Systems and methods for shunting fluid

Abstract

Systems and methods are provided herein that generally involve shunting fluid, e.g., shunting cerebrospinal fluid in the treatment of hydrocephalus. Self-cleaning catheters are provided which include split tips configured such that pulsatile flow of fluid in a cavity in which the catheter is inserted can cause the tips to strike one another and thereby clear obstructions. Catheters with built-in flow indicators are also provided. Exemplary flow indicators include projections that extend radially inward from the interior surface of the catheter and which include imageable portions (e.g., portions which are visible under magnetic resonance imaging (MRI)). Movement of the flow indicators caused by fluid flowing through the catheter can be detected using MRI, thereby providing a reliable indication as to whether the catheter is partially or completely blocked. Systems and methods for flushing a shunt system are also disclosed herein, as are various systems and methods for opening auxiliary fluid pathways through a shunt system.

1 - 20 . (canceled) 
     
     
         21 . A method of shunting body fluid, comprising:
 inserting a catheter having first and second flexible tips extending from a distal end thereof and coupled to one another into a fluid-containing cavity such that fluid can flow out of the cavity through the catheter; and   decoupling the first and second tips such that pulsatile flow of fluid within the cavity causes the first and second tips to strike one another, thereby dislodging obstructions from the first and second tips.   
     
     
         22 . The method of  claim 21 , wherein said decoupling comprises at least one of removing a sheath disposed around the first and second tips, removing a stylet or cannula disposed around the first and second tips, and exposing a bioabsorbable adhesive disposed between the first and second tips to the fluid. 
     
     
         23 . The method of  claim 21 , further comprising adjusting a fluid flow rate through a valve in response to an output of a pressure sensor disposed on at least one of the first and second tips. 
     
     
         24 . A catheter, comprising:
 an elongate tubular body having proximal and distal ends and a fluid lumen extending therethrough; and   a plurality of flow-indicating projections extending radially inward from an interior surface of the fluid lumen, each of the projections having an imageable portion;   wherein at least the imageable portions of the projections are configured to move relative to the fluid lumen when fluid is flowing through the fluid lumen and to remain stationary relative to the fluid lumen when fluid is not flowing through the fluid lumen.   
     
     
         25 . The catheter of  claim 24 , wherein the projections each include a first end fixed to the interior surface of the fluid lumen and a second end free to move relative to the interior surface of the fluid lumen. 
     
     
         26 . The catheter of  claim 25 , wherein the imageable portions are disposed at the second free ends of the projections. 
     
     
         27 . The catheter of  claim 24 , wherein the projections are formed by advancing the projections through openings pierced through a sidewall of the elongate tubular body and then sealing the openings. 
     
     
         28 . The catheter of  claim 24 , wherein the imageable portions are formed from a radiopaque material. 
     
     
         29 . The catheter of  claim 24 , wherein the imageable portions are formed from a metallic material. 
     
     
         30 . The catheter of  claim 24 , wherein the imageable portions are formed from a material that is visible under magnetic resonance imaging (MRI). 
     
     
         31 . The catheter of  claim 24 , wherein the projections are flexible. 
     
     
         32 . The catheter of  claim 24 , wherein the projections are disposed throughout the length of the elongate tubular body. 
     
     
         33 . The catheter of  claim 24 , wherein the projections are grouped in one or more clusters formed at discrete locations within the elongate tubular body. 
     
     
         34 . A method of determining whether fluid is flowing through a fluid lumen of an implanted catheter, comprising:
 capturing one or more images of the catheter and a plurality of flow-indicating projections extending radially inward from an interior surface of the fluid lumen, each of the projections having an imageable portion;   determining that fluid is flowing through the fluid lumen when the images indicate that the imageable portions are moving relative to the fluid lumen; and   determining that fluid is not flowing through the fluid lumen when the images indicate that the imageable portions are stationary relative to the fluid lumen.   
     
     
         35 . The method of  claim 34 , wherein the images are at least one of magnetic resonance images, computed tomography images, positron emission tomography images, and fluoroscopic images. 
     
     
         36 . A catheter comprising:
 an elongate body having proximal and distal ends and a plurality of independent fluid lumens extending through at least a portion thereof;   a plurality of fluid openings formed in a sidewall of the elongate body, each fluid opening being in fluid communication with one of the plurality of fluid lumens;   wherein the fluid openings are formed such that fluid openings that are in fluid communication with different ones of the plurality of independent fluid lumens face in different directions.   
     
     
         37 . The catheter of  claim 36 , further comprising a conical tip formed at the distal end of the elongate body, the conical tip having a plurality of fluid openings formed therein, each of the fluid openings being in fluid communication with one or more of the plurality of fluid lumens. 
     
     
         38 . A flusher comprising:
 a body having an upstream port and a downstream port;   a flush channel extending from a ventricle channel and a drain channel to a dome, the ventricle channel extending from the upstream port to the flush channel and the drain channel extending from the downstream port to the flush channel; and   a valve disposed in the flush channel having a first position in which the ventricle channel and the drain channel are in fluid communication with one another and the dome is not in fluid communication with the ventricle channel or the drain channel via the flush channel, and a second position in which the dome is in fluid communication with the ventricle channel via the flush channel and the drain channel is not in fluid communication with the dome or the ventricle channel;   wherein the dome is collapsible to move the valve to the second position and flush fluid through the ventricle channel.   
     
     
         39 . A flushing system, comprising:
 a flush component having a collapsible dome;   a valve component coupled to the flush component by a first catheter and having a flush valve and a flapper valve disposed therein; and   a Y adapter coupled to the valve component by a second catheter and coupled to the flush component by a third catheter;   wherein the flush valve is configured to open when a pressure differential across the flush valve exceeds a predetermined threshold;   wherein the flapper valve is configured to open when the flush valve opens to block fluid flow from the valve component to the Y adapter; and   wherein the dome is collapsible to create a pressure differential across the flush valve.   
     
     
         40 - 44 . (canceled)