U.S. patent number 3,589,368 [Application Number 04/797,512] was granted by the patent office on 1971-06-29 for postsurgical tubes with capped proximal end.
This patent grant is currently assigned to David S. Sheridan. Invention is credited to Isaac S. Jackson, David S. Sheridan.
United States Patent |
3,589,368 |
Jackson , et al. |
June 29, 1971 |
POSTSURGICAL TUBES WITH CAPPED PROXIMAL END
Abstract
Thoracic catheters and similar postsurgical drainage tubes are
made with a proximal end unit which forms an end closure to
maintain sterile conditions and to provide forceps grasping means
during patient insertion procedures. Following placement in the
patient, the closed tip of the proximal end is cut off to permit
fluid flow through the tube.
Inventors: |
Jackson; Isaac S. (Greenwich,
NY), Sheridan; David S. (Argyle, NY) |
Assignee: |
Sheridan; David S. (Argyle,
NY)
|
Family
ID: |
25171040 |
Appl.
No.: |
04/797,512 |
Filed: |
February 7, 1969 |
Current U.S.
Class: |
604/541; 138/96R;
604/256; D24/127; 138/89; 604/246 |
Current CPC
Class: |
A61M
25/0074 (20130101); A61M 25/0068 (20130101); A61M
25/0069 (20130101); A61M 25/008 (20130101) |
Current International
Class: |
A61M
25/00 (20060101); A61m 027/00 () |
Field of
Search: |
;119/14.19,14.21
;128/348,349,349B,349BV,350,35V,351 ;138/89 ;285/260,284 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Pace; C. L.
Claims
We claim:
1. A postsurgical drainage tube in which the lumen of the proximal
end can remain sterile throughout placement of the tube in a
patient and until the tube is prepared for fluid flow therethrough
formed of nonfibrous plastic material comprising a distal end
portion, at least one fluid opening in said distal end portion, a
proximal end portion, a central body portion joining the distal end
portion to the proximal end portion, and a closed cap on said
proximal end, said closed cap having an elongated cylindrical
portion which tapers to a closed tip, said cylindrical portion
having an outside diameter at least equal to the outside diameter
of said proximal end, said closed tip having an arcuate perimeter,
no portion of said closed tip having dimension transverse to the
longitudinal axis of said cylindrical portion as great as said
outside diameter.
2. A postsurgical drainage tube of claim 1 which is an intercostal
catheter.
3. A postsurgical drainage tube of claim 1 wherein said closed tip
has a width longer than its depth.
4. A postsurgical drainage tube of claim 1 wherein the inside
diameter of said cylindrical portion is substantially equal to the
outside diameter of said proximal end and said closed cap is joined
to said proximal end with an overlap joint.
5. A postsurgical drainage tube of claim 1 wherein said outside
diameter is substantially equal to the outside diameter of said
proximal end and said closed cap is joined to said proximal end by
a butt joint.
6. A post surgical drainage tube of claim 1 wherein said tube is
formed of flexible transparent plastic material and said closed cap
is formed of semirigid plastic material.
Description
BACKGROUND OF THE INVENTION
The present invention relates to medicosurgical tubes with capped
proximal ends. More particularly, it is concerned with improved
catheters and equivalent tubes which are used for drainage
procedures involving placement of the catheter in the patient by
drawing the proximal end through a secondary incision in the
patient made for this purpose.
Intercostal catheters and equivalent medicosurgical tubes are
utilized with surgical operations for postsurgical drainage
purposes to remove fluids and other matter from body cavities of
the patient. The intercostal catheters and similar postsurgical
drainage tubes are positioned in the patient at the completion of
the surgical operation by insertion through the original incision
with the proximal end portion of the catheter entering the incision
ahead of the distal end contrary to the more normal placement of a
catheter where the distal end first enters the patient. A second
incision or stab wound is made in the patient and forceps are
inserted through it to grasp the proximal end of the catheter. The
catheter is pulled into the body until the distal end portion is
properly positioned with the tube leading out through the second
incision. The catheter placement procedure is completed by
connecting the proximal end to necessary auxiliary drainage
equipment, e.g., an underwater seal.
The reverse method of installing intercostal catheters with the
proximal end portion first entering the patient and then again
being withdrawn is employed by surgeons to safeguard against
contamination of the pleural area or other body region from which
materials are to be withdrawn through the catheter. However, this
system of catheter installation creates problems which can lead to
ripping or tearing of body tissue as the proximal end of the
catheter is drawn to and through the second incision or stab wound.
A so-called coring effect can occur which will lodge body tissue in
the lumen of the proximal end portion of the catheter. These
difficulties associated with use of postsurgical drainage tubes are
well known to the medical profession and various modifications in
drainage tube construction have been proposed to mitigate the
problems (see U.S. Pat. Nos. 3,190,290 and 3,295,527).
In addition to the slanted or fusiform ends for medical catheters
as proposed in the aforementioned patents, a variety of other end
constructions have been proposed in the past in the construction of
catheters. Such proposals have included a "duckbill" end for a
catheter with two opposed branches which may be closed by
compression to form a conical or wedge shape upon the end of the
catheter during its passage into a body channel or cavity (see U.S.
Pat. No. 217,711). Notwithstanding all of these prior ideas for
catheter improvement, more is needed to insure the safe and
efficient utilization of intercostal catheters or equivalent
postsurgical drainage tubes as a part of successful surgical
operation upon a patient.
OBJECTS
A principal object of this invention is the provision of new
improvements in the proximal end portion of medicosurgical
tubes.
Further objects include the provision of:
1. Postsurgical drainage tubes of improved construction having
nontraumatic proximal ends which permit smooth installation in a
patient without ripping, coring or tearing of body tissue of the
patient.
2. Improved drainage catheters which prevent material from entering
the interior until the catheter is properly positioned and ready
for connection of the proximal end to auxiliary drainage
equipment.
3. New proximal end portions for catheters that permit surgical
forceps to obtain a sure, firm grip upon the proximal end of the
catheter and insure satisfactory movement of the catheter through
body tissue during patient placement.
Other objects and further scope of applicability of the present
invention will become apparent from the detailed description given
hereinafter; it should be understood, however, that the detailed
description, while indicating preferred embodiments of the
invention, is given by way of illustration only, since various
changes and modifications within the spirit and scope of the
invention will become apparent to those skilled in the art from
this detailed description. It should also be understood the
foregoing abstract of the disclosure is for the purpose of
providing a nonlegal brief statement to serve as a
searching-scanning tool for scientists, engineers and researchers
and is not intended to limit the scope of the invention as
disclosed herein nor is it intended it should be used in
interpreting or in any way limiting the scope or fair meaning of
the appended claims.
SUMMARY OF THE INVENTION
These objects are accomplished according to the present invention
by constructing medicosurgical tubes of flexible plastic material
to include a distal end portion comprising at least one fluid
opening, a proximal end portion and a central body portion
integrally joining the distal end portion to the proximal end
portion, the tubes being characterized by the proximal end portion
being closed by a tapered closed tip. In a preferred embodiment,
the closed tip is provided by a closed cap that is fixed to the
tube with the closed cap having an elongated cylindrical portion
which tapers to a closed tip.
Advantageously, the closed cap defining the proximal end of the
drainage tubes is molded of plastic material such as by injection
molding, dipping, plastisol molding, dielectric molding or other
suitable molding procedure known to the plastics art. Such molded
closed cap is affixed by cement, by fusion or other suitable means
to the end of the drainage tube. This closed cap may be molded of
flexible, semirigid or rigid plastic material while the remainder
of the tube is advantageously formed of flexible plastic material
and desirably of transparent plastic material. Fabrication of the
medicosurgical tubes from the flexible plastic material is
advantageously accomplished by extrusion although dipping or other
fabrication techniques may be employed.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is a fragmentary side elevational view, partially in
section, of the proximal end portion of the embodiment of a
postsurgical drainage tube in accordance with the invention.
FIG. 2 is a fragmentary top elevational view of the proximal end
portion of the embodiment of the invention illustrated in FIG.
1.
FIG. 3 is a fragmentary side elevational view of the proximal end
portion of the embodiment of the invention illustrated in FIG. 1
being gripped between jaws of surgical forceps. FIG. 4 is a
fragmentary perspective view of a postsurgical drainage tube in
accordance with the invention showing the distal end portion and
the proximal end portion.
FIG. 5 is a fragmentary perspective view similar to FIG. 4 showing
another embodiment of postsurgical drainage tube of the invention
with the nontraumatic proximal end partially cut off in preparation
for connection to auxiliary drainage equipment.
FIG. 6 is a top elevational view of the proximal end portion of a
different form of postsurgical catheter.
FIG. 7 is a side elevational view of the proximal end portion of
the catheter illustrated in FIG. 6.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
FIGS. 1 through 5 illustrate preferred embodiments of
medicosurgical tubes in accordance with the invention. In order to
illustrate in as large scale as possible within the limitations of
the accompanying drawing, the distal end portion of the new
drainage catheters is not shown in FIGS. 1--3 and the central body
portions are not shown in FIGS. 4 and 5. Generally, the distal end
portion will involve an open end tip and a plurality of side inlet
openings (see U.S. Pat. No. 3,190,290). Additionally, the new
catheters may include an X-ray line (see U.S. Pat. No. 3,295,527)
or other suitable imprinted or infused X-ray opaque inlet
perimeters, tube portions or the like designed to aid the surgeon,
physician or other person attending the patient to determine
location of any desired section of the catheter within a body
cavity or channel in the patient.
Referring in detail to FIGS. 1--3, the drainage tube 2 has a
proximal end portion 4 which is integrally joined to a central body
portion 6 which constitutes the major longitudinal extension of the
catheter. Normally, the central body portion 6 will constitute an
extruded flexible plastic tube of uniform diameter and wall
thickness. However, if dictated by preference of the surgeon using
the catheter or other special requirements, the body portion can be
formed with variations in wall thickness, tapered sections or the
like using pressure blowing, vacuum drawing or other techniques
known to the plastics art.
The closed cap 8 has an elongated cylindrical portion 10, a tapered
section 12 and a closed tip 14. The closed tip might be described
as a closed duckbill. It presents a semielliptical perimeter 16
comprising one side 18, an arcuate end 20 and another side 22. It
further comprises a top face 24 and a bottom face 26. The width of
the closed tip 14 measured between the sides 18 and 22 is longer
than the depth measured between the top face 24 and the bottom face
26. As can be seen from FIGS. 1 and 2, no portion of the closed tip
14 has a dimension transverse to the longitudinal axis of the
cylindrical portion 10 as great as the outside diameter of the
portion 10 i.e., the maximum transverse dimension of the closed tip
14 is between the sides 18 and 22 and this is not as great as the
outside diameter of portion 10. The generally flat surfaces of the
top face 24 and the bottom face 26 provide means by which surgical
forceps 28 may firmly grip the closed cap 8 when it becomes
necessary for the surgeon to withdraw the catheter through body
tissue and a second incision in the patient in accordance with
established procedures for installation of intercostal
catheters.
In the form of catheters shown in FIGS. 1--3, the elongated
cylindrical portion 10 of the closed cap 8 is of substantially
uniform cross section and inside diameter. This inside diameter is
substantially equal to the outside diameter of the proximal end
tube portion 30. Consequently, the closed cap 8 forms an overlap
joint with the tube end portion 30 and is affixed to the tube by
cement. Alternatively, solvent which will soften the plastic of the
tube or the molded cap or both may be used to fix the cap to the
tube or electronic welding or any other equivalent fabrication
technique may be used to unite the molded cap 8 to the tube end
portion 30. As an alternative, the closed cap 10 can be molded with
a stepped or recessed end so that the tip 32 of the tube would butt
against a radial face molded in the closed cap 10. As a further
modification, the cylindrical portion 10 of the cap could be of the
same inside and outside diameter as the tube tip 32 with these
separate parts being joined by a butt joint formed by friction
welding, cementing or equivalent method of attachment.
In use, the catheter will be led through the major incision formed
in the patient during the surgery by leading the closed tip 14 into
the incision to be followed by the cylindrical cap portion 10 and
then the tube body portion 6. A second incision or stab wound is
also made in the patient according to established surgical
practice, the surgical forceps 28 will be inserted through the
second incision until the tip 14 within the patient body cavity can
be grasped as shown in FIG. 3. The proximal end portion of the
catheter may then be withdrawn from the patient's body without any
tearing, ripping or coring of body tissue. Such withdrawing of the
proximal end will continue until the distal end assumes the
required position within the body cavity or channel as determined
by suitable procedure known to the medical profession. An anchor
stitch through the skin of the patient adjacent the second incision
or equivalent method will be applied to insure that the catheter is
retained in this critical position in the patient. During all of
this manipulation, the closed cap maintains the interior of the
catheter sterile until the moment when the surgeon determines the
time has arrived to attach the catheter at the proximal end to
auxiliary drainage equipment. To accomplish this, the end of the
closed cap 10 can be severed with a scissors at the junction 34
between the cylindrical portion 10 and the base of the taper
portion 12. This will permit the use of a connector with a lumen
size equal to or larger than tube 6 to the auxiliary drainage
equipment, facilitating "milking" of blood clots or other possible
solid obstructions in the tube if this should become necessary
during the postsurgical drainage procedure.
In the embodiment of the invention shown in FIG. 4, the intercostal
catheter 2a comprises a proximal end portion 4a, a tube 6 and a
distal end portion 40. The nontraumatic closed cap 8a has a closed
tip 14a joined to an elongated cylindrical portion 10a by a tapered
section 12a. The closed tip 14a is oval in cross section and
provides means by which forceps may securely grasp the catheter
during the placement procedure.
The closed cap 8a is joined by an overlap joint to the tube 6 and
is secured by solvent welding or its equivalent. Since the closed
cap has an inside diameter equal to the outside diameter of the
tube 6, the bore of the tube 6 continues at full size clear to its
end. This permits a connection to be made at the proximal end
giving full lumen drainage to the catheter. The distal edge 42 of
the cap 8a may be beveled as shown to provide the maximum of smooth
flow and easy, nontraumatic passage through body tissue of a
patient.
The distal end 40 of the catheter has a rounded tip 44 made of a
fused ring of X-ray opaque plastic material. An inlet opening 46
enters through the tip 44. The catheter is also provided with side
entering inlet eyes 48 which are generally from three to five in
number depending on the catheter size.
In the embodiment of the intercostal catheter 2b shown in FIG. 5,
the tube 6 has a cap 8a which has been cut off after placement in
the patient leaving an open end. The bore of the catheter 2b is
packed by a slightly compressed rod 52 of plastic foam which
extends from the distal end opening 46 along the entire length of
the tube bore and into the cap 8a. With the closed end of the cap
cut off, the proximal end 54 of the plastic foam rod 52 becomes
available to the surgeon permitting the rod 52 to be withdrawn to
open the full lumen of the tube to drainage through the inlet
openings 46 and 48. The plastic foam rod packing in the catheter 2b
provides means to prevent blockage of the tube by blood clots or
other solid matter during the procedure of placement of the
catheter in the patient as disclosed in copending application of
Sheridan, filed Feb. 19, 1969, as Ser. No. 800,547, and entitled
"Insured Internal Flow Medicosurgical Tubes."
The closed caps of the new drainage catheters can be molded in any
of the standard sizes of thoracic catheters such as French size 16
through 40 and the flexible tube comprising the central portion and
the distal end portion may be of any required length such as the
usual 20-inch length. Further, the catheter may be formed with a
straight central body portion of with a right angle proximal to the
drainage inlets or eyes as required by certain postsurgical
drainage procedures. Advantageously, each individual catheter will
be enclosed in a separate package or envelope, sealed and then
sterilized in known fashion by ethylene oxide vapor exposure, gamma
ray irradiation or the like in order to sterilize the package and
catheter. When marketed in this manner, each individual catheter is
ready for immediate use without requiring sterilization.
Formulation of the plastic material from which the postsurgical
drainage tube is extruded can be controlled as is known in the art
to give tube flexibility at body temperatures while maintaining
necessary wall strength so that the catheter will conform
adequately to the contours of the body cavity or channels to which
it extends within the patient. Marker rings or other length indicia
may be printed on the outside wall of the tube 6 at required
locations to aid the surgeon in determining the location of the
most proximal inlet opening or eye along the distal end portion of
the catheter. Skilled users of the catheters may use such markings
in lieu of X-ray examination to determine position of the distal
end portion of the catheter within the patient
ADDITIONAL DISCLOSURE
Another form of catheter end which may be used in construction of
intercostal catheters is illustrated in FIGS. 6 and 7. In this form
of catheter 40', the proximal end portion 42' comprises an upper
wedge shape lip 44' and a lower complementary shaped lip 46'.
Rounded tips 48' are formed on each of these lips and side edges
50' and 52' are provided with inwardly extending bevels 54'. The
lips 44' and 46' are compressed together as shown in FIG. 7 and
fixed in this position by cement, heat fusion or in equivalent
manner. This serves to reduce ripping or tearing of body tissue
when a drainage catheter of this form is positioned within a
patient according to the established procedure as described
previously. When the catheter has been properly installed, the
proximal end of the catheter may be opened by cutting along the
seam line 56' forming an open mouth end which serves as connector
means for joining the catheter to the required tubes or equipment.
The joined lip construction of these catheters provides a stiffer
end than the remainder of the tube during the placement procedure
which aids in the installation and grasping of the tip by forceps.
Also, the open lip arrangement which results when the lips are
separated after placement gives a flexibility to the proximal end
that permits an absolutely airtight connection to be made to
auxiliary drainage equipment. As is known in the use of thoracic
catheters no leaks of any kind can be tolerated in the drainage
system.
* * * * *