WO1995013840A1 - Sliceable hemostatic valve and sheath and method - Google Patents

Abstract

A sliceable hemostatic valve and introducer sheath (10) is provided for introductions of leads or catheters through the valve (16) and sheath (12) combination into a vein or artery. Because of the hemostatic valve, this sheath can remain in the vein throughout the operation with the advantage of free lead (24) exchange possibility and easier lead manipulation, without bleeding, risk of air embolism or repeated sheath insertion related trauma for lead exchange. A side arm (18) to the hemostatic valve cage provides continuous fluid drip in order to prevent clot formation in the lumen of the sheath (12).

Description

SLICEABLE HEMOSTATIC VALVE AND SHEATH AND METHOD

RELATED APPLICATIONS

The present application is a continuation-in-part application of copending application serial no. 07/905,045 filed June 26, 1992, which in turn is a continuation-in- part of application serial no. 07/727,191, filed July 9, 1991 and issued June 30, 1992 as U.S. Patent 5,125,904.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to the field of pacemaker leads and catheters and methods for insertion of the same, and in particular to leads used in veins such as in connection with pacemaker procedures such as pacemaker lead insertion.

2. Description of the Prior Art

There are many medical procedures which require a puncture and catheterization of an artery or vein for various purposes.

In the prior art process of percutaneous puncture, a guidewire is introduced into the vessel through a hollow needle. The needle is withdrawn leaving the guidewire in the vessel. A TEFLON dilator and venous sheath assembly are then advanced in a rotary motion over the guidewire into the vessel. The TEFLON dilator and the guidewire are then removed leaving the flexible sheath in the vessel. At this point, various types of catheters or leads are insert¬ ed using the sheath as a conduit to avoid tearing or further trauma to the vessel wall.

In the case where a pacemaker lead must be permanently inserted into the patient, the pacemaker is subcutaneously implanted in the patient and the lead, which extends from the pacemaker into the heart chamber, remains permanently disposed through the vessel wall and in the vessel lumen. A sheath is nevertheless used in order to guide insertion of the lead into vein lumen, but must be removed leaving the lead in place. However, the sheath cannot simply, in all cases, be slipped over the exterior end of the pacemak¬ er lead which may be provided with a special termination for connection to the pacemaker.

In this case, the prior art has devised a number of splittable or peel away sheaths. The sheath is scored so that it is withdrawn by splitting or peeling it off from the pacemaker catheter. See, Philip O. Littleford, et al, "The American Journal of Cardiology," Vol. 43, pp. 980-982 (May 1979) ; Littleford, "Apparatus and Method for Inserting an Electrode," U.S. Patent 4,166,469 (1979); Littleford, "Method for Inserting Pacemaker Electrodes and the Like," U.S. Patent 4,243,050 (1981) and Littleford, "Split Sleeve Introducers for Pacemaker Electrodes and the Like," U.S. Patent 4,345,606 (1982) ; Osborne, "Tear Apart Cannula," U.S. Patent Reissue 31,855 (1985) , a reissue of U.S. Patent 4,306,562 (1981); Boarini et al., "Peelable Catheter with Securing Ring and Suture Sleeve," U.S. Patent 4,411,654 (1983) ; Moorehead, "Medical Layered Peel Away Sheath and Methods," U.S. Patent 4,983,168 (1991) . A splittable cannula is also taught by Kousai et al., "Medical Tool Introduction Cannula and Method of Manufacturing the Same," U.S. Patent 4,883,468 (1989). U.S. Patent 4,997,424 (1991) , Little, "Catheter Introducer and Introducer Slitter," describes an introducer slitter which slits an introducer tube to facilitate separating the introducer from the catheter without having to slide the introducer tube over the proximal end of the catheter.

However, in each of these prior art sheath assemblies, once the sheath has been inserted the sheath provides a passage for the free flow of blood. In practice a signifi¬ cant amount of bleeding may occur at the operation site, which requires constant mopping and cleaning. The amount of loss of blood during an operation may begin to have a negative impact upon the patient. Secondly, in addition to the sheath assembly providing an open passage for the loss of blood, the sheath assembly also provides an open passage for the introduction of air into the vein. The inadvertent introduction of air into the blood system causes air embolism in the patient and its consequent negative effects.

Thirdly, clotting may be formed in the lumen of the sheath if the sheath remains in for a prolonged time, and this may cause embolism to the lung and its consequent negative effects. Because of the three problems above, the prior art splittable sheath has to be removed as soon as the lead is introduced into the vessel lumen, although it is very desirable to retain the sheath in place throughout opera¬ tion because the lead can be manipulated much easier without interference from other existing lead or tissue friction and can be exchanged freely without repeated sheath insertion trauma.

When the catheter or lead is introduced in the sheath, a certain amount of blood leakage will occur between the catheter and the sheath walls. The prior art has also devised hemostatic valves which provide a seal around the catheter introduced through the sheath. One such sheath and hemostatic valve is manufactured and marketed by Cordis Corp. of Miami, Florida as the UNISTASIS valve in the Cordis catheter sheath introducer. Another example is manufactured by Bard of Billerica, Massachusetts as the 5F HEMAQUET introducer. A hemostatic valve combined with a splittable sheath is also illustrated in Schiff, "Introduc¬ er Assembly for Intra-Aortic Balloons and the Like Incorpo- rating a Sliding, Blood-Tight Seal," U.S. Patent 4,473,067 (1984) .

However, all the prior art hemostatic valve struc¬ tures, even when combined with a splittable sheath, such as shown by Schiff, are integral or rigid units, which do not split and must be removed by sliding along the end of the catheter. In the case of Schiff, the sheath is split in order to appropriately position the balloon catheter. However, after the balloon angioplasty procedure is com¬ pleted, the entire catheter is removed so that at no point is the hemostatic valve entirely removed from the catheter nor need it be.

What is needed then is some type of sheath and valve system which can be used in' connection with our vessel introducers, which introducers can then remain in place without risking undue bleeding, air embolism, or clotting while retaining the advantages of an introducer sheath for free lead exchange and easier lead manipulation.

SUMMARY OF THE INVENTION

The invention is a sheath assembly for use with a lead or catheter comprising an introducer sheath, and a hemo¬ static valve coupled to the introducer sheath. The hemo¬ static valve and introducer sheath are arranged and config- ured to permit introduction of at least one lead or cathe- ter therethrough. The assembly permits removal of the hemostatic valve and introducer sheath from the catheter disposed therethrough without requiring the introducer sheath and hemostatic valve to be removed from an end of the catheter. The assembly is sliceable by a blade edge along a longitudinal extent thereof to form a slit through which the lead or catheter may be passed to permit removal of the assembly without requiring the sheath and valve to be removed from an end of the catheter. A side arm is connected to the hemostatic valve cage and provides contin¬ uous fluid drip in order to prevent clot formation in the sheath lumen.

As a result, the assembly may safely remain in the vessel lumen throughout the operation without substantial bleeding, risk of air embolism, clotting, or need of repeated sheath insertion for lead exchange.

An element for slicing the introducer sheath and hemo¬ static valve is provided, and may comprise a knife blade which can be used to slit the material of the sheath and valve.

The introducer sheath and hemostatic valve are inte¬ grally formed and the element for permitting removal of the valve and sheath permits removal of the valve and sheath as an integral body from the catheter disposed therethrough. In another embodiment the introducer sheath and hemostatic valve are separate body portions coupled to each other and the element for permitting removal of the valve and sheath from the lead or catheter allow separate removal of the hemostatic valve and sheath from the lead or cathe- ter.

The hemostatic valve is self sealing. The hemostatic valve and sheath are arranged and configured to allow the insertion therethrough of multiple leads or catheters. The hemostatic valve further comprises an intravenous sidearm assembly. The element for permitting removal of the hemostatic valve and sheath leaves the sidearm assembly intact.

The invention is also characterized as a method of percutaneous sheath lead or catheterization comprising the steps of disposing an introducer sheath and hemostatic valve coupled to the introducer sheath into a body lumen. At least one lead or catheter is disposed through the valve and introducer sheath into the body lumen. The lead or catheter is sealed within the hemostatic valve to prevent bleeding and introduction of air into the body lumen with disposition of the lead or catheter therein. The hemostat¬ ic valve and introducer sheath is removed while leaving the lead or catheter in place within the body lumen without sliding either the introducer sheath or hemostatic valve over an end of the lead or catheter. The removal of the valve and sheath is accomplished by slicing a longitudinal opening along the longitudinal extent of the valve and sheath assembly. The lead or catheter can be passed through the opening. As a result, implanted leads or catheters may be disposed into the body lumen without bleeding, risk of air embolism, clotting or requiring the end of the lead or catheter to have a structure to permit removal of the sheath and valve thereover.

The invention is better visualized by now turning to the following drawings wherein like elements are referenced by like numerals.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a partially cutaway side view of a splitt¬ able introducer sheath devised according to the invention. FIG. 2 is an enlargement of the splittable valve portion shown in FIG. 1 wherein a lead or catheter has been disposed through the valve. FIG. 3 is a rear prospective view of the valve and sheath combinations of FIGS. 1 and 2 showing an embodiment of diametric longitudinal score lines.

FIG. 4 is a simplified side elevational view of an additional embodiment of the invention.

FIG. 5 is a side cross-sectional view in enlarged scale of selected cut-away portions of the hemostatic valve and sheath of FIG. 4.

FIG. 6 is a perspective view of the diaphragm of the hemostatic valve of FIG. 5 shown in isolation of all remaining elements.

FIG. 7a and b is a perpendicular cross-sectional view of the valve of FIGS. 4 and 5 as seen through sectional line 7-7 of FIG. 5. FIG. 7a shows the valve body assembled and closed with tape as shown in FIG. 4, while FIG. 7b shows the tape removed and valve body halves separated.

FIG. 8 shows another embodiment of the valve body in perpendicular cross-sectional view as would be seen through section line 7-7 of FIG. 5. FIG. 9a is another embodiment of the valve body wherein a tongue and groove connection and pop-out indenta¬ tion is provided. FIG. 9b is the side elevational of the valve body, the perpendicular" cross-sectional of which is shown in FIG. 9a as seen through section lines 9a-9a of FIG. 9b.

FIG. 10 is another embodiment of the valve body as seen in the perpendicular cross-sectional view as would be seen through section line 7-7 of FIG. 5.

FIG. 11 is another embodiment of the invention, wherein the valve and sheath are sliced to permit removal of the catheter or lead therefrom.

FIG. 12 is a partial longitudinal cross-sectional view taken along lines 12-12 of FIG. 11.

FIG. 13 is a transverse cross-section taken along line 13-13 of FIG. 11. The invention and its various embodiments may now be understood by turning to the following detailed descrip¬ tion.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

An improved hemostatic valve and introducer sheath is provided for introductions of leads or catheters through the valve and sheath combination into a vessel or artery. At the point in the operation where the introducer sheath and hemostatic valve must be removed from the lead or catheter, which must remain implanted, means are employed to split or separate the introducer sheath and valve apart so that the sheath and valve are removed from the implanted lead or catheter without the necessity of sliding either the sheath or valve over the free end of the lead or catheter. The hemostatic valve is made in two separate parts which include a fluid-tight seal to facilitate splitting of the valve. In this manner, any termination which may be provided on the free end of the lead or catheter, such as a terminal for connection to a pacemaker, will not interfere with the optimal use of the introducer sheath and hemostatic valve.

A splittable introducer sheath and valve assembly, generally noted by reference numeral 10 in FIG. 1, is depicted in partially cutaway side view. Valve and sheath assembly 10 comprise a splittable sheath 12 connected, coupled or extending from a splittable hemostatic valve assembly 14. Valve assembly 14 in turn is comprised of a valve body 16, an intravenous sidearm 18 with a sidearm of valve 20. The details of the design of sidearm valve 20 and to a certain extent sidearm 18 are largely inconsequen¬ tial to the present invention and therefore will not be further described except insofar as necessary to illustrate the invention. Hemostatic valve assembly 14 is shown in FIG. 1 in cutaway view exposing the interior of valve 16 which includes a valve membrane 22. The details of valve assembly 14 again are not critical to an understanding of the invention, but in the preferred embodiment, valve membrane 22 is a self-sealing membrane through which a lead or catheter may be introduced without leakage between membrane 22 and leads or lead 24 such as shown in the partially cutaway view of FIG. 2 depicted in expanded scale. Valve body 16 in the illustrated embodiment is comprised of two sections 16a and b which are bonded together after assembly.

In the depiction of FIG. 1, a conventional dilator 28 is shown as disposed through valve assembly 14 and sheath 12 having a tapered tip 30 extending from the distal end 32 of sheath 12. As in the conventional methodology described above in connection with percutaneous sheath lead or catheterization, the artery or vessel is punctured with a needle into which a guidewire is placed. The needle removed and then dilator and sheath assembly 12 advanced on the guidewire into the vessel. The guidewire will extend through valve assembly 14 and be sealed by means of mem¬ brane 22. The guidewires and TEFLON dilator are then removed leaving the flexible sheath assembly 10 in place. However, virtually no bleeding occurs since the entire assembly is sealed by self-sealing membrane 22. At this point one or more leads or catheters as suggested in FIG. 2 can be introduced, removed and reintroduced and manipu¬ lated without any significant possibility of bleeding, clotting, risk of air embolism or repeated sheath insertion related trauma since once inserted sheath assembly 10 is in place regardless of the number of leads or catheters inserted and removed throughout the operation.

In addition, since sealing of leads or catheters 24 and 26 is effectuated by membrane 22 of valve assembly 14, valve body 16 and at least a portion of sheath 12 may be made larger than normal to allow a more loose fit between the interior surfaces of introducer sheath assembly 10 and leads or catheters 24 and 26, since blood sealing between the lead or catheter and sheath 12 is not required. This allows leads or catheters 24 and 26 to be introduced and removed from introducer sheath assembly 10 with less friction or interference with assembly 10 and with each other. Therefore, the lead can be manipulated much easier.

The detailed construction of sheath 12 and valve assembly 14 as previously implied is not critical to the invention, at least to the extent of whether sheath 12 and valve assembly 10 must be separate or integral parts or how they may be connected with each other. Therefore, it must be expressly understood that valve assembly 14 and sheath 12 may be fabricated according to any structure or out of any material now known to the art or later devised without departing from the spirit and scope of the invention. For example, sheath 12 may be integrally molded or cast with valve assembly, may be adhesively affixed thereto, may be compression fitted, slip-fit, threaded, or connected in any manner desired to valve assembly 14 consistent with the teachings of the present invention.

FIG. 3 illustrates in enlarged scale a rear perspec- tive view of introducer sheath assembly 10. According to the invention, both valve assembly 14 and sheath 12 are splittable or have a peel away construction. Again, the detailed nature by which such splittable structure is implemented or how peel-away feature is realized is not critical to the invention. Any method now known or later devised by which such sheaths 12 and valve assemblies 14 may be split or separated may be employed and are contem¬ plated as being within the scope of the invention.

In the illustrated embodiment, sheath 12 and valve assembly 14 are shown as integrally fabricated and having a pair of longitudinal score lines 34 and 36 defined along their axial length. Score lines 34 and 36 are shown as being diametrically opposed from each other across the cross section of introducer sheath 10. Intravenous sidearm 18 is depicted in FIG. 3 as being disposed between score lines 34 and 36 interlying surface between them. Score lines 34 and 36 are shown as having a V-shaped cross section but have such a shape and depth as to permit the entire length of introducer sheath 10 to be manually separated. It is contemplated that at the end of the operation the physician will grasp opposing flange portions 38 and 40 to peel them apart while pulling out the sheath and holding the lead. This will cause valve body 16 to tear along a section line depicted by dotted lines 42 through the body of valve assembly 14. Both body portions 16a and b may be scored to facilitate this tearing. In addition the bonding of the body portions 16a and 16b assists in tearing the inner body portion as the outer body portion is being torn along its corresponding tear line. The portions become through the bonding as a single body and the fracture or tear propagates from the outer body portion through the inner body portion. Membrane 22 has a weak line or score line and can easily be removed from the lead. In the illustrated embodiment flanges 38 and 40 are formed in two halves having diametrically opposing slots 44 and 46 aligned with score lines 34 and 36 defined into valve body 16. However, it is entirely possible that score lines 34 and 36 will be continued through flanges 38 and 40 to provide deep scores instead of open slots 44 and 46.

In any case, valve body 16 is peeled apart with separation continuing through any transition portion 48 between valve body 16 and sheath 12 and on along the longitudinal length of sheath 12. Sheath 12 is then removed and peeled followed by additional removal of sheath 12 from the puncture site and peeling of the removed portions until the entire valve and introducer sheath assembly 10 of FIG. 1 has been split and removed from the lead or catheter, which is then permanently implanted into the puncture site and with which the surrounding tissue makes a blood tight seal.

The hemostatic valve and sheath 10 as seen in FIG. 1 is shown in an alternative embodiment and side elevational view in FIG. 4. In the embodiment of FIG. 4, splittable hemostatic valve assembly 14 is integrally molded or made separable from splittable sheath 12 and fitted at its proximal end with a dilator head fitting 50. Dilator head fitting 50 as shown in enlarged view in FIG. 5 is secured to valve assembly 14 by means of a conventional Luer lock 52. The score line 34 on sheath 12 continues along sheath 12 into split body portions 14a and 14b which comprise the body of valve assembly 14. Valve membrane 22, disposed within valve assembly 14, is also provided with a Y-shaped incision 54 as best depicted in the perspective view of FIG. 6 to facilitate opening and tearing of membrane 22 when valve body halves 14a and 14b are separated.

In the embodiment of FIG. 4, valve halves 14a and 14b are temporarily fixed together by means of tearable single- sided adhesive tape 56. The binding of the body portions and the hemostatic membrane need not be excessively sturdy since the device is used at low pressures, 5-10 mm Hg and its use is typically of only 10-30 minutes duration. The long leg of the Y shape incision into or through membrane 22 may or may not extend to the periphery of membrane 22 as may be needed to facilitate its tearing or cutting.

The practicing physician may then take a scalpel and easily cut tape 56 along the split line 34 and valve assembly 14 thereby separating the valve body portions 14a and 14b. As described above with the body portions 14a and 14b separated, sheath 12, which is integral, is then readily split along score line 34.

Valve body 14 may be manufactured from valve body portions 14a and 14b in a number of alternative forms. One embodiment is shown in FIG. 7a and 7b wherein valve body 14 is generally split into two halves, an upper half 14b and a lower half 14a. Lower half 14a is provided with an interior circumferential lip 58a which slip fits into an exterior circumferential lip 58b defined in upper body half 14b. The two body halves, 14a and 14b, as shown in FIG. 7, which is a perpendicular cross-sectional view taken through section lines 7-7 of FIG. 5, are then held together using tape 56. Once the tape is cut, the two body halves may then be manually separated as depicted in FIG. 7b. While assembled, however, valve assembly 14 provides a water¬ tight or blood-tight valve assembly.

Another embodiment of the body of valve assembly 14 is depicted in the perpendicular cross-sectional view of FIG. 8 as would also be seen through section line 7-7 of FIG. 5. In the embodiment of FIG. 8, lower body portion 14a com¬ prises a rectangular box, while upper body portion 14b is formed like a lid covering and seals the box-shape of body portion 14a. In the embodiment of FIG. 8, the outer circumferential seal 60a is provided on the lower body portion 14a while the inner circumferential seal 60b is defined on the upper lid body portion 14b, which is the conceptional reverse of the embodiment of FIG. 7.

FIGS. 9a and 9b illustrate yet another embodiment in which lower body portion 14a again defines a box-like shape and is coupled to upper body portion 14b acting as a lid, the two portions comprising an interior tongue and groove snap-fit seal. In the embodiment of FIG. 9a, which is a perpendicular cross-sectional view as would be seen through section lines 7-7 of FIG. 5, a groove 62a is defined in lower body portion 14a while a mating tongue 62b is provid- ed in upper lip portion 14b. Along the side of valve assembly 14 is a cut-out recess 64 in a least one position along line 34 wherein the surgeon can insert a scalpel or tool to pry body portions 14a and 14b apart. Thus, it is contemplated that at least in the embodiment of FIGS. 9a and 9b, if not other ones of the embodiment shown, that the need for tape 56 may be unnecessary in that the body portions will fit tightly together by virtue of their snap fit. The disengagement will then be affected by prying them apart, with the assistance, if necessary, of a recess 64 as depicted in FIGS. 9a and 9b.

Yet another embodiment of valve body 14 is depicted in perpendicular cross-sectional view of FIG. 10, again as would be seen through section line 7-7 of FIG. 5. In the embodiment of FIG. 10, separation between body portions 14a and 14b occurs generally along the mid-portion of lateral sides 66 of valve body 14 and are defined by providing a knife edge seal 68 in the one body portion, such as lower body portion 14a, and a conforming groove 70 in the oppos- ing body portion, such upper portion 14b. Again, portions 14a and 14b may be held together by an exterior tape 56 or may have a snap-fit facilitated by an expanded head 72 below knife edge 78 which is accommodated by a snap-fit conforming interior shape of groove 70. It must be understood that many other embodiments may be devised by which the body portion of valve assembly 14 may be manufactured as separate halves and then be tempo¬ rarily joined together with or without the aid of an exterior fastening means such as tape, friable spots of adhesive disposed in the joints between body portions 14a and 14b, or various compression fitting seals, some of which have been depicted by way of illustration in FIGS. 7- 10.

FIG. 11 illustrates another embodiment of the inven- tion, wherein the introducer sheath and hemostatic valve assembly 100 is split by means of a slicer device 120. In this embodiment, the assembly 100 is fabricated of a sliceable material. The sheaths are conventionally made from polyurethane or TEFLON; valves are conventionally made from a silicon rubber. The walls of the valve body 110 as well as the wall of the sheath 102 are made thin enough to be readily sliced open by a sharp blade edge. The physi¬ cian can then, after insertion of the sheath into the blood vessel and insertion of the lead or catheter therethrough, remove the sheath and valve assembly from the body without requiring the sheath or valve to be slid over the free end of the catheter or lead, by splitting the valve and sheath open by a slicing action with the slicer device 120. Thus, at this stage of the procedure, a sharp blade edge 122 of the device 120 is brought into engagement with the end 112 of the valve 110. The knife edge is brought against the opening sealed by the membrane, and pressure is brought to bear by the physician to slice through a wall of the valve body 110. As the body is sliced through, the knife blade is brought into contact with a peripheral wall of the sheath 102. The knife blade is positioned to slice through the sheath wall as well, until the assembly 100 has been sliced longitudinally open along its entire length. The inserted lead or catheter is removed through the sliced opening. The physician may perform the slicing while simultaneously withdrawing the sheath from the patient's body.

The slicer device 120 can be of the type shown in U.S. Patent 4,997,424, such as, by way of example only, device 10. Other types of slicing devices could alternatively be employed.

The valve and sheath assembly 100 may be a single piece unit, in which case the valve and sheath will be removed as a single unit. Alternatively, the assembly 100 may be fabricated from a separate valve body, subsequently coupled to the sheath. In this case, the valve body can be sliced through and removed from the lead or catheter in a separate motion from the slicing of the sheath and removal of the sheath from the lead or catheter and from the patient's body, or in a single motion with the removal of the valve body.

Many alterations and modifications may be made by those having ordinary skill in the art without departing from the spirit and scope of the invention. Therefore, it must be expressly understood that the illustrated embodi¬ ment has been shown only for the purposes of example and should not be taken as limiting the invention which is defined by the following claims. The following claims are thus to be read as not only literally including what is set forth by the claims but also to include all equivalent elements for performing substantially the same function in substantially the same way to obtain substantially the same result even though not identical in other respects to what is shown and described in the above illustration.

Claims

CLAIMSWhat is claimed is;

1. A sheath assembly for use with a lead or catheter comprising: an introducer sheath; a hemostatic valve coupled to said introducer sheath, said hemostatic valve and introducer sheath being arranged and configured to permit introduction of at least one lead or catheter therethrough; means for permitting removal of said hemostatic valve and introducer sheath from said lead or catheter disposed therethrough without requiring said introduc¬ er sheath and hemostatic valve to be removed from an end of said lead or catheter, said means comprising a sliceable longitudinal wall extending along the longitudinal extent of said valve and introducer sheath, said wall being sliceable by a blade edge passed therethrough to define a longitudinal split opening and permit said lead or catheter to be passed therethrough; whereby said assembly may remain in a vessel throughout an operation with the advantage of free lead exchange and easier lead manipulation without substantial bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma from lead exchange.

2. The assembly of Claim 1 wherein said introducer sheath and hemostatic valve are integrally formed and wherein said means for permitting removal of said valve and sheath permits removal of said valve and sheath as an integral body from said lead or catheter disposable there¬ through.

3. The assembly of Claim 1 wherein said introducer sheath and hemostatic valve are separate body portions coupled to each other and wherein said means for permitting removal of said valve and sheath from said lead or catheter disposable therethrough allow separate removal of said hemostatic valve and sheath from said lead or catheter.

4. The assembly of Claim 1 wherein said hemostatic valve is self sealing.

5. The assembly of Claim 1 wherein said hemostatic valve and sheath are arranged and configured to allow the insertion therethrough of multiple leads or catheters.

6. The assembly of Claim 1 wherein said hemostatic valve further comprises an intravenous sidearm assembly.

7. The assembly of Claim 6 wherein said means for permitting removal of said hemostatic valve and sheath leaves said sidearm assembly intact.

8. A method of percutaneous sheath lead or catheter¬ ization comprising the steps of: disposing an introducer sheath and hemostatic valve coupled to said introducer sheath into a body lumen; disposing at least one lead or catheter through said valve and introducer sheath into said body lumen; sealing said lead or catheter within said hemo¬ static valve to prevent bleeding and introduction of air into said body lumen with disposition of said lead or catheter therein; slicing said hemostatic valve and introducer sheath along a longitudinal extent thereof to form an elongated slit along said longitudinal extent; and removing said hemostatic valve and introducer sheath by passing said lead or catheter through said slit while leaving said lead or catheter in place within said body lumen without sliding either said introducer sheath or hemostatic valve over an end of said lead or catheter, whereby implanted leads or catheters may be disposed into said body lumen without bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma for lead exchange or requiring said end of said lead or catheter to have a structure to permit removal of said sheath and valve thereover.

9. An improvement in an introducer sheath and valve assembly for implantation of pacemaker leads, comprising: means for slicing open said hemostatic valve to form a longitudinal slit so . as to permit removal through said longitudinal slit of a lead or catheter disposed through said valve from said valve without necessitating removal of said valve over an end of said lead or catheter; and means for cutting open said introducer sheath to form a longitudinal slit' along a longitudinal extent thereof so as to permit removal through said slit of a lead or catheter disposed through said sheath from said sheath with necessitating removal of said sheath over an end of said lead or catheter; and whereby bleeding, risk of air embolism, clotting and repeated sheath insertion related trauma from lead exchange is substantially avoided.

10. A method of percutaneous catheterization, com¬ prising the steps of: disposing an introducer sheath and hemostatic valve coupled to said introducer sheath into a body lumen; disposing at least one lead or catheter through said valve and introducer sheath into said body lumen; sealing said lead or catheter within said hemo¬ static valve to prevent bleeding and introduction of air into said body lumen with disposition of said lead or catheter therein; and later removing said hemostatic valve and intro¬ ducer sheath while leaving said lead or catheter in place within said body lumen without sliding either said introducer sheath or hemostatic valve over an end of said lead or catheter, wherein said step of removing said hemostatic valve and introducer sheath includes slicing said valve and sheath along a longitudinal extent thereof to form a slit along said longitudinal extent, passing said lead or catheter through said slit, and removing said valve and introducer sheath; whereby implanted "leads or catheters may be disposed into said body lumen without bleeding, risk of air embolism, clotting or repeated sheath insertion related to trauma for lead exchange or requiring said lead or catheter to have a structure to permit removal of said sheath and valve thereover.

11. The method of Claim 10 where said step of remov¬ ing said sheath and lead or catheter comprises the step of disposing said lead or catheter radially through said longitudinal slit.

12. A method of percutaneous sheath lead or catheter¬ ization, comprising a sequence of the following steps: disposing an introducer sheath and hemostatic valve coupled to said introducer sheath in a body lumen; disposing at least one lead or catheter through said valve and introducer sheath into said body lumen; sealing said lead or catheter within said hemo¬ static valve to prevent bleeding and introduction of air into said body lumen with disposition of said lead or catheter therein; continuously introducing fluid through a sidearm disposed in said hemostatic valve downstream from said valve to continuously flush said introducer sheath to prevent coagulation in said introducer sheath; and removing said hemostatic valve and introducer sheath while leaving said lead or catheter in place within said body lumen without sliding either said introducer sheath or hemostatic valve over an end of said lead or catheter; wherein said step of removing said hemostatic valve and introducer sheath includes slicing said valve and sheath along a- longitudinal extent thereof to form a slit along said longitudinal extent, passing said lead or catheter through said slit, and removing said valve and introducer sheath; whereby implanted leads or catheters may be disposed into said body lumen without bleeding, risk of air embolism, clotting or repeated sheath insertion related trauma for lead exchange or requiring said end of said lead or catheter to have a structure to permit removal of said sheath and valve thereover.