the new shunt system 10 utilizes some of the components of existing shunt systems , namely a brain ventricular catheter 12 , a distal or downstream catheter 14 , and a regulating valve 16 , and adds new components in order to overcome the problems particular to the patient population with significant blood in the csf and its propensity for clogging existing shunt systems . the catheter 12 is positioned for draining fluid from the brain ventricle , and the distal catheter 14 passes the fluid to a selected terminus within the patient &# 39 ; s system , such as the peritoneal cavity , the pleural cavity , the pleural cavity , or the blood circulation system . the shunt system function will be independent of the type of regulating valve mechanism utilized and therefore independent of the valve manufacturer . each catheter preferably includes a sylastic tube . in order to overcome the problem of the propensity for obstruction of the valve system with blood and debris , the blood is broken down prior to entering the regulating valve . in this way , the likelihood of the valve becoming occluded is dramatically lessened or even eliminated . a thrombolytic agent is introduced into the shunt system before the bloody csf reaches the regulating valve , preventing the otherwise inevitable obstruction of the valve by the bloody csf . in order to accomplish this , a number of technical problems have been addressed to maintain the efficacy of the system without creating risk from the system , and specifically from the use of thrombolytics . the first problem to resolve is the way in which a continuous dose of thrombolytics is infused into the shunt system at a dose rate that is sufficient to create breakdown of bloody csf . the system used to deliver the thrombolytics has the capacity to deliver the medication through a completely self - contained mechanism . in other words , the entire system may be implantable and does not require any external devises for its use . second , the system desirably is able to deliver medication to the shunt system for a long enough period of time that external breaching of the system , for refill of medication , for example , should be minimal so as to reduce the risk of infection and the need for dedicated medical assistance . this necessitates that the medication used be very effective in small doses for its thrombolytics effects , and that the reservoir for delivery of the drug be sufficiently large so as to not need frequent refills . the drug delivery system preferably consists of a drug reservoir fitted with a constant flow output pump , i . e ., a pump that dispenses a known quantity of fluid each time the pump is cycled . the pump will be connected to the shunt system via sylastic tubing at a point proximal to and upstream from the regulating valve . in this way , the bloody csf will mix with the thrombolytics prior to entering the regulating valve . this allows the blood in the csf to break down prior to reaching the valve , and therefore prevent valve obstruction . another aspect to resolve relates to safety . upstream to the point where the drug reservoir fluidly connects to the system , a one - way valve is incorporated . these valves are “ on - off ” type valves with little in the way of a mechanism that could get obstructed . the valves do , however , prevent a back flow of csf mixed with thrombolytics from gaining access into the brain ventricle . in this way , the thrombolytics will only have access to the shunt tubing from the one - way valve and downstream from the one - way valve , including the regulating valve mechanism and the distal tubing . no thrombolytics could enter into the brain ventricle . the risk of subsequent intraventricular hemorrhage induced by thrombolytics should be eliminated . the components to be added to the traditional shunt system would be three : 1 . a one - way or check valve 18 spaced along the tubing 12 coming form the brain ventricle and before reaching the regulating valve 16 . the check valve 18 may use a simple flap 20 inside of the tubing ( see fig2 ) that can open only in the direction of forward csf flow and does not allow retrograde flow . the flap 20 is thus positioned between the brain ventricle end of the ventricular catheter and the regulating valve , and prevents any thrombolytics from gaining access to the ventricular system . the check valve 18 is shown in greater detail in fig2 . 2 . a reservoir 30 which is intended for the mixing of bloody csf with thrombolytics . this reservoir will be placed downstream from the one - way valve 18 earlier and upstream of the regulating valve 16 of the shunt system . this reservoir will have two inlets , one to accept the bloody csf coming from the ventricular system , and the second to accept the thrombolytic agent coming from the pump . this reservoir will allow an area for the mixing of the bloody csf and the thrombolytics that will break down of blood products prior to them reaching the valve . the mixing reservoir 30 preferably has a cross - section greater than that of the upstream and downstream catheters , and preferably has a volume of from about 1 to about 5 cc . in some applications , the mixing reservoir or chamber may not be used , although the junction of the ventricular catheter and the liquid thrombolytic solution from the pump preferably include a small chamber where mixing occurs before the mixed fluid is passed to the regulating valve . 3 . a drug delivery system 28 with an implantable pump 24 . this may be simple pump with a set rate of drug delivery . the device will be fully implantable in the subcutaneous tissue where it will be accessible for refilling with medication . reservoir 26 contains the thrombolytic agent of sufficient size ( 10 - 30 cc volume ) so as to make the need for refill no more than once weekly . the pump 24 may be connected to the shunt system via a sylastic tube 22 and its point of connection to the system will be one of the inlet ports of the reservoir described above . since the intraventricular blood dissolves over the course of 2 - 6 weeks , the long - term function of the pump only needs to be for a period of 6 weeks . at this point it can be removed through a simple operation or it can be left in place indefinitely . the ventricular catheter 12 may be placed into the brain ventricle through a burr hole in the skull . the one - way valve 18 would connect to it and lie on the external surface of the skull , under the scalp . it would connect with the three - way connector 36 which contains the reservoir 30 and then to the regulating valve 16 , which will also be on the surface of the skull , below the scalp . the distal catheter 14 may then be placed under the subcutaneous tissue and extend to a selected terminus within the patient . the implantable drug delivery pump 24 and reservoir 26 may be placed under the subcutaneous tissue of the anterior chest wall , and then its connecting tubing connected to the three - way valve under the scalp . the pump 24 and reservoir 26 may be made as a single unit , and may be external to or implanted under the patient &# 39 ; s skin . the system may be a completely implantable device that can be utilized while the patient still has significant amounts of blood in the csf . this will allow for early mobilization of patients without having the complication of shunt malfunction due to obstruction of the regulating valve system by bloody csf . the benefits will be dramatic , both for the patient by reducing morbidity and mortality associated with infections and other complications associated with externalized ventricular catheters , and for the health care system by reducing costs associated with increased length of stay in the intensive care settings . the term “ check valve ” as used herein is broadly referring to any type of valve for allowing fluid flow in one direction and substantially prohibiting fluid flow in an opposite direction . a check valve with a flapper member is preferred , but other types of valves may serve the same purpose . the term “ regulating valve ” as used herein is intended to refer to any valve for controlling flow through the distal catheter . various types of regulating valves have been used for selectively controlling the passage of cerebral spinal fluid to a selected terminus within the patient , and may be used with the shunt system of the present invention . similarly , various types of pumps have been devised for delivering a liquid thrombolytic solution to a delivery location upstream from the regulating valve . a constant flow output pump which dispenses a given quantity of fluid each time the pump is cycled is preferred for many applications . although specific embodiments of the invention have been described herein in some detail , this has been done solely for the purposes of explaining the various aspects of the invention , and is not intended to limit the scope of the invention as defined in the claims which follow . those skilled in the art will understand that the embodiment shown and described is exemplary , and various other substitutions , alterations and modifications , including but not limited to those design alternatives specifically discussed herein , may be made in the practice of the invention without departing from its scope .
an implantable shunt system 10 and method include a ventricle catheter 12 for insertion into the brain ventricle , a distal catheter 14 for insertion into a selected terminus in the patient , and a regulating valve 16 for controlling flow through the distal catheter . an implantable pump 24 delivers a liquid thrombolytic solution upstream from the regulating valve , and a check valve 18 prohibits flow through the check valve in the direction toward the brain ventricle . a storage reservoir or chamber 26 is provided for containing the thrombolytic agent .