present disclosure relates to an instrument advancement device. [Background technology]

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Provisional Application No. 63 / 400,503, entitled "Instrument Advancement Device," filed August 24, 2022, the entire disclosure of which is incorporated herein by reference in its entirety.

[0003] Catheters are frequently used to administer fluids into and out of the body. Patients in various settings, including hospitals and home care, receive fluids, medications, and blood products through vascular access devices inserted into the patient's vascular system. Catheters of various types and sizes are widely used in a variety of procedures, including, but not limited to, treating infections, providing anesthesia or pain relief, providing nutritional support, treating cancerous growths, maintaining blood pressure and cardiac rhythm, and many other clinical applications. A typical vascular access device is a plastic catheter inserted into a patient's vein. Catheter lengths can vary from a few centimeters for peripheral access to tens of centimeters for central access. Catheters are commonly incorporated into catheter adapters to aid in the ease, accessibility, and usefulness of the catheter. The catheter adapter can be adapted to accommodate one end of the catheter, such that the catheter is supported by the catheter adapter and the catheter body and tip extend beyond the first end of the catheter adapter. The catheter adapter generally further includes a second end adapted to receive additional infusion components for use with the catheter. For example, the second end of the catheter adapter may include a series of threads for attaching an intravenous line or for coupling a syringe to the catheter adapter, thereby providing access to the patient's vascular system via the attached catheter.

[0004] Catheters can be inserted percutaneously. When inserted percutaneously, catheter insertion is typically aided by an introducer needle. The introducer needle is typically housed within the lumen of the catheter such that the needle gauge approximates the inner diameter of the catheter. The needle is positioned within the catheter such that the needle tip extends beyond the tip of the catheter, whereby the needle is used to penetrate the patient's vein and provide an opening for insertion of the catheter.

[0005] To verify proper placement of the introducer needle and / or catheter within the blood vessel, the clinician typically checks for a "flashback" of blood within the flashback chamber of the catheter assembly. Once needle placement is confirmed, the clinician may temporarily occlude flow within the vasculature and remove the needle, leaving the catheter in place for subsequent blood collection or infusion.

[0006] Blood collection or transfusion using a catheter can be difficult for several reasons, especially if the catheter remains in the patient for more than a day. For example, if a catheter remains inserted in a patient for an extended period of time, the blood vessels and catheter may become more susceptible to narrowing, breaking, kinking, blockage by debris (e.g., fibrin or platelet clots, thrombi, etc.), and adhesion of the catheter tip to the vasculature. For this reason, catheters are often used to collect blood samples at the time of catheter placement, but much less frequently to collect blood samples during the catheter's indwelling period. Thus, when a blood sample is required, an additional needlestick is used to provide venous access for collection, which can be painful for the patient and results in higher material costs. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] US Patent Application Publication No. 2021 / 0290126 Summary of the Invention

[0008] In one aspect or embodiment, the instrument advancement device includes an access connector configured to connect to a vascular access device, a primary lumen in fluid communication with the access connector, an instrument received within the primary lumen and having a retracted position in which a distal end of the instrument is disposed within the primary lumen or the access connector and an extended position in which the distal end of the instrument extends beyond the primary lumen and the distal end of the access connector, an advancement member configured to be grasped by a medical technician, wherein movement of the advancement member moves the instrument between the retracted and extended positions, and a lumen seal received within the primary lumen and connected to the instrument, the lumen seal defining a space between the lumen seal and the primary lumen when the instrument is in the retracted position and engaging the primary lumen when the instrument is in the advanced position.

[0009] The lumen seal may engage the constriction of the primary lumen when the instrument is in the advanced position, the constriction having a smaller inner diameter than the remainder of the primary lumen. The lumen seal may include a first portion and a second portion, the first portion having a larger diameter than the second portion. The lumen seal may include a distal tapered portion. The lumen seal may include an elastomeric material. The lumen seal may define a central opening through which a portion of the instrument passes.

[0010] The instrument may include a flow tube and a guidewire disposed distal to the flow tube. The guidewire may include a helical coil portion. The device may include a wedge member defining a central passage, wherein the central passage of the wedge member receives a portion of the flow tube and a portion of the guidewire, the guidewire and the flow tube being attached to the wedge member. The advancement member may be configured to move along an outer surface of the primary lumen, the advancement member engaging the wedge member from outside the primary lumen to move the instrument between the retracted position and the extended position. The lumen seal may define a central opening that receives a portion of the wedge member, the lumen seal being attached to the wedge member. The guidewire may extend through the lumen seal, and a portion of the flow tube is received within the central opening of the lumen seal.

[0011] The device may include a cannula configured to penetrate the lumen seal when the instrument is moved to the advanced position, where a flow path defined by the instrument is sealed until the cannula penetrates the lumen seal. The device may include a vent plug disposed within the primary lumen and positioned proximal to the advancement member, where a flow path to the vent plug extends from the access connector, through the primary lumen, and between the primary lumen and the lumen seal. The vent plug may be a hydrophilic vent and may be configured to allow the primary lumen to receive a waste blood volume.

[0012] When the access connector is connected to the integrated catheter, the flow tube can be configured to be received within at least a portion of the integrated catheter.

[0013] At least a portion of the primary lumen can have an asymmetric cross-section defining a larger diameter portion and a smaller diameter portion, with a portion of the guidewire received within the smaller diameter portion. The smaller diameter portion can be configured to support the guidewire as the device moves from the retracted position to the advanced position.

[0014] The device may include a flow restrictor configured to reduce the risk of hemolysis. The flow restrictor may be a tubular insert received within at least a portion of the access connector. [Brief explanation of the drawings]

[0015] The above and other features and advantages of the present disclosure, and the manner in which they are achieved, will become more apparent, and the disclosure itself will be better understood, by reference to the following description of embodiments of the disclosure taken in conjunction with the accompanying drawings. [Figure 1] FIG. 1 is a perspective view of an instrument advancement device according to one aspect or embodiment of the present application, showing the device having an access device. [Figure 2] FIG. 2 is a perspective view of the device of FIG. 1 showing the retracted position of the tool. [Figure 3] FIG. 3 is a cross-sectional view of the device of FIG. 1 showing the retracted position of the tool. [Figure 4] FIG. 4 is a perspective view of an instrument advancement device according to a further aspect or embodiment of the present application, showing the instrument in a retracted position. [Figure 5] FIG. 5 is a cross-sectional view of the device of FIG. 4 showing the retracted position of the tool. [Figure 6] FIG. 6 is a partial cross-sectional view of the device of FIG. [Figure 7] FIG. 7 is a partial cross-sectional view of the device of FIG. [Figure 8] FIG. 8 is a partial cross-sectional view of the device of FIG. 1 showing the instrument in an advanced position. [Figure 9] FIG. 9 is a partial cross-sectional view of the device of FIG. 1 showing the instrument in an advanced position. [Figure 10] FIG. 10 is a perspective view of an instrument advancement device according to a further aspect or embodiment of the present application showing the instrument in a retracted position. [Figure 11] FIG. 11 is a cross-sectional view of the device of FIG. 10 showing the retracted position of the tool. [Figure 12]FIG. 12 is a perspective view of an instrument advancement device according to a further aspect or embodiment of the present application showing the instrument in a retracted position. [Figure 13] FIG. 13 is a partial cross-sectional view of the device of FIG. 12 showing the retracted position of the tool. [Figure 14] FIG. 14 is a partial cross-sectional view of the device of FIG. 12 showing a vent plug according to one aspect or embodiment of the present application. [Figure 15] FIG. 15 is a partial cross-sectional view of the device of FIG. 12 showing the instrument in a partially advanced position. [Figure 16] FIG. 16 is a partial cross-sectional view of the device of FIG. 12 showing the instrument in an advanced position. [Figure 17] FIG. 17 is a partial cross-sectional view of the device of FIG. 12 showing the instrument in an advanced position. [Figure 18] FIG. 18 is a perspective view of an instrument advancement device according to a further aspect or embodiment of the present application showing the instrument in a retracted position. [Figure 19] FIG. 19 is a partial cross-sectional view of the device of FIG. 18 showing an instrument received within the integrated catheter. [Figure 20] 20 is a partial cross-sectional view of the device of FIG. 18 showing an instrument received within the T-connector. [Figure 21] FIG. 21 is a schematic illustration of an advancement member and instrument according to a further aspect or embodiment of the present application. [Figure 22] FIG. 22 is a schematic diagram of the device of FIG. [Figure 23] FIG. 23 is a schematic diagram of the advancement member and instrument of FIG. 21, showing the instrument in an unbuckled state. [Figure 24] FIG. 24 is a schematic diagram of the advancement member and instrument of FIG. 21 showing the instrument in a buckled state. [Figure 25] FIG. 25 is a schematic diagram of the advancement member and instrument of FIG. [Figure 26] FIG. 26 is a partial cross-sectional view of an instrument advancement device according to a further aspect or embodiment of the present application. [Figure 27]FIG. 27 is a perspective view of the device of FIG. 1 showing the device utilized in connection with a blood sample collection system.

[0016] Corresponding reference characters indicate corresponding parts throughout the several views. The illustrations presented herein illustrate exemplary embodiments of the present disclosure, and such illustrations should not be construed as limiting the scope of the present disclosure in any way. DETAILED DESCRIPTION OF THE INVENTION

[0017] Spatial or directional terms such as "left," "right," "inner," "outer," "above," "below," etc. should not be considered limiting as the present invention may assume various alternative orientations.

[0018] For purposes of explanation hereinafter, the terms "upper," "lower," "right," "left," "vertical," "horizontal," "top," "bottom," "sideways," "vertical," and derivatives thereof, shall refer to the invention as oriented in the drawings. However, it will be understood that the invention may assume various alternative modifications unless expressly specified to the contrary. It should also be understood that the specific devices illustrated in the accompanying drawings, and described in the following specification, are simply exemplary embodiments of the invention.

[0019] Unless otherwise indicated, all ranges or ratios disclosed herein should be understood to encompass the starting and ending values, and any and all subranges or subratios therein. For example, a specified range or ratio of "1 to 10" should be considered to include any and all subranges or subratios between (and including) the minimum value of 1 and the maximum value of 10; i.e., all subranges or subratios begin with a minimum value of 1 or greater and end with a maximum value of 10 or less.

[0020] The terms "first," "second," and the like are not intended to refer to any particular order or chronology, but rather to different conditions, characteristics, or elements.

[0021] As used herein, "at least one" is synonymous with "one or more." For example, the phrase "at least one of A, B, and C" means any one of A, B, or C, or any combination of any two or more of A, B, or C. For example, "at least one of A, B, and C" includes one or more As alone, or one or more Bs alone, or one or more Cs alone, or one or more As and one or more Bs, or one or more As and one or more Cs, or one or more Bs and one or more Cs, or all one or more of A, B, and C.

[0022] 1-9 , in one aspect or embodiment, an instrument advancement device 10 includes an access connector 12 configured to connect to a vascular access device, a primary lumen 14 in fluid communication with the access connector 12, an instrument 16 received within the primary lumen 14, an advancement member 18 configured to be grasped by a medical technician, and a lumen seal 20 received within the primary lumen 14 and connected to the instrument 16. The instrument 16 has a retracted position ( FIG. 3 ) in which the distal end of the instrument 16 is disposed within the primary lumen 14 or the access connector 12, and an extended position ( FIG. 8 ) in which the distal end of the instrument 16 extends beyond the distal ends of the primary lumen 14 and the access connector 12. Movement of the advancement member 18 moves the instrument 16 between the retracted and extended positions. The lumen seal 20 defines a space between the lumen seal 20 and the primary lumen 14 when the instrument 16 is in the retracted position. When instrument 16 is in the advanced position, lumen seal 20 engages primary lumen 14. Instrument advancement device 10 is configured to connect to a vascular access device, such as a catheter, to extend instrument 16 into a patient's vasculature and provide access past a clot, valve, or other obstruction, thereby enabling blood withdrawal through the vascular access device. By providing space between lumen seal 20 and primary lumen 14 when instrument 16 is in the retracted position and engaging primary lumen 14 when instrument 16 is in the advanced position, the force required to move advancement member 18 and instrument 16 is minimized while allowing the flow path through primary lumen 14 to be sealed when instrument 16 is moved to the advanced position.

[0023] 6, for example, the advancement member 18 is configured to travel along the outer surface of the primary lumen 14, with the advancement member 18 being disposed entirely outside of the primary lumen 14. The advancement member 18 includes a body 22 having a gripping surface 24 and a ball bearing 26, or other suitable feature, that engages the outer surface of the primary lumen 14 and compresses the primary lumen 14, thereby enabling advancement of the instrument 16, as described in additional detail below. Although the ball bearing 26 is shown in certain figures as extending through the primary lumen 14, the ball bearing 26 does not extend through the primary lumen 14 but only externally contacts or compresses the primary lumen 14. The advancement member 18 may be the same as or similar to the translation handle shown and described in U.S. Patent Application Publication No. 2009 / 0129990, which is incorporated herein by reference in its entirety.

[0024] 4, 5, 8, and 9, when instrument 16 is in the advanced position, lumen seal 20 engages constriction 28 of primary lumen 14, constriction 28 having a smaller inner diameter than the remainder of primary lumen 14. As shown in FIGS. 4 and 5, in some aspects or embodiments, constriction 28 is longer than constriction 28 shown in FIGS. 2 and 3, which allows instrument 16 to be further advanced and retracted while in the suction zone, with lumen seal 20 forming a seal with primary lumen 14. In one aspect or embodiment, vacuum suction is applied before advancement or retraction of instrument 16 while in the suction zone. In one aspect or embodiment, device 10 is fully primed to remove air from device 10 while in the suction zone and before advancement or retraction of instrument 16.

[0025] 6-9 , in one aspect or embodiment, the lumen seal 20 includes a first portion 30 and a second portion 32, with the first portion 30 having a larger diameter than the second portion 32. The lumen seal 20 also includes a distal tapered portion 34. In some aspects or embodiments, the lumen seal 20 is formed from an elastomeric material such as polyisoprene, although other suitable materials may be utilized. The lumen seal 20 and / or the instrument 16 may include a lubricant to facilitate sliding between the components. The lumen seal 20 defines a central opening 36 through which a portion of the instrument 16 passes. As shown, in one aspect or embodiment, the instrument 16 includes a flow tube 38 and a guidewire 40 disposed distally of the flow tube 38. The guidewire 40 may also include a helical coil portion 42 at the distal end of the guidewire 40. However, other suitable arrangements for the device 16 may be utilized, such as a flow tube extending the length of the device 16, a guidewire extending the length of the device 16, or a sensor deployment device.

[0026] Referring to FIG. 7 , the device 10 further includes a wedge member 44 defining a central passage 46 that receives a portion of the flow tube 38 and a portion of the guidewire 40. The guidewire 40 and the flow tube 38 are attached to the wedge member 44. In one aspect or embodiment, the guidewire 40 and / or the flow tube 38 may be bonded or attached to the wedge member 44 via adhesive, overmolding, or other suitable techniques. The proximal end of the guidewire 40 may extend through the flow tube 38 and into the wedge member 44. The advancement member 18 engages the wedge member 44 from outside the primary lumen 14 to move the instrument 16 between the retracted and extended positions. The central opening 36 of the lumen seal 20 receives a portion of the wedge member 44, and the lumen seal 20 is attached to the wedge member 44. Lumen seal 20 may be attached to wedge member 44 via adhesive, overmolding, or other suitable techniques. Guidewire 40 extends through lumen seal 20, and a portion of flow tube 38 is received within central opening 36 of lumen seal 20. When instrument 16 is moved to the advanced position and lumen seal 20 engages primary lumen 14, access connector 12 is no longer in fluid communication with primary lumen 14, but only with flow tube 38.

[0027] 1 , the proximal end of the primary lumen 14 is connected to a needleless connector 48, through which the flow tube 38 of the instrument 16 extends. The proximal end of the flow tube 38 includes a connector 50 configured to connect to an access device 60, which may be a BD Vacutainer® Luer-Lok™ access device. A vacuum container (not shown) may be inserted into the access device 60 to facilitate blood collection via the instrument 16.

[0028] 10 and 11 , in one aspect or embodiment, instead of providing a constriction 28, the primary lumen 14 has a catch or clip 62 configured to secure the lumen seal 20 after the instrument 16 is fully advanced to the advanced position. The catch or clip 62 may have a larger inner diameter compared to the remainder of the primary lumen 14, allowing the lumen seal 20 to catch and lock into the catch or clip 62 as it is advanced and to remain within the catch or clip 62 when the advancement member 18 is retracted. The lumen seal 20 may have an interference fit with the primary lumen 14, allowing the instrument 16 to be withdrawn through the lumen seal 20. While requiring a higher force during advancement of the instrument 16, the instrument 16 is not exposed to such force except when the instrument 16 is withdrawn while tensioned, thereby minimizing buckling. Fluid communication exists from the access connector 12 to the primary lumen 14 until the advancement member 18 is moved to the advanced position. When the advancement member 18 is advanced, fluid communication occurs only between the access connector 12 and the flow tube 38 .

[0029] 12-17 , in further aspects or embodiments, the instrument advancement device 10 includes a cannula 70 configured to penetrate the lumen seal 20 when the instrument 16 is moved to the advanced position. The flow path defined by the flow tube 38 of the instrument 16 is sealed until the cannula 70 penetrates the lumen seal 20. A vent plug 72 is disposed within the primary lumen 14, proximal to the advancement member 18, and the flow tube 38 of the instrument 16 defines a vent opening 74 in fluid communication with the vent plug 72. The flow path to the vent plug 72 extends from the access connector 12, through the primary lumen 14, and between the primary lumen 14 and the lumen seal 20. In some aspects or embodiments, the vent plug 72 is a hydrophilic vent, such as a porex flow plug or similar occlusion device. The vent plug 72 is configured to allow the primary lumen 14 to accept a waste blood volume, which is configured to eliminate the need to withdraw the waste tube. If additional suction of the vacuum tube or syringe is required to allow blood to flow at a desired rate during waste disposal, an oversized primary vacuum tube or syringe with a withdrawal plunger can be used to withdraw air, allowing the required amount of blood to collect in the remaining volume of the vacuum tube or syringe after the cannula 70 penetrates the lumen seal 20. Blood flow is stopped by the vent plug 72 upon final advancement of the instrument 16, causing the cannula 70 to penetrate the lumen seal 20 and provide an open fluid path through the flow tube 38 of the instrument 16, thereby providing a fluid path less likely to contain contaminants. In some aspects or embodiments, instead of providing a vent plug 72, the needleless connector 48 can include a hydrophilic vent, thereby eliminating the need for an additional vent opening 74 in the flow tube 38. Drawdown of waste into the primary lumen 14 can be assisted by the use of a vacuum tube. As shown more clearly in FIG. 17, cannula 70 includes a flange portion 76 that is attached to primary lumen 14 and / or access connector 12, and an extension portion 78 having a sharp distal end.Guidewire 40 is configured to extend through cannula 70 when instrument 16 is moved to the advanced position, which forms a fluid pathway between guidewire 40 and cannula 70 .

[0030] 18-20 , in one aspect or embodiment, the flow tube 38 of the instrument 16 extends distally relative to the lumen seal 20 but does not extend the entire length of the instrument 16. In such a configuration, as shown in FIG. 19 , when the access connector 12 is connected to the integrated catheter 80, the flow tube 38 is configured to be received within at least a portion of the integrated catheter 80. Similarly, as shown in FIG. 20 , the flow tube 38 of the instrument 16 is configured to extend beyond the T-connector 82. Providing the flow tube 38 distal to the lumen seal 20 is configured to reduce mixing of fluids within the integrated catheter 80 or T-connector 82, thereby preventing contamination of the T-connector 82 and the integrated catheter 80. The flow tube 38 may form a seal with a portion of the T-connector 82 or the wedge member 44 to ensure mixing, dilution, and / or contamination does not migrate from those areas.

[0031] 21-25 , in a further aspect or embodiment, at least a portion of primary lumen 14 has an asymmetric cross-section defining a larger diameter portion 86 and a smaller diameter portion 88, with a portion of guidewire 40 received within smaller diameter portion 88. Smaller diameter portion 88 is configured to support guidewire 40 and prevent guidewire 40 from entering larger diameter portion 86 when device 16 is moved from the retracted position to the advanced position. The asymmetric cross-section may be provided along the entire length of primary lumen 14, at intermittent locations along the length, or only at the end of primary lumen 14.

[0032] 26 , in a further aspect or embodiment, the instrument advancement device 10 includes a flow restrictor 90 configured to reduce the risk of hemolysis. The flow restrictor 90 may be a tubular insert 92 received within at least a portion of the access connector 12. The flow restrictor 90 may have a smaller inner diameter than the primary lumen 14, and the guidewire 40 of the instrument 16 is configured to extend through the flow restrictor 90. The flow restrictor 90 may be formed from stainless steel, extruded plastic, or other suitable material.

[0033] 27 , in some aspects or embodiments, the access device 60 is a blood culture specimen collection system 94 including a vessel holder 96, an adapter 98, and a collection vessel 100. The blood culture specimen collection system 94 is configured to be assembled with the collection vessel 100 in a pre-advance position and sterilized, thereby eliminating a connection step and reducing the risk of sample contamination.

[0034] While the present invention has been described in detail for purposes of illustration, based on what are presently considered to be the most practical and preferred embodiments or aspects, it should be understood that such detail is for that purpose only, and that the present invention is not limited to the disclosed embodiments or aspects, but on the contrary, is intended to cover modifications and equivalent arrangements within the spirit and scope of the appended claims. For example, it should be understood that the present invention contemplates that, to the extent possible, one or more features of any embodiment can be combined with one or more features of any other embodiment.

Claims

1. 1. An instrument advancement device comprising: an access connector configured to connect to a vascular access device; a primary lumen in fluid communication with the access connector; an instrument received within the primary lumen, the instrument having a retracted position in which a distal end of the instrument is disposed within the primary lumen or the access connector, and an extended position in which the distal end of the instrument extends beyond the primary lumen and the distal end of the access connector; an advancement member configured to be grasped by a medical technician, wherein movement of the advancement member moves the instrument between the retracted position and the extended position; a lumen seal received within the primary lumen and connected to the instrument, the lumen seal defining a space between the lumen seal and the primary lumen when the instrument is in the retracted portion and engaging the primary lumen when the instrument is in the advanced position; 1. An instrument advancement device comprising:

2. 10. The instrument advancement device of claim 1, wherein the lumen seal engages a constriction of the primary lumen when the instrument is in the advanced position, the constriction having a smaller inner diameter than the remainder of the primary lumen.

3. The instrument advancement device of claim 1 , wherein the lumen seal comprises a first portion and a second portion, the first portion having a larger diameter than the second portion.

4. The instrument advancement device of claim 3 , wherein the lumen seal comprises a distal tapered portion.

5. The instrument advancement device of claim 1 , wherein the lumen seal is comprised of an elastomeric material.

6. The instrument advancement device of claim 1 , wherein the lumen seal defines a central opening, a portion of the instrument passing through the central opening.

7. The instrument advancement device of claim 1 , wherein the instrument comprises a flow tube and a guidewire disposed distally of the flow tube.

8. The instrument advancement device of claim 7 , wherein the guidewire comprises a helical coil portion.

9. 8. The instrument advancement device of claim 7, further comprising a wedge member defining a central passageway, the central passageway of the wedge member receiving a portion of the flow tube and a portion of the guidewire, the guidewire and the flow tube being attached to the wedge member.

10. 10. The instrument advancement device of claim 9, wherein the advancement member is configured to travel along an outer surface of the primary lumen, the advancement member engaging the wedge member from outside the primary lumen to move the instrument between the retracted position and the extended position.

11. The instrument advancement device of claim 9 , wherein the lumen seal defines a central opening that receives a portion of the wedge member, the lumen seal being attached to the wedge member.

12. The instrument advancement device of claim 11 , wherein the guidewire extends through the lumen seal and a portion of the flow tube is received within the central opening of the lumen seal.

13. 10. The instrument advancement device of claim 1, further comprising a cannula configured to penetrate the lumen seal when the instrument is moved to the advanced position, wherein a flow path defined by the instrument is sealed until the cannula penetrates the lumen seal.

14. 14. The instrument advancement device of claim 13, further comprising a vent plug disposed within the primary lumen and positioned proximal to the advancement member, a flow path to the vent plug extending from the access connector, through the primary lumen, and between the primary lumen and the lumen seal.

15. The instrument advancement device of claim 14 , wherein the vent plug comprises a hydrophilic vent and is configured to allow the primary lumen to receive a waste blood volume.

16. The instrument advancement device of claim 7 , wherein the flow tube is configured to be received within at least a portion of the integrated catheter when the access connector is connected to the integrated catheter.

17. 8. The instrument advancement device of claim 7, wherein at least a portion of the primary lumen has an asymmetric cross-section defining a larger diameter portion and a smaller diameter portion, a portion of the guidewire being received within the smaller diameter portion.

18. 18. The instrument advancement device of claim 17, wherein the smaller diameter portion is configured to support the guidewire when the instrument is moved from the retracted position to the advanced position.

19. The instrument advancement device of claim 1 , further comprising a flow restrictor configured to reduce the risk of hemolysis.

20. The instrument advancement device of claim 19, wherein the flow restrictor comprises a tubular insert received within at least a portion of the access connector.

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