US20110118701A1 - Dose Dividing Delivery Device - Google Patents
Dose Dividing Delivery Device Download PDFInfo
- Publication number
- US20110118701A1 US20110118701A1 US12/864,685 US86468508A US2011118701A1 US 20110118701 A1 US20110118701 A1 US 20110118701A1 US 86468508 A US86468508 A US 86468508A US 2011118701 A1 US2011118701 A1 US 2011118701A1
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- Prior art keywords
- plunger
- follower
- set forth
- track
- barrel
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/315—Pistons; Piston-rods; Guiding, blocking or restricting the movement of the rod or piston; Appliances on the rod for facilitating dosing ; Dosing mechanisms
- A61M5/31525—Dosing
- A61M5/31526—Dosing by means of stepwise axial movements, e.g. ratchet mechanisms or detents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/315—Pistons; Piston-rods; Guiding, blocking or restricting the movement of the rod or piston; Appliances on the rod for facilitating dosing ; Dosing mechanisms
- A61M5/31565—Administration mechanisms, i.e. constructional features, modes of administering a dose
- A61M5/3159—Dose expelling manners
- A61M5/31593—Multi-dose, i.e. individually set dose repeatedly administered from the same medicament reservoir
- A61M5/31595—Pre-defined multi-dose administration by repeated overcoming of means blocking the free advancing movement of piston rod, e.g. by tearing or de-blocking
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/315—Pistons; Piston-rods; Guiding, blocking or restricting the movement of the rod or piston; Appliances on the rod for facilitating dosing ; Dosing mechanisms
- A61M5/31525—Dosing
- A61M5/31528—Dosing by means of rotational movements, e.g. screw-thread mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/3129—Syringe barrels
- A61M5/3134—Syringe barrels characterised by constructional features of the distal end, i.e. end closest to the tip of the needle cannula
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/32—Needles; Details of needles pertaining to their connection with syringe or hub; Accessories for bringing the needle into, or holding the needle on, the body; Devices for protection of needles
- A61M5/3205—Apparatus for removing or disposing of used needles or syringes, e.g. containers; Means for protection against accidental injuries from used needles
- A61M5/321—Means for protection against accidental injuries by used needles
- A61M5/3243—Means for protection against accidental injuries by used needles being axially-extensible, e.g. protective sleeves coaxially slidable on the syringe barrel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/178—Syringes
- A61M5/31—Details
- A61M5/32—Needles; Details of needles pertaining to their connection with syringe or hub; Accessories for bringing the needle into, or holding the needle on, the body; Devices for protection of needles
- A61M5/3293—Needles; Details of needles pertaining to their connection with syringe or hub; Accessories for bringing the needle into, or holding the needle on, the body; Devices for protection of needles characterised by features of the needle hub
Abstract
A simple method and device enabling a unit dose from a reservoir is provided. The dose is drawn into the reservoir and is then expelled from the device by depressing the plunger. The plunger (30) has features which divide the dose into discrete intervals. As the plunger is moved during delivery, features on the plunger and features connected to the barrel interact to provide for intermittent stops to the injection process. Other aspects of the device provide-for reduced dead space, safety and selective interconnection with other devices. Thus, the delivery device divides the dose.
Description
- The present invention relates generally to delivery devices for delivering substances such as drugs, vaccines and the like, and more specifically relates to a drug delivery system and device having a system for dividing the dose into multiple sub-doses for injection through a needle. More specifically, the present invention relates to a method and apparatus for filling, dosing and disposing an intradermal delivery device using a needle sized for intradermal delivery and a dose divider for dividing the dose for multiple injections using the same needle.
- Traditionally, syringes are filled by inserting the needle into a vial. The dose is drawn from the vial, pulling the liquid drug dose from the vial into the syringe. The dosage is then expelled from the device by depressing the plunger. If it is desired to divide the total dose into discrete intervals, it must be accomplished manually, or via complicated and costly systems. In the actual usage of devices of this type, multiple doses are given to the same patient at various locations. With a conventional syringe the practitioner must stop depressing the plunger based on visual feedback (from the scale on the syringe). Consequently, it is difficult to perform the repeat dose injections with a high degree of accuracy and/or precision. Furthermore, intradermal injections which can be performed at repeated sites are difficult to perform and adding the difficulty of manually dividing the dose at each site has historically been difficult. Medication pens were developed to produce multiple injections, but are complicated and comprised of many parts. For example, a pen like device is described in U.S. Pat. No. 4,592,745. This pen device is complicated and performs multiple injections but with significant cost. Furthermore, medication pens are not readily adapted for use with fill at time of use systems, especially systems which require reconstitution steps. What is needed is a device and technique for expelling repeated doses from a fill able single syringe to perform multiple injections without having to solely rely on visual feedback from the scale of the syringe, or complicated devices with multiple parts. Furthermore, what is needed is a system that divides the dose that is compatible with conventional reconstitution practices. Attached are the results of a general background search which was conducted for the dose dividers.
- In one embodiment the medication device having aspects of the invention uses a radially moving collar having a cantilevered beam which serves as a pawl. The collar is slidable from a first position to a second position on the flange of the syringe barrel. Furthermore, the plunger of the device is ratcheted with a plurality of spaced detents. In the first position the collar is positioned such that the pawls of the cantilevered beams do not interact with the ratchets of the plunger. A filling needle is attached to the syringe barrel. The first position is the filling position and allows the syringe to be used as a conventional syringe; however, in the usage of this device, the first position primarily serves to fill the syringe using a filling needle without interference by the ratchets. The filling needle is removed from the barrel and an injection needle is attached. The collar is moved to a second position. In the second position the collar is positioned such that the pawls of the cantilevered beams interfere with the detents of the plunger. This position allows the syringe to be used as a multiple repeat dose device. The practitioner inserts the needle into the patient and depresses the plunger. As the plunger is depressed, the pawls interact with the detents which provide for tactile feedback to the practitioner that the discrete intermediate dosage has been delivered. The practitioner then moves the needle to a new injection site and repeats the process. This process continues until the entire dose is delivered.
- In another embodiment having aspects of the invention, the device uses a radially slidable component having a follower. The component is slidable from a first position to a second position on the flange of the syringe barrel or on an intermediate part snapped on the syringe flange. Furthermore, the sides of the plunger are grooved with a track having a plurality of spaced units having at least a stop portion. In some embodiments the track has an angled portion, and in others there is a capture portion. In alternate embodiments the track is along the contoured radial surface of the plunger, as the track. In yet another embodiment, the track is configured with units such that the follower is caught in retention areas. In alternate embodiments the plunger contains a plurality of followers and the track is on the slider, thus reversing the location of the features on the parts. In the first position the component is positioned such that the follower of the component does not interact with the tracks of the plunger. Optionally, a filling needle is attached to the syringe barrel. The first position is the filling position and allows the syringe to be used as a conventional syringe; however, in usage of this device the first position primarily serves to fill the syringe using a filling needle (or injection needle) without interference by the follower/tracks. The filling needle is removed from the barrel and an ID injection needle is attached. The component is moved to a second position. In the second position the component is positioned such that the follower of the component is riding in the track of the plunger, and is at the start of an injection cycle. In this case it is at the bottom of a unit. This is the discrete injection position and allows the syringe to be used as a multiple repeat dose device. The practitioner inserts the needle into the patient and depresses the plunger. As the plunger is depressed and begins to move distally, the follower travels along the track. As the follower travels along the angled portion of the track, the component is moved to a third position which is intermediate to the first and second position. At the cusp of the unit, the follower hits a stop point, which is the beginning of the adjacent unit, wherein the plunger is prevented from moving distally. The practitioner then moves the component from the third position to the second position which places the follower at the beginning of angled portion of the adjacent unit. The practitioner then moves the needle to a new injection site and repeats the process. This process continues until the entire dose is delivered.
- Other advantages of the present invention will be readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings wherein:
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FIG. 1 shows a perspective view of a delivery device having aspects of the invention. -
FIG. 2 shows and Enlargement of Detail “A” of the delivery device ofFIG. 1 . -
FIG. 3 shows a side view of the distal end of the device ofFIG. 1 with the shield of the device removed. -
FIG. 4 shows a perspective view of a slider of the embodiment ofFIG. 1 . -
FIG. 5 shows side view of a plunger of the embodiment ofFIG. 1 . -
FIG. 6 shows a perspective view of a slider/clip assembly of the device ofFIG. 1 . -
FIG. 7 shows a perspective view of a slider, clip and plunger assembly of the device ofFIG. 1 . -
FIG. 7A shows a perspective view of a clip and plunger assembly of an alternate embodiment having aspects of the invention. -
FIG. 8 shows an enlarged side view of the plunger ofFIG. 5 . -
FIGS. 9A and 9B show an enlarged side view of Detail “B” and Detail “C” the plunger ofFIG. 5 , respectively. -
FIG. 10 shows a cross-sectional view of the hub and barrel assembly ofFIG. 3 with the sheath and shield removed for clarity. -
FIG. 11A shows a perspective view of an alternate embodiment of a clip, plunger and barrel having aspects of the invention. -
FIG. 11B is a reverse perspective view of the components ofFIG. 11A . -
FIG. 12 shows an enlarged side view of a plunger used in the embodiment ofFIG. 11A-B . - As used herein, the term “proximal” and derivatives thereof, shall mean the end of an item or direction closest to the caregiver during use of the subject invention. The term “distal” and derivatives thereof, shall mean the end of an item or direction towards a patient during use of the subject invention. As used herein, the term “drug substance” and derivatives thereof shall mean any substance that is intended for injection into a patient, including, by way of non-limiting example, drugs, vaccines, therapeutics, and the like. It will be obvious to a person of skill in the art, and from the disclosure provided herein, that the subject invention is not limited or otherwise defined by the type or class of substance administered using the inventive injection device.
- For many drug substances, it may be desirable to fill the delivery device at the point of, and immediately prior to use. In this situation, the delivery device is normally filled from a unit dose or multi-dose vial. A multi-dose vial may be more economical and it enables the user to fill the delivery device with the specific dose required. Alternatively, the syringe is pre-filled with a diluent. Alternatively, the syringe is pre-filled with the drug substance, and no filling step is required, and in this case the follower may be pre-set to be within the track. The multi-dose vial may be pre-filled with a liquid substance or with a dry substance. For example, it is now conventional to reduce certain drugs to a dry or powdered form to increase the shelf life of drugs and reduce inventory space. Multi-dose vials are typically sealed with an elastomeric stopper or septum. A needle on the delivery device may be used to pierce the stopper or septum and draw the drug substance from the vial into the delivery device, typically a syringe. The drug substance may then be administered using the delivery device, which is discarded after use, and the unit-dose vial may be stored for further use. Alternatively, the drug substance may be contained in a cryogenic vial. Furthermore, the cryogenic vial may be involved in a complex multi-step reconstitution procedure.
- Standard methods for preserving the therapeutic and/or diagnostic substances, such as maintaining them in liquid or powder form in conventional vials for future use, may be used with the intradermal devices of the present invention. The substances for use with the device and method include vaccines and certain medicaments and drugs. Additionally, these substances can be used for diagnostic testing such as, for example, the Mantoux test to determine immunity status against tuberculosis and immediate hypersensivity status of Type I allergic diseases. Also, the substance preferably intradermally delivered in accordance with aspects of the methods and devices of the present invention is selected from the group consisting of drugs, vaccines and the like used in the prevention, diagnosis, alleviation, treatment, or cure of disease, with the drugs including Alpha-1 anti-trypsin, Anti-Angiogenesis agents, Antisense, butorphanol, Calcitonin and analogs, Ceredase, COX-II inhibitors, dermatological agents, dihydroergotamine, Dopamine agonists and antagonists, Enkephalins and other opioid peptides, Epidermal growth factors, Erythropoietin and analogs, Follicle stimulating hormone, G-CSF, Glucagon, GM-CSF, granisetron, Growth hormone and analogs (including growth hormone releasing hormone), Growth hormone antagonists, Hirudin and Hirudin analogs such as hirulog, IgE suppressors, Insulin, insulinotropin and analogs, Insulin-like growth factors, Interferons, Interleukins, Leutenizing hormone, Leutenizing hormone releasing hormone and analogs, Low molecular weight heparin, M-CSF, metoclopramide, Midazolam, Monoclonal antibodies, Narcotic analgesics, nicotine, Non-steroid anti-inflammatory agents, Oligosaccharides, ondansetron, Parathyroid hormone and analogs, Parathyroid hormone antagonists, Prostaglandin antagonists, Prostaglandins, Recombinant soluble receptors, scopolamine, Serotonin agonists and antagonists, Sildenafil, Terbutaline, Thrombolytics, Tissue plasminogen activators, TNF−, and TNF− antagonist, the vaccines, with or without carriers/adjuvants, including prophylactics and therapeutic antigens (including but not limited to subunit protein, peptide and polysaccharide, polysaccharide conjugates, toxoids, genetic based vaccines, live attenuated, reassortant, inactivated, whole cells, viral and bacterial vectors) in connection with, addiction, arthritis, cholera, cocaine addiction, diphtheria, tetanus, HIB, Lyme disease, meningococcus, measles, mumps, rubella, varicella, yellow fever, Respiratory syncytial virus, tick borne japanese encephalitis, pneumococcus, streptococcus, typhoid, influenza, hepatitis, including hepatitis A, B, C and E, otitis media, rabies, polio, HIV, parainfluenza, rotavirus, Epstein Barr Virus, CMV, chlamydia, non-typeable haemophilus, moraxella catarrhalis, human papilloma virus, tuberculosis including BCG, gonorrhoea, asthma, atheroschlerosis malaria, E-coli, Alzheimers, H. Pylori, salmonella, diabetes, cancer, herpes simplex, human papilloma and the like other substances including all of the major therapeutics such as agents for the common cold, Anti-addiction, anti-allergy, anti-emetics, anti-obesity, antiosteoporeteic, anti-infectives, analgesics, anesthetics, anorexics, antiarthritics, antiasthmatic agents, anticonvulsants, anti-depressants, antidiabetic agents, antihistamines, anti-inflammatory agents, antimigraine preparations, antimotion sickness preparations, antinauseants, antineoplastics, antiparkinsonism drugs, antipruritics, antipsychotics, antipyretics, anticholinergics, benzodiazepine antagonists, vasodilators, including general, coronary, peripheral and cerebral, bone stimulating agents, central nervous system stimulants, hormones, hypnotics, immunosuppressives, muscle relaxants, parasympatholytics, parasympathomimetrics, prostaglandins, proteins, peptides, polypeptides and other macromolecules, psychostimulants, sedatives, sexual hypofunction and tranquilizers and major diagnostics such as tuberculin and other hypersensitivity agents.
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FIG. 1 shows a delivery device having aspects of the invention.Delivery device 10 includes asyringe 11 with abarrel 40 andplunger 30.Plunger 30 is inserted intobarrel 40 at the proximal end ofdevice 10. At the distal end ofplunger 30 is a stopper which is used to sealbarrel 40 to form a reservoir for the drug substance. At the proximal end ofplunger 30 ispush pad 32. At the distal end ofbarrel 40 is attached needle assembly 12. Needle assembly 12 is preferably comprised ofhub 50 having a needle,sheath 80 andshield 70.Shield 70 is removably attached to the distal end of needle assembly 12. Preferably, needle assembly 12 is attached tobarrel 40 via a threaded luer connection, however other connection methods may be used, inter alia luer slip or integral formation.Optional sheath 80 is slidably connected tohub 50 in order to protect the needle after use of the device. Alternatively, a conventional needle assembly may be used such as the type depicted in U.S. Pat. No. 6,494,865 to Alchas, the entire contents of which is incorporated by reference herein, or a standard hypodermic detachable needle. Alternatively, the needle may be integrally assembled onto or into thebarrel 40, such that it is a not removable barrel. Typicallybarrel 40 is plastic but it may be comprised of glass or any other material suitable for drug delivery. At the proximal end ofdelivery device 10 isdose divider 13. Preferably,dose divider 13 includes aslider 20 andclip 60 which cooperate withplunger 30 to divide the entire dose contained within thesyringe 11 into preselected increments. The construction and operation of thedose divider 13 is more readily seen inFIG. 2 and is described below. - Now turning to
FIG. 2 , thedose divider 13 includes aslider 20 having abutton 21 which is depressible by the health care professional.Slider 20 includesfollower 28 which cooperates withtrack 100 ofplunger 30 to divide the entire dose of the drug substance contained in the reservoir of the syringe into discrete unit doses. The unassembled slider is shown inFIG. 4 .Slider 20 includesfollower 28 which is preferably mounted ondeflectable beam 27. In this embodiment opening 26 serves to allowbeam 27, and thusfollower 28 to deflect in the radial direction. Thus since opening 26 is a closed hole,beam 27 is a double supported beam. Alternatively, opening 26 could be formed such thatbeam 27 is a cantilevered beam. Alternatively, opening 26 could be omitted such thatfollower 28 is located on a rigid portion ofslider 20, andfollower 28 and/or track 100 is elastically deformed and movement on a beam is not required. In this case, the parts would be sized dimensionally such that the interference of the parts was not so great to cause permanent deformation of the parts. Preferably,slider 20 also includes at least onerail 22 which cooperates with features onclip 60 to allow secure slidable engagement between the parts.Follower 28 is a cylindrical protrusion with a portion which is chamfered. Other profiles of protrusions may be used forfollower 28.Slider 20 is slidably engaged to clip 60 which is attached tobarrel 40. The engagement ofslider 20 andclip 60 is shown clearly inFIG. 6 .Rails 22 cooperate with opening 62 on the proximal side ofclip 60 to provide a secure sliding connection betweenclip 60 andslider 20. Other slidable connection means may be employed inter alia detents, holes and pins, and slots and followers.Clip 60 optionally includesradial opening 68 which receives a flanged portion ofbarrel 40.Slider 20 withclip 60 attached tobarrel 40 andslider 20 slidably engaged toclip 60,slider 20 is able to be slid in a radial direction with respect to the longitudinal axis ofbarrel 40, which would extend through barrel opening 69 on distal side ofclip 60. Furthermore, substantial proximal and or distal movement offollower 28 with respect tobarrel 40 is substantially prevented by the design ofslider 20,clip 60 and connection methods employed. Preferably, crushribs 67 ofclip 60 are used to provide a secure connection between flange ofbarrel 40 andclip 60, which substantially prevents relative movement in the barrel axial direction. Optionally, all of the aspects ofClip 60 described herein would be readily integrally formed intobarrel 40, however, for ease of using glass barrels,clip 60 is a separate component, however since the connection ofclip 60 tobarrel 40 is a connection which prevents any substantial distal or proximal movement ofclip 60 tobarrel 40, they (clip 60, barrel 40) function as one.Clip 60 optionally includestactile ribs 61 for gripping by the health care professional.Clip 60 is attached to the distal end ofbarrel 40, which preferably includes a flange. In this embodiment,Clip 60 is slid radially onto a flange ofbarrel 40 before insertion ofplunger 30 intobarrel 40.Clip 60 also preferably includestang 66 which serves to guideplunger 30 in use ofdose divider 30. Now referring back toFIG. 2 , for clarity,slider 20 is only shown withfollower 28 outside oftrack 100 ofplunger 30. Furthermore, this setting ofslider 20 enables use of thesyringe 11 as if there were nodose divider 13 attached. In this setting,follower 28 does not interact withtrack 100 to substantially hinder distal or proximal movement ofplunger 30. The dose dividing operation and cooperation offollower 28 andtrack 100 are further shown inFIGS. 5 , 8, and 9A-9B. - Shown in
FIG. 5 is theplunger 30.Plunger 30 comprises distal end with stopper retention means 33, and proximal end withpush button 32. Along an exterior surface ofplunger 30 istrack 100.Track 100 is comprised of one or morediscrete units 101 which each of which correspond to a unit dose. The distance between units onPlunger 30 is directly correlated to the amount of substance delivered for each unit. In one embodiment units are of equal size, thus providing equal volumetric unit doses. In an alternate embodiment, the units are differing sizes, thus providing varying volumetric unit doses. Optionally,track 100 includes on distal portion of plunger 30 a startingportion 107. Optionally,track 100 includes on proximal portion ofplunger 30 an endingportion 108. These portions are described more fully below and inFIG. 9A-B . InFIG. 9B one can see a detail of startingportion 107 oftrack 100. The two positions of thefollower 28 are represented inFIG. 9B by the position circles labeled A and B, labeledreference numerals Position A 128 represents a position of the follower that is outside oftrack 100. In this position there is no interference of the movement of theplunger 30 by thefollower 28. To activate the dose dividing system thefollower 28 is biased in the direct of the arrow labeled 118, fromposition A 128 to positionB 129. Inposition B 129 the follower is within the track, and subject to the guidance oftrack 100. More specifically thefollower 28 is within the startingportion 107 of thetrack 100; however, it is not mandatory that thefollower 28 start in the startingportion 107 of thetrack 100, only that in order to use the device thefollower 28 is within thetrack 100. InFIG. 9A one can see a detail of finishingportion 108 oftrack 100 withangled wall 112. Furthermore, the details of theunit 101 are described below and inFIG. 8 . - Now turning to
FIG. 8 , the sides ofplunger 30 comprisetrack 100 with a plurality of spacedunits 101. Preferablyunits 101 are “Z” shaped.Track 100 has angledportions 102 withangled wall portions 112, which are skewed from the longitudinal axis ofplunger 30.Track 100 also comprises a plurality of abuttingwalls 110 which are a portion oftrack 100 which is substantially perpendicular to the longitudinal axis ofplunger 30.Track 100 also preferably comprises a plurality ofdetent tabs 104 which are aligned substantially parallel to the longitudinal axis ofplunger 30. In the first position theslider 20 is positioned such that thefollower 28 of theslider 20 does not interact with thetrack 100 ofplunger 30. A filling needle is attached to the syringe barrel. The first position of slider as described above is the filling position and allowssyringe 11 to be used as a conventional syringe; however, in usage ofdelivery device 10 in the first position ofslider 20 primarily serves to fill the syringe using either a filling needle or needle assembly 12 without any substantial interference. Thus theplunger 30 may enter thebarrel 40 along the length of theplunger 30 with no stoppages. If a filling needle is employed, the filling needle is removed from the barrel and needle assembly 12 is attached in preparation for the unit dosing, after the entire dose is drawn into thebarrel 40. In preparation for unit dosing, theslider 20 is moved to a second position in the direction ofarrow 114, upon which thefollower 28 is now withintrack 100. - Preferably, the
follower 28 is positioned within the track at the starting position 107 (shown inFIG. 9B ) which serves as an area to purge the syringe of air and set the plunger to the first unit dose, however, the follower may be placed directly in one of the plurality of units. The health care professional then moves theplunger 30 distally, in the direction ofarrow 115. Thefollower 28 is then directed to position “P0” at the proximal end of startingposition 107 via theangled wall 112 oftrack 100. The dose expelled during this phase is optionally discarded. Alternatively, the dose created during this phase is injected into the patient. When the follower reaches position “P0” labeled asreference numeral 119, thefollower 28abuts abutting wall 110 and distal movement of the plunger is prevented. Position “P0” is the initial position of unit dosing which corresponds to position labeled “P1” identified byreference numeral 120 inFIG. 8 . As distal movement of the plunger is prevented by abuttingwall 110, the health care professional depresses theslider button 21 to moveslider 20 radially in the direction ofarrow 114, and reset thedose divider 13. Preferably,follower 28 abutsdetent tab 104 which provides resistance tofollower 28, thus theslider 20 to move in the radial direction; however, sincefollower 28 is flexibly mounted onbeam 27 ofslider 20, movement in the radial direction is possible with deflection of the follower. As discussed previously, a designed deformation of the follower, track or combinations thereof would serve the same purposes. The resistance of the deflection offollower 28 overdetent tab 104 is preferably selected so that it gives tactile feedback to the health care professional that the next dose is ready to be delivered. Optionally, thefollower 28,beam 27 anddetent tab 104 dimensions are selected such that an audible click is heard by the health care professional. - As the
follower 28 has now passeddetent tab 104, the follower is now at position labeled “P2” identified byreference numeral 121 at the distal end ofunit 101. Thus, this is the start of theunit 101 and the start of the delivery of a unit dose. The health care professional inserts theneedle 56 into the patient and depresses theplunger 30, preferably bypush button 32. As thepush button 32 is depressed and theplunger 30 begins to move distally, and since thefollower 28 is contained withintrack 100, thefollower 28 travels along theangled portion 102 oftrack 100.Angled wall 112biases follower 28 in the direction ofarrow 116, and therefore movesslider 120 in the direction ofarrow 116.Angled wall 112 serves to cam the follower into another position. At the approximate middle of theunit 101, the follower is now at position labeled “P3” identified byreference numeral 122, in which as thefollower 120 travels along theangled portion 102 oftrack 100, theslider 20 is radially moved proportionally to the distal movement of theplunger 30, dependant on the angle ofangled portion 102. As thefollower 28 reaches position labeled “P1′” identified byreference numeral 120′ at the proximal end ofunit 101, thefollower 28 reaches a stop point which is the beginning of theadjacent unit 101, wherein theplunger 30 is prevented from moving distally by the interaction offollower 28 and abuttingwall 110. Thus, the resetting of the dose divider process is repeated to bring the follower to position labeled “P2′” which is labeled withreference numeral 121′. The practitioner then moves the needle to a new injection site and repeats the process of injection. This process continues until the entire dose is delivered in a series of unit doses. Optionally, the last unit dose has thefollower 28 traveling within the ending portion 108 (shown inFIG. 9A ) oftrack 100. In the endingportion 108 there is a large space oftrack 100 which allowsfollower 28 ofslider 28 to move radially, which indicates to the health care professional that the last dose is delivered. The volumetric unit doses are comprised of the axial distance between positions P2 and P2′ multiplied by the area of the cross section of thebarrel 40. Preferably, the unit doses are equally spaced, although it would be possible to pre-select unit doses of varying volumes by selecting the spacing of P2 and P2″ for eachunit 101 oftrack 100. - Now turning to
FIG. 11A-B andFIG. 12 which shows an alternate embodiment of dose divider which is similar to the dose divider as described above. The dose divider of this embodiment contains similar features and operates similarly to the dose divider as described above with a modification in the track and configuration of the unit and the addition of a biasing feature between the slider and the clip.Plunger 30 of this embodiment comprisestrack 200 havingunit 201. Furthermore clip 600 hasslider 220 integrally formed therein.Clip 600 is slide ontoflange 41 ofbarrel 40 as described above.Clip 600 also comprisesstabilizer 255 which serves to stabilizeplunger 30 andslider 220, as well as secure theclip 600 onto theflange 41, or combinations of these purposes.Slider 220 further comprisesfollower 280. In thisembodiment follower 280 is a ratchet-like protrusion onslider 220, although may have other shapes, such as any of the embodiments described herein.Slider 220 is biased radially outward by biasingmeans 250. In this embodiment biasing means 250 are a series of integrally molded leaf springs 251. Biasing means 250 is designed to place a bias toslider 220 and thereforefollower 280 in the operation of the device.Slider 220 also containsoptional push button 210. AlthoughSlider 220 is integrally formed withclip 600,slider 220 is able to be slid in a radial direction with respect to the longitudinal axis ofbarrel 40. Furthermore, substantial proximal and or distal movement offollower 280 with respect tobarrel 40 is substantially prevented by the design ofslider 220,clip 600 and connection methods employed. Optionally, all of the aspects ofClip 600 described herein would be readily integrally formed intobarrel 40, however, for ease of using glass barrels,clip 600 is a separate component, however since the connection ofclip 600 tobarrel 40 is a connection which prevents any substantial distal or proximal movement ofclip 60 tobarrel 40, they (clip 60, barrel 40) function as one. - Now turning to
FIG. 12 , as thefollower 280 has three positions (P1, P2, P3) which will be described below. At the beginning of a unit dose, follower is located as position “P1.” In order to begin the dosing sequence, the health care professional depressesbutton 210 which applies a bias toslider 220 in the direction ofarrow 114 and thus forcesfollower 280 to pass now passeddetent tab 104, thefollower 280 is now at position labeled “P2” identified byreference numeral 121 at the distal end ofunit 201. The health care professional inserts theneedle 56 into the patient and depresses theplunger 30, preferably bypush button 32. As thepush button 32 is depressed and theplunger 30 begins to move distally in the direction ofarrow 115, and since thefollower 280 is contained withintrack 200, thefollower 28 travels alongtrack 200. However, since there is a bias applied by bias means 250 applied to theslider 220 andfollower 280 in the direction in the direction ofarrow 202, and therefore movesslider 220 in the direction ofarrow 202. At the approximate middle of theunit 201, the follower is now at position labeled “P3” identified byreference numeral 122, in which as thefollower 280 travels alongtrack 200, theslider 220 is biased by bias means 250 into thecapture portion 202 oftrack 200. As thefollower 280 reaches position labeled “P1′” identified byreference numeral 120′ at the proximal end ofunit 201, thefollower 280 reaches a stop point which is the beginning of theadjacent unit 201, wherein theplunger 30 is prevented from moving distally by the interaction offollower 28 and abuttingwall 110. Thus, the resetting of the dose divider process is repeated to bring the follower to position in which the plunger may be moved distally as described above. The practitioner then moves the needle to a new injection site and repeats the process of injection. This process continues until the entire dose is delivered in a series of unit doses. Optionally, the last unit dose has thefollower 280 traveling within the ending portion oftrack 200, similarly as described in the previous embodiment. As in the previous embodiment, the volumetric unit doses are comprised of the axial distance between positions P2 and P2′ multiplied by the area of the cross section of thebarrel 40. Preferably, the unit doses are equally spaced, although it would be possible to pre-select unit doses of varying volumes by selecting the spacing of P2 and P2″ for eachunit 201 oftrack 200. - Now turning to
FIG. 7A which shows an alternate embodiment ofdose divider 1300 which uses aradially moving collar 160 having a cantileveredbeam 270 which serves as apawl having follower 280. Thecollar 160 is slidable from a first position to a second position on the flange of thebarrel 40. Furthermore, theplunger 30 of the device is ratcheted with a plurality of spaceddetents 1110.Detents 1110 are formed intounits 1010. In thefirst position collar 160 is positioned such that thefollower 280 of the cantileveredbeams 270 do not interact with thedetents 1110 of theplunger 30. A filling needle is attached to the syringe barrel. The first position is the filling position and allows thesyringe 11 to be used as a conventional syringe; however, in the usage of this device, the first position ofcollar 160 primarily serves to fill the syringe using a filling needle without interference by thedosing device 1300. The filling needle is removed from the barrel and a needle assembly 12. Thecollar 160 is moved to a second position on the flange ofbarrel 40. In the second position thecollar 160 is positioned such that thefollower 280 of the cantileveredbeams 270 interfere with thedetents 1110 of theplunger 30. This is the discrete injection position and allows thesyringe 11 to be used as a multiple repeat dose device. The practitioner inserts the needle into the patient and depresses the plunger. As the plunger is depressed, thefollower 280 interacts with thedetents 1110 which provide for tactile feedback to the health care professional that the discrete intermediate dosage has been delivered. The health care professional then moves the needle to a new injection site and repeats the process. This process continues until the entire dose is delivered. - Now turning to
FIG. 3 andFIG. 10 , the needle assembly 12 includes aneedle cannula 56 located at the distal end of thehub 50. In the embodiment depicted inFIGS. 3 and 10 ,needle 56 is inserted intohub 50 defined at that distal end of needle assembly 12 in a manner known to those skilled in the art. For example,needle 56 may be secured using a friction fit, snap fit, suitable adhesive, solvent weld, or other now known or hereafter developed means of securing a needle to a hub.Sheath 80 is slidably engaged tohub 50 byribs embodiment rib 54 has detents which cooperate with detenting means 82 to locksheath 80 in at least one of two or more positions. In the intradermal embodiment of needle assembly 12,hub 50 includes a specifically designedskin engaging surface 57, which cooperates withneedle 56, extending from the distal end ofsurface 57 from 0.3 mm to 3 mm, preferably 0.5 mm to 1.5 mm. -
FIG. 10 shows a cross section of needle assembly 12 attached to distal end ofbarrel 40.Barrel 40 comprisescollar 48 which containsinternal threads 49 which engage withexternal threads 58 ofhub 50.Barrel 40 also comprisesluer tip 46 which has a taper of “L” degrees. Typically “L” is approximately between 1.5 and 2.0 degrees. Preferably “L” is approximately 1.75 degrees.Hub 50 also has a corresponding taper withinluer opening 51. Preferably, luer opening 51 ofhub 50 is adapted to only receivespecialized luer tip 46 ofbarrel 40. Luer opening 51 is designed to have a stepped opening, such that standard luer tips of standard syringes will not fully engageluer opening 51 and thus be un-usable withhub 50 of needle assembly 12. Luer opening 51 is elongated and has a depth dimension of D1+D2. Preferably, dimension D2 is selected such that it is greater than the extension of standard luer tips. More preferably, dimension D2 is selected such that it does not allow engagement ofthreads 58 into standard luer lock barrels, but the fact that hubproximal end 51 protrudes at distance D2 fromthreads 58, this does not allow engagement of the components. The interior diameter between D1 and D2 has adiscontinuity 59 of dimension D3 such that a step is formed at the interface between D1 and D2. Typically D3 ranges from 0.05 mm to 0.15 mm, preferably approximately 0.1 mm. Typically D1 ranges from 6 mm to 10 mm, preferably approximately 8 mm. Typically D2 ranges from 4.5 mm to 8.5 mm, preferably approximately 6.5 mm. The location of thediscontinuity 59 is selected such that effective use ofhub 50 on standard luer tips is prevented. Preferably, the location ofdiscontinuity 59 is at the same location asthreads 58 alonghub 50. However, since the distal end ofluer tip 46 is standard in nature,luer tip 46 allows attachment of a standard luer needle with no degradation in performance. As such,luer tip 46 allows both use of a standard luer needle for filling andhub 50 of specialized needle assembly 12 for injection. - Preferably inserted in the internal diameter of
luer tip 46 isrestrictor pin 92.Restrictor pin 92 is substantially cylindrical and comprises a flattenedportion 93 such that whenrestrictor pin 92 is inserted into internal diameter ofluer tip 46, the internal diameter is substantially but not completely obstructed to formflow path 91. Preferably flowpath 91 is sized to enable effective filling ofdelivery device 10 and prevent excessive shear forces on any substances delivered.Restrictor pin 92 also optionally comprisesdetent 94 which cooperates withoptional detent rib 44 withinluer tip 46 which serves to retainrestrictor pin 92 inluer tip 46. Other methods may be used to retainrestrictor pin 92 inluer tip 46.Hub 50 hasdead space 90 which is included of the overall dead space of the system. It may be desirable to add a second restrictor pin within hubdead space 90, as well. Alternatively, an elongated restrictor pin of similar design may be used in both spaces. Thus,restrictor pin 46 serves to reduce the overall “dead space” ofdelivery device 10. - In use, a health care professional administering the injection will unwrap the protective packaging from the vial. The health care professional will then manually insert the medication device into the vial in preparation for aspiration of medication into
barrel 40. If supplied as separate components, the health care professional will then manually insert thesyringe 11 into the filling needle in preparation for aspiration of medication. Alternatively, the filling needle anddelivery device 10 are pre-assembled in a kit supplied with needle assembly 12. In another embodiment, all three components (needle assembly 12,syringe 40 and the filling needle are supplied in a kit. In another embodiment,syringe 40 is pre-filled with the drug substance and no filling is required. In another embodiment,syringe 40 is pre-filled with a diluent. Optionally, at this point, a diluent is injected in the medication vial. The healthcare professional then aspirates the syringe with the medication from the medication vial fromsyringe 11. The health care professional will then manually remove thesyringe 11 from the filling needle in preparation for administration of the injection. The needle assembly 12 is then attached to the device. In another embodiment, the filling needle is the same needle as the needle assembly 12. Administration will, in one embodiment, involve pressing theskin engaging surface 57 of thehub 50 substantially perpendicular to a surface of the patient's skin. The first unit dose of the drug substance will then be injected using theplunger 30. As the plunger is depressed the follower of thedose divider 13 follows the path of thetrack point 122. Upon completion of the unit dose, the health care professional withdraws the needle cannula from the patient's skin and prepares to reset the dose divider. Optionally the health care professional prepares the next injection site. Thedose divider 13 is then reset in order to deliver the next unit dose, which entails moving the follower to startpoint 120. Preferably, the reset involves pushing a button on the slider such that the follower is moved into thestart point 120. This cycle is then repeated for the number of units along the length of the plunger. Upon completion of the entire dose, the health care professional withdraws the needle cannula from the patient's skin and disposes the usedinjection device 10 in a suitable container. Prior to disposal, the health care professional optionally activates the shielding portion of delivery device by slidingsheath 80 distally. - As will now be understood, the delivery device having aspects of the invention may include a needle enclosure means which encloses or conceals the needle cannula tip following injection and which preferably cannot be retracted to prevent accidental needle contact or reuse. In the embodiment shown in
FIGS. 1 and 3 , asheath 80 may be extended following injection and locked in place. The assembly includessheath 80 which locks in the extended position, preventing contact with the needle by use of locking means 82.Optionally arm 84 extends for the main portion ofsheath 80 to aid in activation. - The invention has been described in an illustrative manner, and it is to be understood that the terminology which has been used is intended to be in the nature of words of description rather than of limitation.
- Obviously, many modifications and variations of the present invention are possible in light of the above teachings. It is, therefore, to be understood that within the scope of the appended claims, wherein reference numerals are merely for convenience and are not to be in any way limiting, the invention may be practiced otherwise than as specifically described.
Claims (34)
1) A multiple dose injection device comprising:
a fluid conduit;
a barrel having a bore, a distal end, and a proximal end wherein the fluid conduit is located at the distal end of the barrel, in fluid communication with the bore and the proximal end of the barrel is adapted to receive a stopper;
a plunger having a distal end and a proximal end and a longitudinal axis wherein the stopper is connected the distal end of the plunger and movable within the barrel, and the plunger has at least one continuous track formed between the distal and proximal ends of the plunger wherein the track further comprises at least one of each of the following:
a first rest position,
a stop position, having a proximal abutment, a second rest position,
a camming portion which is skewed to the longitudinal axis of the plunger and formed between the first rest position and the stop;
a reset portion substantially perpendicular to the axis of the plunger and formed between the stop an the second rest position; and,
a slider having a follower movable substantially perpendicular to the axis of the plunger, the slider having a user-pressable portion;
wherein when a portion of the plunger is depressed by a user, the follower moves with respect to the plunger along the camming portion of the track, thereby causing radial motion of the follower and movement of the follower to the stop position at which position the plunger distal movement is prevented by contact of the follower to the proximal abutment, wherein the user may apply biasing force to the user-pressable portion of the slider, thereby moving the follower along the reset portion to the second rest position.
2) A device as set forth in claim 1 ) wherein the follower is movable from an initial position wherein the follower is located outside of the track and does not interfere with the plunger movement, to a first position wherein the follower is located within the track.
3) A device as set forth in claim 1 ) further comprising a loading portion of the track located at a distal portion of the plunger wherein the loading portion allows the follower to enter the track and the follower to the first rest position.
4) A device as set forth in claim 1 ) wherein the axial distance between stop positions multiplied by the cross sectional area of the bore is a unit volume which comprises a unit dose.
5) A device as set forth in claim 5 ) wherein the unit dose is a plurality of unit doses and all unit doses are substantially equal.
6) A device as set forth in claim 5 ) wherein the unit dose is a plurality of unit doses and all unit doses are of varying dosages.
7) A device as set forth in claim 1 ) further comprising a clip which engages a flange on the barrel and the slider is slidably engaged to the clip.
8) A device as set forth in claim 7 ) the clip further comprising a plunger guiding portion.
9) A device as set forth in claim 7 ) wherein the clip and slider are integrally formed with a slidable relationship.
10) A device as set forth in claim 1 ) wherein the at least one continuous track further comprises two tracks, located on opposing sides of the plunger.
11) A device as set forth in claim 1 ) wherein the at least one continuous track is a helical track around the circumference of the plunger.
12) A device as set forth in claim 1 ) wherein the follower is mounted on a deflectable beam.
13) A device as set forth in claim 1 ) wherein the follower is elastically deformed in use.
14) A device as set forth in claim 12 ) wherein the reset portion further comprises a detent tab located in the track which deflects the follower.
15) A device as set forth in claim 12 ) wherein the reset portion further comprises a deflectable detent tab located in the track.
16) A device as set forth in claim 14 ) wherein the deflection creates an audible sound, thereby providing feedback to the user.
17) A device as set forth in claim 1 ) wherein the fluid conduit further comprises a detachable needle assembly having a hub, attachable to the distal end of the barrel and a needle inserted into the hub.
18) A device as set forth in claim 17 ) wherein the hub further comprises a proximal opening adapted to receive an elongated luer tip located at the proximal end of the barrel and is adapted to prevent effective use of a standard luer tipped barrel.
19) A device as set forth in claim 1 ) further comprising a restrictor pin within the fluid conduit thereby reducing dead space.
20) A device as set forth in claim 1 ) further comprising a hub engaged to the barrel having needle cover removably attached to said hub.
21) A device as set forth in claim 20 ) further comprising a shield which is slidably engaged to the hub.
22) A multiple dose injection device comprising:
a fluid conduit;
a barrel having a bore, a distal end, and a proximal end wherein the fluid conduit is located at the distal end of the barrel, in fluid communication with the bore and the proximal end of the barrel is adapted to receive a stopper;
a plunger having a distal end and a proximal end and a longitudinal axis wherein the stopper is connected the distal end of the plunger and movable within the barrel, and the plunger has at least one continuous track formed between the distal and proximal ends of the plunger wherein the track further comprises at least one of each of the following:
a first rest position,
a stop position, having a proximal abutment,
a second rest position,
a capturing portion formed between the first rest position and the stop;
a reset portion substantially perpendicular to the axis of the plunger and formed between the stop an the second rest position; and,
a slider having a follower movable substantially perpendicular to the axis of the plunger, the slider having a user-pressable portion;
wherein the follower is biased toward the stop, thereby radially biasing the follower in the capture portion to the stop position at which position the plunger distal movement is prevented by contact of the follower to the proximal abutment, wherein the user may apply a reverse biasing force to the user-pressable portion of the slider, thereby moving the follower along the reset portion to the second rest position.
23) A device as set forth in claim 22 ) wherein the follower is movable from an initial position wherein the follower is located outside of the track and does not interfere with the plunger movement, to a first position wherein the follower is located within the track.
24) A device as set forth in claim 22 ) further comprising a loading portion of the track located at a distal portion of the plunger wherein the loading portion allows the follower to enter the track and the follower to the first rest position.
25) A device as set forth in claim 22 ) wherein the axial distance between stop positions multiplied by the cross sectional area of the bore is a unit volume which comprises a unit dose.
26) A device as set forth in claim 25 ) wherein the unit dose is a plurality of unit doses and all unit doses are substantially equal.
27) A device as set forth in claim 25 ) wherein the unit dose is a plurality of unit doses and all unit doses are of varying dosages.
28) A device as set forth in claim 22 ) further comprising a clip which engages a flange on the barrel and wherein the clip and the slider are integrally formed with a slidable relationship therebetween.
29) A device as set forth in claim 22 ) wherein the at least one continuous track further comprises two tracks, located on opposing sides of the plunger.
30) A device as set forth in claim 28 ) further comprising integrated leaf springs which are integrally molded.
31) A device as set forth in claim 22 ) wherein the follower is mounted on a deflectable beam.
32) A device as set forth in claim 31 ) wherein the deflection creates an audible sound, thereby providing feedback to the user.
33) A device as set forth in claim 22 ) wherein the fluid conduit further comprises a detachable needle assembly having a hub, attachable to the distal end of the barrel and a needle inserted into the hub.
34) A method of performing a multiple dose delivery comprising:
providing a device comprising a fluid conduit; a barrel having a bore, a distal end, and a proximal end wherein the fluid conduit is located at the distal end of the barrel, in fluid communication with the bore and the proximal end of the barrel is adapted to receive a stopper; a plunger connected to the stopper and movable within the barrel, thereby forming a reservoir, the plunger having a longitudinal axis and at least one continuous track formed between a distal end of the plunger and a proximal end of the plunger wherein the track further comprises at least one of each of the following:
a first rest position,
a stop position, having a proximal abutment,
a second rest position,
a camming portion not parallel to the longitudinal axis of the plunger and formed between the first rest position and the stop position;
a reset portion substantially perpendicular to the axis of the plunger and formed between the stop an the second rest position; and,
a slider having a follower and a user depressable portion;
filling the reservoir of the device with a fluid;
moving the slider from an initial position wherein the follower is located outside of the track and does not interfere with plunger movement, to a first position wherein the follower is located within the track;
depressing a portion of the plunger to dispense a portion of the fluid through the fluid conduit and thereby moving the follower with respect to the plunger along the camming portion of the track, thereby causing radial motion of the follower and movement of the follower to the stop position wherein the plunger distal movement is prevented by contact of the follower to the proximal abutment;
applying a biasing force to the user-pressable portion of the slider, thereby moving the follower along the reset portion to the second rest position which coincides with the first rest position; and,
repeating the depressing and applying steps until all the fluid is dispensed from the reservoir.
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Also Published As
Publication number | Publication date |
---|---|
JP2011510727A (en) | 2011-04-07 |
JP5347174B2 (en) | 2013-11-20 |
US20150141932A1 (en) | 2015-05-21 |
US20130289493A1 (en) | 2013-10-31 |
EP2257323B1 (en) | 2019-05-29 |
US8939959B2 (en) | 2015-01-27 |
WO2009095735A1 (en) | 2009-08-06 |
EP2257323A1 (en) | 2010-12-08 |
US9579465B2 (en) | 2017-02-28 |
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