U.S. patent number 3,568,660 [Application Number 04/684,460] was granted by the patent office on 1971-03-09 for pacemaker catheter.
This patent grant is currently assigned to The Battelle Development Corporation. Invention is credited to Samuel P. Chambers, Nelson A. Crites.
United States Patent |
3,568,660 |
Crites , et al. |
March 9, 1971 |
**Please see images for:
( Certificate of Correction ) ** |
PACEMAKER CATHETER
Abstract
A multipurpose catheter and method of producing the same which
involves applying a thin, first layer of rubber over the external
surface of a selected length of flexible tubing, with the rubber
being dissolved in a solvent and applied to the tubing in an
atmosphere of the solvent, partially drying the first layer of
rubber, helically winding at least two electrical conducting wires
over the surface of the tubing and embedding the wires in the first
layer of rubber, drying the first layer of rubber, extracting an
end portion of each conductor from beneath the first coating near
one end of the tubing and flat winding each end portion to form
spaced electrode bases, providing a metal contact sleeve over each
base to form electrodes, applying a thin second layer of rubber
over the first layer in an atmosphere of the rubber solvent, drying
the second layer of rubber, and connecting the opposite ends of the
conductors to electrical jacks. A split needle is provided for use
in inserting the catheter, the needle being thereafter withdrawn.
For facilitating such withdrawal, the needle is constructed in two
halves with a slidable cylindrical lock ring.
Inventors: |
Crites; Nelson A. (Columbus,
OH), Chambers; Samuel P. (Columbus, OH) |
Assignee: |
The Battelle Development
Corporation (Columbus, OH)
|
Family
ID: |
24748132 |
Appl.
No.: |
04/684,460 |
Filed: |
November 20, 1967 |
Current U.S.
Class: |
607/122; 29/460;
29/874; 29/458; 29/850 |
Current CPC
Class: |
A61N
1/056 (20130101); A61M 25/0108 (20130101); A61M
25/00 (20130101); A61M 25/04 (20130101); A61M
25/0045 (20130101); Y10T 29/49888 (20150115); Y10T
29/49204 (20150115); A61M 25/0012 (20130101); Y10T
29/49885 (20150115); A61M 25/005 (20130101); Y10T
29/49162 (20150115) |
Current International
Class: |
A61M
25/04 (20060101); A61M 25/02 (20060101); A61M
25/00 (20060101); A61M 25/01 (20060101); A61N
1/05 (20060101); A61b 005/10 () |
Field of
Search: |
;128/2,2.05,2.06,2.1,172.1,348,416,418,419,404 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
823,320 |
|
Dec 1951 |
|
DT |
|
1,033,971 |
|
Jun 1966 |
|
GB |
|
Primary Examiner: Lowe; Delbert B.
Claims
We claim:
1. A catheter for insertion into the circulatory system
comprising:
a. a flexible tubing having a central lumen;
b. a first coating of rubber on the outer surface of said
tubing;
c. at least two conductors helically wound over said flexible
tubing and embedded in said first coating of rubber;
d. a second coating of rubber overlying said first coating; and
e. an electrode connected to each said at least two conductors,
each said electrode including a flat wound section of the
corresponding conductor overlaid by and attached to a metallic
sleeve with each said electrode spaced from one another and near
one end of said tubing, the conductor ends opposite the electrodes
being accessible for connection to electrical jacks.
2. A catheter according to claim 1 wherein said metallic sleeve
comprises at least one layer of metal having characteristics
resulting from having been electroplated over the flat wound
section of the conductor.
3. A catheter for insertion into said circulatory system according
to claim 1 wherein a woven Dacron sleeve is positioned between said
first and second coatings of rubber.
4. A method of producing a catheter comprising:
a. applying a first coating of rubber to the outer surface of a
base tubing in an atmosphere of rubber solvent;
b. helically winding at least two conductors into said first
coating of rubber before the rubber has dried;
c. extracting an end portion of each of said conductors from
beneath said first coating of rubber near one end of said base
tubing and flat winding each of said end portions to form electrode
bases;
d. attaching a metal sleeve over each said electrode base to form
the outer surface of the electrode;
e. masking off the outer surface of the electrodes;
f. applying a second coating of rubber over said first coating of
rubber in an atmosphere of rubber solvent;
g. attaching the end of said base tubing that is opposite from the
end having said electrodes to a Luer-Lok and
h. connecting said two conductors to electrical plug-in means.
5. A method of producing a catheter comprising;
a. straightening a base tubing by threading said base tubing onto a
wire, applying tension to the ends of said base tubing and applying
heated air to said base tubing;
b. applying a first coating of rubber to the outer surface of said
base tubing in an atmosphere of rubber solvent;
c. helically winding at least two conductors into said first
coating of rubber before the rubber has dried;
d. extracting an end portion of each of said conductors from
beneath said first coating of rubber near one end of said base
tubing and flat winding of each of said end portions to form
electrode bases;
e. electroplating a metal sleeve over each said electrode base to
form the outer surface of said electrode;
f. masking off the outer surface of the electrodes;
g. applying a second coating of rubber over said first coating of
rubber in an atmosphere of rubber solvent;
h. attaching the end of said base tubing that is opposite from the
end having said electrodes to a Luer-Lok and
i. connecting said two conductors to electrical plug-in means.
Description
BACKGROUND OF THE INVENTION
This invention concerns a medical device for insertion into the
circulatory system to obtain blood samples, introduce fluids into
the circulatory system, detect cardiac ailments, or provide
electrical impulses for stimulating heart beat as a temporary
pacemaker.
There have been a number of catheters developed in the past usually
designed for a specific requirement or test on the heart. Here have
been phonocardiac catheters, pacemaker catheters, catheters with
thermistors, platinum electrodes, strain gauges sampling lumen,
etc. There are very few catheters that combine a number of the
various recording or activating elements and, as a consequence,
right heart catheterization usually requires more than one catheter
if there are a number of tasks to be done. Once a catheter position
has been reached it is time consuming and often impossible to
duplicate the position with a second catheter for additional
different measurements or treatments. Also, present catheters
(especially catheters for taking more than one reading or having a
central lumen) are no smaller than a No. 6 French (.078 inch
outside diameter) and usually require the aid of a fluoroscope for
insertion through the blood vessels into the heart.
There is little time to spare with a heart failure patient. When a
patient would benefit from a pacemaker the quickest solution has
been to apply an external pacemaker to the chest over the heart
area. This type of pacemaker sends a heavy electric charge through
the chest wall and frequently causes damage to tissue. Therefore,
there is a need for a catheter that can be quickly inserted
directly into the heart so that the pacemaker voltage can be small.
Such a pacemaker can be maintained for prolonged periods until the
patient recovers or a more permanent battery operated pacemaker can
be installed by surgery.
In order to establish a diagnosis or evaluate the severity of heart
problems, other catheter functions are extremely useful, such as:
blood samples for oxygen determination, intercavity
electrocardiograms, hydrogen-sensing electrodes to detect cardiac
shunts, pressure recording in cardiac chambers, great vessels and
from pulmonary wedge positions, injection of radiopaque substances
for X-ray studies, and injection of an indicator dye to determine
circulatory dynamics.
Ordinarily, the catheter is inserted in an appropriate vein
(usually the median basilic vein of an adult or the saphenous vein
in the groin of an infant) and the tip of the catheter is
maneuvered while the patient is under a fluoroscope until the
catheter reaches the accessible intracardiac chamber or great
vessels. A hypodermic needle of appropriate size is first inserted
into the vein and the catheter is then inserted through the
hydpodermic needle. The needle withdrawn remains in the body until
the catheter is withdrawn. Flexibility is an important factor,
since, if the catheter is too stiff, it will tend to pierce the
walls of the vessels. The catheter of this invention is both small
in diameter and flexible so that it tends to follow the blood
vessel readily, thereby eliminating the need for a fluoroscope.
Furthermore, use of the split needle disclosed herein allows the
entering and guiding hypodermic needle to be removed from the body
after the catheter is in position to reduce tissue damage and
discomfort in the area of catheter insertion. The small outside
diameter of the catheter is especially advantageous in the
catheterization of infants who naturally have small blood vessels.
Thus, the .048 inch outside diameter of the catheter disclosed is
an important factor.
SUMMARY OF THE INVENTION
The apparatus of this invention includes a flexible tubing base
having a central lumen, a first coating of rubber over the tubing,
at least two conductors helically wrapped around the tubing base
and embedded in the first coating of rubber, a second coating of
rubber over the conductors, at least two electrodes spaced from one
another near one end of the tubing, each electrode connected to one
of the conductors, and means at the opposite end of the tubing for
providing electrical jacks for the conductors and a connector to
provide access to the central lumen. Some special provisions
include platinum electrodes plated over the conductors which are
flat wound over the tubing base at the desired positions for the
electrodes. Also, another embodiment includes fiber glass or dacron
woven sleeving over the outside of the catheter which may be
impregnated with rubber.
Briefly described, the method of producing a multipurpose catheter
includes applying a thin, first layer of rubber over the external
surface of a selected length of flexible tubing, with the rubber
being dissolved in a solvent and applied to the tubing in an
atmosphere of the solvent; partially drying the first layer of
rubber; helically winding at least two electrical conducting wires
over the surface of the tubing and embedding the wires in the first
layer of rubber; drying the first layer of rubber; applying a thin
second layer of rubber in an atmosphere of the rubber solvent;
drying the second layer of rubber; and connecting an electrode to
each of the wires with the electrodes fitting closely around the
tubing, spaced from one another, and near one end of the
tubing.
One object of this invention is to provide a medical device for use
in the catheterization of the circulatory system that acts as a
pacemaker, means for introducing fluids into the blood stream at
selected locations, and a blood pressure measuring device,
detecting various pathological conditions and measuring electrical
impulses from the heart.
Another object of this invention is to provide a medical device
including a very small catheter having a useful central lumen to
reduce trauma and other difficulties associated with
catheterization.
Still another object of this invention is to provide a method of
fabricating a miniaturized catheter having all the features and
advantages of larger catheters and combining the uses of a number
of catheters.
One advantage of this invention is that the catheter has a small
outside diameter but still has a central lumen that has a
sufficiently large inside diameter to be useful in taking blood
samples, administering fluids, etc.
Still other objects and advantages of the invention will be
apparent from the detailed description of the process and
apparatus, the drawings, and claims that follow.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a plan view of an apparatus suitable for constructing the
catheter of this invention;
FIG. 2 shows a method of positioning a cup around the tubing base
in preparing to apply a rubber coating to the tubing;
FIG. 3 shows a method of applying a rubber coating to the
tubing;
FIG. 4 is an enlarged view of the carriage of the apparatus of FIG.
1 showing the application of the wire conductors to the
catheter;
FIG. 5 is a cross section of the catheter showing the conductor
wires after they have been wound onto the catheter through the
first soft rubber coating;
FIG. 6 is a cross section of the catheter showing the condition
after the first coating of rubber heals over the conductor wires
and hardens;
FIG. 7 is a view of the eventual electrode end of the catheter
showing some of the steps in applying the electrodes;
FIG. 8 is a view of the eventual electrode end of the catheter
showing one method of applying the electrodes;
FIG. 9 is a view of the electrode end of the catheter showing a
plating method of applying the electrodes;
FIG. 10 is a cross-sectional view of the catheter showing the
attachment of the catheter tube to a Luer-Lok and the attachment of
the wire conductors to electrical jacks;
FIG. 11 is a perspective view of the split needle; and
FIG. 12 is a diagram of the catheter inserted into a patient and
having an enlarged insert showing the removal of the split needle
after the catheter is in position in the body.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
In the drawings, the same reference numerals are applied to
identical parts in all embodiments and such identically numbered
parts are substantially identical in structure, function and
operation. Therefore, to eliminate confusing duplication, these
parts, their interrelationship and their function will be described
only in conjunction with a single embodiment, such description
applying to all embodiments where there parts appear.
Referring to FIG. 1, the tubing base 21 is threaded onto a mounting
wire 23 and one end of 29 wire 23 is positioned in the tailstock
chuck 25 which is tightened to hold the wire 23 firmly at one end.
One way of making it easier to thread the tubing 21 onto the
mounting wire 23 is to coat the wire with sodium bicarbonate which
then acts as a lubricant when the tubing 21 is threaded onto the
wire 23. The opposite end of wire 23 is affixed in the headstock
chuck 27. Headstock chuck 27 is slideably mounted on shaft 29 by
means of a key (not shown) fitted into a groove 31 on shaft 29. A
spring 33 is attached between shaft 29 and chuck 27 and is adjusted
to exert a pulling force (preferably about 10 pounds) on chuck 27
which is applied along wire 23.
A power source 35 (such as an electric motor) rotates shaft 37 by
means of pulley 39, belt 41, and pulley 43. A chain and sprocket
device 45, connected between shafts 37 and 29, drives headstock
chuck 27 and similarly a chain and sprocket device 47 drives shaft
48 of the tailstock chuck 25. The positive drive, such as a chain
and sprocket, is preferred to ensure that both of the chucks 25 and
27 rotate at the same speed, thus eliminating any twisting of the
mounting wire 23. A step pulley 49 is attached to shaft 37 and
drives another step pulley 51 by means of a belt 53. Step pullet 51
is affixed to a shaft 55 which has threads 57 over most of its
length. The belt 53 may be positioned on different steps of pulleys
49 and 51 to adjust the rotational speed of shaft 55.
A carriage 59 is provided with a guide 61 that is fitted into a
track 63 running parallel to the length of the tubing 21. A
projection 65 on the carriage 59 includes thread-engaging means 67
that is moved into and out of engagement with threads 57 by
rotating a handle 69 so that the carriage 59 is driven along the
track 63 when thread engaging means 67 is pressed against threads
57. The carriage 59 is movable in either direction. Direction
change is accomplished by twisting belt 53 into a figure eight.
Carriage 59 includes a number of devices that are used to construct
the catheter. These include a cup holder 71, comb slot 73, wire
spools 75 and 77 and spool brakes 79 and 81.
The entire device is mounted on a table having a fixed portion 83
and a tiltable portion 85. The two table portion 83 and 85 are
connected by hinges 87-87. A stop or rest 89 is positioned under
tiltable portion 85 to maintain it in the horizontal position.
During the application of rubber coatings to the tube 21 the
tiltable portion 85 is raised until the tube 21 is inclined at an
angle of at least 45.degree. degrees above the horizontal. Suitable
bearing mounts 91-91 are provided for shafts 29, 37, 48, and
55.
After the mounting wire 23 is affixed in the chucks 25 and 27, a
stretching force (of about 1 pound, preferably) is applied to the
tube 21 manually and the ends of the tube are taped to the wire 23.
The wire 23 and tube 21 are then rotated and hot air (at about 350
to 450.degree. F.) is blown over the tubing 21. The hot air softens
the tubing 21 (preferably constructed of Teflon) removing any kinks
or undulations that may have been originally constructed into the
tubing 21.
FIGS. 2 and 3 show a method of applying a rubber coating to the
tubing 21. A flexible cup 93 having a small hole 95 in the bottom
and a split 97 down the side and across the bottom to the hole 95
is spread apart by suitable means such as the instrument 99, fitted
over the tubing 21 and allowed to spring back so that the tube 21
passes through the hole 95 in the bottom. The cup 93 is supported
by a yoke 100 having two ends 101-101 that are pivotally mounted in
the sides of the cup 93 and an arm 103 fits slideably into a tube
105 of cup holder 71. The cup 93 is thus allowed to both pivot (at
ends 101) and slide (arm 103 and tube 105) in gimballike
arrangement so that any irregularities in the mounting wire 23 or
tubing 21 are tracked or followed by the cup 93 as the tubing 21 is
rotated.
The table portion 85 is tilted upward to about 45 degrees or more
and the carriage 59 with the cup 93 is moved up next to the
tailstock chuck 25. The cup 93 is partially filled with liquid
rubber 107 in a solvent such as xylene. A cap 109 having a slot 111
and central opening 113 is placed on the cup 93 and, preferably, an
atmosphere of xylene is introduced into the space above the liquid
rubber 107 (for example with an atomizer). Pulleys 49 aNd 51 are
connected by belt 53 so that the carriage 59 moves in the direction
of the arrow 115 (from tailstock toward headstock) while the tube
21 is rotated and a thin coating of rubber 107' is applied to the
surface of the tubing 21. Preferably the tubing 21 is made of
Teflon with an etched exterior surface. The etched surface aids in
making a good bond between the tubing 21 and the rubber coating
107'.
FIG. 4 shows a means of adding the wire conductors 117 and 119 to
the tubing 21 with rubber coating 107'. The carriage 59 has moved
back to the headstock chuck 27 while applying the rubber coating
107'. The coating 107' is allowed about 10 minutes drying time. The
wires 118 and 119 are passed from spools 75 and 77 through a comb
121 affixed to a block 123 that is mounted in comb slot 73. The
belt 53 is arranged so that the carriage moves from the headstock
chuck 27 toward the tailstock chuck 25 as indicated by the arrow
125 in FIG. 4. The tubing 21 rotates and the wires 117 an 119 are
pulled from the spools 75 and 77 and applied in a helical fashion
to the tubing 21. The brakes 79 and 81 create a drag on the spools
75 and 77 ensuring that the wires 117 and 119 are wound tightly
onto the tubing 21.
FIG. 5 shows how the wires 117 and 119 "bite" through the
incompletely hardened rubber coating 17' so that the wires 117 and
119 are actually wound onto the exterior surface of tubing 21. As
the coating 107' congeals more and hardens, it heals over the wires
117 and 119 as shown in FIG. 6. The step of winding the wires 117
and 119 "through" the rubber coating 107' is important, since, by
using this procedure, a smooth coating over the wires 117 and 119
results. If the wires 117 and 119 were applied before the rubber
coating 107', the result would be an undesirable series of bumps
over each wire or a wavy appearance.
FIG. 7 shows the early steps in adding the electrodes to the
catheter. Both of the wires 117 and 119 are "teased" out through
the rubber coating 107' at the electrode end of the catheter. A
length of the rubber coating 107' is scraped off. After the rubber
coating 107' has been removed the tubing 21 is preferably reetched
and then one of the wires (for example 119) is rewrapped onto the
tubing 21. The rewound wire 119 is then covered by a length of thin
Teflon tape 127 which is held in place by an epoxy cement. In one
embodiment, a woven (preferably Dacron) sleeve is slid over the
tubing before the second coating of rubber is applied.
In FIG. 8 one type of electrode exterior is being added to the
catheter shown in FIG. 7. One of the wires 117 is flat wound around
the tubing 21 over the tape 127 to form an electrode base 117' for
the proximal electrode 131. The other wire 119 is flat wound around
the tubing 21 closer to the end or at the end to form an electrode
base 119' for the distal electrode 133. After the wire is flat
wound a silver epoxy 135 is applied over the wire and to the inside
of the electrode exterior sleeves 129 (in this instance the
electrode exterior sleeves 129 are machined from a suitable
material such as stainless steel) and the sleeves 129 are passed
over the end of the tubing 21 and pushed over the electrode bases
117' and 119' as shown by the arrow 137. The silver epoxy 135 acts
as a solder connection to give good electrical contact between the
electrode bases 117', and 119', and the sleeves 129-129.
Another method of forming the electrodes is shown in FIG. 9. The
wire conductors 117 and 119 are again flat wound to form electrode
bases 117' and 119' . The electrode bases 117' and 119' are coated
with a silver epoxy 135 and the electrode exteriors are formed by
plating the electrode bases 117' and 119'. A container 139 (such as
an eye dropper) is filled with a plating solution 141. A droplet
143 is fed around the electrode base 117' with capillary exchange
between the container 139 and droplet 143 aided by a plurality of
small fibers 145 at the mouth 147 of the container 139. The
conductor 117 is connected to a battery 149 so that the electrode
base 117' acts as a cathode and the anode 151 is also connected to
battery 149 by a conductor 153. The container 139 is oscillated
gently, as shown by the double arrow 155, by a small force applied
through the container holder 157. If desired, additional wire may
be wound over electrode bases 117'--119' and soldered in place in
order to build the final diameter of the electrodes up to a
selected size.
Preferably, three layers of material are plated onto the electrode
base. The first layer is a thin copper plate, followed by a thin
plate of 24 carat gold and finally a plate of platinum. After the
electrodes are completed, a final coat 158 of medical grade
silicone rubber is applied to the entire catheter in the same
manner shown in FIG. 3. In order to prevent the coating from
adhering to the electrodes, they are masked off by a thin coating
of adhesive which is removed after the final coating of rubber has
hardened.
FIG. 10 shows the completed catheter with a Luer-lok 159 attached
to the end opposite the electrodes 131--133. The catheter end piece
160 is constructed by cutting off part of the needle portion 161
from a standard hypodermic needle. The cut end preferably is flared
very slightly to form a small end enlargement 163. A cylinder 165
having a rounded nose 167 is fitted over the needle 161 and affixed
to the Luer-Lok 159. A handle 169 is fitted over the cylinder 165
and also attached to the Luer-Lok 159. An electrically insulating
epoxy 171 is applied over the exposed surface of the cylinder 165
and a surface 173 of the handle 169. The conductors 175 and 177
from two electrical jacks 179-179 (or as many jacks as there are
conductors woven into the catheter) are glued in place along the
insulating epoxy 171 on the exposed surface 173 of the handle 169.
The lumen 181 of the tubing 21 is enlarged by thrusting a heated
needle or wire into the lumen 181, thereby expanding the lumen to
fit over the needle portion 161 and cylinder 165. After the needle
portion 161 and cylinder 165 has been inserted into the lumen 181,
a length of wire 183 is wrapped over the exterior of the catheter
to hold the catheter to the catheter end piece 160. The proximal
ends of the conductors 117 and 119 are then soldered to the
conductors 175 and 177. The Luer-Lok 159 is masked off and the end
piece and proximal end of the catheter are dipper repeatedly in
liquid rubber until a thick protective base 185 is built up around
the junction of the end piece 160 and the catheter, the base 185
tapering off along the catheter. Preferably, the thickness of the
rubber 185 at the junction of the end piece and tubing inches is
about 50 mils tapering to zero at about 11/4 inches from the
junction.
FIG. 11 shows the portion of the medical device that is used
preliminary to inserting the catheter into the body and it is
called a split needle 187. This portion of the medical device
includes a needle 189 customarily provided with an end piece 191
and Luer-Lok 193. A syringe portion 195 usually containing saline
is attached to the Luer-Lok 193. A split needle 197 having two
portions 199 and 201 is slipped over the needle 189 and the two
portions 199 and 201 are held together by a cylinder 203 that
slides over the assembled split needle 197.
FIG. 12 shows the medical device in use. The standard hypodermic
needle 189 (FIG. 11) is inserted into a blood vessel 205 and the
split needle 197 is slid along the needle 189 until it is also
positioned in the blood vessel 205. The standard needle 189 is the
withdrawn and the catheter is inserted through the split needle
197. The catheter is further fed through the split needle 197 and
blood vessel 205 until it reaches the desired position in the heart
207 (as determined, for example, by indication from an
electrocardiograph). Once the catheter has reached the desired
position in the circulatory system, the split needle 197 is
withdrawn from the blood vessel 205; the sleeve 203 is slid off the
split needle 197; and the two halves 199 and 201 are separated and
removed from the catheter. The jacks 179-179 and Luer-Lok 159 may
be connected to appropriate mechanisms any time during the
procedure as desired by the operator.
It will be understood, of course, that, while the forms of the
invention herein shown and described constitute the preferred
embodiments of the invention, it is not intended herein to
illustrate all of the possible equivalent forms or ramifications of
the invention. It will also be understood that the words used are
words of description rather than of limitation, and that various
changes, such as changes in shape, relative size, and arrangement
of parts may be substituted without departing from the spirit or
scope of the invention herein disclosed.
* * * * *