U.S. patent application number 10/602886 was filed with the patent office on 2004-04-15 for surgical chair for percutaneous spinal catheter insertion.
Invention is credited to Murphy, Kieran P., Rigamonte, Daniele, Williams, Michael A..
Application Number | 20040070253 10/602886 |
Document ID | / |
Family ID | 30770872 |
Filed Date | 2004-04-15 |
United States Patent
Application |
20040070253 |
Kind Code |
A1 |
Murphy, Kieran P. ; et
al. |
April 15, 2004 |
Surgical chair for percutaneous spinal catheter insertion
Abstract
A novel method of spinal catheter insertion via seated lumbar
puncture using a surgical chair in which the patient is
forward-facing is provided. The chair provides a stable, safe
platform for patients, and reduces the need for additional
personnel to maintain the patient's position. The seated position
provides for ergonomically desirable alignment of the spinous
processes, aiding in the successful lumbar puncture and spinal
catheter insertion.
Inventors: |
Murphy, Kieran P.;
(Baltimore, MD) ; Williams, Michael A.;
(Baltimore, MD) ; Rigamonte, Daniele; (Baltimore,
MD) |
Correspondence
Address: |
PATENT ADMINSTRATOR
KATTEN MUCHIN ZAVIS ROSENMAN
525 WEST MONROE STREET
SUITE 1600
CHICAGO
IL
60661-3693
US
|
Family ID: |
30770872 |
Appl. No.: |
10/602886 |
Filed: |
June 25, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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60391085 |
Jun 25, 2002 |
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Current U.S.
Class: |
297/423.11 |
Current CPC
Class: |
A61B 50/33 20160201;
A61B 17/3401 20130101; A61G 15/00 20130101 |
Class at
Publication: |
297/423.11 |
International
Class: |
A47C 007/50 |
Claims
We claim:
1. A surgical chair comprising: a frame; a seat attached to said
frame; a face-rest attached to said frame; a chest-pad attached to
said frame at a position between said seat and said face-rest, said
seat, face-rest and chest-pad mounted on said frame such that when
a patient sits in said seat and said patient's face rests in said
face-rest then at least a desired portion of said patient's spine
is presented in an ergonomic manner to a medical professional so
that said professional can perform a procedure on said spine.
2. The chair according to claim 1 wherein said seat and said
face-rest are adjustable.
3. The chair according to claim 1 wherein said chair further
comprises at least one knee-pad attached to said frame for
receiving said patient's knees when said patient is seated.
4. The chair according to claim 3 wherein the knee-pads are
removable.
5. The chair according to claim 3 wherein the knee-pads are
adjustable.
6. The chair according to claim 3 wherein said frame supports said
seat, face-rest, chest-pad and knee-pads such that said patient can
slide sideways into a seated position within said chair without
raising his or her leg over same frame.
7. The chair according to claim 1 wherein said chair further
comprises an arm rest.
8. The chair according to claim 6 wherein said arm rest is
adjustable to allow said patient's arms to be positioned at
substantially the same height as said patient's chest.
9. The chair according to claim 1 wherein said face rest is donut
shaped to support the periphery of said patient's face while
providing a pathway for breathing through a centre of said donut
shape.
10. The chair according to claim 1 wherein said desired portion is
said patient's lumbosacral spine.
11. The chair according to claim 1 wherein at least a portion
thereof is made from a radioluscent material.
12. A prepackaged sterile tray of parts for use in performing a
spinal catheter insertion comprising a lumbar puncture tray, a
separate spinal catheter tray, and separate collection of gauze
sponges, iodine solution, sutures, needle holders, and
scissors.
13. A spinal catheter having a narrow end for insertion into a
lumbar puncture and a waist at a predetermined distance from said
narrow end, said waist being wider than said narrow end such that
said waist provides a seal between an exterior of said catheter and
said puncture.
Description
PRIORITY CLAIM
[0001] The present application claims priority from U.S. Ser. No.
60/391,085, filed Jun. 25, 2002, the contents of which are
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention relates generally to catheters and
more particularly relates to a surgical chair and a spinal catheter
kit for percutaneous spinal catheter insertion via lumbar
puncture.
BACKGROUND OF THE INVENTION
[0003] Spinal catheter insertion may be used for cerebrospinal
fluid (CSF) pressure monitoring and controlled CSF drainage for the
diagnosis of adult hydrocephalus (See, for example, discussions in
Williams M A, Razumovsky A Y, Hanley D F. Comparison of Pcsf
monitoring and controlled CSF drainage to diagnose normal pressure
hydrocephalus. Acta Neurochir 1998;71:328-330. and, Haan J, Thomeer
P T. Predictive value of temporary external lumbar drainage in
normal pressure hydrocephalus. Neurosurgery 1988;22:388-391. The
contents of which are incorporated herein by reference.)
[0004] Existing spinal catheter insertion techniques are based on
traditional lumbar puncture (LP) and spinal anesthetic techniques,
with patients either in the lateral decubitus or seated positions.
(See, for example, Patten J. Neurological Differential Diagnosis. 2
ed. London:Springer-Verlag, 1995:273; Lee J A, Atkinson R S, Watt M
J. Sir Robert Macintosh's Lumbar Puncture and Spinal Analgesia:
Intradural and Extradural. Edinburgh: Churchill Livingstone,
1985:159; Barnett R. Nathan. Cerebrospinal Fluid and Intracranial
Pressure. In: Goetz C G, Pappert E J, eds. Textbook of Clinical
Neurology [online]. Philadelphia: W. B. Saunders, 1999:480-481.
Available at:
[0005] http://home.mdconsult.com/das/book/13710379/view/889.
Accessed Oct. 10, 2001; and, Lund P C. Principles and Practice of
Spinal Anesthesia. Springfield, Ill.: Charles C. Thomas, 1971:304
The contents of all of these references are incorporated herein by
reference.) Because adult hydrocephalus predominantly affects
persons between the ages of 60 and 90, the LP in the lateral
decubitus position may be difficult because it is hard for patients
to maintain the proper position due to discomfort or arthritic
changes of the spine that impede their ability to flex, or because
it is difficult to keep their pelvis and shoulders perpendicular to
the surface of the bed or examination table, resulting in rotation
the spine. (See Patten J. Neurological Differential Diagnosis. 2
ed. London: Springer-Verlag, 1995:273, the contents of which is
incorporated herein by reference.)
[0006] Attempts to perform LPs with patients in the seated position
are often difficult in the hospital setting because of the lack of
a stable, safe platform for the patient. A commonly used technique,
though apparently undocumented in peer-reviewed literature, is to
have the patient sit on the edge of the bed while flexing and
leaning on an over-bed table with a pillow on it. While this
approach may improve flexion of the lumbosacral spine, it carries
the risk that the over-bed table (which is on wheels) can move
forward, potentially causing the patient to fall, or sideways,
potentially misaligning the spine. This technique further requires
the assistance of an additional person or persons to help maintain
the patient's position, to prevent the over-bed table from moving,
or to assure that the patient's breathing is not obstructed because
the face is in, the pillow. The presence of an assistant to
stabilize the seated patient for lumbar puncture is illustrated in
two spinal anesthesia texts. (See Lee J A, Atkinson R S, Watt M J.
Sir Robert Macintosh's Lumbar Puncture and Spinal Analgesia:
Intradural and Extradural. Edinburgh: Churchill Livingstone,
1985:159. See also Lund P C. Principles and Practice of Spinal
Anesthesia. Springfield, Ill.: Charles C. Thomas, 1971:304, the
contents of both of which are incorporated herein by reference. See
also Williams M A: Seated L P using a massage chair Page 2)
SUMMARY OF THE INVENTION
[0007] It is an object of the invention to provide a novel surgical
chair and method for its use that obviates or mitigates at least
one of the above-identified disadvantages of the prior art.
[0008] An aspect of the invention provides a surgical chair
comprising, a frame and a seat attached to the frame. The chair
also comprises a face-rest attached to the frame, and a chest-pad
attached to the frame at a position between the seat and the
face-rest. The seat, face-rest and chest-pad are mounted on the
frame such that when a patient sits in the seat and the patient's
face rests in the face-rest then a desired portion of the patient's
spine is presented in an ergonomic manner to a medical professional
so that the professional can perform a procedure on the spine. The
seat and face-rest can be adjustable to accommodate patient's of
different sizes. The chair can further comprise at least one
knee-pad attached to the frame for supporting the patient's knees
when the patient is seated. The knee-pads can be removable and/or
adjustable.
[0009] The frame can support the seat, face-rest, chest-pad and
knee-pads in a particular configuration such that the patient can
slide sideways into a seated position. within the chair without
raising his or her leg over the frame.
[0010] The chair can further comprise an arm rest. The arm rest can
be adjustable to allow the patient's arms to be positioned at
substantially the same height as the patient's chest.
[0011] The face rest of the chair can be donut shaped to support
the periphery of the patient's face while providing a pathway for
breathing through a centre of the donut shape.
[0012] The desired portion of the patient's spinal is typically the
patient's lumbosacral spine.
[0013] Another aspect of the invention provides a prepackaged
sterile tray of parts for use in performing a spinal catheter
insertion comprising a lumbar puncture tray, a separate spinal
catheter tray, and a separate collection of gauze sponges, iodine
solution, sutures, needle holders, and scissors.
[0014] Another aspect of the invention provides a spinal catheter
that can be packaged as part of the tray of parts or separately
therefrom. The catheter has a narrow end for insertion into a
lumbar puncture and a waist at a predetermined distance from the
narrow end, the waist being wider than the narrow end such that the
waist provides a seal between an exterior of the catheter and the
puncture.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] Preferred embodiments of the present invention will now be
explained, by way of example only, with reference to the attached
Figures in which:
[0016] FIG. 1 shows an isometric view of a surgical chair in
accordance with an embodiment of the invention;
[0017] FIG. 2 shows a side view of the surgical chair shown in FIG.
1;
[0018] FIG. 3 shows the chair of FIG. 2 with a patient seated
thereon;
[0019] FIG. 4 shows a rear view of the chair and patient shown in
FIG. 3;
[0020] FIG. 5 shows an isometric view of a surgical chair in
accordance with another embodiment of the invention;
[0021] FIG. 6 shows a side view of the chair and patient shown in
FIG. 5;
[0022] FIG. 7 shows a tray of parts for use in performing a spinal
catheter insertion in accordance with another embodiment of the
invention;
[0023] FIG. 8 is an isometric view of the tray of FIG. 7;
[0024] FIG. 9 shows the guidewire of FIG. 7 in when removed from
the tray of FIG. 7; and
[0025] FIG. 10 shows a tapered spinal catheter in accordance with
another embodiment of the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0026] Referring now to FIGS. 1-4, a surgical chair for use in
performing a seated lumbar puncture in accordance with an
embodiment of the invention is indicated generally at 20. A
presently preferred surgical chair is a suitably configured Ergo
Pro Massage chair sold by Stronglite, Inc. 255 Davidson Street
Cottage Grove Oreg. 97424 U.S.A., and shown as chair 20 in FIG. 1.
In a presently preferred embodiment, chair 20 has an aluminum
tubular construction capable of supporting about 1200 pounds (545
Kg) static weight. Chair 20 comprises an aluminum tubular frame 24
that supports a substantially donut-shaped face rest 28 which is
intended to support a patient's head when facing downwards, such
that the periphery of the patient's face is supported by face rest
28, while the hollow centre provides an unobstructed airway to
allow the patient to comfortably breathe, see and speak during the
procedure. Chair 20 further includes a chest-pad onto which a
patient can lean his or her chest while placing their head
face-down on face rest 28.
[0027] Chair 20 also includes an arm rest 36 that is supported by
frame 24, which the patient can use to place his or her arms while
the procedure is being performed. Frame 24 of chair 20 also
supports a seat 40 and knee pads 44. In sum, the various components
of chair 20 allow a patient to rest comfortably while facing
forward, and thereby present the lumbar region of the patient to a
surgeon (or other medical professional) who will perform a spinal
catheter procedure, the details of which will be discussed in
greater detail below.
[0028] Preferably, face rest 28, chest pad 32, arm rest 36, seat 40
and knee pads 44 are all adjustable to comfortably accommodate
patients of various sizes, heights and weights, and conditions of
the patient. For example, the height and angle of face rest 28 are
adjustable to accommodate differences in patient height or ability
to flex the neck. Arm rest 36 allows the arms to rest comfortably
at approximately the level of the heart. Further, it is presently
preferred that knee pads 44 can be removable. When present, knee
pads 44 can be used to permit the patient to rest with both hips
and knees in flexion. When knee pads 44 are removed chair 20 can
then accommodate patients with limited knee mobility.
[0029] As best seen in FIGS. 3 and 4, when seated in chair 20, the
patient faces forward and the chair is adjusted for comfortable
flexion of the hips and lumbosacral spine, thereby ergonomically
presenting the lumbosacral spine, identified in FIG. 3 generally at
50 to the medical professional. It will now be understood that face
rest 28, chest pad 32, arm rest 36, seat 40 and knee pads 44 of
chair 20 are adjusted so as to achieve a desired level of comfort
for the patient, while also presenting lumbosacral spine 50 in an
ergonomically desirable manner to the medical professional.
[0030] Referring now to FIGS. 5 and 6, a surgical chair in
accordance with another embodiment of the invention is indicated
generally at 20a. Chair 20a includes a similar structure to chair
20 shown in FIGS. 1-4, and thus beats like reference numerals to
its various components, except that components in chair 20a are
followed with the letter "a". Thus, chair 20a is substantially the
same as chair 20, except that frame 24a and knee rests 44a do not
form a cross spar (as found in chair 20) that impedes sideways
movement of the patient's legs across the center line XX of the
chair 20 as seen in FIG. 4, when the patient slides into chair 20a
from the side. As best seen in FIGS. 5 and 6, this embodiment of
the chair will allow patients to slide onto the chair from the
side, as if sliding across a bench, allowing them to attain the
proper position for the spinal catheter procedure without having to
straddle the seat or cross spar, or otherwise flex or bend their
legs over the cross spar so as to attain the proper position for
the procedure. Put in other words, the patient can slide sideways
into chair 20a without having to raise his or her leg over frame
24a. Chair 20a is thus suitable for epidural anesthesia with or
without epidural catheter insertion for pregnant women for the
purpose of labor and delivery, or for other patients in need of
spinal anesthesia.
[0031] In another embodiment of the invention, chair 20, chair 20a
or a combination or variation of components thereof are made from
materials such that frame 24, seat 40, knee pads 44, chest pad 32,
arm rest 36, and face rest 28 are constructed of radioluscent
materials (e.g. wood, graphite composite, or structurally sound
polymers) so that the chair is invisible under an imaging beam, but
lumbar puncture and associated catheter procedures are visible and
can thus be performed under fluoroscopic guidance (or the like) as
necessary.
[0032] In another embodiment of the invention, there is provided a
sterile tray of parts for use in performing a spinal catheter
insertion technique using the surgical chair shown in FIGS. 1-6.
The tray of parts preferably contains the items listed in Table 1.
An exemplary configuration of the tray is shown in FIGS. 7 and 8,
and indicated generally at 90.
1TABLE 1 Reference Number of Item or Tray Description of Source
location Part Name Quantity (if applicable) 100 Lumbar puncture 1
Allegiance Healthcare Corp., tray McGaw Park, IL 60085; #4301C 104
Spinal Catheter 1 Medtronic PS Medical, tray Goleta California :
#27034 tray Goleta, California; #27304 110 Gauze sponges 10 Kendall
Curity, 3 .times. 3" #1903 112 2% tincture 50 ml Cumberland Swann;
Smyrna, Iodine Solution TN 37167, 108 Sutures 1 USS/DG; Sofsilk;
#SS-685; 45 cm, C-15 cutting needle 108 Needle Holder 1 Acme
Healthcare; Medical Action Industries. Co.; Arden, NC 108 Scissors
1I Acme Healthcare; Medical Action Industries Co.; Arden, NC 108
Paper Drape 1 Shaped to expose lumbar spine 50 and cover the
surrounding area. Includes an adhesive strips 108 Local Anesthetic
50 ml Abbott Laboratories; North with 1 or 2% Chicago, IL 60064
Lidocaine Solution 116 Closed tip lumbar Medtronic PS Medical,
catheter Goleta, California 120 16 Gauge Needle 1 Becton Dickinson
& Co.; Franklin Lakes, NJ 07417 124 14 Gauge Tuohy 1 Medtronic
PS Medical, Needle Goleta, California 128 Luer Hub with Cap 108
Transparent Op Site; Smith & Nephew Adhesive Medical Ltd; Hull
HU3 2BN Dressing England 132 10 cc Syringe 1 136 3 cc Syringe 1 140
Guidewire 1
[0033] Having appropriately seated the patient on chair 20, the
anatomical landmarks (iliac crests and spinous processes) are
indicated with a surgical marking pen on lumbosacral spine 50.
Personnel present to perform or assist wear sterile cap and masks,
and the person inserting the lumbar catheter wears cap, mask, and
sterile gown and gloves. Intravenous prophylactic antibiotics (1
gram oxacillin or 600 mg clindamycin) are administered during the
procedure. The lumbosacral spine 50 area of the patient's back is
prepared with 2% tincture of iodine solution. A sterile paper drape
with an adhesive strip is attached at the lower margin of the
sterile field.
[0034] Local anesthetic with lidocaine is administered along the
planned puncture track of lumbosacral spine 50, as well as adjacent
to the spinous processes for a field block of the recurrent spinal
nerves (For further discussion on this step, see Wilkinson H A.
"Field block anesthesia for lumbar puncture." JAMA 1983;249:2177,
the contents of which are incorporated herein by reference.)
[0035] A closed tip lumbar catheter is prepared with a guidewire
advanced to within 3-4 cm of the tip of the catheter, leaving the
tip flexible. A suitable closed tip lumbar catheter is available
from Medtronic, PS Medical, Goleta, Calif. The skin may be
punctured to a depth of 2-4 mm with a 16-Ga needle to provide
easier insertion of the 14-Ga Tuohy needle. The Tuohy needle is
advanced with the bevel directed either to the right or to the left
so that it is parallel to the longitudinal fibers of the lumbar
spinal dura. Once CSF is encountered, the needle is rotated so the
bevel is directed cephalad.
[0036] Next, the stylet of the Tuohy needle is withdrawn and the
catheter with guidewire is rapidly inserted so that 10-15 cm of
catheter are inserted beyond the needle tip. The needle is
withdrawn. The guidewire is withdrawn by grasping the catheter
where it exits the skin to prevent its withdrawal while the
guidewire is carefully removed in its entirety. The spinal catheter
is then trimmed to an appropriate length so that a Luer hub with
cap can be attached. A small area of skin on the flank is
anesthetized with lidocaine, and the Luer hub is secured to the
skin with a silk suture, thereby providing strain relief for the
spinal catheter if tension is placed on the Luer hub. Finally, the
catheter site is covered with a transparent adhesive dressing, and
the spinal catheter is connected at the Luer hub to tubing that
attaches to a pressure transducer, controlled CSF drainage
apparatus (or system), or a combination of the two.
[0037] Referring now to FIG. 10, a spinal catheter in accordance
with another embodiment of the invention is shown at 116a. Spinal
catheter 116a is essentially the same as catheter 116, particularly
in its length, except that spinal catheter 116a is tapered. The
narrow end 180 of spinal catheter 116a is smaller in diameter than
the touhy needle. Spinal catheter 116a gradually widens to a waist
184 that is slighter greater in diameter than the touhy needle.
Waist 184 can be about two to eight inches in length from narrow
end 180, or it can be about three to seven inches from narrow end
180, or, more preferably it can be about six inches from narrow end
180. Narrow end 180 of catheter 116a is inserted into the puncture,
until waist 184 reaches the opening of the puncture. By so doing, a
seal is formed around the exterior of catheter 116a and the
puncture, thereby reducing leakage from the puncture. Such a seal
provides a number of advantages, including the ability to attach a
device for measuring CSF pressure. With the seal, a more accurate
measurement of CSF pressure can be made than that with certain
prior art catheters. While not necessary, catheter 116a is
preferably coated with an infection resistant layer and/or an
adhesion resistant layer.
[0038] While only specific combinations of the various features and
components of the present invention have been discussed herein, it
will be apparent to those of skill in the art that desired subsets
of the disclosed features and components and/or alternative
combinations of these features and components can be utilized, as
desired. For example, the above-described embodiments of surgical
chairs and kit of parts and technique can be used for standard
diagnostic lumbar puncture, therapeutic lumbar puncture, spinal
catheter insertion, or epidural catheter insertion for spinal
anesthesia or other purposes that will occur to those of skill in
the art.
[0039] The present invention provides a novel spinal catheter and
method for its insertion via seated lumbar puncture using a
surgical chair. It is the inventors' experience that a successful
spinal catheter insertion can be achieved in certain patients that
do not have physical impairments that might restrict their ability
to physically position themselves on the surgical chair in a
presently preferred embodiment. The surgical chair provides a
stable, substantially safe platform for patients, and reduces the
need for additional personnel to maintain the patient's position.
The seated position provides for good alignment of the spinous
processes, improving the chances for successful lumbar puncture and
spinal catheter insertion. The surgical chair can provide a stable
platform that permits patients to maintain proper position with
reduced effort, and without the need for additional personnel to
keep the patient's legs tucked toward the chest in the decubitus
position, or to prevent an over-bed table from rolling if seated on
the edge of the bed. The face rest can reduce and even prevent
breathing obstruction that occurs when patients lean on an over-bed
table with a pillow on it. The seated position also makes it much
more likely that the spinous processes will be aligned without the
rotation of the spine that can occur in the lateral decubitus
position. The present invention can reduce the procedure time by up
to about 50-75% over prior art procedures for insertion of a spinal
catheter, as typically about 30 minutes or less is required for
most patients for the entire procedure.
* * * * *
References