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WO2023073636A1 - Système de mesure d'ic-ecg - Google Patents

Système de mesure d'ic-ecg Download PDF

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Publication number
WO2023073636A1
WO2023073636A1 PCT/IB2022/060395 IB2022060395W WO2023073636A1 WO 2023073636 A1 WO2023073636 A1 WO 2023073636A1 IB 2022060395 W IB2022060395 W IB 2022060395W WO 2023073636 A1 WO2023073636 A1 WO 2023073636A1
Authority
WO
WIPO (PCT)
Prior art keywords
fluid
piston
syringe
chamber
cylindrical body
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2022/060395
Other languages
English (en)
Inventor
Stefano Boursier Niutta
Enrico De Lutio
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Bcs Srl
Efg Srl
BCS SRL
Original Assignee
Bcs Srl
Efg Srl
BCS SRL
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Bcs Srl, Efg Srl, BCS SRL filed Critical Bcs Srl
Publication of WO2023073636A1 publication Critical patent/WO2023073636A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/178—Syringes
    • A61M5/20—Automatic syringes, e.g. with automatically actuated piston rod, with automatic needle injection, filling automatically
    • A61M5/2033—Spring-loaded one-shot injectors with or without automatic needle insertion

Definitions

  • the present invention relates to an IC-ECG measurement system which uses a syringe provided with a spring to move the piston.
  • a syringe generally consists of a tube, a piston capable of sliding into the tube and a plunger actuated to move the piston in the proximal direction and thereby to exert a suction force on a fluid, e.g., a medicinal fluid so that it flows into the tube through a distal opening of the same and in the distal direction to guide the same fluid outwards through the same distal opening.
  • a fluid e.g., a medicinal fluid so that it flows into the tube through a distal opening of the same and in the distal direction to guide the same fluid outwards through the same distal opening.
  • a known needle, tube or other medical device suitable for the final application of the syringe may be mounted where the distal opening of the syringe tube is located.
  • Some commercially available syringes implement resistance means adapted to regulate the movement of the piston in order to calibrate the amount of fluid fed into the tube.
  • Such syringes employ thrust springs to return the fluid displacement piston to its original position after being pressed into the fluid displacement position.
  • US 2018/0353676 patent application describes syringes, implementing springs external to the syringe barrel to push the piston to an extended position, but which are bulky and difficult to use.
  • Such devices are limited by the fact that the stress mechanisms are not suitable for conventional syringes.
  • these devices are inconvenient to use, mainly because of the mechanical encumbrance caused by the implementation of a spring outside the syringe tube.
  • a serious drawback of these devices is the operation of the device in close proximity to the body, which is obstructed by the protruding spring and by any handles.
  • the construction of such devices is correspondingly complex and expensive, and therefore does not allow for the implementation of disposable devices.
  • the syringes on the market are inconvenient to use in the field of intra-cavitary electrocardiography, particularly in performing the Intracavitary Electrocardiogram (IC-ECG) method for “tip location” in the placement of Central Venous Catheters (CVCs) by using the technique of catheter filled with conductive fluids, such as e.g. saline solution, so as to make the catheter conductive.
  • IC-ECG Intracavitary Electrocardiogram
  • CVCs Central Venous Catheters
  • conductive fluids such as e.g. saline solution
  • the technical problem posed and solved by the present invention is, therefore, to provide an IC-ECG measurement system that makes use of an improved syringe compared to the devices known in the art, i.e., that does not have the above-mentioned drawbacks, and the essential characteristics of which are as defined in the appended claim 1.
  • Other ancillary technical characteristics are the subject of the dependent claims.
  • a first object of the present invention is to provide an IC-ECG measurement system using a syringe defined by the assembly of several components reversibly assembled together to allow for interchangeability of the components.
  • Said components comprise a hollow cylindrical body defining a fluid containment chamber and provided with an elongated hollow tip for the fluid passage where its distal end is located, and an end lid coaxially constrained reversibly to the hollow cylindrical body where its proximal end is located and provided with a through gap for the passage of a piston.
  • the piston in turn, comprises a piston proximal portion, reversibly constrained to a piston distal portion configured to slide into the fluid containment chamber in a fluid- tight manner.
  • the present invention solves the aforementioned technical problem by providing the IC-ECG measuring system that makes use of a syringe wherein a helical spring is installed coaxial to the piston proximal portion and abutted against an internal surface of said lid and against the piston distal portion.
  • the spring is configured so as to be compressed when the piston is pulled to suck a fluid into the fluid containment chamber of the syringe.
  • the spring-loaded syringe covered by the present invention advantageously provides control of the pressure exerted by the piston on the fluid contained in the syringe, so that the spring reaches a home position before the piston has pushed all the fluid contained therein out of the syringe.
  • Figure 1 is an exterior front view of a syringe according to an embodiment of the invention
  • Figure 2 is a frontal cross-sectional view of the syringe shown in Figure 1
  • Figure 3 is a frontal cross-sectional view of the syringe shown in Figures 1 and 2 during a fluid suction phase
  • Figure 4 is a schematic view of the system according to the invention.
  • the IC-ECG measurement system using a spring- loaded syringe according to the present invention is generally referred to as reference number 10.
  • the IC-ECG measurement system 10 is provided with a syringe 1 which comprises a hollow cylindrical body 2 defining a containment chamber 3 containing electrically conductive fluid for the IC-ECG measurement, having a longitudinal axis L, a syringe proximal end 4 and a syringe distal end 5.
  • the electrically conductive fluid is of the type of a saline solution at any title, such as e.g. a physiological solution.
  • the syringe distal end 5 in turn comprises an elongated hollow tip 5a which extends distally therefrom and defines a passage channel 5b for a fluid intended to be fed to fill the hollow cylindrical body 2, to be precise within the fluid containment chamber 3.
  • the syringe 1 may optionally comprise a Luer-Lock type connector mounted where said elongated hollow tip 5a is located in a concentric manner thereto.
  • the internal surface of the connector may comprise one or more threads to allow an external operator to reversibly engage a needle assembly, cannula, or other suitable medical device, not shown in the figure, so as to set the chamber 3 of the hollow cylindrical body 2 in fluid communication with the lumen of, e.g., a cannula or a needle.
  • a fluid displacement piston 6 mounted inside the fluid containment chamber 3 of the hollow cylindrical body 2, to which it is coaxial, in a sliding and fluid-tight engagement manner with the internal surface of the cylindrical body 2.
  • the function of the piston 6 is to suck inwards to the syringe 1 and to push the fluid outwards from the syringe 1, when the piston 6 is pulled in the proximal direction and pushed in the distal direction respectively, such as e.g. by an external operator or by the spring 8, as will be described later in this disclosure.
  • the piston 6 comprises a piston proximal portion 6a and a piston distal portion 6b, wherein the piston proximal portion 6a has a smaller diameter than the piston distal portion 6b and is preferably reversibly constrained thereto.
  • the distal portion 6b has a diameter substantially equal to the internal diameter of the hollow cylindrical body 2 and is configured to slide in a fluid-tight manner into the fluid containment chamber 3.
  • the piston distal portion 6b comprises an end tip 9 reversibly constrained thereto in the distal position.
  • Said tip 9 is in direct contact with the fluid contained in the chamber 3 and is configured to push said fluid outwards from the syringe when the piston 6 is depressed, e.g. by the external operator or by the spring 8.
  • the end tip 9 may comprise one or more ring seals that extend in a radial pattern to prevent fluid from bypassing the tip 9 when the piston 6 is depressed and made to slide into the chamber 3.
  • the end tip 9 also has a fluid displacement surface facing axially in the direction of the syringe distal end. Said surface preferably has a conical profile to fit the end surface of the fluid containment chamber 3, as with the ordinary syringes, and to facilitate pushing the fluid through the passage channel 5b.
  • the end tip 9 is made of a more flexible material than the piston distal portion 6b in the presence of a force directed distally from the distal portion 6b onto the tip 9.
  • the end tip 9 can be made of natural rubber, synthetic rubber, silicone, polyurethane or any flexible material. In this way, when the piston 6 is pushed in the distal direction, e.g. by the external operator or by the spring 8, the force applied to the piston distal end does not cause plastic distortion of the end tip 9 due to the fluid-tight structure, and the end tip 9 is free to flex in response to the force.
  • the piston proximal portion 6a may, in turn, comprise a flange 6c, external to said hollow cylindrical body 2, configured to facilitate the grip and handling of the piston 6 by an external operator.
  • the syringe 1 is made so that the syringe proximal end 4 comprises a lid 7 that partly encloses the hollow cylindrical body 2.
  • the lid 7 is preferably a hollow cylindrical body of uniform internal cross-sectional area and having an internal diameter equal to that of the hollow cylindrical body 2, and is coaxially constrained reversibly to said hollow cylindrical body 2, e.g. by means of threading, interlocking or any other method known in the art.
  • Said lid 7 is characterized by a through hole 4a having a through-span less than a cross-sectional area of the fluid containment chamber 3, such that the piston proximal portion 6a is fitted through said through hole 4a so that it can slide through it and extend outwards from the syringe 1.
  • the lid 7 may comprise, in the proximal position, one or more flanges 7a configured to facilitate one-handed syringe gripping in synergy with said flange 6c of the piston 6.
  • a helical spring 8 preferably with congruent coils, that is, coils having the same distance from each other so that the spring pitch is constant, is placed around said piston proximal portion 6a and is coaxial thereto.
  • the spring 8 comprises a spring proximal end 8a abutted against an internal surface of said lid 7 and a spring distal end 8b abutted against the piston distal portion 6b. As it is fitted, it is appreciated that the spring 8 is never wetted by the fluid contained in the syringe while always remaining confined within the hollow cylindrical body 2 of the syringe.
  • the helical spring 8 is fitted so as to be compressed when the piston 6 is pulled to fill the chamber 3 with the fluid, e.g. a saline solution, through the elongated hollow tip 5a, and so as to be elongated when the piston 6 is pushed to release a fluid present in the chamber 3 through the elongated hollow tip 5a.
  • the fluid e.g. a saline solution
  • the helical spring 8 is configured to reach a home position before the piston 6 has reached a bottom of the chamber 3 and before all the fluid contained in the chamber 3 has been pushed out of the elongated hollow tip 5a.
  • the residual fluid volume ensures that the hydrostatic equilibrium is reached before the spring 8 is completely discharged, thus ensuring that the catheter 11 always remains full of fluid as will be better described later in this description.
  • the piston distal portion 6b evenly distributes the piston thrust force on the end tip 9, particularly in the presence of a thrust force applied, e.g. by the external operator or by the spring 8, to the piston 6 in the distal direction.
  • a thrust force applied e.g. by the external operator or by the spring 8
  • the piston distal portion 6b prevents the ring seals of the end tip 9 from being deformed, which are therefore kept intact regardless of the thrust force exerted, without affecting the soundness of the fluid seal.
  • the spring 8 can be selected for its geometrical characteristics so that its external helical diameter is equal to the internal diameter of the hollow cylindrical body 2.
  • the spring can be selected so that its internal helical diameter is equal to the diameter of the piston proximal portion 6a. It will be obvious to the expert in the technical branch that, depending on the size of the diameter of the piston proximal portion 6a, it is possible to select a spring that meets both of the above requirements, i.e., a spring with an external helical diameter equal to the internal diameter of the hollow cylindrical body 2 and with an internal helical diameter equal to the diameter of the piston proximal portion 6a.
  • the spring constant can be selected appropriately so that the spring will overcome the frictional resistance between the piston 6 and the inside of the hollow cylindrical body 2, e.g., the friction generated by the sliding of the piston distal portion 6b or that generated by the ring seals for the fluid tightness of the end tip 9, either when the piston is pushed or when the piston is retracted.
  • the spring 8 is preferably made of chemically inert metal or metal alloy such as stainless steel or any other material known in the art that meets the compatibility requirements with medical devices.
  • the system 10 comprises a venous catheter 11 provided with a first passage extremity 12 connected, in use, in a fluid- operated manner, to the passage channel 5b to receive the fluid and at least a second passage extremity 13 of the fluid adapted to be arranged, in use, within a vena cava 14, the conductive fluid, in use, filling the catheter 11 to measure the IC-ECG.
  • the second passage extremity 13 is adapted, in use, to be connected with the outside in a fluid- operated manner, such as e.g. with the vena cava 14 when fitted within the latter.
  • the system 10 comprises measuring means 15 of the IC-ECG, operationally connected to the catheter 11 and configured to measure the IC- ECG.
  • the measuring means 15 are of the type of known electronic measuring means that employ at least the same fluid- filled catheter 11 as the measuring electrode.
  • the catheter 11 when the catheter 11 remains filled, preferably only by fluid, it properly serves as an electrode for the measuring means 15.
  • the outside e.g., that of the blood flowing in the vena cava 14
  • outside fluids e.g., the blood itself
  • the spring 8 gradually decompresses and discharges without, however, decompressing and discharging totally.
  • the pressure of the external fluid actuating at the interface with the second passage extremity 13 prevents the spring 8 from totally decompressing and unloading.
  • the syringe 1 comprises opening and closing means 16 which are operable to clear and obstruct the fluid passage through the passage channel 5b.
  • the helical spring 8 remains compressed when the opening and closing means 16 obstruct the fluid passage and is free to decompress when the opening and closing means 16 clear the fluid passage until, at the interface of the second passage extremity 13, the fluid within the catheter and the fluid outside the catheter reach the hydrostatic equilibrium.
  • the opening and closing means 16 are manually operable.
  • the opening and closing means 16 are of the type of a tap mounted on the syringe 1 or clamp.
  • the syringe 1 is configured to switch from a first operating configuration to a second and third operating configuration.
  • the external operator can load the chamber 3 by sucking a certain amount of fluid, e.g. a saline solution.
  • a certain amount of fluid e.g. a saline solution.
  • the operator can employ the needle to perforate the membrane of a common medicinal liquid bottle and apply pressure to the piston 6 so as to push it completely in the distal direction thus bringing it to a position of maximum thrust and cause the end tip 9 to be in contact with the ending surface of the chamber 3.
  • the volume of fluid fed into the syringe is such that it fills said gap 3 a and constitutes the residual volume characterizing the syringe 1.
  • the syringe is again in the first operating configuration, wherein the helical spring 8 and the piston 6 are in the home position, with a defined residual volume of fluid contained in the gap 3a of the syringe chamber 3.
  • the operator can continue to fill the syringe with a further volume of the same, or another fluid by bringing the syringe 1 into a third operating configuration, or dispense all, or part, of the residual volume of fluid, as explained in detail in the following paragraphs.
  • the operator can perforate again the first bottle, a new bottle or a blood vessel and bring the syringe into a third operating configuration by exerting a pulling force on the piston, using a one-handed grip facilitated by the flanges 6c and 7a, to suck a given volume of fluid.
  • the external surface of the hollow cylindrical body 2 of the syringe 1 can be provided with calibration marks indicating the volume contained within the fluid containment chamber 3 depending on the position of the piston 6.
  • a further advantage of the presence of a residual volume of fluid in the syringe is the facilitation for the operator of the fluid collection process which, with ordinary syringes, often requires the elimination of air bubbles that have penetrated into the syringe due to inadvertent piston movements.
  • the use of a syringe according to the present invention, containing a residual volume of fluid reduces the risk of the introduction of air bubbles into the syringe chamber because the fluid containment chamber 3 is already partly filled with a residual volume of fluid.
  • the gas is air.
  • the syringe 1 is provided already pre-filled with the fluid to define the space 17.
  • pre-filled syringe means that the syringe has been filled and stored for use even after a long time.
  • pre-filled syringes may remain unused for a long period of time during which the piston 6 may “stick” to the walls of the chamber 3.
  • the piston 6 is pulled just enough to ensure that it is released, without the syringe 1 losing its functionality and effectiveness.
  • the space 17 must be of a size that allows the piston 6 to be pulled by at least one millimeter.
  • the syringe of this disclosure makes it particularly advantageous to use the syringe of this disclosure to perform IC-ECG for catheter tip placement.
  • the syringe is connected to the catheter 11 fitted into the vena cava (typically the superior vena cava) of a patient, and the piston 6 of the syringe 1 is released so that the compressed spring 8 moves the piston 6 forward.
  • the piston 6 of the syringe 1 is released so that the compressed spring 8 moves the piston 6 forward.
  • the catheter 11 filled in this way once hydrostatic equilibrium has been reached, remains filled, preferably without releasing further fluid, and serves as an electrode for IC-ECG measurement.
  • the operator may decide, based on needs, to dispense part or all of the fluid residual volume by applying pressure to the piston 6 so as to push it further in the distal direction by bringing the end tip 9 closer to the ending surface of the chamber 3, by pushing the fluid residual volume outwards through the passage channel 5b, possibly bringing the syringe into the second operating configuration, with the piston 6 in the position of maximum thrust and the end tip 9 in contact with the ending surface of the chamber 3, thus dispensing all the residual volume of fluid and by emptying the chamber 3.
  • the present invention relates to a syringe 1 comprising a hollow cylindrical body 2 defining an electrically conductive fluid containment chamber 3 for the measurement of IC-ECG, having a longitudinal axis L, and comprising a syringe proximal end 4 and a syringe distal end 5.
  • the syringe distal end 5 comprises an elongated hollow tip 5a extending distally therefrom and defining a passage channel 5b for a fluid contained in the hollow cylindrical body 2.
  • the syringe 1 comprises a piston 6 for the fluid displacement which is mounted within the fluid containment chamber 3 of the hollow cylindrical body 2 in a sliding manner in fluid-tight engagement with the internal surface of the cylindrical body 2 to suck the fluid inwards to the syringe 1 and to push the fluid outwards from the syringe 1, the piston being coaxial to the cylindrical body 2 and comprising a piston proximal portion 6a and a piston distal portion 6b.
  • the syringe proximal end 4 comprises a lid 7 that partly encloses the hollow cylindrical body 2, the lid having a through hole 4a having a through-hole span smaller than a cross-sectional area of the fluid containment chamber 3, the piston distal portion 6b is configured to slide tightly into the fluid containment chamber, and the piston proximal portion 6a is fitted through the through hole 4a and extends outwards from the syringe 1, a helical spring 8 is placed around the piston proximal portion 6a and coaxial thereto, the spring 8 comprising a spring proximal end 8a abutted against an internal surface of the lid and a spring distal end 8b abutted against the piston distal portion 6b, the helical spring 8 being installed so as to be compressed when the piston 6 is pulled to suck the fluid into the chamber 3 through the elongated hollow tip 5 a, and so as to be elongated when the piston 6 is pushed
  • the syringe 1 has one or more of the characteristics listed in the description of the system 10 with reference to the syringe 1.
  • the present invention relates to a method of detecting the position of a venous catheter by means of IC-ECG measurement system, comprising at least the steps of: supply of an IC-ECG measurement system 10; measurement of IC-ECG by means of the measuring means 15; detection of the position of the second passage extremity 13 of the catheter 11 along the vena cava 14 depending on the measured IC-ECG.
  • the detection of the second passage extremity 13 along the vena cava 14 is performed depending on the wave P of the IC-ECG.
  • the amplitude of the wave P provides an indication of the position of the second passage extremity 13 with respect to the heart.
  • the method just described comprises one or more of the processes described or directly derivable with reference to the system 10 described above.

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  • Health & Medical Sciences (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)

Abstract

La présente invention concerne un système de mesure d'IC-ECG (10) comprenant : une seringue (1), comprenant : un corps cylindrique creux (2) définissant une chambre (3) de confinement contenant un fluide électriquement conducteur destiné à la mesure d'IC-ECG, comprenant une extrémité distale de seringue (5), l'extrémité distale de seringue (5) comprenant une pointe creuse allongée (5a) définissant un canal de passage (5b), un piston (6) de déplacement de fluide, monté à l'intérieur de la chambre (3) de confinement de fluide du corps cylindrique creux (2) pour pousser le fluide vers l'extérieur depuis la seringue (1), et un cathéter (11) veineux pourvu d'une première extrémité de passage (12) raccordée, durant l'utilisation, au canal de passage (5b) pour recevoir le fluide et au moins une seconde extrémité de passage (13) adaptée pour être disposée, durant l'utilisation, à l'intérieur d'une veine cave (14), et un moyen de mesure (15) de l'IC-ECG, fonctionnellement raccordé au cathéter (11) et conçu pour mesurer l'IC-ECG : un ressort hélicoïdal (8), le ressort hélicoïdal (8) étant ajusté afin d'être comprimé lorsque le piston (6) est tiré, et afin d'être allongé lorsque le piston (6) est poussé, le ressort hélicoïdal (8) étant conçu pour atteindre une position de repos avant que le piston (6) a atteint un fond de la chambre (3) et avant que tout le fluide contenu dans la chambre (3) a été poussé hors de la pointe creuse allongée (3), le piston (6), en résultat de la décompression du ressort hélicoïdal (8), pousse le fluide pour remplir le cathéter (11).
PCT/IB2022/060395 2021-10-29 2022-10-28 Système de mesure d'ic-ecg Ceased WO2023073636A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT102021000027785 2021-10-29
IT102021000027785A IT202100027785A1 (it) 2021-10-29 2021-10-29 Siringa con molla

Publications (1)

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WO2023073636A1 true WO2023073636A1 (fr) 2023-05-04

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WO (1) WO2023073636A1 (fr)

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999020327A2 (fr) * 1997-10-21 1999-04-29 I-Flow Corporation Seringue de perfusion a ressort
WO2006078400A1 (fr) * 2005-01-18 2006-07-27 Infusive Technologies, Llc Systeme d'entrainement de seringue
US20110071393A1 (en) * 2009-09-18 2011-03-24 Yunxing Liu Locking syringe with integrated bias member
US20130018248A1 (en) * 2011-07-12 2013-01-17 Romedex International Srl Devices and methods for ECG guided vascular access
WO2015054075A1 (fr) * 2013-10-07 2015-04-16 Ocuject, Llc Dispositifs d'administration intraoculaire et procédés associés
WO2017046358A1 (fr) * 2015-09-17 2017-03-23 Medterials, Inc. Dispositif d'injection ophtalmique

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106267462A (zh) 2015-05-25 2017-01-04 美敦力公司 用于对患者进行给药的流体输注装置

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999020327A2 (fr) * 1997-10-21 1999-04-29 I-Flow Corporation Seringue de perfusion a ressort
WO2006078400A1 (fr) * 2005-01-18 2006-07-27 Infusive Technologies, Llc Systeme d'entrainement de seringue
US20110071393A1 (en) * 2009-09-18 2011-03-24 Yunxing Liu Locking syringe with integrated bias member
US20130018248A1 (en) * 2011-07-12 2013-01-17 Romedex International Srl Devices and methods for ECG guided vascular access
WO2015054075A1 (fr) * 2013-10-07 2015-04-16 Ocuject, Llc Dispositifs d'administration intraoculaire et procédés associés
WO2017046358A1 (fr) * 2015-09-17 2017-03-23 Medterials, Inc. Dispositif d'injection ophtalmique

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