A medication delivery and monitoring system and methods whereby drugs are safely delivered to a patient, monitored in real-time during delivery and crucial events are recorded during delivery to provide real-time, on-line information and detail for an audit trail. A novel safety label cradle unit is disclosed. Safety label cradles (slc's) are provided in a plurality of sizes to match varying sizes of syringes which are disposed on a cradle of the slc to provide a constant needle height on the slc unit independent of syringe volume (barrel diameter). A selected slc is securely affixed to a syringe by an adhesively backed label wrapping. The label is preprinted to provide drug identification indicia and drug preparation information. The information is automatically read into the system from the label. A novel delivery station of the system monitors drug delivery as a plunger of the syringe is pushed to deliver a drug to a patient. A smart tray in cooperation with a slider portion of the slc is used to selectively deliver drugs to a port in the IV set. The smart tray comprises a first portion for carrying slc units, an attachable second portion having a control panel for operating the system and a cover for lockably affixing the slc units to the tray.
|
0. 44. A syringe label cradle unit comprising a medical syringe comprising an elongated barrel having a needle extending therefrom, said needle having an end attached to said barrel and another end remote therefrom, cradle means for supporting said syringe having a holder for adhering a label containing machine readable information, said another end of said needle being accessible when said syringe is supported by said cradle means.
0. 43. A method for delivering and monitoring drugs to a port in an IV set comprising the steps of delivering a needle on a drug loaded syringe into the port; automatically determining identification information relative to the drug contained in the syringe by electronically scanning a label; pushing a plunger of the syringe to deliver a volume of the drug through the port; monitoring movement of the plunger for the purpose of calculating and storing the volume of drug delivered.
0. 33. A method for delivering and monitoring drugs to a port in an IV set, said method comprising delivering a needle on a drug loaded syringe to the port, automatically determining identification information relative to the drug contained in the syringe by electronically scanning a label associated with the syringe, inserting the needle into the port, pushing a plunger of the syringe to deliver a volume of the drug through the port, and monitoring movement of the plunger while delivering the drug for calculating the volume of the drug derived from the syringe.
32. A method for delivering and monitoring drugs to a port in an IV set comprising the steps of:
delivering a safety syringe label cradle unit to the port such that a needle on a drug loaded syringe which is a part of the safety syringe label cradle unit is inserted into the port; automatically determining identification information relative to the drug contained in the syringe by electronically scanning a label on the safety syringe label cradle unit; pushing a plunger of the syringe to deliver a volume of the drug through the port; monitoring movement of the plunger for the purpose of calculating and storing the volume of drug delivered.
0. 49. A drug delivery system comprising an interface to a patient IV set including a port exposer for exposing a port of the IV set for needle insertion, a syringe comprising an elongated barrel having a needle extending therefrom, a label in association with said syringe containing machine readable information regarding the identification of a drug to be delivered by said syringe, a label indicia reader for reading said information on said label, and a syringe plunger position determining sensor, said sensor determining changes of the plunger position as a drug is delivered from said syringe, the plunger movement being determinative of the volume of the drug delivered from said syringe.
30. A syringe label cradle (slc) unit comprising:
a medical syringe comprising an elongated barrel having a known transverse diameter and a medical needle disposed along the longitudinal axis of the barrel; a slc comprising a cradle for the syringe and a slider which is slideably disposed at the slc to deliver the medical needle to a port in a patient IV set, the slc further comprising an area for a bar code label, the slider comprising a vertical width which adjusts the needle to a predetermined height; and a label which is carried by the slc, the medical syringe being securely affixed to the slc, and the label comprising indicia which is automatically readable by a label indicia reader.
31. A smart tray for holding and selectively delivering a plurality of syringe label cradle (slc) units to a drug delivery and monitoring system, said smart tray comprising:
a first slc unit tray portion comprising a transverse width which is at least as wide as the longest slc unit which it holds and a length consistent with receiving and holding said plurality of slc units; a plurality of slots disposed transversely relative to said length, each slot having a depth which is the same as the other slots; a second portion of the smart tray which is releasibly affixable to the first portion, said second portion comprising: a data entry mechanism for entering patient data; a control panel comprising: a computer output display; an input keypad; a slot for one slc unit wherein the slc unit is constantly monitored; a lockable cover which securely releasibly affixes the slc units to the smart tray.
25. A drug delivery station comprising:
an interface to a patient IV set comprising a port exposer for exposing a port of the IV set for medical needle insertion and a needle aligner for aligning the medical needle at the port; a syringe label cradle (slc) unit comprising: a medical syringe cradle, a space for a label and a slider which in combination with a syringe comprising a needle, a barrel, and a plunger and position of the cradle relative to the slider provides vertical alignment for the needle such that the syringe needle is juxtaposed the interface when the slc unit is disposed in the needle aligner; a label securely affixed to the syringe and which comprises machine readable drug identifying indicia; a label indicia reader for automatically reading drug identification information from the label; a syringe plunger position determining sensor whereby the station measures the plunger position and change of position as a drug is delivered to the patient from the medical syringe; the barrel having a known transverse diameter with the medical needle disposed along the longitudinal axis of the barrel; the slider being disposed to slideably ride within said needle aligner to deliver the medical needle to the port, the slc comprises an area for the bar code label and the slider comprising a width which adjusts the needle to a predetermined height relative to the port.
1. A drug delivery and monitoring system comprising: a drug delivery station comprising:
an interface to a patient IV set comprising a port exposer for exposing a port of the IV set for medical needle insertion and a needle aligner for aligning the needle at the port; a syringe label cradle (slc) unit comprising: a medical syringe comprising an elongated barrel having a known transverse diameter and a medical needle disposed along the longitudinal axis of the barrel; a slc comprising a cradle for the syringe and a slider which is disposed to slideably ride within said needle aligner to deliver the medical needle to a port in a patient IV set and which comprises an area for a bar code label and a vertical slider width which adjusts the needle to a predetermined height relative to the port; and a label which is securely affixed to the medical syringe, the label comprising patient correlation indicia which is readable by a label indicia reader; an slc unit delivery tray which provides secure containment for one or more slc units including the aforesaid slc; a microprocessor controller; the drug delivery station further comprising: a syringe plunger position determining sensor whereby the system measures the plunger position and change of position as a drug is delivered to the patient; and the aforesaid label indicia reader for automatically reading critical drug identification information from the label. 2. A drug delivery and monitoring system according to
3. A drug delivery and monitoring system according to
4. A drug delivery and monitoring system according to
5. A drug delivery and monitoring system according to
6. A drug delivery and monitoring system according to
7. A drug delivery and monitoring system according to
8. A drug delivery and monitoring system according to
9. A drug delivery and monitoring system according to
10. A drug delivery and monitoring system according to
11. A drug delivery and monitoring system according to
12. A drug delivery and monitoring system according to
13. A drug delivery and monitoring system according to
14. A drug delivery and monitoring system according to
15. A drug delivery and monitoring system according to
16. A drug delivery and monitoring system according to
17. A drug delivery and monitoring system according to
18. A drug delivery and monitoring system according to
19. A drug delivery and monitoring system according to
20. A drug delivery and monitoring system according to
21. A drug delivery and monitoring system according to
22. A system according to
23. A system according to
24. A system according to
26. A drug delivery and monitoring system according to
27. A drug delivery and monitoring system according to
28. A drug delivery and monitoring system according to
29. A drug delivery and monitoring system according to
0. 34. The method of
0. 35. The method of
0. 36. The method of
0. 37. The method of
0. 38. The method of
0. 39. The method of
0. 40. The method of
0. 41. The method of
0. 42. The method of
0. 45. The unit of
0. 46. The unit of
0. 47. The unit of
0. 48. The unit of
0. 50. The system of
0. 51. The system of
0. 52. The system of
0. 53. The system of
0. 54. The system of
0. 55. The system of
0. 56. The system of
0. 57. The system of
|
The field of the invention is control and monitoring of medications delivered to a patient and more particularly to methods and apparatus involved in automatically controlling drug delivery, including controlling of drug administration rate and volume, with real-time monitoring and record keeping.
Problems related to misidentification and resulting erroneous delivery of drugs are well known in the medical care art. Other problems related to drug control, maintaining adequate drug records, contamination of drugs prepared on patient floors are also well known in the pharmaceutical art. This invention provides solutions to the above disclosed problems and many others as will become evident hereafter.
Manual dispensing of drugs from pharmacy to anesthesia is a common practice in hospitals and other surgery facilities today. Anesthesia providing departments generally fill syringes with drugs, administer the drugs directly to patients and document the drug handling process in a retrospective manner using handwritten entries. The likelihood of human imperfections makes drug diversion, medication errors, errors of omission, medication contamination and inadvertent needle sticks a constant companion to drug administration. Additionally, the process is exacerbated by emergency situations which demand hurried set up and administration of drugs, with concurrently less time to pay attention to timely and accurate record keeping.
Contemporarily, the problems related above are being addressed by approaches meant to improve drug delivery and control. These approaches comprise production and use of pre-packaged drug menus which involve return to the pharmacy of each unused package to simplify and assure better control in drug accounting; making drug dispensing machines which automatically dispense drugs and provide a record certain as drugs are removed therefrom; delivering drug "lock boxes" to a requesting physician, thereby putting direct responsibility for drug accounting upon the physician of record; and utilizing electronic recording devices whereby documentation of drug delivery data is captured via electronic data acquisition devices, such as bar code readers or keyboards. All of these approaches, used alone or in combination, exhibit deficiencies which are well known in the drug dispensing and monitoring art.
In brief summary, this novel invention alleviates all of the known problems related to drug administration. The present invention pertains to a system which is used to assure proper identification and administration of prescribed drugs, to control access to drugs and to record drug distribution activities. The invention also permits direct use of centralized pharmaceutical resources in preparing medications in clean (e.g. air hood) environments where contamination is less likely, in producing standardized labeling and in packaging drugs for distribution within a medical facility. The invention is particularly well adapted for use in handling prescription dose quantities rather than single-dose medication(s), thereby providing opportunity for reduced cost of drug handling.
The present invention improves drug delivery and control by capturing all related data immediately upon administration of a drug through employment of an inventive automatic drug infusion monitoring system. Elemental parts of the system comprise a scanning module, a syringe label cradle, a cassette tray and a receptacle.
The scanning module employs bar code or other digital indicia scanners to read labels affixed to the syringe label cradle. Information contained on the label comprises a code identifying a drug contained in an associated syringe, size of the syringe, syringe type, preparer of the drug, and any expiration data associated with the drug. The scanning module readers are also used to monitor syringe plunger movement as a drug is administered thus acquiring drug administration dynamics in real time. Scanning by the scanning module may comprise two scanners, one for reading drug related codes and one for tracking advancement of an associated syringe plunger, thereby determining delivery rate and volume of administered drugs.
Dynamic control and delivery of drugs permits use of pre-filled syringes at the pharmacy and eliminates the need for unit dose sized medicants and the need for filling syringes by a bedside clinician. This approach yields cost efficiencies in both drug handling and clinician time. Pre-filling syringes by batch processing under sterile hoods reduces errors and nosocomial infections and allows quick and efficient response to clinical (emergency) situations.
The syringe label cradle is a holder and positioner for a drug containing syringe. A syringe disposed in the cradle is preferably securely affixed thereto by an self-adhesing, pre-printed label. Presently preferable machine readable codes are bar codes. The syringe label cradle is instrumental in holding and positioning the syringe for drug administration as well as providing access to the label.
The cassette tray secures syringe containing syringe label cradles in place for transport and storage prior to, during and after use. The cassette tray has a lock which remains locked by the system until opened by an authorized (properly identified) clinician. Generally, the cassette tray is organized to hold syringe label cradles and their contents in a logically progressive array. In use, the cassette tray is aligned with an injection port most commonly connected to a patient-connected needleless IV injection set. In any event, a clinician advances the aligned syringe label cradle to a docked position for drug infusion after which infusion is automatically monitored and recorded.
The receptacle comprises the injection port, generally referenced hereafter as an injection port module (IPM). The receptacle also comprises a scanner module, hard copy generator (printer) and a control module. The IPM secures an IV line in position to accept selected syringe label cradles for drug injection through the port.
The scanner module reads data encoded on the label, secures the syringe label cradle in position for injection and tracks syringe plunger advancement. The printer is used to generate printouts of drug administration event chronology and other critical data either as they are recorded or after they have been stored for later printout.
The control module holds syringes containing controlled drugs (such as a narcotic syringe) in an off-use holding site. The control module continuously monitors the syringes while they remain in the holding position, thereby preventing drug diversion or other undesirable manipulations of narcotics or other control substances. Information transfer to a user is upgraded and enhanced by on-line printers and liquid crystal displays (LCD's) available on the control module. Also a real-time interface is available for transmitting and receiving electronic medical records, billings, or other standard depositories of hospital information. Further the real-time interface makes customized data bases such as pre-operative interview results, potential drug interactions, allergic reactions, physician profiling, outcome analysis available to a user at the control module.
A natural benefit of the instant invention is production of an drug administration audit trail. As well, drug access is severely limited by locked, secured lids on cassette trays. The cassette trays assuredly thereby contain only original syringes and associated syringe label cradle's (SLC's) permitting an accurate quality assurance to be maintained by pharmacy. Return of unused drugs under controlled conditions allows a significant reduction in drug waste due to otherwise unwarranted disposition.
Automatically powered needle injection into IV set injection sites under protective cover provided by a shield associated with each SLC is a major factor in eliminating needle sticks which could otherwise occur. Contamination is thereby minimized as well. Additional patient protection is provided by data contained on a patient data card which is an integral part of patient data management capability of the inventive combination.
Accordingly, it is a primary object to provide a medical drug delivery and monitoring system having capability for automatically dispensing drugs to a patient, monitoring and recording drug rates and volumes in real time, and providing drug control and drug record security throughout a medical procedure.
It is a fundamental object to provide method and apparatus for safely and securely delivering drugs to a patient site for use in a controlled manner.
It is another fundamental object to provide a Syringe Label Cradle (SLC) for securing a drug containing syringe in position for use and as an integral function thereof to provide an identifying label which is automatically read to identify the syringe, its contents, preparer of the contents, critical drug data including expiration data and drug volume available in the syringe.
It is another fundamental object to provide a cassette tray which secures SLC's in place for transport and storage, prior to, during and after use in drug infusion.
It is yet another fundamental object to provide a receptacle which comprises an injection port module (IPM) through which drugs are automatically injected into an IV line from a drug containing syringe.
It is still another fundamental object to provide a scanner within the receptacle which tracks movement of each plunger of each syringe as it is driven to inject a drug into the IV line.
It is an object to provide a printer for hard copy output of data acquired by the system, including, but not limited to, drug types, administered volumes, time of administration, and pertinent patient data.
It is a further object to provide a control module which comprises a keyboard and liquid crystal display (LCD) which permits clinician access to patient and system status, warnings, event chronology and other system and patient related parameters.
It is an important object to provide a system which sequentially utilizes portions of drugs contained in syringes placed in the SLC's thereby eliminating the necessity of prepackaging drugs in predetermined quantities, such as unit doses, and of preparing syringes at a patient site by a clinician, thereby making drug preparation more efficient, less prone to contamination and error and less expensive due to higher volume preparation at a central pharmaceutical site.
These and other objects and features of the present invention will be apparent from the detailed description taken with reference to accompanying drawings.
In this description, the term proximal is used to indicate the segment of the device normally closest to the object of the sentence describing its position. The term distal refers to the other end. Reference is now made to the embodiments illustrated in
Reference is now made to
System 10 also comprises a plurality of syringes 50 which reside in a tray 60. Tray 60 is commonly referenced as a smart tray due to an inherent ability of the tray to read labels and other machine readable indicia. A complete description of 60 tray operation is provided hereafter. Tray 60 comprises a scanner slot 70 for each syringe 50 position. System 10 provides a pair of transverse slide mechanisms 80 which dovetails with juxtaposed grooves 90 to permit each syringe 50 and associated slot 70 to be disposed in alignment with injection port 40.
The most proximal slot 70' is commonly dedicated to acting as a portable scanner and continuously monitors a syringe 50 placed thereat, except when the syringe 50 is advanced toward port 40 for injection or removed from slot 70'.
System 10 further comprises a scanning and recording module 99. Scanning and recording module 99 comprises a patient and procedure storage mechanism 100 for magnetically or otherwise imprinting data upon a portable data card 110 and a hard copy printer 120. Scanning and recording module 99 may be mounted upon a riser 130 upon which system 10 is securely affixed for ready and facile access and illuminated by a lamp 140. Associated with reader 100 is an operating panel 150 comprising a display (preferably a LCD) 160 and a keyboard entry pad 170 which is used for system 10 control and data entry. An optional reader 180 may be provided for scanning for entry of indicia found on supplies and other implements not otherwise recorded by system 10, but which are important to device record keeping.
Reference is now made to
A key process for using system 10 is preparing a drug or other medical fluid bearing syringe for use. As may be seen in
As height of needle 202 is dependent upon the cylindrical diameter of syringe 50 and port 40 is at a fixed height relative to a fixture which holds syringe 50, the height of needle 202 is adjusted by the width of label holder 204. A plurality of needle holders, designated 210, 212, 214, 216 and 218, showing size variances for 20, 10, 5, 3 and 1 ml syringes, respectively are seen in FIG. 3A. Both lateral elevation and end-on views of the needle holders are seen in FIG. 3A. In the end-on view, a constant port 40 height above each slider 208 is indicated by "+" signs.
It is also desirable to arrange the width of each label holder 204 such that one common label area is available for access by a scanning reader. Such overlap is seen in FIG. 3B. Note that when label holders are juxtaposed, an overlapping area 220 is commonly available for label placement.
Reference is now made to
To securely affix syringe 50 to SLC 200, a label 224 is preferably adhesively applied as is best seen in FIG. 5. Generally syringe 50 is affixed to SLC 200 by disposing syringe 50 onto cradle 222. Thereafter, label 224, prepared with an adhesive backing 225, is wrapped about syringe 50 and SLC 200. Label 224 may comprise a wealth of man and machine readable information, but foremost among the information provided thereon are drug name and drug concentration disposed on the visible top of the label for easy viewing by an operator and a bar code 226 (or other machine readable indicia) disposed in the overlapping area 220 where labels are commonly scanned for automatic acquisition of label information. Also, detailed drug information, which may include concentration, preparer, expiration date, expected size of syringe to be used and other pertinent drug delivery information, is commonly printed above the bar code. An example of such label information is seen in FIG. 5A.
Steps commonly used to prepare and initiate a drug infusion and monitoring sequence is seen in
Unit 231 is for monitoring during an injection, moved in a fashion described by dashed line and arrow 232 to insert slider 208 of SLC 200 into a slot 70" of a scanner block 234 associated with a patient IV insertion module 30 and in alignment with an injection port 40 as seen schematically in FIG. 6D. In this manner, unit 231 is readied and put in place for drug injection.
Most often, slot 70" of block 234 is also aligned with a slot 70 or 70' of tray 60 which holds a plurality of units 231. Tray 60 is seen in FIG. 7. As seen in
Reference is now made to
For transport, a cover 244 is provided to contain and secure loaded SLC's placed for delivery to a patient site in tray 60. Cover 244 is generally "U" shaped and comprises inwardly bent wings at the open end of the "U" which slide along grooves 238 and 240 to position cover 244 over the loaded SLC's. A lock pin 246, operated by key and keylock 192 is outwardly disposed to pass through a hole (not shown) in a side 248 of cover 244 to securely affix cover 244 to tray 60. Unlocking of by key and keylock 192 withdraws lock pin 246 from the hole in side 248 permitting access to the loaded SLC's. Lock status of pin 246 is detected by an associated microswitch (not shown) located in scanner module 242 to permit electrical monitoring of key and keylock operation. Lock pin 246 is also unlocked automatically under program control of system 10 as disclosed hereafter.
A seen in
At the time of use of each SLC unit 231, tray 60 is displaced transversely until the needle 202 of selected SLC unit 231 is juxtaposed and aligned with port 40 and slider 208 of SLC unit 231 in its slot 70 is likewise aligned with slot 70". (Slot 70" is best seen in
Generally scanner module 242 may be used independently or in conjunction with tray 60 as seen in FIG. 12. Scanner module 242 may be mounted alone on a pole 260 in one form of use. In another form a handle 262 may be attached to scanner module 242 providing a useful portable unit. Also, as earlier described, scanner module 242 may be joined with tray 60 to form a "smart tray 243." Generally, the smart tray is used in conjunction with a complete system 10, as is also seen in FIG. 1.
An important aspect of system operation is detector/reading scanning operation of scanner module 242. As mentioned earlier a label 224 preferably comprising a readable bar code 226 is disposed upon slider 208. In one embodiment, scanner module 242 comprises a pair of scanning devices. A first scanning device 270 comprises an emitter-detector pair and is used to read bar codes as slider 208 is moved into and out of slot 70". Electrical signals from device is transmitted to a microcontroller for processing as described in detail hereafter.
A second scanning device 280 is used to monitor position of a plunger 282 associated with syringe 50 disposed in selected unit 231. Device 280 is seen to be a linear array detector, but other detectors may be used within the scope of the invention. From label 224, information is provided to a system controller 300 (see
A plurality of scanning devices and device arrangements are seen in
A block diagram of an electronic processor 300 for system 10 is seen in FIG. 13. Processor 300 employs parts representing numerous technologies. While there are various parts which may substitute for other parts, review of advantages and disadvantages have resulted in selection of parts recommended for use herein. Even so, some alternatives are disclosed.
Referring to
As disclosed above, this novel invention involves control and monitoring of drug delivery in a clinical environment. Drug delivery typically begins at the pharmacy where syringes are preferably pre-loaded with prescribed drugs. Preloaded syringes are then generally delivered to a clinician who administers the drugs.
The first step in the drug loading and preparation process involves matching a selected syringe 50 with an appropriate matching syringe label cradle (SLC). A pharmacist or other qualified profession (generally referenced by PH/QP hereafter) prepares drugs as prescribed. Usually the compliment of delivered drugs are ordered according to a specific procedure (e.g. cardiac, general, orthopedic, etc.) Following is an example of steps which may be involved in preparing a tray 60:
Step 1--The PH/QP notes the size of a selected syringe 50 and selects a matching SLC 200 as disclosed above. Note that it is preferable to color code each SLC 200 for easy identification.
Step 2--Using a bar code imprinting machine, the PH/QP encodes a label 224 with information comprising drug type, syringe size, patient name, identification of the PH/QP, etc. in a format standardized for system 10.
Step 3--The selected syringe 50 is filled with the prescribed drug and places syringe 50 on the matching SLC 200. As part on generally accepted practice, syringe 50 and cradle 200 are preferably placed into a protective hood while syringe 50 is being filled.
Step 4--As necessary, the PH/QP removes adhesive backing from printed label 224 and secures syringe 50 to SLC 200 by wrapping label 224 over syringe 50 and SLC 200 as previously described. Note that label 224 which is disposed across the visible surface of syringe 50 should be made of clear material so that the position of plunger 282 and volume of drug inside syringe 50 may be seen by a using clinician.
Step 5--The prepared SLC unit 231 is then slid into an appropriate slot 70 (docking channel) in a tray 60. Most often, the SLC's are aligned in a sequential pattern such that each next used narcotic is located in the next available docking channel on tray 60 and a reversal agent is located in the last available docking channel.
Steps 1 through 5 are repeated for all ordered drugs.
Step 6--Tray 60 is secured by sliding cover 244 into place and extending lock pin 246 to a locked position using key and keylock 192.
Step 7--Transporting tray 60 and its contents to the designated medical procedure site.
An example of steps taken by the tray 60 receiving clinician at the site of the medical procedure is as follows:
Step 1--Tray 60 is slideably loaded onto system 10 using grooves 238 and 240. Access to the drugs is gained by advancing the tray to a predetermined position relative to module 242 whereat entry of an appropriate identification code into the system controller magnetically releases lock pin 246. The identification code my be entered via keyboard 170 or via a magnetic card being swiped through magnetic card reading slot 191'. All such events are stored for recall and audit trail purposes in microcontroller 302.
Step 2--A patient identifying card is placed into PCM/CIA slot 304304 disposed in system 10.
Step 3--Now active and operable, system 10 provides the following functions:
a. A narcotic syringe is monitored from the time cover 248 is removed, even while in the holding position. It is for this reason that slot 70', being adjacent to module 99 or 242, is dedicated to use by the narcotic syringe.
b. Data obtained from the patient identifying card is automatically read and stored in microcontroller 302. In addition, appropriate hospital data bases and available customized data bases are accessed for information regarding possible allergic reactions, contraindications, drug interactions, etc.).
c. The operator interface comprising the liquid crystal display 160, keypad 170 and printer 120 are activated to provide system status, flash warnings for drug interactions and other pre-programmed instructions to the operating clinician to accept and respond to clinician requests such a request to display chronology of drug administration to the present time.
d. Optical reader 180 is activated for entry of bar code data which should be recorded in the course of the medical procedure.
Referring to
Drugs are administered to a patient through port 40 and influent tube 340 by the following steps:
Step 1--Selecting the SLC unit 231 having a desired drug.
Step 2--Relative to orientation of slot 70", transversely sliding tray 60 until slot 70 containing the selected SLC unit 231 is juxtaposed slot 70'.
Step 3--Advancing the selected SLC unit 231 into slot 70", at which time label 224 is read providing drug identification, syringe size/type, preparer and expiration data to microcontroller 302.
Step 4--Immediately thereafter, the current position of SLC unit 231 plunger 282 monitoring begins by activating a light source disposed within module 242, and position and change of position of plunger 282 are detected thereafter automatically.
Step 5--A message on LCD 160 provides verification to the clinician that the SLC unit 231 is properly placed.
Having read bar code data of a so-docked SLC unit 231, microcontroller 302 is programmed to check the name of the drug derived from bar code 226 for a check against possible problems/conflicts. If a problem is determined, an alarm notifies the clinician. A warning message on LCD 160 specifies the nature of the alarm. The problem can be addressed or overridden by the clinician (via keypad 170).
Barring occurrence of difficulties which cannot be readily overcome, system 10 is ready for the clinician to advance plunger 282 to dispense the drug contained in the selected SLC unit 231 at a rate to a volume determined by the clinician. System 10 monitors rate and volume of the injected drug. Once the injection is complete, the selected SLC unit 231 may be returned to a holding position, preferably in its original slot 70.
To complete an injection cycle, the clinician enters acknowledgement of the event into microcontroller 302 via keypad 170. Microcontroller 302 calculates, and stores for future use, residual volumes of drugs unused/remaining in syringes to provide an audit trail comprising notations each last time each SLC unit 231 was scanned while docked in scanning module 242. After final administration of drugs from tray 60, cover 244 is reseated, locked in place and the tray containing all unused drugs is returned to the pharmacy. Unused drugs are disposed of according to protocol.
Referring again to
The microprocessor must be capable of supporting external memory and peripheral devices. There are many microprocessors which are currently available with can perform all system 10 functions adequately. However, an eight or sixteen bit microprocessor with built-in communication hardware for networked applications is preferred. One such microprocessor found to be acceptable is the Intel 8044AH.
It is preferred that Flash memory be utilized to hold the computer operating system. The Flash memory should be configured as a memory mapped peripheral device to the microprocessor. In normal operation, the microprocessor accesses Flash Memory to run the drug monitoring and delivery system programming. In do so, the microprocessor performs diagnostics on system 10 and accesses codes specific to each hospital using system 10. The fact that Flash Memory is erasable and programmable on-line allows system 10 to be custom configured for each user. An additional advantage afforded by using Flash memory is the capability of performing software upgrades via a remote link (e.g. via modem).
The USART, which is part of microcontroller 302, provides a serial interface to printer 120 and keypad 170. Preferably, the USART is memory mapped into the microprocessor's external address space. Writing data to this space loads the USART's communications buffer so that data may be transmitted serially The USART chosen for this application should have two serial ports such that one chip can support both printer 120 and keypad 170.
When the USART receives data from a serial communications device, an interrupt is generated to alert the processor that data is available. The particular chip chosen for this application should be capable of generating an interrupt automatically upon receipt of data. The microprocessor, once interrupted, reads data from the USART's receive buffer. The current Intel USART version is part no. 8251A; the contemporary Motorola USART version is part no. 68681. When choosing a particular chip for this application, care should be taken to assure compatibility with a chosen microprocessor.
The Parallel Interface is used for communications with the PCM/CIA (patient card) slot 304, and LCD 160. The Parallel Interface should be memory mapped into the microprocessors external address space. PCM/CIA slot 304 and LCD 160 should each be assigned a unique address to distinguish between the two. Writing a byte to either of these two addresses thereby sends data to each respective device.
The current Intel version of the parallel interface adaptor chip is part no. 8255A. The Motorola version of the parallel interface adapter part no. 68230. Both Intel's and Motorola's chips provide three independent parallel ports which may be configured individually as either inputs or outputs.
PCM/CIA slot 304, through a parallel port, also provides a modem connection for communications external to system 10. This modem connection may be used for debugging during development of the drug monitoring and for delivery system 10 software via long line (e.g. telephone) communications. The modem connection may also be used for performing remote diagnostics and for installing software upgrades from a remote location.
The Watchdog Timekeeper is a real-time clock and is used as a basis for ensuring that system 10 software is functioning properly. Related real-time clock functions comprise generating interrupts to the processor at a specific time, tracking the usage time of the machine, tracking events, etc. The Watchdog Timekeeper is a critical component of the system since many of the crucial monitoring functions are time based. Any time a time-critical event occurs during the operation of system 10, time of the event must be accurately recorded. The Watchdog Timekeeper is battery backed to maintain an accurate clock. Time from the clock is accessible at any time via keypad 170 and LCD 160.
Timed interrupts are important for interrupting the microprocessor to periodically and regularly test and ensure that system 10 software is functioning properly. For such purposes, the microprocessor receives periodic interrupts from the Watchdog Timekeeper and responds by resetting each interrupt and re-arming the Watchdog Timekeeper to generate another timed interrupt. If system 10 software is not functioning properly, a last generated interrupt is not reset and system 10 operation is halted. Generally, such an event occurs when system 10 computer operation has "gone astray". In this manner, the Watchdog Timekeeper prevents unwanted and perhaps dangerous events from occurring. In addition, the Watchdog Timekeeper generates an alarm when system 10 software is not functioning properly.
There are a number of watchdog type chips, manufactured by Dallas Semiconductor, which may be used-in the system, one of which is Part no. DS1286. The Watchdog Timekeeper is preferably memory mapped into the microprocessor's external address space.
Battery-backed RAM is used to maintain a portion of the data collective by system 10 in a non-volatile state for access after a break in normal power. Making a portion of data of system 10 non-volatile is critically important for this invention since all acquired drug monitoring and delivery drug records are crucial to efficacious medical record keeping. Should a power outage occur in the middle of a procedure, all important data captured and stored by system 10 must be available once power is restored.
Battery-backed RAM is programmed to hold all event data until the end of a procedure, at which time the event data is down-loaded onto the patient data card via slot 304 and made available on hard copy via printer 120. Battery-backed RAM modules may be acquired from Dallas Semiconductor in the form of part no. DS1230Y. Memory size for the microprocessor selected for this application is determined by the expanse of program size required by system 10. Such requirements should be reviewed to provide a basis for selecting a specific memory chip to be used. Preferably, the Battery-backed RAM is memory-mapped into the microprocessor's external address space.
Magnetic card reader 303 provides automatic data input to system 10 and a measure of security. Magnetic card reader 303 is preferred to consist of a standard off-the-shelf magnetic strip reader which may be flush-mounted on a flat surface. Magnetic card reader 303 has a slot through which a magnetically encoded card may be inserted. As an encoded card is passed through the reader slot, encoded data is read and transmitted over a serial port to the microprocessor. Encoded cards contain prerecorded identification of a predetermined clinician planned to use system 10. When initiating system operation, the clinician is prompted to enter an identification code, equivalent to the PIN (personal identification number) used in ATM's (automatic teller machines), through keypad 170. If the identification code corresponds to that stored for the attending clinician as identified on an inserted clinician encoded card, user access to system 10 is permitted and system 10 permits access to drugs in tray 60 and begins monitoring and control of drug delivery. If the identification code does not match the ID, then system 10 sounds an alarm and concurrently denies user access.
Magnetic card reader 303 is optionally used for other purposes including entering drug identification information and drug delivery information. In some embodiments, system 10 is further enhanced to include automatic delivery of drugs using automated plunger 282 actuation mechanisms. In such cases, drug identification and delivery rate is entered by swiping a drug ID card through magnetic card reader 303. Information for each drug is stored in battery-backed RAM or Flash Memory and compared with other stored patient data patient which comprises weight, allergies, etc. In this manner, drug information, including dosage rates, is readily and facilely entered into system 10 permitting drug delivery to be automatically tailored to a patient.
As mentioned earlier, magnetic card reader 303 is connected to the microprocessor through a serial port and USART chip. Communication between the microprocessor and magnetic card reader 303 primarily occurs as data is passed from reader 303 to the microprocessor; however, setup commands may be transmitted from the microprocessor to reader 303 by apparatus and methods well known in the computer art.
Printer 120 is integrated into system 10 for the purpose of producing hard copy of critical system 10 events. Hard copies provide reports of all critical transactions which occur during each operative procedure. Printer 120 is preferably a panel mount, off-the-shelf thermal printer. Communication to printer 120 from the microprocessor is best performed through a serial port, though a parallel port may be used. Preferably, selected printer 120 is capable of printing a line of 40 characters across the width of a printer tape.
The primary function of printer 120 is to provide hard copy record of transactions which occur during an operative procedure. Such a record generally includes time drug is given a drug, the type and amount of drug given. A summary of an entire operative procedure including all drugs administered with total amount administered for each drug is printed at the end of each procedure. In addition, printer 120 is used to report diagnostic information regarding the system during routine inspection and maintenance procedures. A diagnostic software routine, which is readily provided by one who is skilled in computer system programming, detects any failures or errors which occur during operation of system 10. As a consequence of error or failure detection, printer 120 is used to not only print a summary of these errors and failures, but also a list of procedures which should be followed to correct each detected problem. In this manner, output of printer 120 is used to provide self-diagnostics and repair guidance.
Printer 120 is also used to record data gathered for billing purposes should system 10 be leased or rented from a third party. Time that the machine was used under a rental agreement is optionally recorded in batter-backed RAM and supplied as a print-out when the machine is returned or when a billing agent accesses system 10. As an alternative, such information may be downloaded through a modem to a remote billing office.
Keypad 170 is provided to permit user interaction with system 10. Preferably, keypad 170 is a membrane keypad imprinted with custom icons representing action of each key. A keypad decoder converts depression of each key into a ASCII code and then transmits ASCII codes over a serial line which is interfaced to the microprocessor. The keypad decoder is connected to the USART chip which receives the data, stores it, and interrupts the microprocessor. Any time a key is depressed, the microprocessor is interrupted and the microprocessor is programmed to immediately interpret meaning of the interrupt and to take action relative to each key-press.
Custom icons are preferably used to represent each key function rather than using a numbered menu system which might correspond to an LCD 160 displayed menu. Although interaction through the keypad 170 is minimal in a normal procedure, keypad 170 may be used extensively for diagnostic purposes and for performing special functions. For example, a clinician may exercise keyboard 170 to obtain:
1) a summary printout of current status operative procedure before the end of a procedure.
2) status information on system 10 (e.g. how many syringes have been detected by system 10 detected including drug names of drugs read from the SLC units 231).
3) patient information in hard copy.
4) drug interaction information resulting from a comparison of patient information with drug types, etc.
All of this data is readily available through the use of keypad 170. The exact number of keys and their specific functions may vary for each different clinical application of the system.
In a diagnostic mode, keypad 170 is used to instruct system 10 to perform a self-diagnostic procedure and then print results. In this case also, each specific diagnostic routine is preferably identified by a specific graphical icon.
Use of PCM/CIA slots, like PCM/CIA slot 304, is becoming increasingly popular due to their small size and flexibility. A wide range of cards providing a computer connection from modem to memory on a single card not much larger than a credit card made to plug into a standard PCM/CIA slot are presently commercially available. This technology provides a key element for system 10 communications.
System 10 preferably receives patient information through a patient data card (PDC) that plugs into PCM/CIA slot 304. Slot 304 is preferably a PCM/CIA type II slot. This PDC is preferably a battery-backed memory card which receives and stores information regarding a patient scheduled to undergo a system 10 related procedure. Such information is normally derived from a pre-operative interview. Through the use of a PDA (personal digital assistant) patient information entered into a PCM/CIA Type II slot for ultimate use by system 10. Prior to interviewing the patient, a blank memory card is formatted specific to that patient and plugged into the PDA. As information is entered into the PDA, at least a portion of the same information is stored onto the memory card. When the clinician completes the pre-operative interview, the patient card is removed from the PDA and stored for use in system 10. Later, as the clinician prepares the system for use, the memory card specific to that patient is inserted into PCM/CIA slot 304. In due course system 10 reads information regarding the patient from the PCM/CIA slot 304 and makes a logical comparison with drug related information acquired from SLC units 231 assembled onto tray 60.
Upon completion of an given procedure, information regarding drugs monitored by system 10 and amounts available and administered is downloaded to the patient card. The patient card is then removed from the system and forwarded to billing and records for further use by the institution at the site of the procedure. Later, the card may be plugged into another PCM/CIA slot made available on a remote computer and pertinent data downloaded for other uses. Issues related to drug security are facilitated from information made available in this manner to institutional computers.
PCM/CIA slot 304 also allows system 10 to adapt to changes in ways individual hospitals communicate. Eventually, all departments within a hospital are projected to be connected through local area networks with data captured and downloaded to interconnected departments instantaneously. Many institutions have already implemented such networks. The use of PCM/CIA slot 304 on system 10 allows ready adoption to such communication changes. When local area network hardware (e.g., ethernet, token ring) is already available, system 10 can be flexibly incorporated to compatibly become a working part of the hospital network system.
PCM/CIA slot 304 also provides a system a communication link for system 10 through a modem. Through the use of a PCM/CIA formated modem, remote diagnostics are usefully performed on system 10. Should something malfunction on system 10 and a quick fix be needed, remote diagnostics are an important aid to a clinician or technician in evaluating and correcting the malfunction. By plugging a modem card into PCM/CIA slot 304, a remote service facility can dial into system 10 and thereby remotely perform a diagnostic series of tests. If necessary, new software is downloaded to system 10 from the remote site. This is beneficial in maintaining updated software in system 10 with little cost (monetary or system down time) to an end user.
PCM/CIA slot 304 is integrated with the microprocessor through a parallel port. A handshaking scenario, conforming with the PCM/CIA (Type II or Type III standard) is implemented to control the direction of data transfer and timing.
LCD 160 is used to display pertinent information for the clinician regarding the status of system 10 during each procedure. Each clinician is able to determine at all times drugs available in system 10, total amount of drugs delivered to a patient, and drug amounts left in each syringe 50 from LCD 160.
A commercial, off-the-shelf LCD is preferably used in system 10. It is also preferred that LCD 160 have graphical display capability for custom characters and icons generation as well as the enhanced resolution and graphical data presentation. LCD 160 is integrated with the microprocessor through a parallel port and configured as a peripheral to the microprocessor.
Generally during a standard procedure, LCD 160 displays a list comprising names of drugs loaded into the system, amount remaining in each syringe 50 and the current total amount of each drug delivered to a patient. As syringes are changed or additional drugs delivered to the patient, the LCD 160 display is automatically updated. In addition to drug status information, the current date and time is displayed along with certain key patient identification and status data. The exact configuration of the display and all information displayed may be varied by system 10 use and kind and nationality of each clinical site.
In the diagnostic mode, LCD 160 indicates the status of critical subsystems. After a diagnostic routine has been run, LCD 160 is programmably charted to give an indication as to whether each tested subsystem has passed each test or is in need of repair. In addition, LCD 160 lists a series of steps which must be taken to correct an error if one is detected.
Automatic drug identification, syringe 50 size determination and plunger position monitoring are novel elements of the invention. System 10 uniquely monitors drug delivery first by identifying the drug being administered and second by measuring the amount administered in real time by tracking the advancement of syringe plunger 282 as it is moved in syringe 50 to expel liquid into port 40 and onward to a patient.
A plurality of embodiments of plunger 282 tracking devices may be used within the scope of the invention. Further, with some of the embodiments, it is possible to read bar code 226 using the same element which selectively detects plunger 282 movement and position. A plurality of different solid state CCD-based sensors may be used. Line scan array 280 depicted in
In the case where two line scan CCD elements 280 are used for both reading bar code 226 and position of plunger 282, reliance is placed upon the fact that substantially all syringes are made from a transparent or translucent material and have a high contrast (black) plunger 282 which is easily optically tracked as fluid is delivered through needle 202. In like manner, it is well known that white/black lines in a standard bar code arrangement are also facilely read by like elements and can therefore be used to identify meaning of indicia on label 224.
For desired accuracy, a 1024 pixel CCD sensor is preferred for linear array transducer 280. A four inch lens 284 window running the length of syringe 50 barrel permits transducer 280 a full view of plunger 282 progression. In the reader, it is best to provide a start and a stop band (not shown), imprinted with black ink marks to mark limits of travel of plunger 282. The start and stop bands provide start and stop limits and a measure of a known distance (and therefore syringe 50 volume) therebetween.
In a standard 1024 pixel CCD sensor, pixel sensor elements are evenly distributed over the four inch window. Assuming the width of the start and stop bands to each be one-eighth of an inch in width, each band consumes 32 pixels, leaving 960 pixels available for tracking plunger 282. The tracking length is therefore 3.75 inches. This provides a resolution of 256 pixels/inch or a resolution of 0.0039 inches. If one assumes that there is an error in measurement of three pixels, effective resolution is 0.012 inches.
Volumetric resolution depends upon syringe diameter (i.e. the larger syringe 50, the greater the volumetric error). Effective resolution (Res) may be expressed in terms of syringe 50 radius (r) as:
The volume of a drug in syringe 50 is calculated using πr2l, where l is the distance from the start mark to needle 202 edge of plunger 282. An incremental volume dispensed as plunger 282 moves from linearly from position l1 to l2 is calculated by:
One who is skilled in the art of drug administration would recognize that measurement accuracy of volumes by measuring plunger 282 position using a 1024 pixel CCD element is adequate. Note that a value for "r" for each syringe 50 is determined from reading label 224.
A preferred method for reading bar code 226 is by a bar code wand which decodes data as SLC unit 231 is advanced into slot 70", eliminating the need to read the entire bar code at one time. An alternative method for reading bar code 226 utilizes a second 1024 pixel linear array 280 as seen in FIGS. 11B and 11C. Using the resolution determining logic and mathematics described above, bar code resolution is also 0.012 inches. For this reason, no black or white line thickness may be greater than 0.012 inches, providing a maximum number of black/white lines of 333. Given an ASCII code in which each alphanumeric character is represented by 8 lines, the largest total number of characters is 41. To conserve drug identification, dates, and identification of a preparing PH/QP, each element is preferably numerically encoded into multiple character equivalents, thereby reducing the total number of characters required by bar code 226.
A light source (not shown in the figures as such light sources are well known in the image detection art) is required to illuminate both syringe 50 and bar code 226. The light source is preferably an array of light emitting diodes (LEDs) placed along side each CCD sensor. The LEDs are strobed individually to expose the CCD elements to selected portions syringe 50 and bar code 226 in a time dependent sequence. See
An alternative to linear array 280 is the use of a two dimensional area scan CCD such as array 500, seen in FIG. 15. It is preferable to replace linear array 280 with array 500 in single sensor applications, such as the application seen in FIG. 11C. Also, LED array 280' is replaced by LED array 280". This approach uses a single 1024×1024 area scan CCD array 500 to track both plunger 282 and bar code 226. When tracking an area comprising both plunger 282 and bar code 226, the viewing window is about 2 inches in width by four inches in length. As calculated above, length resolution is about 0.012 inches, limiting the number of bar code characters to about 41 as indicated above. However, the width resolution is approximately 0.006, providing sufficient resolution to differentiate between plunger 282 and bar code 226 images with a single element.
The primary difference use of a linear array sensor and an area array sensor in plunger 282 position scanning is that, in tracking plunger 282, a large segment of the 1024×1024 image array may be used to determine the location of plunger 282 and the start and stop bands. Once the bands have been located, microprocessor software need only process those pixels which are along the axis of syringe 50 to locate plunger 282.
Of course, processing the additional data available in a two dimensional array requires a higher speed processor than the lesser amount of data of a linear array requires. One of the advantages, is that a plurality of bar code 226 lines may be detected by an area array, as many as 25 bar code 226 lines for a 1024 pixel width. Such an increase in the number of detectable bar code 226 lines increases the bar code 226 capacity from 41 characters to 1025 characters.
The number of electronic components required to service an area array is much greater than the number of electronic components required to service a linear array. For this reason, unless low cost, very large scale area array decoding chips are available, it is presently economically more reasonable to use linear arrays with the recognized limitations of fewer bar code 282 characters available.
An array of LEDs is required to illuminate both syringe plunger 282 and bar code 226. A LED array (such a LED array 280') is normally placed around the perimeter of the CCD sensor, as seen in
One embodiment of the CCD sensor technology above has been tested using an area scan camera having less resolution that the 1024 element sensor disclosed above. The area scan CCD used in the test comprised 192 horizontal pixels and 164 vertical binary bits. Even the lower resolution was sufficient for adequately tracking a plunger location in a gross fashion. In this case, resolution was inadequate for tracking the plunger in only the smallest syringe (5 cc).
For the test, a mock-up base tray was constructed and six syringe sizes were prepared with a bar code 226 printed on a clear acetate label 224. Acetate label 224 was formed around syringe 50 such that a small rectangular section protruded away from the syringe. This rectangular section was used to hold bar code 226 (which was printed on the side and partially on the bottom) and to secure syringe 50 to a base tray (function of SLC 200). The center of the rectangular protrusion was clear so that plunger 282 could be visibly accessed through label 224. The distance from the bottom of acetate label 224 to syringe plunger 282 varied depending on the size of plunger 282 (the distance being greater for smaller syringes). The CCD array was located on the under side of the base tray along with an LED array for illumination. This embodiment permitted tracking plungers of selected sizes of syringes using the 192×164 CCD sensor.
The process was repeated for a plurality of varied sizes of syringes 50. The CCD sensor was able to adequately locate plunger 282 for all syringes except the smallest (size 5 cc). It was determined that failure to read the plunger position of the small syringe was due to the fact that the small syringe was located the greatest distance from the base tray and acetate label 224 was not truly clear. The black plunger was indistinguishable on the smallest syringe because of reduced resolution due to lack of acetate clarity and distance of syringe barrel from the reader.
Even so, this testing with a reduced resolution reader clearly proved the feasibility of using an optical system for tracking progression of a plunger. As sensitivity of a sensor system is increased, resolution becomes greater and accuracy in tracking a plunger and calculating drug volume and volumetric changes is improved. It should be readily apparent to one skilled in the visual sensor art that plunger movement of even the smallest cylinder used in the test is detectable with improved sensor resolution.
An alternative technology which may be used to both read the bar code and track the syringe plunger is an infrared emitter/detector pair 270 (see FIG. 11D), mechanically scanned over an area of interest. The emitter directs an infrared beam onto a surface and the detector receives reflected light. Successful operation of this concept is based upon the fact the black objects absorb more light than white surfaces making, the difference between black and white discernable.
To mechanize emitter/detector pair 270, a mechanical actuator consisting of an electric motor with a cam is attached to a shaft. A beam splitter/mirror 286 is attached to the cam such that the emitter's infrared beam is scanned across the area of interest. Beam splitter 286 allows infrared light from the emitter to be directed outward toward the surface of interest and causes reflected light to pass through to the detector. The detector responds to the reflected light by outputting a voltage which is proportional to the intensity of sensed reflected light. By setting a threshold between the intensity received from a light surface and the intensity received from a dark surface, a binary output can be determined which indicates whether the surface is white or black. As beam splitter/mirror 286 is rotated in direction of arrow 288 by the electric motor, the entire surface of interest is scanned. Speed at which the motor is rotated and the sampling rate of signals from pair 270, in combination, determine the resolution of this detector system. This proposed concept is illustrated in FIG. 11D.
When reading bar code 226, each scanner works in a manner which is similar to scanners seen in a grocery store. A beam is scanned across bar code 226 to distinguish between light and dark stripes. If a starting location is either predetermined or known through an indicator encoded within bar code 226, the microcontroller begins reading bar code 226 to distinguish between light and dark stripes. If a starting location is either predetermined or known through an indicator encoded within the bar code, the microcontroller begins reading bar code 226 by counting the number of white and black stripes.
Reading the location of the syringe plunger may be more difficult using the emitter/detector pair 270 but extensions of the methods disclosed above permit determination of plunger 282 position. Since the infrared beam is scanned over the entire area of interest (syringe 50 and bottom of the slider 208), the reflected beam is sampled sufficiently fast to create a black/white image of the area. From this image, start and stop marks on syringe 50 are located as well as the black image of the syringe plunger 282.
An advantage of this approach is the relatively inexpensive technology required to implement an emitter/detector pair 270. From an economical standpoint, this approach appears to be the best compared to other sensor approaches described heretofore. However, there are some drawbacks to the emitter/detector pair 270 which cause this embodiment not to be currently preferred. First, use of a mechanical actuator introduces a weak point in system 10 from the standpoint of ruggedness. System 10 must endure rugged manipulation by a user, including being knocked over or dropped. Further, a mechanical actuator must be precisely calibrated to scan an area of interest to make sure that a beam splitter/mirror 286 combination is aligned with emitter/detector pair 270. The likelihood of failure of a solid state CCD-based system is much less, making embodiments seen in
Computer processing time required to sample a syringe plunger 282 position and bar code 226 information by the embodiment of
Another approach to plunger 282 tracking and bar code 226 reading utilizes a mechanical method of tracking plunger movement and reading a bar code as seen in FIG. 11E. This method is the easiest to implement; however, it is the most cumbersome for a clinician to set up and use. Because of clinician (user) difficulties in using this approach, it is not presently preferred.
Mechanical reading of bar code 226 may be performed by using an off-the-shelf bar code wand which is integrated into the system. Before SLC unit 231 is slid into base tray 60, a clinician runs the bar code wand over bar code 226. Data encoded on the bar code is read and decoded by system 10. One major disadvantage of this approach is a requirement for the clinician to perform a scanning step without a guarantee that SLC unit 231 will thereafter be placed into a correct slot.
Mechanical tracking of plunger 282 movement is accomplished by using an alternative holder which includes arm 296 that extends back to the portion of a plunger which is disposed at a site where a clinician pushes. A schematic representation of this holder is provided in FIG. 11E. As the clinician advances plunger 282, the extending arm is also advanced. Since the extending arm 296 runs underneath the syringe and is exposed underneath the holder, mechanical roller 290 with an attached encoder may be used to track progress. An incremental encoder attached to the shaft of a free-wheeling roller tracks progress of the plunger as the clinician advances it. Resolution of this system depends on resolution of the incremental encoder, generally expressed in counts/revolution. Encoders having adequate resolution are readily commercially available. In addition, the track in which the extension arm 296 rides may be grooved such that retracting the plunger 282 is prohibited as long as syringe 50 remains in the system 10. The method used to prohibit plunger 282 retraction may make use of insertable plastic parts which operate in a manner similar to catches used in making wire ties.
The main advantage to using a mechanical method for tracking plunger 282 is the relative low cost of implementing the mechanical technology. Fabricating a roller with incremental encoders is the most easily achieved of all alternatives thus far described. Such implementation allows the system computer to track each syringe simultaneously and any movement is immediately detected. However, as mentioned earlier, a major disadvantage is found in the mechanical aspects of the system.
Notably, an additional advantage is the inclusion of mechanical extension arm 296 which provides a basis for automatically advancing plunger 282 without manual assistance. Attachment of an electric motor to advance plunger 282 in response to a clinician's direction is well within the current state of the art for automated medical systems. Using such plunger 282 advancement, a clinician would enter the drug and amount to be delivered to the patient into the system 10 through keypad 170. System 10 then determines which slot the desired drug is located in and automatically advances each plunger 282 at a programmed rate until the desired drug volume has been delivered. When contemplating automatic delivery of drugs, obvious legal issues must be addressed; however, automatic drug delivery is now in use in hospitals and system use is generally accepted.
The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiments are therefore to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.
Evans, Robert F., Hanson, Robert, Burrow, Michael F., Walker, Richard Bradley
Patent | Priority | Assignee | Title |
10022498, | Dec 16 2011 | ICU Medical, Inc | System for monitoring and delivering medication to a patient and method of using the same to minimize the risks associated with automated therapy |
10071203, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10076611, | Feb 01 2005 | kaleo, Inc. | Medicament delivery device having an electronic circuit system |
10099023, | Feb 01 2005 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10105489, | Feb 01 2005 | kaleo, Inc. | Medical injector with compliance tracking and monitoring |
10143792, | Feb 28 2011 | kaleo, Inc. | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
10143795, | Aug 18 2014 | ICU Medical, Inc | Intravenous pole integrated power, control, and communication system and method for an infusion pump |
10143830, | Mar 13 2013 | CRISI Medical Systems, Inc. | Injection site information cap |
10166328, | May 29 2013 | ICU Medical, Inc | Infusion system which utilizes one or more sensors and additional information to make an air determination regarding the infusion system |
10183116, | Jan 26 2011 | kaleo, Inc. | Devices and methods for delivering medicaments from a multi-chamber container |
10192464, | Jul 28 2008 | kaleo, Inc. | Medicament delivery device configured to produce wireless and audible outputs |
10220158, | Jul 18 2014 | kaleo, Inc. | Devices and methods for delivering opioid antagonists including formulations for naloxone |
10220973, | Oct 10 2014 | Becton, Dickinson and Company | Tensioning control device |
10220974, | Oct 10 2014 | Becton, Dickinson and Company | Syringe labeling device |
10226583, | May 22 2012 | kaleo, Inc. | Devices and methods for delivering medicaments from a multi-chamber container |
10229578, | Dec 27 2012 | kaleo, Inc. | Devices, systems and methods for locating and interacting with medicament delivery systems |
10238806, | Jan 26 2011 | kaleo, Inc. | Medicament delivery devices for administration of a medicament within a prefilled syringe |
10245214, | Apr 27 2010 | CRISI Medical Systems, Inc. | Medication and identification information transfer apparatus |
10258735, | Feb 05 2007 | kaleo, Inc. | Apparatus and methods for self-administration of vaccines and other medicaments |
10293107, | Jun 22 2011 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Selectively Controlling fluid flow through a fluid pathway |
10314977, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10322239, | Jan 26 2011 | kaleo, Inc. | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
10327987, | May 30 2010 | CRISI Medical Systems, Inc. | Medication container encoding, verification, and identification |
10332623, | Jan 17 2017 | Cambridge Consultants Limited; KALEO, INC | Medicament delivery devices with wireless connectivity and event detection |
10335549, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10342917, | Feb 28 2014 | ICU Medical, Inc | Infusion system and method which utilizes dual wavelength optical air-in-line detection |
10342924, | Jan 26 2011 | kaleo, Inc. | Medicament delivery devices for administration of a medicament within a prefilled syringe |
10384014, | Sep 02 2014 | Eli Lilly and Company | Sensing system for detecting a piston in a medical fluid container |
10391033, | Jun 16 2011 | CRISI Medical Systems, Inc. | Medication dose preparation and transfer system |
10420926, | Mar 13 2013 | CRISI Medical Systems, Inc. | Injection site information cap |
10430761, | Aug 19 2011 | ICU Medical, Inc | Systems and methods for a graphical interface including a graphical representation of medical data |
10463788, | Jul 31 2012 | ICU Medical, Inc | Patient care system for critical medications |
10471213, | Aug 10 2012 | Sanofi-Aventis Deutschland GmbH | Pen-type drug injection device and electronic add-on monitoring module for|monitoring and logging dose setting and administration |
10492991, | May 30 2010 | CRISI Medical Systems, Inc. | Medication container encoding, verification, and identification |
10503873, | Nov 06 2009 | CRISI Medical Systems, Inc. | Medication injection site and data collection system |
10532154, | Jun 22 2011 | CRISI Medical Systems, Inc. | Selectively controlling fluid flow through a fluid pathway |
10576206, | Jun 30 2015 | KALEO, INC | Auto-injectors for administration of a medicament within a prefilled syringe |
10578474, | Mar 30 2012 | ICU Medical, Inc. | Air detection system and method for detecting air in a pump of an infusion system |
10596316, | May 29 2013 | ICU Medical, Inc. | Infusion system and method of use which prevents over-saturation of an analog-to-digital converter |
10635784, | Dec 18 2007 | ICU Medical, Inc | User interface improvements for medical devices |
10656894, | Dec 27 2017 | ICU Medical, Inc. | Synchronized display of screen content on networked devices |
10661935, | Oct 10 2014 | Becton, Dickinson and Company | Syringe labeling device |
10688244, | Dec 23 2016 | KALEO, INC | Medicament delivery device and methods for delivering drugs to infants and children |
10695495, | Mar 24 2015 | KALEO, INC | Devices and methods for delivering a lyophilized medicament |
10726701, | Dec 27 2012 | kaleo, Inc. | Devices, systems and methods for locating and interacting with medicament delivery systems |
10737028, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10751253, | Apr 27 2010 | CRISI Medical Systems, Inc. | Medication and identification information transfer apparatus |
10796604, | Feb 27 2007 | kaleo, Inc. | Medical injector simulation device and containers for storing delivery devices |
10813836, | May 30 2010 | CRISI Medical Systems, Inc. | Medication container encoding, verification, and identification |
10835673, | Oct 31 2005 | kaleo, Inc. | Devices, systems, and methods for medicament delivery |
10839669, | Dec 27 2012 | kaleo, Inc. | Devices, systems and methods for locating and interacting with medicament delivery systems |
10842938, | Dec 23 2016 | kaleo, Inc. | Medicament delivery device and methods for delivering drugs to infants and children |
10850024, | Mar 02 2015 | ICU Medical, Inc | Infusion system, device, and method having advanced infusion features |
10874793, | May 24 2013 | ICU Medical, Inc. | Multi-sensor infusion system for detecting air or an occlusion in the infusion system |
10918787, | May 26 2015 | ICU Medical, Inc | Disposable infusion fluid delivery device for programmable large volume drug delivery |
10918791, | Dec 04 2006 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
10937537, | Jan 17 2017 | kaleo, Inc. | Medicament delivery devices with wireless connectivity and event detection |
10946184, | Mar 13 2013 | CRISI Medical Systems, Inc. | Injection site information cap |
10954019, | Oct 10 2014 | Becton, Dickinson and Company | Tensioning control device |
10960155, | Feb 01 2005 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
11004035, | Aug 19 2011 | ICU Medical, Inc. | Systems and methods for a graphical interface including a graphical representation of medical data |
11029911, | Dec 27 2017 | ICU Medical, Inc. | Synchronized display of screen content on networked devices |
11135360, | Dec 07 2020 | ICU Medical, Inc | Concurrent infusion with common line auto flush |
11167087, | Aug 09 2019 | KALEO, INC | Devices and methods for delivery of substances within a prefilled syringe |
11213619, | Nov 11 2013 | ICU Medical, Inc. | Thermal management system and method for medical devices |
11246985, | May 13 2016 | ICU Medical, Inc. | Infusion pump system and method with common line auto flush |
11263921, | Jul 28 2008 | kaleo, Inc. | Medicament delivery device configured to produce wireless and audible outputs |
11278671, | Dec 04 2019 | ICU Medical, Inc | Infusion pump with safety sequence keypad |
11324888, | Jun 10 2016 | ICU Medical, Inc. | Acoustic flow sensor for continuous medication flow measurements and feedback control of infusion |
11339774, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11344668, | Dec 19 2014 | ICU Medical, Inc | Infusion system with concurrent TPN/insulin infusion |
11344673, | May 29 2014 | ICU Medical, Inc | Infusion system and pump with configurable closed loop delivery rate catch-up |
11364335, | Apr 05 2006 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11376361, | Dec 16 2011 | ICU Medical, Inc. | System for monitoring and delivering medication to a patient and method of using the same to minimize the risks associated with automated therapy |
11391273, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11395877, | Feb 09 2006 | DEKA Products Limited Partnership | Systems and methods for fluid delivery |
11404776, | Dec 31 2007 | DEKA Products Limited Partnership | Split ring resonator antenna adapted for use in wirelessly controlled medical device |
11406753, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11408414, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11413391, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
11426512, | Feb 09 2006 | DEKA Products Limited Partnership | Apparatus, systems and methods for an infusion pump assembly |
11426520, | Jan 26 2011 | kaleo, Inc. | Medicament delivery devices for administration of a medicament within a prefilled syringe |
11433177, | May 29 2013 | ICU Medical, Inc. | Infusion system which utilizes one or more sensors and additional information to make an air determination regarding the infusion system |
11464708, | Jun 16 2011 | CRISI Medical Systems, Inc. | Medication dose preparation and transfer system |
11464904, | Jun 22 2011 | CRISI Medical Systems, Inc. | Selectively controlling fluid flow through a fluid pathway |
11478623, | Feb 09 2006 | DEKA Products Limited Partnership | Infusion pump assembly |
11491273, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11497686, | Dec 31 2007 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11497846, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
11517674, | Jun 30 2015 | kaleo, Inc. | Auto-injectors for administration of a medicament within a prefilled syringe |
11523972, | Apr 24 2018 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11524151, | Mar 07 2012 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11534542, | Dec 31 2007 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11534543, | Feb 09 2006 | DEKA Products Limited Partnership | Method for making patch-sized fluid delivery systems |
11559625, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
11590286, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
11596737, | May 29 2013 | ICU Medical, Inc. | Infusion system and method of use which prevents over-saturation of an analog-to-digital converter |
11597541, | Jul 03 2013 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11599854, | Aug 19 2011 | ICU Medical, Inc. | Systems and methods for a graphical interface including a graphical representation of medical data |
11617826, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
11623042, | Jul 31 2012 | ICU Medical, Inc. | Patient care system for critical medications |
11642283, | Dec 31 2007 | DEKA Products Limited Partnership | Method for fluid delivery |
11660386, | May 26 2015 | ICU Medical, Inc. | Disposable infusion fluid delivery device for programmable large volume drug delivery |
11690952, | Feb 09 2006 | DEKA Products Limited Partnership | Pumping fluid delivery systems and methods using force application assembly |
11690958, | Nov 06 2009 | CRISI Medical Systems, Inc. | Medication injection site and data collection system |
11701300, | Dec 31 2007 | DEKA Products Limited Partnership | Method for fluid delivery |
11712513, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11717609, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11717667, | Mar 13 2013 | CRISI Medical Systems, Inc. | Injection site information cap |
11723841, | Dec 31 2007 | DEKA Products Limited Partnership | Apparatus, system and method for fluid delivery |
11738139, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
11771830, | Dec 23 2016 | kaleo, Inc. | Medicament delivery device and methods for delivering drugs to infants and children |
11786651, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery system |
11801201, | Apr 27 2010 | CRISI Medical Systems, Inc. | Medication and identification information transfer apparatus |
11844926, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
11868161, | Dec 27 2017 | ICU Medical, Inc. | Synchronized display of screen content on networked devices |
11890448, | Feb 09 2006 | DEKA Products Limited Partnership | Method and system for shape-memory alloy wire control |
11894609, | Dec 31 2007 | DEKA Products Limited Partnership | Split ring resonator antenna adapted for use in wirelessly controlled medical device |
11904134, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
7413123, | Dec 29 2006 | Mallinckrodt Nuclear Medicine LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7416540, | Nov 22 2004 | KALEO, INC | Devices systems and methods for medicament delivery |
7504646, | Aug 30 2004 | BRACCO DIAGNOSTICS INC | Containers for pharmaceuticals, particularly for use in radioisotope generators |
7588189, | Apr 04 2006 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7648482, | Nov 23 2004 | KALEO, INC | Devices, systems, and methods for medicament delivery |
7648483, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
7698180, | Apr 06 2005 | Mallinckrodt Nuclear Medicine LLC | System for tracking data relating to radiopharmaceuticals and/or containers therefor |
7731686, | Feb 01 2005 | KALEO, INC | Devices, systems and methods for medicament delivery |
7731690, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
7749194, | Feb 01 2005 | KALEO, INC | Devices, systems, and methods for medicament delivery |
7819838, | Sep 02 2008 | ICU Medical, Inc | Cassette for use in a medication delivery flow sensor assembly and method of making the same |
7828147, | Apr 24 2004 | EMMA HEALTH TECHNOLOGIES, INC | Multi-layer medication carrier |
7835817, | Apr 24 2004 | INRange Systems, Inc. | Integrated, non-sequential, remote medication management and compliance system |
7859473, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7898416, | Apr 06 2005 | Mallinckrodt Nuclear Medicine LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7918823, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
7933682, | Apr 24 2004 | InRange Systems | Integrated, non-sequential, remote medication management and compliance system |
7941949, | May 11 2007 | ACCU-CHART PLUS HEALTHCARE SYSTEMS, INC | Multi-flag label |
7947017, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
7963936, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7975922, | Apr 06 2005 | Mallinckrodt Nuclear Medicine LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
7991627, | Jun 21 2005 | General Electric Company; The General Electric Company | Injected drug identification and fail-safe system |
8016788, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8016789, | Oct 10 2008 | DEKA Products Limited Partnership | Pump assembly with a removable cover assembly |
8019471, | Apr 24 2004 | EMMA HEALTH TECHNOLOGIES, INC | Integrated, non-sequential, remote medication management and compliance system |
8021344, | Jul 28 2008 | KALEO, INC | Medicament delivery device configured to produce an audible output |
8034026, | May 18 2001 | EUGLY DIABETES CARE LLC | Infusion pump assembly |
8035517, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
8048022, | Jan 30 2009 | ICU Medical, Inc | Cassette for differential pressure based medication delivery flow sensor assembly for medication delivery monitoring and method of making the same |
8058632, | Aug 30 2004 | Bracco Diagnostics, Inc. | Containers for pharmaceuticals, particularly for use in radioisotope generators |
8065924, | May 23 2008 | ICU Medical, Inc | Cassette for differential pressure based medication delivery flow sensor assembly for medication delivery monitoring and method of making the same |
8066672, | Oct 10 2008 | DEKA Products Limited Partnership | Infusion pump assembly with a backup power supply |
8105281, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8113244, | Feb 09 2006 | DEKA Products Limited Partnership | Adhesive and peripheral systems and methods for medical devices |
8123719, | Mar 29 2006 | KALEO, INC | Devices, systems and methods for medicament delivery |
8140349, | Nov 29 2000 | MERATIVE US L P | Drug delivery device incorporating a tracking code |
8161810, | Jan 29 2008 | CAREFUSION 303, INC | Syringe imaging systems |
8172082, | Feb 01 2005 | KALEO, INC | Devices, systems and methods for medicament delivery |
8206360, | Feb 01 2005 | KALEO, INC | Devices, systems and methods for medicament delivery |
8223028, | Oct 10 2008 | DEKA Products Limited Partnership | Occlusion detection system and method |
8226610, | Feb 01 2005 | KALEO, INC | Medical injector with compliance tracking and monitoring |
8231573, | Feb 01 2005 | KALEO, INC | Medicament delivery device having an electronic circuit system |
8262616, | Oct 10 2008 | EUGLY DIABETES CARE LLC | Infusion pump assembly |
8267892, | Oct 10 2008 | DEKA Products Limited Partnership | Multi-language / multi-processor infusion pump assembly |
8313466, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8317099, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
8328082, | May 30 2010 | CRISI Medical Systems, Inc. | Medication container encoding, verification, and identification |
8355753, | Nov 06 2009 | CRISI MEDICAL SYSTEMS, INC | Medication injection site and data collection system |
8361026, | Feb 05 2007 | KALEO, INC | Apparatus and methods for self-administration of vaccines and other medicaments |
8361029, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8385972, | Nov 06 2009 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Medication injection site and data collection system |
8394053, | Nov 06 2009 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Medication injection site and data collection system |
8403908, | Dec 17 2007 | ICU Medical, Inc | Differential pressure based flow sensor assembly for medication delivery monitoring and method of using the same |
8414522, | Feb 09 2006 | DEKA Products Limited Partnership | Fluid delivery systems and methods |
8414563, | Dec 31 2007 | DEKA Products Limited Partnership | Pump assembly with switch |
8425462, | Nov 23 2004 | KALEO, INC | Devices, systems, and methods for medicament delivery |
8446280, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and syringes therefor |
8491570, | Dec 31 2007 | DEKA Products Limited Partnership | Infusion pump assembly |
8496646, | Feb 09 2006 | DEKA Products Limited Partnership | Infusion pump assembly |
8544645, | Feb 01 2005 | KALEO, INC | Devices, systems and methods for medicament delivery |
8545445, | Feb 09 2006 | DEKA Products Limited Partnership | Patch-sized fluid delivery systems and methods |
8585377, | Feb 09 2006 | DEKA Products Limited Partnership | Pumping fluid delivery systems and methods using force application assembly |
8606596, | Jun 27 2010 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Medication waste and data collection system |
8608698, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8622973, | Jul 28 2008 | KALEO, INC | Simulated medicament delivery device configured to produce an audible output |
8627816, | Feb 28 2011 | KALEO, INC | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
8639525, | Oct 16 2009 | The General Hospital Corporation | Drug labeling |
8657778, | Sep 02 2008 | ICU Medical, Inc | Cassette for use in a medication delivery flow sensor assembly and method of making the same |
8690827, | Feb 01 2005 | KALEO, INC | Devices, systems, and methods for medicament delivery |
8702674, | Apr 27 2010 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Medication and identification information transfer apparatus |
8708376, | Oct 10 2008 | DEKA Products Limited Partnership | Medium connector |
8745906, | May 11 2007 | ACCU-CHART PLUS HEALTHCARE SYSTEMS, INC | Dosage tracking method and label therefor |
8899987, | Feb 01 2005 | KALEO, INC | Simulated medicament delivery device having an electronic circuit system |
8920367, | Mar 29 2006 | KALEO, INC | Devices, systems and methods for medicament delivery |
8920377, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
8926594, | Feb 01 2005 | KALEO, INC | Devices, systems and methods for medicament delivery |
8932252, | Feb 27 2007 | KALEO, INC | Medical injector simulation device |
8939943, | Jan 26 2011 | KALEO, INC | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
9022022, | Feb 28 2011 | kaleo, Inc. | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
9022980, | Feb 27 2007 | KALEO, INC | Medical injector simulation device |
9056170, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9078809, | Jun 16 2011 | CRISI Medical Systems, Inc. | Medication dose preparation and transfer system |
9082157, | Apr 06 2005 | LIEBEL-FLARSHEIM COMPANY LLC | Systems and methods for managing information relating to medical fluids and containers therefor |
9084849, | Jan 26 2011 | KALEO, INC | Medicament delivery devices for administration of a medicament within a prefilled syringe |
9101534, | Apr 27 2010 | CRISI Medical Systems, Inc. | Medication and identification information transfer apparatus |
9149579, | Nov 23 2004 | KALEO, INC | Devices, systems and methods for medicament delivery |
9173996, | May 18 2001 | DEKA Products Limited Partnership | Infusion set for a fluid pump |
9173999, | Jan 26 2011 | KALEO, INC | Devices and methods for delivering medicaments from a multi-chamber container |
9180245, | Oct 10 2008 | DEKA Products Limited Partnership | System and method for administering an infusible fluid |
9238108, | Feb 01 2005 | KALEO, INC | Medicament delivery device having an electronic circuit system |
9240044, | Jun 26 2012 | PANASONIC INTELLECTUAL PROPERTY MANAGEMENT CO , LTD | Drug solution inspection device and drug solution inspection method |
9259539, | Feb 01 2005 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9272089, | Dec 17 2007 | ICU Medical, Inc | Differential pressure based flow sensor assembly for medication delivery monitoring and method of using the same |
9278177, | Feb 01 2005 | kaleo, Inc. | Medical injector with compliance tracking and monitoring |
9278182, | Oct 31 2005 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9327077, | Feb 01 2005 | KALEO, INC | Medical injector with compliance tracking and monitoring |
9352091, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9387288, | Nov 03 2008 | Calibra Medical, Inc. | Dosage sensing unit with tactile feedback |
9474869, | Feb 28 2011 | kaleo, Inc. | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
9505233, | Oct 10 2014 | Becton, Dickinson and Company | Tensioning control device |
9514131, | May 30 2010 | CRISI MEDICAL SYSTEMS, INC | Medication container encoding, verification, and identification |
9517307, | Jul 18 2014 | KALEO, INC | Devices and methods for delivering opioid antagonists including formulations for naloxone |
9522235, | May 22 2012 | KALEO, INC | Devices and methods for delivering medicaments from a multi-chamber container |
9526830, | Dec 31 2007 | DEKA Products Limited Partnership | Wearable pump assembly |
9542826, | Dec 27 2012 | kaleo, Inc. | Devices, systems and methods for locating and interacting with medicament delivery systems |
9555191, | Feb 05 2007 | kaleo, Inc. | Apparatus and methods for self-administration of vaccines and other medicaments |
9562640, | Aug 30 2004 | Bracco Diagnostics Inc. | Containers for pharmaceuticals, particularly for use in radioisotope generators |
9615999, | Jun 16 2011 | CRISI Medical Systems, Inc. | Medication dose preparation and transfer system |
9724471, | Oct 31 2005 | kaleo, Inc. | Devices, systems, and methods for medicament delivery |
9737669, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9744298, | Jun 22 2011 | CRISI Medical Systems, Inc.; CRISI MEDICAL SYSTEMS, INC | Selectively controlling fluid flow through a fluid pathway |
9776757, | Oct 10 2014 | Becton, Dickinson and Company | Syringe labeling device |
9805620, | Feb 27 2007 | kaleo, Inc. | Medical injector simulation device |
9814838, | Jan 26 2011 | kaleo, Inc. | Medicament delivery device for administration of opioid antagonists including formulations for naloxone |
9833573, | Nov 23 2004 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9836948, | Dec 27 2012 | kaleo, Inc. | Devices, systems and methods for locating and interacting with medicament delivery systems |
9867938, | Mar 29 2006 | kaleo, Inc. | Devices, systems and methods for medicament delivery |
9911308, | Dec 27 2012 | KALEO, INC ; Cambridge Consultants Limited | Devices, systems and methods for locating and interacting with medicament delivery systems |
9931498, | Mar 13 2013 | CRISI Medical Systems, Inc. | Injection site information cap |
D485356, | Jan 10 2002 | MERGE HEALTHCARE SOLUTIONS INC | Syringe label cradle |
D939079, | Aug 22 2019 | ICU Medical, Inc | Infusion pump |
ER3536, | |||
ER3951, | |||
ER9785, |
Patent | Priority | Assignee | Title |
2427552, | |||
3152723, | |||
3270548, | |||
3599833, | |||
3656138, | |||
3677092, | |||
3677448, | |||
4013194, | May 14 1974 | PLINT & PARTNERS LTD | Device for metering by weight the delivery of liquids |
4074356, | Sep 07 1976 | Veeder Industries, Inc. | Fluid delivery control and registration system |
4079736, | May 24 1976 | Valleylab | Combination drug administration device and alarm system and method |
4105138, | Mar 04 1976 | Apparatebau Hundsbach Prof. Dr.-Ing. Habil., Dr. Phil. Nat. Karl-Otto | Apparatus for presetting volumes of liquid |
4121584, | Oct 15 1976 | R. Scott, Turner | Method and apparatus for controlling the dispensing of fluid |
4191184, | Jan 06 1977 | Intravenous infusion regulation system with reciprocal metering means | |
4217993, | Dec 02 1977 | Baxter Travenol Laboratories, Inc. | Flow metering apparatus for a fluid infusion system |
4291693, | Nov 13 1979 | Sorenson Research Company, Inc. | Fluid metering device |
4383252, | Nov 24 1980 | Intravenous drip feed monitor | |
4427132, | Sep 18 1980 | Avery-Hardoll Limited | Liquid storage and measurement system |
4436223, | Feb 03 1981 | Device for recording the dispensing of fluids | |
4507604, | Feb 16 1983 | Flowable material measuring apparatus | |
4555940, | Nov 01 1982 | MEDTRONIC MINIMED, INC | Method and apparatus for measuring fluid flow rates and volumes through fluid flow paths |
4559044, | Aug 03 1982 | GENERAL ELECTRIC CAPITAL CORPORATION, A NEW YORK CORP | Volumetric metering unit for intravenous fluid addition |
4562842, | Feb 21 1984 | MORFELD DIANE E | Blood-loss measurement apparatus |
4589872, | Feb 19 1985 | Biomedical Dynamics Corporation | Quick action flow regulator for medical apparatus |
4592747, | Jun 18 1984 | ARROW INTERVENTIONAL, INC , A CORP OF DE AWARE | Fluid flow sensor |
4597507, | Jul 21 1983 | Noranda Inc. | Apparatus for metering and feeding a solution |
4613325, | Jul 19 1982 | Flow rate sensing device | |
4627840, | Jan 28 1985 | Cordis Corporation | Flow monitoring device |
4648869, | Dec 04 1985 | Baxter International Inc | Automatic infiltration detection system and method |
4650458, | Jun 18 1984 | Gambro Lundia AB | Apparatus for the measurement of fluid flow |
4699617, | Oct 31 1985 | Terumo Corporation | Flowmeter |
4720636, | Aug 06 1984 | Abbott Laboratories | Drop detecting system which operates under different ambient light conditions |
4736871, | Nov 19 1986 | LUCIANI, DORIAN E ; RYAN, WILLIAM A | Liquid measuring dispenser |
4744955, | Aug 08 1986 | Adjustable volume pipette sampler | |
4760939, | May 04 1985 | Jencons (Scientific) Limited | Liquid dosing device with digital display |
4781696, | Sep 14 1983 | Method of dispensing medicine | |
4784648, | Sep 15 1986 | Applied Biomedical Corporation | Infiltration indicator and alarm |
4802506, | Jul 13 1984 | Conmed Corporation | Flow control device for administration of intravenous fluids |
4842028, | May 13 1987 | Baxter International Inc. | Fluid transfer apparatus |
4853521, | Dec 28 1987 | System for verifying and recording drug administration to a patient | |
4938072, | Jan 20 1988 | Masar Limited | Flow measurement device |
4976687, | May 11 1987 | Apparatus for controlling the supplying of intravenous fluids | |
4978335, | Sep 29 1989 | Medex, Inc. | Infusion pump with bar code input to computer |
5133480, | Apr 03 1987 | Seicho Kogyo Co., Ltd. | Liquid dispensing apparatus |
5222027, | Dec 14 1990 | TITAN INDUSTRIES, INC , AN OK CORP | Injector communications system |
5295976, | Apr 04 1990 | Eli Lilly and Company | Dose indicating injection pen |
5308341, | Sep 28 1993 | Becton, Dickinson and Company; Becton Dickinson and Company | Method of testing the dose accuracy of a medication delivery device |
5328486, | Nov 19 1991 | American Cyanamid Company | Syringe for dispensing multiple dosages |
5366454, | Mar 17 1993 | La Corporation de l'Ecole Polytechnique | Implantable medication dispensing device |
5385559, | Dec 20 1993 | NEWSOM, R JASON | Syringe filling and metering device |
5433342, | Dec 20 1991 | ETABLISSEMENTS LURO S A R L | Method and apparatus for supplying preset quantities of liquids |
5445621, | Dec 20 1991 | HOSPIRA, INC | Drug identification and security apparatus for infusion and pumping systems |
5449344, | Jun 18 1992 | Merit Medical Systems, Inc.; Merit Medical Systems, Inc | Syringe apparatus with pressure gauge and detachable timer |
5454793, | Jan 22 1992 | ARZNEIMITTEL GMBH APOTHEKER VETTER & CO RAVENSBURG | Medicine dispensing device |
5468233, | Dec 06 1993 | STAT MEDICAL DEVICES INC | Hypodermic dosage measuring device |
5522805, | May 03 1994 | VANCAILLIE, THIERRY G | Surgical fluid monitor |
5533981, | Oct 06 1994 | Baxter International Inc. | Syringe infusion pump having a syringe plunger sensor |
5536945, | Mar 16 1994 | CARDINAL HEALTH 414, INC | Container and method for transporting a syringe containing radioactive material |
5569212, | Jul 22 1994 | HEALTH HERO NETWORK, INC | Apparatus for electrically determining injection doses in syringes |
5593390, | Dec 05 1994 | Becton, Dickinson and Company | Medication delivery device with a microprocessor and characteristic monitor |
5602745, | Jan 18 1995 | Gilbarco Inc | Fuel dispenser electronics design |
5609576, | Sep 13 1994 | CAREFUSION 303, INC | Fluid flow impedance monitoring system |
5632411, | Jun 17 1992 | Dewvale Limited | Meter and a method for measuring quantity of a flowing liquid |
5662612, | Nov 24 1993 | Liebel Flarsheim Company | Controlling plunger drives for fluid injections in animals |
5674204, | Sep 19 1995 | Becton Dickinson and Company | Medication delivery pen cap actuated dose delivery clutch |
5690618, | Feb 22 1995 | Mark Timothy, Smith | Electronic syringe |
5697916, | Nov 21 1995 | STAT MEDICAL DEVICES INC | Hypodermic dosage measuring device |
5709670, | May 03 1994 | VANCAILLIE, THIERRY G | Surgical fluid and tissue loss monitor |
5716345, | Feb 27 1996 | Hypodermic syringe filling apparatuses and hypodermic syringe grasping apparatuses | |
5755358, | Jul 01 1996 | Xerox Corporation | Toner level detection system |
5872814, | Feb 24 1997 | AT&T MOBILITY II LLC | Method for linearization of RF transmission electronics using baseband pre-distortion in T/R compensation pilot signals |
5882338, | Apr 28 1994 | AstraZeneca UK Limited | Syringes and syringe pumps |
5925021, | Mar 09 1994 | Becton, Dickinson and Company | Medication delivery device with a microprocessor and characteristic monitor |
5928197, | Nov 24 1993 | Liebel-Flarsheim Company | Controlling plunger drives for fluid injections in animals |
5997502, | Aug 17 1992 | Medrad, Inc. | Front loading medical injector and syringe for use therewith |
6090064, | Aug 17 1992 | Medrad, Inc. | Front loading medical injector and syringe for use therewith |
Executed on | Assignor | Assignee | Conveyance | Frame | Reel | Doc |
Jun 21 1999 | HANSON, ROBERT | MEDDOC, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 030581 | /0512 | |
Jun 21 1999 | EVANS, ROBERT F | MEDDOC, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 030581 | /0512 | |
Jul 26 1999 | BURROW, MICHAEL F | MEDDOC, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 030581 | /0512 | |
Jul 26 1999 | WALKER, RICHARD BRADLEY | MEDDOC, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 030581 | /0512 | |
Jul 28 1999 | DocuSys, Inc. | (assignment on the face of the patent) | / | |||
Aug 02 1999 | MEDDOC, INC | DOCUSYS, INC | MERGER SEE DOCUMENT FOR DETAILS | 030581 | /0537 | |
Aug 17 2001 | DOCUSYS, INC | MEDDOC, INC | CHANGE OF NAME SEE DOCUMENT FOR DETAILS | 012263 | /0640 | |
Dec 17 2001 | MEDDOC, INC | DOCUSYS, INC | CHANGE OF NAME SEE DOCUMENT FOR DETAILS | 012762 | /0725 | |
Aug 06 2008 | DOCUSYS, INC | Silicon Valley Bank | SECURITY AGREEMENT | 021339 | /0630 | |
Mar 25 2010 | DOCUSYS, INC | MERGE EMED, INC | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 025178 | /0059 | |
Mar 26 2010 | Silicon Valley Bank | DOCUSYS, INC | RELEASE | 024160 | /0426 | |
Dec 29 2010 | MERGE EMED, INC | AMICAS, INC | MERGER SEE DOCUMENT FOR DETAILS | 030581 | /0570 | |
Dec 30 2010 | AMICAS, INC | MERGE HEALTHCARE SOLUTIONS INC | CHANGE OF NAME SEE DOCUMENT FOR DETAILS | 030591 | /0954 | |
Apr 23 2013 | Merge Healthcare Incorporated | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE INTERACTIVE, INCORPORATED | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | REQUISITE SOFTWARE INC | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE SH HOLDINGS, INC | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE SF HOLDINGS, INC | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE HEALTHCARE SOLUTIONS INC | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE ECLINICAL INC | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 23 2013 | MERGE ASSET MANAGEMENT CORP | JEFFERIES FINANCE LLC | SECURITY AGREEMENT | 030281 | /0510 | |
Apr 29 2014 | MERGE HEALTHCARE SOLUTIONS INC | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | Merge Healthcare Incorporated | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | MERGE ASSET MANAGEMENT CORP | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | MERGE ECLINICAL INC | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | MERGE SF HOLDINGS, INC | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | MERGE SH HOLDINGS, INC | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | REQUISITE SOFTWARE INC | GUGGENHEIM CORPORATE FUNDING, LLC, AS COLLATERAL AGENT | PATENT SECURITY AGREEMENT | 032784 | /0644 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | Merge Healthcare Incorporated | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE ASSET MANAGEMENT CORP | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | REQUISITE SOFTWARE INC | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE SH HOLDINGS, INC | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE SF HOLDINGS, INC | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE HEALTHCARE SOLUTIONS INC | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE ECLINICAL INC | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Apr 29 2014 | JEFFERIES FINANCE LLC, AS COLLATERAL AGENT | MERGE INTERACTIVE, INCORPORATED | TERMINATION AND RELEASE OF SECURITY INTEREST PATENTS REEL 030281 FRAME 0510 | 032784 | /0850 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | MERGE ECLINICAL, INC | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | UltraVisual Medical Systems Corporation | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | CEDARA SOFTWARE CORP | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | REQUISITE SOFTWARE, INC | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | Merge Healthcare Incorporated | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | MERGE HEALTHCARE SOLUTIONS INC | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Oct 13 2015 | GUGGENHEIM CORPORATE FUNDING, LLC | MERGE SH HOLDINGS, INC | RELEASE BY SECURED PARTY SEE DOCUMENT FOR DETAILS | 036874 | /0234 | |
Mar 15 2021 | MERGE HEALTHCARE SOLUTIONS INC | International Business Machines Corporation | ASSIGNMENT OF ASSIGNORS INTEREST SEE DOCUMENT FOR DETAILS | 055617 | /0985 |
Date | Maintenance Fee Events |
Jan 10 2005 | M1552: Payment of Maintenance Fee, 8th Year, Large Entity. |
Jan 19 2005 | STOL: Pat Hldr no Longer Claims Small Ent Stat |
Dec 31 2008 | M1553: Payment of Maintenance Fee, 12th Year, Large Entity. |
Date | Maintenance Schedule |
Jul 15 2006 | 4 years fee payment window open |
Jan 15 2007 | 6 months grace period start (w surcharge) |
Jul 15 2007 | patent expiry (for year 4) |
Jul 15 2009 | 2 years to revive unintentionally abandoned end. (for year 4) |
Jul 15 2010 | 8 years fee payment window open |
Jan 15 2011 | 6 months grace period start (w surcharge) |
Jul 15 2011 | patent expiry (for year 8) |
Jul 15 2013 | 2 years to revive unintentionally abandoned end. (for year 8) |
Jul 15 2014 | 12 years fee payment window open |
Jan 15 2015 | 6 months grace period start (w surcharge) |
Jul 15 2015 | patent expiry (for year 12) |
Jul 15 2017 | 2 years to revive unintentionally abandoned end. (for year 12) |