WO1999027852A1 - Method and apparatus for obtaining interstitial fluid for diagnostic tests - Google Patents
Method and apparatus for obtaining interstitial fluid for diagnostic tests Download PDFInfo
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- WO1999027852A1 WO1999027852A1 PCT/US1998/024962 US9824962W WO9927852A1 WO 1999027852 A1 WO1999027852 A1 WO 1999027852A1 US 9824962 W US9824962 W US 9824962W WO 9927852 A1 WO9927852 A1 WO 9927852A1
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- Prior art keywords
- skin
- opening
- sample
- interstitial fluid
- area
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14507—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue specially adapted for measuring characteristics of body fluids other than blood
- A61B5/1451—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue specially adapted for measuring characteristics of body fluids other than blood for interstitial fluid
- A61B5/14514—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue specially adapted for measuring characteristics of body fluids other than blood for interstitial fluid using means for aiding extraction of interstitial fluid, e.g. microneedles or suction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/0045—Devices for taking samples of body liquids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/0045—Devices for taking samples of body liquids
- A61B2010/008—Interstitial fluid
-
- 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
- A61M37/00—Other apparatus for introducing media into the body; Percutany, i.e. introducing medicines into the body by diffusion through the skin
- A61M2037/0007—Other apparatus for introducing media into the body; Percutany, i.e. introducing medicines into the body by diffusion through the skin having means for enhancing the permeation of substances through the epidermis, e.g. using suction or depression, electric or magnetic fields, sound waves or chemical agents
Definitions
- This invention relates to a method and apparatus for obtaining samples of interstitial fluid for diagnostic purposes.
- Diabetes can lead to numerous complications, such as, for example, retinopathy, nephropathy, and neuropathy.
- the most important factor for reducing diabetes-associated complications is the maintenance of an appropriate level of glucose in the blood stream.
- the maintenance of the appropriate level of glucose in the blood stream may prevent and even reverse many of the effects of diabetes.
- Glucose monitoring devices of the prior art have operated on the principle of taking blood from an individual by a variety of methods, such as by needle or lancet. An individual then coats a paper strip carrying chemistry with the blood, and finally insert the blood-coated strip into a blood glucose meter for measurement of glucose concentration by determination of change in reflectance.
- This invention provides a method and apparatus for obtaining a sample of interstitial fluid from a patient for subsequent diagnostic tests, e.g., glucose monitoring. It is believed that the concentration of glucose in interstitial fluid is correlated to the concentration of glucose in blood.
- the method comprises the steps of:
- Step (b) is preceded by the step of increasing the availability of biological fluids in the portion of the skin from which the sample is to be extracted.
- the availability of biological fluids in the area of the skin from which the sample is to be extracted is increased, preferably by means of a vacuum, which is applied to the surface of the skin in the vicinity of the opening prior to forming the opening in the skin.
- the vacuum causes the portion of the skin in the vicinity of the interstitial fluid extraction site to become engorged with biological fluids, i. e., blood and interstitial fluid.
- biological fluids i. e., blood and interstitial fluid.
- the vacuum also causes the portion of the skin in the vicinity of the interstitial fluid extraction site to become stretched.
- An opening in this stretched portion of skin can be formed with a cutting device, e. g., a rotating lancet, a rotating drill, or other device capable of forming an opening in the skin, e. g., a laser. If a cutting device is used to form the opening, it must be retracted from the opening prior to the step of extracting the sample of interstitial fluid from the opening. This retraction will allow the unrestricted flow of interstitial fluid through the opening. After the opening is formed, a vacuum is preferably used to aid in extracting the sample of interstitial fluid from the opening in the skin.
- a cutting device e. g., a rotating lancet, a rotating drill, or other device capable of forming an opening in the skin, e. g., a laser.
- the sample can be analyzed from the drops of interstitial fluid that collect on the surface of the skin at the site of the opening by applying the interstitial fluid directly to a glucose detector.
- the sample be collected in such a manner, e. g., via a capillary tube, that it can be analyzed by conventional diagnostic devices, such as, for example, a biosensor.
- the sample can be collected in a collection zone that is integrated with a conventional diagnostic device, e. g., a biosensor.
- the availability of interstitial fluid in the area of the skin from which the sample is to be extracted can be increased by means of applying thermal energy to that area of skin.
- the thermal energy causes the interstitial fluids in that area of the skin to flow more rapidly, thereby allowing more interstitial fluid to be collected per given unit of time.
- steps (b) and (c) can be carried out in the same manner as they were carried out in the embodiment where a vacuum is used to treat the skin prior to forming the opening.
- an apparatus for collecting a sample of interstitial fluid for analysis in a diagnostic test comprises:
- a device for forming an unobstructed opening in an area of skin from which said sample is to be extracted preferably a rotating drill or a rotating lancet
- the housing is preferred for the convenience of the patient and the protection of the components.
- the vacuum pump and the opening-forming device require a source of power.
- the source of power can be disposed within the housing.
- the source of power can be external to the housing.
- the preferred device for forming an unobstructed opening in the area of the skin from which the sample of interstitial fluid is to be extracted is a lancing assembly, which preferably comprises a rotating drill or a rotating lancet, for forming an opening in the skin.
- the unobstructed opening in the skin can be formed by a laser.
- the vacuum pump can serve the dual purposes of (1) stretching the skin and (2) enhancing the extraction of the sample of interstitial fluid from the unobstructed opening in the skin.
- the vacuum pump can serve the purposes of (1) stretching the skin, (2) increasing the availability of biological fluids to the area of the skin from which the sample is to be extracted, (3) holding the skin in precise position for accurate cutting by means of a cutting tool, and (4) enhancing the extraction of the sample of interstitial fluid from the unobstructed opening in the skin.
- the housing further contains electronics having programmed instructions to switch the vacuum pump on and off to maintain the desired level of vacuum.
- the apparatus preferably contains a motor for driving the rotating drill or rotating lancet, valves, such as, for example, solenoid valves, for releasing the vacuum at the conclusion of the interstitial fluid extraction procedure.
- the apparatus can optionally contain a heating element to increase the availability of biological fluids to the area of the skin from which the sample is to be extracted.
- the apparatus can also contain a glucose detector integrated with the apparatus, e. g., a biosensor, to analyze the sample of interstitial fluid collected by the apparatus.
- the method and apparatus of this invention provide several advantages over the methods and apparatus of the prior art.
- FIG. 1A is a plan view of an opening, greatly enlarged, in the stratum corneum formed by a rotating drill.
- FIG. 1 B is a plan view of an opening, greatly enlarged, in the stratum corneum formed by a rotating lancet.
- FIG. 2 is a plan view of the components of a preferred embodiment of the apparatus of this invention. In this figure, the cover of the housing is removed.
- FIG. 3 is a schematic diagram illustrating how a vacuum causes a portion of the skin to become stretched prior to the formation of an opening in the skin from which the sample of interstitial fluid is extracted.
- FIG. 3 also illustrates the spatial relationship between the nosepiece of the lancing assembly and a glucose detector, e.g., a biosensor.
- FIG. 4 is a block diagram illustrating the electronics of the preferred embodiment.
- FIG. 5 is cross-sectional view of a lancing assembly suitable for use in this invention.
- FIGS. 6A, 6B, and 6C are schematic diagrams illustrating the position of the lancet relative to the surface of the skin prior to, during and after the lancing step of the method of this invention.
- interstitial fluid means the substantially clear, substantially colorless fluid found in the human body, which occupies the space between the cells of the human body.
- the term “drill” means an implement with cutting edges or a pointed end for boring holes in the skin, usually by rotating abrasion.
- the term “lancet” means a medical implement having a multi-faceted blade.
- the embodiments of this invention require the following steps to carry out the function of obtaining a sample of interstitial fluid for carrying out a diagnostic test, e. g., glucose monitoring:
- step (c) extracting the sample of interstitial fluid from the opening in the skin, with the aid of vacuum and stretching of the skin.
- step (b) the step of forming the unobstructed opening, is preceded by the step of increasing the availability of interstitial fluid at the area of the skin from which the sample is to be extracted.
- the availability of interstitial fluids at a given area of the skin can be increased by at least two methods. In one method, a vacuum can be used to cause interstitial fluid to pool in the area of the skin where the vacuum is applied.
- heat can be used to cause interstitial fluid to flow more rapidly in the area of the skin where heat is applied, thereby allowing a greater quantity of interstitial fluid to be extracted from the interstitial fluid extraction site per unit of time.
- the combination of vacuum and heat can also be used.
- Elements for increasing the availability of interstitial fluid at an interstitial fluid extraction site that are suitable for use in this invention include, but are not limited to, a vacuum pump, a localized heating element, skin stretching element, and chemicals.
- a vacuum pump applying a vacuum to the area of the skin from which interstitial fluid is to be extracted can increase interstitial fluid availability under and within the skin at the application site.
- the vacuum can also be used to stretch the skin upwardly into a chamber, thereby increasing pooling of interstitial fluid under the skin.
- This combination of vacuum and skin stretching can also be used to extract interstitial fluid from the opening in the skin. It is well-known that heat can increase perfusion on the large scale of a limb.
- Chemical means such as histamine, can be used to cause a physiological response to increase perfusion under and within the skin.
- the step of forming an unobstructed opening in the area of the skin from which the sample of interstitial fluid is to be extracted is carried out by a cutting device or some other type of device capable of forming an unobstructed opening in the skin.
- Cutting devices suitable for this invention include, but are not limited to, mechanical lancing assemblies.
- Mechanical lancing assemblies- suitable for use in this invention include, but are not limited to, rotating opening- forming devices, such as, for example, rotating drills and rotating lancets.
- Rotating devices are particularly preferred because the depth of cut obtained from these devices is more controllable than the depth of cut obtainable from conventional lancets.
- the skin is very elastic and will deform when struck by the lancet.
- the lancet will penetrate the skin, but the depth of penetration is not easily controllable because this deformation of the skin is not reproducible.
- Conventional lancing devices are designed to penetrate much deeper than necessary because of the variability in the deformation of the skin to lancing.
- a lancet need only penetrate from 0.2 to 0.5 mm into the skin to reach the capillary loops of the skin's dermal layer.
- the standard depth of lancet penetration is 1.6 mm. In order to assure that capillaries are reached the lancet must be fired much deeper than theoretically necessary.
- the depth setting of lancet penetration may be deeper than the preferred 0.2 mm to 0.5 mm, because the skin deforms when it is contacted by the rotary drill or lancet.
- the depth setting does not indicate the actual depth of penetration into the skin.
- the depth setting takes into account a combination of factors including deformation and depth of penetration into the skin.
- a conventional lancing device cannot be used to reliably make the shallow openings in the skin that would be necessary to obtain interstitial fluid without penetrating to the dermal layer and obtaining blood.
- Rotating the lancet or using a drill bit to form the opening in the stratum corneum provides a means of forming a shallow opening.
- the act of rotation with a cutting tool is known to form openings in materials by abrading the surface of the material.
- Rotating devices can be closely controlled by specifying the following parameters:
- the depth of cut must be sufficiently great to penetrate the stratum corneum, but must also be sufficiently low to avoid piercing capillaries. With respect to revolutions per minute, this setting must be sufficiently high to avoid inducing pain in the patient, but must also be sufficiently low to avoid burning the flesh of the patient.
- the diameter of the drill bit must be sufficiently large to bore an opening or openings of sufficient diameter to allow extraction of at least about 0.25 microliters of interstitial fluid within about five minutes or less, but must be sufficiently small so that the opening or openings bored will be of low enough diameter to heal within about seven days, preferably about four days, more preferably about two days.
- time setting must be sufficiently high to ascertain that the proper depth is reached but must be sufficiently low that only the stratum corneum is pierced and at most an insubstantial amount of capillaries are pierced.
- Representative examples of settings suitable for use with a rotating drill are as follows:
- Rotating drills are sometimes preferred over rotating lancets because rotating drills form an opening of the type shown in FIG. 1A, whereas rotating lancets form an opening of the type shown in FIG. 1 B.
- the letter "S" represents the skin
- the letter "O” represents the opening in the skin.
- Other types of devices capable of forming an unobstructed opening in the skin include, but are not limited to, lasers. Lasers suitable for forming an unobstructed opening in the skin to draw blood are also well-known in the art. See for example, U. S. Patent Nos. 4,775,361 , 5,165,418, 5,374,556, International Publication Number WO 94/09713, Lane et al.
- Lasers that are suitable for forming an unobstructed opening in the skin the skin include Er:YAG, Nd:YAG, and semiconductor lasers. Other types of devices capable of forming an unobstructed opening in the skin can be used, and this disclosure should not be construed so as to be limited to the devices listed.
- the opening formed by the device must be unobstructed.
- unobstructed means free from clogging, hampering, blocking, or closing up by an obstacle. More specifically, the expressions "unobstructed opening in the area of the skin from which the sample is to be extracted”, “unobstructed opening in the skin”, and the like are intended to mean that the portion of the opening below the surface of the skin is free from any foreign object that would clog, hamper, block, or close up the opening, such as, for example, a drill bit from a rotating drill or a lancet from a rotating lancet.
- the drill bit must be retracted from the opening prior to the commencement of the extraction of interstitial fluid.
- this type of device typically provides unobstructed openings.
- these expressions are not intended to include foreign objects at the surface of the skin or above the surface of the skin, such as, for example, a glucose monitor, e. g., a biosensor strip.
- the requirement of an unobstructed opening exposes the body to a foreign object either not at all or for only a very short period of time, which is welcomed by the patient.
- the step of extracting the sample of interstitial fluid from the opening In the skin is preferably carried out by a combination of extraction enhancing elements.
- Extraction enhancing elements suitable for use in this invention include, but are not limited to, vacuum, skin stretching elements, and heating elements. It has been discovered that when these elements are used in combination, the volume of interstitial fluid extracted is greatly increased, particularly when a vacuum is applied in combination with skin stretching. In this combination, the vacuum not only causes the interstitial fluid to be rapidly removed from the unobstructed opening by suction, it also causes a portion of the skin in the vicinity of the opening to be stretched. Stretching of the skin can be effected by other means, such as mechanical means or adhesives.
- the extracted interstitial fluid is also collected.
- the step of collecting the sample of interstitial fluid can be carried out in a variety of ways.
- the interstitial fluid can be collected in capillary tubes or absorbent paper.
- the interstitial fluid can be allowed to remain in the interstitial fluid collection chamber, from which it can used directly in a diagnostic test.
- the sample of interstitial fluid is collected on the application zone of a glucose detector, from where it can be used to provide an indication of the concentration of glucose in the blood. As stated previously, it is believed that the concentration of glucose in interstitial fluid is correlated to the concentration of glucose in blood. Regardless of the manner in which the interstitial fluid sample is collected, the sample can be analyzed at a time later than the time of collection or at a location remote from the location of collection or both.
- interstitial fluid extraction device 10 comprises a housing 12. Disposed within the housing 12 are a vacuum pump 14, a lancing assembly 16 containing a rotating drill (not shown), a battery 18, and electronics 20. A switch 22 is provided to activate electronics 20. A motor (not shown) is provided to operate the rotating drill of the lancing assembly 16.
- the housing 12 is preferably made from a plastic material. It is preferably of sufficient size to contain all of the components that are required for forming an unobstructed opening in the area of the skin from which the sample of interstitial fluid is to be extracted, extracting the sample of interstitial fluid from the unobstructed opening in the skin, preferably with the aid of a vacuum and a stretching of the skin, and collecting the extracted sample in an amount sufficient to carry out a diagnostic test. Methods of preparing the housing 12 are well-known to one of ordinary skill in the art. As stated previously, the housing
- the vacuum pump 14 must be capable of providing a vacuum that will provide sufficient suction to stretch the portion of the skin in the region from which the sample of interstitial fluid is to be extracted.
- the portion of stretched skin is raised a distance of 1 to 10 mm, preferably 3 to 5 mm, from the plane of the body part of which it is a portion.
- the suction provided by the vacuum pump 14 is stretching the appropriate portion of skin, the suction provided by the vacuum pump 14 also causes the stretched portion to become engorged with interstitial fluid.
- the level of suction provided must be sufficient to cause a relatively large volume of interstitial fluid to become engorged at the point that the vacuum is applied.
- the vacuum pump 14 must also be capable of providing sufficient suction to extract interstitial fluid from the opening in the skin at a rate sufficient to extract at least 0.25 ⁇ L of interstitial fluid within a period of five minutes, preferably within a period of two minutes.
- a vacuum pump 14 that is suitable for the device of this invention can be a diaphragm pump, a piston pump, a rotary vane pump, or any other pump that will perform the required functions set forth previously.
- the vacuum pump 14 employs a self- contained permanent magnet DC motor.
- Vacuum pumps that are suitable for this invention are well-known to those of ordinary skill in the art and are commercially available.
- a vacuum pump suitable for use in the present invention is available from T-Squared Manufacturing Company, Nutley, NJ, and has the part number T2-03.08.004.
- the vacuum pump 14 is preferably capable of providing a pressure of down to about -14.7 psig, and is more preferably operated at from about -3.0 psig to about -10.0 psig.
- the area of the skin subjected to vacuum preferably ranges up to about 50 cm 2 , more preferably from about 0.1 to about 5.0 cm 2 .
- the period of vacuum application prior to forming the opening in the skin i. e., for increasing the availability of interstitial fluid to the application site, preferably ranges up to about 5 minutes, preferably from about 1 to about 60 seconds.
- the period of vacuum application subsequent to forming the opening in the skin i.
- the vacuum provided by the vacuum pump 14 can be continuous or pulsed.
- a continuous vacuum is preferred for the reason that it requires fewer components than does a pulsed vacuum.
- the vacuum applied not cause irreversible damage to the skin. It is preferred that the vacuum applied not produce bruises and discolorations of the skin that persist for several days. It is also preferred that the level of vacuum applied and duration of application of vacuum not be so excessive that it causes the dermis to separate from the epidermis, which results in the formation of a blister filled with fluid.
- the lancing assembly 16 preferably comprises a rotating cutting element, preferably a rotating drill or a rotating lancet. See FIG. 5.
- a rotating cutting element preferably a rotating drill or a rotating lancet.
- narrow gauge (28 to 30 gauge) drill bits are preferred.
- Drill bits and lancet needles suitable for this invention can be made from metal or plastic.
- the depth of penetration of the rotating cutting element preferably ranges from about 0.1 mm to about 1.5 mm, more preferably from about 0.1 mm to about 1.0 mm.
- Lancing assemblies utilizing a rotating cutting element as described herein have never been used in the art. Any lancing assembly selected should operate in conjunction with the other features of the apparatus of this invention. For example, if a vacuum is employed, the lancing assembly must be designed so that a vacuum can be formed and drawn through the assembly.
- the vacuum pump 14 is connected to the lancing assembly 16 by an evacuation tube 24.
- the air that is evacuated from the lancing assembly 16 by the vacuum pump 14 is removed via the evacuation tube 24.
- the evacuation tube 24 is typically made from a polymeric material.
- a check valve 26 is placed between the vacuum pump 14 and the lancing assembly 16 at a point in the evacuation tube 24 to prevent air removed from the lancing assembly 16 by the vacuum pump 14 from flowing back to the lancing assembly 16 and adversely affecting the vacuum.
- a source of power for the vacuum pump 14 and the motor that runs the rotating cutting element can be disposed within the housing 12.
- a source of power suitable for the device of this invention is a battery 18.
- an external source of power can be used to operate the vacuum pump 14 and the motor that runs the rotating cutting element.
- the power source is actuated by the electronics 20, which, in turn, is actuated by the switch 22.
- the electronics 20 may incorporate a microprocessor or microcontroller.
- the function of the electronics 20 is to switch power on and off to operate the various components in the apparatus. These components include, but are not limited to, the vacuum pump 14.
- the electronics 20 can also be use to switch power on and off to operate components in alternative embodiments, e. g., heating elements, lancing assemblies, indicating devices, motors, and valves.
- Electronics suitable for this invention is the "TATTLETALE MODEL 5F" controller/data logger, commercially available from Onset Computer Corporation, 536 MacArthur Blvd. P. O. Box 3450, Pocasset, Massachusetts
- Auxiliary electronic devices such as power transistors, pressure monitors, and OP-Amps (operational amplifiers), may also be required in order to provide an interface between the controller and the operational components. All electronics required for this invention are well-known to one of ordinary skill in the art and are commercially available. Auxiliary electronic devices suitable for use in this invention include the components listed in Table 1. Table 1
- FIG. 4 illustrates by way of a block diagram how the foregoing electronic components can be arranged to carry out the method of the present invention. Operation of the interstitial fluid extraction device 10 will now be described.
- the nosepiece 30 of the lancing assembly 16 is applied to the surface of the skin, designated herein by the letter "S".
- the end of the nosepiece 30 that contacts the skin is equipped with a seal 32.
- the purpose of the seal 32 is to prevent air from leaking into interstitial fluid extraction chamber 34, so that the vacuum pump 14 can provide sufficient suction action for increasing the availability of interstitial fluid to the area of the skin from which the sample is to be extracted, stretching the skin, and extracting the sample of interstitial fluid from the unobstructed opening in the skin.
- the seal 32 surrounds an opening 33 in the nosepiece 30.
- the opening 33 in the nosepiece allows communication between the surface of the skin and a interstitial fluid extraction chamber 34 in the nosepiece 30.
- the seal 32 is preferably made of a rubber or an elastomeric material.
- the switch 22 is actuated, typically by being pressed, thereby activating the electronics 20, which starts the vacuum pump 14.
- the vacuum pump 14 then provides a suction action.
- the suction action of the vacuum pump 14 causes the skin circumscribed by the seal 32 to become engorged with interstitial fluid. Engorgement of the skin with interstitial fluid is accompanied by a stretching of and rising up of the skin up to opening 33.
- the lancing assembly 16 is actuated, thereby causing the rotating cutting element 36 to first rotate at the proper rotational speed and then to abrade the skin that has risen up to the opening 33.
- the rotating cutting element 36 is caused to rotate at the proper rotational speed prior to being allowed to abrade the skin.
- the rotating cutting element 36 is then retracted, preferably automatically. Thereupon, the interstitial fluid flows out of the unobstructed opening resulting from the rotating cutting element 36, and, aided by the vacuum generated by the vacuum pump 14, is collected.
- the electronics 20 causes the vacuum pump 14 to stop.
- the lancing assembly 16 preferably has a drive system 40 to bring about rotation of the lancet 36, a spring 42 to drive the lancet 36, and a release button 44 to allow the rotating lancet 36 to be released, whereby the rotating lancet 36 can penetrate the skin.
- the drive system 40 includes a clutch 46 to disengage when the rotating lancet 36 is projected upon actuation of the release button 44.
- the spring 42 and the release button 44 are not needed.
- FIGS. 6A, 6B, and 6C illustrate schematically the positioning of the lancet assembly 50 of the apparatus of this invention before, during, and after the formation of an unobstructed opening in the skin for the purpose of obtaining intestitial fluid.
- FIG. 6A shows the position of the lancing assembly 50 before formation of the opening;
- FIG. 6B shows the position of the lancing assembly 50 during formation of the opening;
- FIG. 6C shows the position of the lancing assembly 50 after formation of the opening.
- the lancet of the lancing assembly 50 is designated by the reference numeral 52 and the lancet holder of the lancing assembly 50 is designated by the reference numeral 54.
- the direction of rotation of the rotating lancet is indicated by the arrow "Z".
- the interstitial fluid is preferably directly collected on the application zone of a glucose detector, e. g., a reflectance strip or biosensor.
- the interstitial fluid can then be used as the sample for a determination of glucose concentration in blood. It is believed that the concentration of glucose in blood is correlated to the concentration of glucose in interstitial fluid.
- the interstitial fluid can be collected by other collection devices, such as, for example, a capillary tube or absorbent paper.
- the apparatus of the present invention can include a glucose detector for analyzing the fluid sample obtained by the apparatus.
- Glucose detectors are well-known in the art. With respect to glucose monitoring, there are two major categories of glucose detectors - optical detectors, e. g., reflectometers, and electrochemical detectors, e. g., biosensors. Representative examples of reflectometers suitable for this invention are described in U. S. Patent No.
- the glucose detector is preferably disposed in or near the nosepiece 30 of the lancing assembly 16.
- the glucose detector must be located at a position sufficiently close to the site of fluid extraction so that the quantity of extracted fluid collected will be sufficient to carry out a standard glucose determination. Typically, this distance will preferably be no more than 5 mm from the site of fluid extraction, more preferably no more than 3 mm from the site of fluid extraction, most preferably no more than 1 mm from the site of fluid extraction.
- the glucose detector 60 can be modified, if necessary, so that the interstitial fluid collected in the collection zone of the glucose detector is capable of being used to activate the glucose detector.
- FIG. 3 also illustrates a manner for disposing a glucose detector 60 in the nosepiece 30 of the lancing assembly 16.
- This invention provides numerous advantages over fluid extraction devices of the prior art. Among these advantages are the following: 1. Ability to use numerous parts of the body as a site for the extraction of interstitial fluid;
- the apparatus included a small drill press (Electro-Mechanico, model 106 W) with a stationary platform for steadying and centering the arm below the drill head. Through the top of the platform was a 1.25 inch diameter opening with a clear plastic fitting that mounted flush with the bottom of the platform. In the clear plastic fitting a small opening that was just larger than the drill bit being used was centered to the drill head . The clear fitting allowed visual centering of the area at which the stratum corneum was to be opened. The depth of drill penetration was set at 1.08 mm below the bottom platform (depth setting determined experimentally to give good results) and the drill speed was set at
- the drill bit selected was a 0.74 mm stainless steel twist drill.
- Sites on the upper forearm that were to have the openings formed were initially not pretreated with any form of vacuum or heat. These sites were compared directly to sites that were pretreated with heat (45° C) and vacuum (- 10 psig) for 60 seconds over an area of 10 square millimeters. The area was then pressed tightly up and centered under the clear plastic fitting, the drill head and bit lowered, and the top layer of skin opened with a 3 second application of the rotating drill bit. Vacuum (-10 psig) was reapplied to the opened area for 60 seconds by using a plastic fitting having an opening of diameter of 14.29 mm.
- This example illustrates that the application of vacuum with stretching of the skin results in a greater volume of interstitial fluid being obtained after formation of the opening. Decreasing the size of the area to which vacuum is applied for the collection of interstitial fluid results in a decrease in recovery of interstitial fluid.
- Example 1 The apparatus, the pretreatment, and the forming of the opening in the skin were carried out as described in Example 1.
- Plastic vacuum collection fittings were used. One fitting had a 7.5 mm diameter opening without mesh, and two fittings had 14.29 mm diameter openings, one without mesh and one with a 2 mm x 2 mm mesh across the opening.
- the effect of stretching the skin and the effect of the area of applied vacuum can be assessed by the volumes of interstitial fluid recovered.
- the results of recovery of interstial fluid are set forth in Table 3. Table 3
Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA002309962A CA2309962A1 (en) | 1997-12-02 | 1998-11-20 | Method and apparatus for obtaining interstitial fluid for diagnostic tests |
AT98958113T ATE286675T1 (en) | 1997-12-02 | 1998-11-20 | DEVICE FOR SAMPLING INTERSTITIAL FLUID FOR DIAGNOSTIC TESTS |
JP2000522844A JP2001524343A (en) | 1997-12-02 | 1998-11-20 | Method and apparatus for obtaining interstitial fluid for diagnostic tests |
EP98958113A EP1035799B1 (en) | 1997-12-02 | 1998-11-20 | Apparatus for obtaining interstitial fluid for diagnostic tests |
DE69828645T DE69828645T2 (en) | 1997-12-02 | 1998-11-20 | APPARATUS FOR REMOVING INTERSTITIAL FLUID FOR DIAGNOSTIC TEST |
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Also Published As
Publication number | Publication date |
---|---|
DE69828645T2 (en) | 2005-12-29 |
ES2236960T3 (en) | 2005-07-16 |
US6155992A (en) | 2000-12-05 |
EP1035799B1 (en) | 2005-01-12 |
DE69828645D1 (en) | 2005-02-17 |
CA2309962A1 (en) | 1999-06-10 |
JP2001524343A (en) | 2001-12-04 |
ATE286675T1 (en) | 2005-01-15 |
EP1035799A1 (en) | 2000-09-20 |
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