Hemostatic powder delivery devices and methods

Abstract

The present invention is directed to a device for expression of a hemostatic powder having an elongated reservoir with a manual air pump, such as a bellows, at a proximal end and an expression port at a distal end. A porous filter is slidably disposed within the elongated reservoir between the bellows, a plunger, and the expression port, and a spring is disposed within the elongated reservoir between the manual air pump and the plunger. The hemostatic powder is disposed within the elongated reservoir between the porous filter and the expression port, and the manual air pump is in a fluid communication with the expression port through the porous filter and through the hemostatic powder.

Claims

1. A method for expressing a hemostatic powder comprising steps of: a) positioning the hemostatic powder in an elongated hollow reservoir having a manual air pump attached to the elongated hollow reservoir and an open-ended port at a distal end of said elongated hollow reservoir, with said hemostatic powder in said elongated hollow reservoir being under a porous filter slidably disposed within the elongated hollow reservoir between said manual air pump and said open-ended port, with a spring disposed within the elongated hollow reservoir between the manual air pump and the porous filter, further comprising a step of a1) opening by rotating a powder trap comprising a tortuous channel for the hemostatic powder having an entrance orifice open to the elongated hollow reservoir and an exit opening, wherein said powder trap is rotatable about the elongated hollow reservoir from a first position to a second position and in the first position the entrance orifice is blocked by a blocking member within the elongated hollow reservoir and in the second position the entrance orifice is not blocked by the blocking member; b) compressing the manual air pump thus supplying pressurized air into the elongated hollow reservoir and simultaneously compressing the spring thus exerting pressure on the porous filter and the hemostatic powder; c) allowing the pressurized air to reach the hemostatic powder through the porous filter and to exit from the open-ended port with a portion of the hemostatic powder; d) simultaneously advancing the porous filter towards the distal end under pressure from the spring, thus keeping the hemostatic powder compressed under the porous filter; e) releasing the manual air pump allowing ambient air to refill the manual air pump; f) repeating the steps (b) through (e).

2. The method of claim 1, wherein said porous filter is attached to a plunger slidably disposed within the elongated hollow reservoir between said porous filter and said manual air pump and a hollow expression cannula is attached to said open-ended port and extends distally, said hollow expression cannula is in fluid communication with said manual air pump.

3. The method of claim 1, wherein the manual air pump is in a fluid communication with the open-ended port through the porous filter and through the hemostatic powder.

4. The method of claim 1, wherein the spring is in a non-compressed state prior to expressing the hemostatic powder.

5. The method of claim 1, wherein the spring is compressed towards the distal end by compressing the manual air pump.

6. The method of claim 1, wherein said hemostatic powder is an ORC powder.

7. The method of claim 1, wherein repeating the compression and the release of the manual air pump delivers uniform quantities of said hemostatic powder expressed over a plurality of sequential expressions.

8. The method of claim 1, wherein said spring, when compressed, applies the pressure on said porous filter causing said porous filter to move in a distal direction.

9. The method of claim 1, wherein said manual air pump comprises a bellows.

10. The method of claim 1, wherein said porous filter comprises interconnected pores or channels having a size substantially preventing the hemostatic powder from passing through the porous filter.

Description

BRIEF DESCRIPTION OF FIGURES

(1) FIG. 1 shows an embodiment of the powder delivery device of the present invention in closed configuration.

(2) FIG. 2 shows an embodiment of the powder delivery device of the present invention in open configuration.

(3) FIG. 3 shows an embodiment of the powder delivery device of the present invention in closed configuration.

(4) FIG. 4 shows an embodiment of the powder delivery device of the present invention in open configuration.

(5) FIG. 5 shows an embodiment of the powder delivery device of the present invention in an exploded view.

(6) FIG. 6 shows an embodiment of the powder delivery device of the present invention in an exploded view.

(7) FIG. 7 shows an embodiment of the powder delivery device of the present invention in a partially disassembled view.

(8) FIG. 8 shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(9) FIG. 9 shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(10) FIG. 10 shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(11) FIG. 11 shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(12) FIG. 12 shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(13) FIG. 13 shows an embodiment of the powder delivery device of the present invention.

(14) FIG. 14 shows an embodiment of the powder delivery device of the present invention.

(15) FIGS. 15A and 15B shows an embodiment of the powder delivery device of the present invention in a cross-sectional view.

(16) FIGS. 16A and 16B shows an alternative embodiment of the powder delivery device of the present invention in a cross-sectional view.

(17) FIG. 17 shows an embodiment of the powder delivery device of the present invention with elongated cannula attached.

(18) FIG. 18 shows rigid shaft with a shroud.

(19) FIG. 19 shows elongated cannula partially inserted into the rigid shaft with a shroud.

(20) FIG. 20 shows an embodiment of the powder delivery device of the present invention with elongated cannula and rigid shaft with a shroud attached.

(21) FIGS. 21A and 21B shows an alternative embodiment of the powder delivery device of the present invention.

(22) FIGS. 22A and 22B shows an alternative embodiment of the powder delivery device of the present invention.

(23) FIG. 23 shows a schematic rendering of an alternative embodiment of the powder delivery device of the present invention.

(24) FIG. 24 shows a schematic rendering of a comparative device used in testing.

(25) FIG. 25 shows a chart of the quantities of powder expressed from the comparative device with each expression or powder burst plotted as cumulative grams expressed relative to the sequential number of expression, using vertical orientation of the comparative device.

(26) FIG. 26 shows a chart of the quantities of powder expressed from the comparative device with each expression or powder burst plotted as cumulative grams expressed relative to the sequential number of expression, using horizontal orientation of the comparative device.

(27) FIG. 27 shows a chart of the quantities of powder expressed from the device of the present invention plotted as cumulative grams expressed relative to the sequential number of expressions, using vertical orientation of the inventive device.

(28) FIG. 28 shows a chart of the quantities of powder expressed from the device of the present invention plotted as cumulative grams expressed relative to the sequential number of expressions, using horizontal orientation of the inventive device.

DETAILED DESCRIPTION

(29) Embodiments of the powder delivery device 10 of the present invention are shown in FIGS. 1-4 in prospective view, FIGS. 5-7 in an exploded view, FIGS. 8-12 in a cross-sectional view, FIGS. 13-14 in a partial prospective internal view. Device 10 comprises a hollow tubular body or reservoir 20 on which a manual air pump, such as a compressible elastic bulb (not shown) or bellows 30 (as shown) is mounted at a proximate end 11. Reservoir 20 has an optional hand grip 25 at proximate end 11. Within reservoir 20 is positioned a plunger 40 with an optional filter 50 mounted on plunger 40. Plunger 40 with filter 50 is mounted slidably within reservoir 20 and is capable of advancing within reservoir 20 towards distal end 12. At distal end 12 of reservoir 20 is positioned an open-ended port 60 which is in fluid communication with reservoir 20. Onto port 60 is axially mounted an optional powder trap 70 onto which is axially mounted a hub 80, which is integrated with a tubular expression cannula 90 having a cannula exit 95. Optional O-rings can be provided (not shown) for air-tight mounting of powder trap 70 and hub 80.

(30) Plunger 40 has an optional plunger stem 42 axially extending from plunger 40 rearward towards proximal end 11. On plunger stem 42 is positioned spring 45. Spring 45 is positioned between bellows 30 and plunger 40 and partially inside bellows 30, more specifically between top of bellows 32 and plunger 40. Plunger 40 and filter 50 are coaxially and slidably moveable within reservoir 20. Plunger 40 forms an optional gap 41 between reservoir 20 and plunger 40, with gap 41 ranging from about 0.01 mm to about 2 mm, such as 0.1 mm, 0.2 mm, 0.3 mm or 0.5 mm. Alternatively to optional gap 41, or in addition to a narrow gap 41, at least one aperture in plunger 40 (aperture not shown) provides for a path for gas to pass from proximal side of plunger 40 to distal side of plunger 40.

(31) Microporous filter 50 snugly and slidably fits within reservoir 20 and moves together with plunger 40 onto which filter 50 is mounted. A portion of reservoir 20 between filter 50 and port 60 is a powder compartment 22, filled with hemostatic powder (not shown). Volume of powder compartment 22 is changing depending on the position of plunger 40 and filter 50, and as plunger 40 advances towards distal end 12 or towards port 60, volume of powder compartment 22 decreases.

(32) As shown in FIGS. 5, 6, 8-10, 12-14, optional powder trap 70 is mounted onto port 60 by any known means, such as by snap-on mounting. Optional powder trap 70 provides for a tortuous path for the powder and gas exiting powder compartment 22. Powder trap is formed by trap lid 76 covering tortuous path 72 which is a channel having several bends and starting with an orifice 73 located within powder compartment 22. As further shown in FIGS. 9, 12 tortuous path 72 results in turning of the direction along which air and powder are advancing within device 10, particularly turning from going generally from proximal towards distal direction, i.e. from powder compartment 22 to cannula exit 95, to going a short distance in other direction, such as in sideways direction and/or in opposite direction, i.e. perpendicular to main axis of device 10 or rearwards, from distal end 12 towards proximal end 11. This change in the direction along which air and powder advancing within device 10 along tortuous path 72 is shown schematically by arrows 100 which indicate air and powder advancement from proximal end 11 towards distal end 12, with a brief intermittent change in the direction when advancing through tortuous path 72.

(33) Powder trap 70 prevents hemostatic powder (not shown) in powder compartment 22 from exiting device 10 via cannula 90 when no air flow is present, i.e. prevents loss of powder especially when device 10 is positioned with cannula exit 95 points generally downwards, especially when device 10 is subject to shaking or vibration or any variable acceleration movements. Powder trap 70 prevents unintentional expression of small quantities of powder from powder compartment 22, while allowing powder expression when driven by air flow.

(34) Optional reservoir ridges 24 and powder trap ridges 75 are grasping features located on the outside surface of reservoir 20 and powder trap 70 and enable an optional blocking feature of device 10, providing for blocking orifices 73 serving as entrance to tortuous path 72. Using powder trap ridges 75 powder trap can be rotated about reservoir 20 to which powder trap 70 is snapfit and rotatably attached at port 60. In the embodiments of FIGS. 2, 4, 7, 9, 10, 12, 13, when reservoir ridges 24 and powder trap ridges 75 are aligned, orifice 73 is open into powder compartment 22 and not blocked by blocking member 28 within reservoir 20 (FIG. 13) so that powder and air can enter tortuous path 72 and exit device 10 via cannula exit 95.

(35) In the embodiments of FIGS. 1, 3, 8, 14, when reservoir ridges 24 and powder trap ridges 75 are not aligned or are rotated at 90° to each other, orifice 73 is blocked by blocking member 28 within reservoir 20 (FIG. 14) and thus orifice 73 is closed preventing powder and air entering tortuous path 72 from powder compartment 22 and exiting device 10 via cannula exit 95. This optional blocking feature prevents inadvertent activation of device 10 and inadvertent expression of powder.

(36) Referring to FIGS. 9, 11, 12, the flow of air and/or air with entrained powder from powder compartment 22 is schematically indicated by arrows 100. Bellows 30 is in fluid communication with cannula exit 95 through gap 41, filter 50, powder compartment 22, tortuous path 72, hub 80, and cannula 90. Upon compression of bellows 30 air moves from bellows 30 via gap 41 and through filter 50 into powder compartment 22. From powder compartment 22, as also is schematically indicated by arrows 100, powder and air stream are entering tortuous path 72 through orifice 73 and then move from tortuous path 72 into hub 80, cannula 90, exiting device 10 via cannula exit 95.

(37) Further referring to FIG. 15, which shows schematically a partial cross-sectional view of device 10, as shown in FIG. 15A, upon applying pressure in the direction schematically shown by arrow 33 on bellows top 32, bellows 30 compresses generating air pressure inside bellows 30. Air is then moving through device 10 as schematically indicated by arrows 100 from bellows 30 via gap 41 and through filter 50 into powder compartment 22. From powder compartment 22, powder 110 and air stream are expressed from the device via cannula 90 (not shown in FIG. 15).

(38) Upon release of pressure on bellows 30, bellows 30 returns to uncompressed state, creating a vacuum inside bellows 30. Air or gas is inspired into bellows 30, with air entering device 10 via cannula 90, passing through powder compartment 22, and filter 50. Filter 50 prevents powder penetration into bellows 30 so that bellows 30 is substantially free of powder throughout the expression.

(39) Powder compartment 22 is maintained so that the volume of powder compartment 22 is substantially filled with powder, with substantially no free air space or minimal free air space. The inventors surprisingly discovered that such arrangement results in better uniformity of powder expression throughout the expression cycle, i.e. from when device 10 is fully charged with powder to emptying of powder compartment 22 of all remaining powder, as well as in better directional expressing uniformity, i.e. in minimal differences between the expression of powder with cannula 90 directed horizontally relative to directed vertically. Powder compartment is also maintained under low compression or no compression. The inventors surprisingly discovered that such arrangement results in much better uniformity of powder expression and prevents aggregation and agglomeration of powder.

(40) Spring 45 serves as a compressible advancer of plunger 40 and filter 50. As bellows 30 is depressed, bellows 30 generates flow of air expressing powder from device 10. Simultaneously, top of bellows 32 is compressing spring 45, which in turn applies pressure on plunger 40 and filter 50 causing plunger 40 and filter 50 to move in distal direction, decreasing the volume of powder compartment 22 as powder is expressed from device 10.

(41) Thus with each depression of bellows 30 generating air flow and powder expression from powder compartment 22, plunger 40 with filter 50 are simultaneously driven towards distal end 12 by spring 40 which is depressed upon compression of bellows 30. Thus upon each expression of powder from device 10, plunger 40 with filter 50, advances distally to take up the space freed by expressed powder. This action results in volume of powder compartment 22 being constantly adjusted to correspond to the volume of powder remaining in powder compartment 22.

(42) Advantageously, upon release of bellows 30 pressure on spring 45 is released and spring can expand rearward or proximally freely, without pulling on plunger 40 with filter 50. Advantageously, spring 40 is not attached to bellows 30, resulting in spring 40 not being pulled proximally upon release of pressure on bellows 30 and expansion of bellows 30 into uncompressed state. Advantageously, plunger 40 with filter 50 are snugly and slidably fit inside reservoir 20 and remain in position furthest advanced during powder expression. During the inspiration of air into bellows, when pressure on bellows 30 is removed allowing bellows to expand, plunger 40 with filter 50 are not moving in proximal direction, instead maintaining the closest position to distal end 12 achieved during the prior powder expression cycle. The frictional engagement of plunger 40 with filter 50 against reservoir 20 prevents easy movement of plunger 40 with filter 50 rearward, i.e. in proximal direction.

(43) Depression of bellows 30 results in simultaneous generation of gas pressure within device 10 and pressure on spring 45 which in turn forces plunger 40 with filter 50 advance within powder compartment 22 to take up any space freed by powder 110 expressed from powder compartment 22.

(44) Advantageously, prior to any expression, there is no or very little pressure on powder in powder compartment 22. Because there is no or very little constant pressure of spring 45 on powder in powder compartment 22, potential agglomeration and caking of powder are prevented.

(45) Referring to FIG. 15A, spring 45 is shown positioned on plunger stem 42. Spring 45 is situated between top of bellows 32 and plunger 40, and is shown touching top of bellows 32. Alternatively, as shown in FIG. 15B, spring 45 can end at a distance 46 from top of bellows 32, distance 46 ranging from 0 mm to about 20 mm, such as 3 mm, 5 mm, 7 mm, 15 mm. FIG. 15B can represent an initial position of spring 45, prior to any expression of powder 110.

(46) FIG. 15B also shows position of spring 45, plunger 40 with filter 50, and powder compartment 22 after one or more powder 110 expressions. As shown in FIG. 15B, upon expression of powder 110 from powder compartment 22, volume of powder compartment 22 decreases with plunger 40 with filter 50 advancing within reservoir 20 and taking freed space. As shown, spring 45 is positioned at distance 46 from top of bellows 32, with distance 46 increasing after each expression.

(47) Referring to FIGS. 16A and 16B, an alternative embodiment of the present invention is shown, in a view similar to the view shown in FIGS. 15A and 15B, whereby spring 45 and optionally plunger 40 are made of compressible foam.

(48) Cannula 90 shown in FIGS. 1-9 is a tubular powder expression member, made of polymer or metal, and can be flexible, semi-flexible, bendable, or rigid. Cannula can have any cross-section, but is preferably tubular with internal diameter from 1 mm to 10 mm, such as 2 mm, 3 mm, 4 mm, 5 mm. Cannula 90 is preferably flexible and can have the length from 3 cm to about 50 cm, such as 4 cm, 5 cm, 10 cm, 20 cm, 30 cm, 40 cm.

(49) Referring to FIG. 17, an elongated cannula 92 useful for laparoscopic applications is shown attached to device 10 at hub 80.

(50) Referring to FIG. 18, a hollow tubular rigid shaft 94 attached to shroud 82 is shown. Rigid shaft 94 is utilized to be positioned over elongated cannula 92 to maintain elongated cannula 92 in a straight linear configuration for delivery through laparoscopic ports and trocars. Rigid shaft 94 has internal diameter closely matching or slightly larger than external diameter of elongated cannula 92, for easy insertion of elongated cannula 92 into rigid shaft 94. FIG. 19 shows insertion of elongated cannula 92 with hub 80 into rigid shaft 94 attached to shroud 82. Shroud 82 is attachable (such as by snap-on means) onto hub 80 and/or onto powder trap 70 and/or onto reservoir 20. FIG. 20 shows device 10 with shroud 82 and rigid shaft 94 attached, with elongated cannula 92 installed and visibly protruding from rigid shaft 94. The length of elongated cannula 92 is selected so as to extend from about 0 mm to about 30 mm from rigid shaft 94, such as extend by 1 mm, 5 mm, 20 mm.

(51) In operation, device 10 filled with powder is brought into a sterile field in operating room. Device 10, if equipped with blocking feature, is then unblocked by aligning reservoir ridges 24 and powder trap ridges 75. Prior to unblocking, or after unblocking, device is directed at the wound or tissue that requires application of hemostatic powder, optionally through a laparoscopic port. Bellows 30 is then depressed, releasing a first portion of hemostatic powder. Bellows 30 is then released, allowing inspiration of air into bellows 30. Steps of depressing and releasing of bellows 30 are then continued sequentially as needed, expressing hemostatic powder towards tissue as needed.

(52) In the device operation, there a number of ways a health practitioner can hold the device for delivering the hemostatic powder. In one application technique, the device 10 is held with one hand, gripping reservoir 20 between index finder and middle finger, or between middle finger and ring finger, and pressing on bellows 30 with the thumb of the same hand for powder expression.

(53) In an alternative application technique, the device 10 is held with one hand, gripping reservoir 20 in a fist by wrapping one or more or index finder, middle finger, ring finger, and little finger, and pressing on bellows 30 with the thumb of the same hand for powder expression. Alternatively, device 10 can be held as convenient by one hand anywhere on reservoir 20, and the bellows 30 can be depressed by another hand. Many other convenient techniques of holding device 10 and depressing bellows 30 for expression of hemostatic powder are possible.

(54) FIG. 21 shows an embodiment of device 10 whereby spring 45 is mounted onto plunger stem 42 between plunger 40 and flange 49. Spring 45 is under constant compression and constantly exerts pressure onto plunger 40. As shown in FIGS. 21A and 21B, upon depressing bellows 30, air moves through the device in a similar way as described above, resulting in expression of powder 110 from powder compartment 22. Pressure from spring 45 forces plunger 40 with filter 50 advances within powder compartment 22 to take up any space freed by powder 110 expressed from powder compartment 22.

(55) FIG. 21B shows position of spring 45, plunger 40 with filter 50, and powder compartment 22 after one or more powder 110 expressions. Upon expression of powder 110 from powder compartment 22, volume of powder compartment 22 decreases with plunger 40 with filter 50 advancing within reservoir 20 and taking freed space. As shown, spring 45 has expanded and takes all space between flange 49 and plunger 40.

(56) FIG. 22 shows an alternative embodiment of the present invention, in a view similar to the view shown in FIGS. 21A and 21B, whereby spring 45 and optionally plunger 40 are made of compressible foam.

(57) FIG. 23 shows an embodiment of inventive device 16 having, no optional powder trap 70, no optional tortuous path 72, no optional orifice 73; no optional reservoir ridges 24 and powder trap ridges 75; no optional blocking feature providing for blocking orifice 73; no optional blocking member 28. Device 16 operates in a similar way to embodiments shown in FIGS. 1-20, whereby upon depressing bellows 30, air moves through the device in a similar way as described above, resulting in expression of powder 110 from powder compartment 22. Pressure from spring 45 forces plunger 40 with filter 50 to advance within powder compartment 22 to take up any space freed by powder 110 expressed from powder compartment 22.

(58) Reservoir 20 can be of any cross-sectional shape, such as rectangular or oval, and is preferably of circular cross-sectional shape, with internal cross-sectional diameter ranging from about 8 mm to about 40 mm, such as 10 mm, 15 mm, 20 mm, 21 mm, 25 mm, and 30 mm.

(59) Bellows 30 has generally a tubular shape and is made of resilient polymeric material, such as polyethylene or polypropylene that enables bellows 30 to be compressed by applying pressure on top of bellows 32, so that when the pressure is removed bellows 30 returns to substantially the same shape as before the compression was applied. Bellows 30 is compressible from about 2:1 ratio of initial height to compressed height to about 6:1 ratio, such as 3:1 ratio of initial height to compressed height. In one embodiment, bellows 30 is about 22 mm in diameter, about 30 mm in uncompressed state, and about 10 mm in fully compressed state, having from 3 to 10 hinges, such as 5 hinges as shown in FIG. 1.

(60) Microporous filter 50 can be made of any porous media such as micro-porated or sintered polymeric material, e.g. PTFE, polyethylene, polypropylene, or similar, preferably with interconnected pores or channels to selectively allow gas flow through filter 50 while preventing flow of powder through filter 50. Pore size or channel density are selected to selectively block passage of powder particles being used, for instance particles ranging from 0.001 mm to 1.0 mm in size, more preferably from 0.05 mm to 0.5 mm, such as particles with effective diameter of 0.05 mm, 0.1 mm, 0.15 mm, 0.20 mm, 0.25 mm, 0.3 mm, 0.35 mm, 0.5 mm. In one embodiment, pore size is at least 20% lower than the average size of particles of the hemostatic powder, such as 50% lower. In the preferred embodiment, filter 50 will block passage of particles with size greater than 0.05 mm.

(61) Spring 45 can be any spring of known types, such as metal wire based spring, or polymeric string based spring. Alternatively, spring 45 is made of compressible and resilient foam.

(62) Filling device 10 with an appropriate hemostatic powder can be performed in a variety of ways. In one method of filling device 10, device 10 is prepared for filling with bellows 30, plunger 40, filter 50, spring 45 removed from reservoir 20, while powder trap 70 is mounted onto port 60, with orifice 73 blocked by blocking member 28 within reservoir 20 and thus closing orifice 73 and preventing powder entering tortuous path 72. Reservoir 20 is then oriented with proximal end 11 facing generally upwards, and reservoir 20 is filled by hemostatic powder gravimetrically or volumetrically through open proximal end 11. In one embodiment, device 10 is filled with 2-10 g of hemostatic powder, such as 3 g, 4 g, or 5 g of hemostatic powder by weight. Thereafter, maintaining vertical orientation of device 10 with proximal end 11 facing generally upwards, plunger 40 and filter 50 are inserted into reservoir 20 from proximal end 11. Thereafter spring 45 is mounted onto plunger stem 42 and bellows 30 is attached to reservoir 20 at proximal end 11.

EXAMPLE 1

Powder Expression—Comparative

(63) A comparative device that is commercially available as the Arista™ delivery device is available from Davol Inc., a subsidiary of C. R. Bard, Inc. The comparative device is pre-filled with 3 g of plant based absorbable surgical hemostatic powder derived from purified plant starch, with no modifications made to the commercially available comparative device or powder filling of said device. The comparative device used in the testing is shown schematically in FIG. 24. Comparative device 17 comprises bellows 30 mounted onto reservoir 20 with grip 25. Powder compartment 22 within reservoir 20 is pre-filled with the hemostatic powder. Device 13 had a tubular expression cannula 90 having a cannula exit 95.

(64) Referring to FIGS. 25 and 26, the results of powder expression testing using comparative device 17 are shown of FIG. 24. The powder was expressed in sequential expressions or bursts when the comparative device was oriented vertically (with cannula 90 and cannula exit 95 facing downwards) with the data presented in FIG. 25; or horizontally (with cannula 90 and cannula exit 95 facing horizontally) with the data presented in FIG. 26. The quantities of powder expressed with each expression or powder burst were measured and plotted as cumulative grams expressed vs. the sequential number of expression. As can be seen from FIG. 25, the comparative device shows highly non-uniform expression of hemostatic powder in vertical orientation, whereby only two expressions express almost all of the powder, and by the fourth expression all 3 g of powder are expressed. This expression pattern is highly non-uniform and inconvenient for the health practitioner, overloading first and second expressions and then expressing little or no powder. This expression pattern is also inconvenient for covering areas of tissue or wound as in only two expressions 80% of the hemostatic powder is expressed leaving nothing for adjacent areas of tissue. Overall in four expressions, all 3 grams of powder were expressed, i.e. on average about 0.75 g per expression was expressed, with first two expressions delivering on average about 1.25 g per expression.

(65) As can be seen from FIG. 26, the comparative device shows non-uniform and incomplete expression of hemostatic powder also in horizontal orientation, whereby by seventh expression of powder the expression of powder ceases with only 2 g or 66% of powder expressed, and 33% of powder still remaining in the device. This expression pattern is inconvenient for the health practitioner, whereby the remaining powder ceases to be expressed from the device in horizontal orientation. On average, the device expressed about 0.25 g per expression, but also failed to express all powder.

(66) Further, with health practitioner changing the direction of expression from horizontal to vertical or any angle in-between, the expression patterns will also change, resulting in unpredictable patterns and expressing more or less powder than expected or needed in each expression. For instance, as shown above, changing orientation can result in changes from 1.25 g per expression to 0.25 g per expression.

EXAMPLE 2

Powder Expression

(67) The hemostatic powder used in testing of the devices of present invention was made from oxidized regenerated cellulose by milling and roller compaction. Briefly, SURGICEL™ ORC fabric was subject to milling and roller compaction. The resulting powder target size was 75 μm-300 μm.

(68) Referring to FIGS. 27 and 28, the results of powder expression testing in the inventive device are shown. Device 10 was loaded with 3 g of hemostatic ORC powder as described above, and the powder was expressed in sequential expressions or powder bursts when device 10 was oriented vertically (with cannula 90 and cannula exit 95 facing downwards), with the data presented in FIG. 27; or horizontally (with cannula 90 and cannula exit 95 facing horizontally), with the data presented in FIG. 28). The quantities of powder expressed with each 5 expressions or powder bursts were measured and plotted as cumulative grams expressed vs. the number of expression. As can be seen from FIG. 27, device 10 shows highly uniform expression of hemostatic powder in vertical orientation, whereby all 3 g of hemostatic powder are expressed in about 35 uniform expressions (grouped in FIG. 27 by five expressions). This expression pattern is uniform and convenient for the health practitioner, resulting in predictable hemostatic powder delivery and delivering smaller quantities of powder, i.e. about 0.075-0.10 g of powder per expression, such as 0.085 g of powder per expression.

(69) As can be seen from FIG. 28, device 10 shows highly uniform expression of hemostatic powder in horizontal orientation as well, whereby all 3 g of hemostatic powder are expressed in seven uniform expressions, albeit with the seventh expression being somewhat lower than previous six. This expression pattern, similarly to data in FIG. 27, is uniform and convenient for the health practitioner, resulting in a predictable hemostatic powder delivery and delivering smaller quantities of powder, i.e. about 0.075-0.10 g of powder per expression, such as 0.085 g of powder per expression.

(70) Further, with health practitioner changing the direction of expression from horizontal to vertical or any angle in-between, the expression patterns will remain substantially unchanged, resulting in predictable patterns and expressing approximately same amount of powder in each expression independently of the orientation of device 10. Device 10 demonstrates substantial independence of the expression of powder from orientation, with orientation changing from downward vertical to horizontal. Further, device 10 demonstrates per expression quantities at the beginning of the powder delivery, i.e. when device 10 is 90-100% full with powder, very similar to per expression quantities at the end of the powder delivery, i.e. when device 10 is almost emptied of the powder, or has 5%-15% powder remaining. Per expression quantities at the beginning of the powder delivery are preferably varying by not more than 5% to 25%, such as varying by not more than 5%, 10%, or 20%.

(71) Having shown and described various versions in the present disclosure, further adaptations of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. The scope of the present invention should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings.