Pericardial access devices and methods
View Patent ↗Described here are devices and methods for accessing the pericardial space. The access devices may include a piercing member such as a needle and a proximal shoulder having a contact surface for contacting the pericardium as the piercing member pierces the pericardium. In some instances, the distance between the piercing member and the proximal shoulder may be adjustable.
1. A method of accessing a pericardial space between a pericardium and a heart, the method comprising:
advancing a distal portion of an access device to the pericardium, the access device comprising a piercing member and a proximal shoulder, the proximal shoulder comprising a distal contact surface having an outer diameter greater than an outer diameter of the piercing member, wherein the piercing member extends distally a first distance beyond the distal contact surface;
engaging the pericardium with the piercing member to tent the pericardium;
piercing through the tented pericardium with the piercing member; and
advancing the access device to engage the pericardium with the distal contact surface of the access device.
2. The method of claim 1 further comprising advancing a distal portion of a guide wire into the pericardial space through an opening in the piercing member.
3. The method of claim 2 further comprising withdrawing the access device while the distal portion of the guide wire remains in the pericardial space.
4. The method of claim 1 wherein the piercing member comprises a needle.
5. The method of claim 4 wherein the needle comprises a Tuohy needle.
6. The method of claim 4 wherein the needle is a 17 gauge needle.
7. The method of claim 1 wherein the position of the proximal shoulder is fixed relative to the position of the piercing member.
8. The method of claim 1 wherein the access device comprises a length between a proximal end and a distal end of the access device, and wherein the access device comprises a curve along its length.
9. The method of claim 1 wherein the first distance is adjustable.
10. The method of claim 9 wherein the access device further comprises a handle comprising an adjustment control configured to adjust the first distance.
11. The method of claim 9 wherein engaging the pericardium with the piercing member comprises advancing the piercing member relative to the proximal shoulder.
12. The method of claim 9 wherein engaging the pericardium with the piercing member comprises retracting the proximal shoulder relative to the piercing member.
13. The method of claim 9 wherein advancing a distal portion of an access device to the pericardium comprises advancing the access device with the piercing member in an at least partially retracted position.
14. The method of claim 9 further comprising increasing the first distance after the piercing member has pierced through the pericardium.
15. The method of claim 1 wherein the first distance is between about 1 mm and 6 mm.
16. The method of claim 15 wherein the first distance is between about 3 mm and 5 mm.
17. The method of claim 16 wherein the first distance is about 4.0 mm.
18. The method of claim 1 wherein the distal contact surface is approximately perpendicular to a longitudinal axis of the piercing member.
19. The method of claim 1 wherein the proximal shoulder comprises a sleeve, and wherein a distal end of the sleeve forms the distal contact surface.
20. The method of claim 1 further comprising delivering a contrast agent into the pericardial space to confirm the positioning of the piercing member.