Method Of Inserting A Suprapubic Catheter

Abstract

A method of and an instrument for inserting a suprapubic catheter. The instrument comprises a tube having a curved distal portion insertable through the urethra into the bladder to bring the distal end of the tube in engagement with the wall of the bladder in register with the suprapubic area of the abdominal wall. After inflating the bladder with a suitable fluid through the tube and a lateral opening in the curved distal portion thereof, an incision is made through the abdominal wall and the wall of the bladder in register with the distal end of the instrument, which then emerges outwardly through the incision.

Description

BACKGROUND OF INVENTION

The present invention relates in general to catheters and, more particularly, to a method of and means for inserting a retention catheter, such as a Foley catheter, from a suprapubic location.

Postoperative bladder drainage by way of a retention catheter inserted into the bladder through the urethra has long been conventional. However, urethral insertion has serious disadvantages, among these being a high incidence of urinary tract infection, urethral irritation and swelling making normal urination difficult or impossible, extreme pain upon withdrawing a catheter which has been in place for some time, and the like.

Such disadvantages of urethral insertion can be eliminated or minimized by insertion through a small suprapubic incision, a technique of relatively recent development and one which is being used progressively more extensively. However, prior suprapubic insertion techniques leave much to be desired.

For example, one prior suprapubic insertion technique involves making a blind puncture through the abdominal wall and into the bladder with a trocar after filling the bladder with a suitable fluid, such as water, through a urethral catheter. Subsequently, a retention catheter is threaded through the trocar into the bladder. This procedure has various disadvantages, not the least of which is the inherent hazard involved in making a blind puncture. Another disadvantage of this process is that the catheter, being insertable through the trocar, is sufficiently smaller than the incision made by the trocar that leakage of urine can occur around the catheter.

Another prior suprapubic insertion technique involves: filling the bladder with water, or other suitable fluid, through a urethral catheter, which is then removed; subsequently inserting through the urethra and into the bladder a rigid instrument having a curved distal portion the end of which is brought into engagement with the anterior wall of the bladder to form a visible outward protrusion of the suprapubic area of the abdominal wall; making a small incision through the abdominal wall and the anterior wall of the bladder in register with the distal end of the instrument, whereupon the distal end of the instrument may be displaced outwardly through the incision; connecting a wire withdrawn from the instrument to the distal end of a retention catheter, such as a Foley catheter; pulling the instrument, with the Foley catheter attached thereto by the wire, through the incision, the bladder and the urethra; disengaging the Foley catheter from the wire; and then pulling the Foley catheter back through the urethra and into the bladder. This procedure, while less objectionable in some respects to the blind puncture technique, creates problems of its own. Among these are the excessive irritation resulting from repeated passes through the urethra, with the attendant possibility of infection, and the contamination of the portion of the catheter which is withdrawn through the suprapubic incision in pulling the distal portion of the catheter back through the urethra and into the bladder.

SUMMARY AND OBJECTS OF INVENTION

Generally speaking, important objects of the present invention are to provide a suprapubic catheter insertion technique and instrument which avoid the hereinbefore-discussed problems and disadvantages associated with prior suprapubic insertion techniques and equipment.

More particularly, an important object of the invention is to provide a technique and instrument which eliminate any necessity for a blind puncture, and which further eliminate any necessity for repeated passes through the urethra.

Another and important object in the foregoing connection is to provide a procedure which involves only a single insertion through the urethra and a single withdrawal therefrom, thereby greatly minimizing urethral irritation and the attendant possibility of infection.

Another object of importance is to provide a technique wherein only the portion of the retention catheter which is required to be within the bladder, is ever inserted thereinto through the suprapubic incision, thereby avoiding contamination of the external portion of the catheter.

Yet another object is to provide a technique and instrument which require an incision no larger than, or smaller than, the portion of the retention catheter to be received in the incision, which portion may be narrowed by stretching, thereby minimizing the possibility of leakage of urine around the catheter.

Still another object of the invention is to provide a procedure which utilizes an instrument capable of functioning both as a catheter and as a trocar. A related object is to provide an instrument of this nature.

The invention may be summarized as including, and a more specific object thereof is to provide a method of suprapubic catheter insertion which includes: inserting through the urethra and into the bladder a curved distal portion of a rigid tubular instrument having a distal end provided with a removable closure and having one or more lateral openings adjacent its distal end; inflating the bladder with water, or other suitable fluid, through the instrument; engaging the distal end of the instrument with the anterior wall of the bladder with sufficient force to provide a visible protrusion of the suprapubic region of the abdominal wall; making a small incision through the abdominal wall and the anterior wall of the bladder in register with the distal end of the instrument; displacing the distal end of the instrument outwardly through the incision, this occurring automatically in most instances as the result of the outward pressure applied by the instrument; removing the closure from the distal end of the instrument; inserting a catheter probe into a Foley catheter, or other retention catheter, to stiffen the catheter; inserting a portion of the catheter into the distal end of the instrument; displacing the distal end of the instrument and a portion of the catheter into the bladder through the incision; withdrawing the instrument from the bladder and the urethra, leaving a portion of the catheter within the bladder; and inflating the inflatable portion of the catheter within the bladder to insure retention.

Another and important object of the invention is to provide an instrument having the characteristics set forth in the foregoing summation of the method of the invention. A related object is to provide an instrument wherein the distal closure is threaded into or otherwise secured to the distal end of the tube.

The foregoing objects, advantages, features and results of the present invention, together with various other objects, advantages, features and results thereof which will be evident to those skilled in the catheter art in the light of this disclosure, may be achieved with the exemplary embodiment of the invention illustrated in the accompanying drawing and described in detail hereinafter.

DESCRIPTION OF DRAWING

In the drawing:

FIGS. 1 to 7 are fragmentary sectional views illustrating semidiagrammatically successive steps involved in the method of the invention of inserting a Foley catheter into a patient's bladder through a suprapubic incision in the abdominal wall and the anterior wall of the bladder; and

FIG. 8 is a fragmentary sectional view illustrating an instrument for use in the technique shown in FIGS. 1 to 7 and serving as both a catheter and a trocar.

DESCRIPTION OF EXEMPLARY EMBODIMENT OF INVENTION

Referring initially to FIG. 8 of the drawing, illustrated fragmentarily therein is an instrument 10 of the invention which, in view of the functions it performs in the method of the invention, may be termed a "cysto-trocar-catheter." The functioning of the instrument 10 as both a catheter and a trocar will become evident in the course of describing the procedure in which it is used.

The instrument 10 comprises simply a rigid tube 12, of metal, plastic, or other suitable material, having a proximal end 14, a straight or substantially straight intermediate portion 16, and a curved distal portion 18 terminating in a distal end 20. The curved distal portion 18 is provided adjacent the distal end 20 with one or more lateral openings 22. The distal end 20 is provided with a removable closure 24 which is rounded externally so that the closure may act as an obturator facilitating insertion of the distal end 20 and the curved distal portion 18 through a patient's urethra 26, FIGS. 1 to 7, and into the patient's bladder 28. The closure 24 may be removably secured to the distal end 20 of the instrument 10 by threading it thereinto. Alternatively, the closure 24 may be threaded onto the distal end 20, or it may be pressed into or onto the distal end, etc.

In the particular construction illustrated, the instrument 10 is of a diameter and a length suitable for use with female patients. However, it may be used with male patients by suitably modifying its length and diameter.

Considering the technique of the invention with which the instrument 10 is used, the distal end 20 of the instrument is first inserted through the urethra 26 into the bladder 28, into the position shown in FIG. 1, for example. Then, suitable fluid, such as water, is introduced into the bladder 28, through the tube 12 and the lateral openings 22, in a quantity sufficient to inflate or distend the bladder, as shown throughout FIGS. 1 to 7 of the drawing. This may be accomplished readily by connecting a fluid source 30 to the proximal end 14 of the tube 12 by means of an elastomeric tube 32 equipped with a clamp 34. As will be apparent, fluid for distending the bladder 28 may be introduced by disengaging the clamp 34, When the bladder has been distended to the proper degree, the clamp 34 is reengaged with the elastomeric tube 32 to prevent further fluid introduction and to prevent reverse flow.

It will be apparent that, in the foregoing operations, the instrument 10 functions as an urethral catheter.

Turning to FIG. 2, the next step is to bring the closed distal end 20 of the instrument 10 into engagement with the anterior wall of the bladder with sufficient force to provide a visible external protrusion 36 in the suprapubic region 38 of the abdominal wall 40. This can be accomplished readily by suitable manipulation of the instrument 10 from adjacent its proximal end 14.

The visible external protrusion 36 produced by the foregoing manipulations locates the closed distal end 20 of the instrument very accurately. Next, the physician, utilizing a scalpel 42, or other appropriate cutting instrument, makes a small incision, at the center of the protrusion 36, through the abdominal wall 40 and the anterior wall of the bladder 28. Normally, this incision need not be more than of the order of 2 to 4 millimeters in length.

The incision through the abdominal wall 40 and the anterior wall of the bladder 28, which incision is designated generally by the numeral 44 in FIGS. 3 to 7 of the drawing, is made while maintaining the closed distal end 20 of the instrument 10 in pressural engagement with the anterior bladder wall. Consequently, when the incision 44 is sufficiently large, the closed distal end 20 is automatically displaced outwardly through the incision. In practice, the closed distal end 20 simply pops into view when the incision is large enough. Thus, the instrument 10 performs its aforementioned trocar function.

Once the closed distal end 20 of the instrument 10 has emerged through the suprapubic area 38 of the abdominal wall 40, the closure 24 is removed, as by unscrewing it, or otherwise removing it, as shown in FIG. 3.

Turning now to FIG. 4 of the drawing, the physician next takes a Foley catheter 50, or other similar retention catheter, and inserts at least the tip portion 42 thereof into the distal end 20 of the instrument 10. To stiffen the catheter 50 for insertion of the portion 52 thereof into the distal end 20 of the instrument, a catheter probe 54 is inserted through the drainage branch 56 of the catheter into the tip portion.

Next, as shown in FIG. 5, the physician inserts the catheter 50 through the incision 44 into the bladder 28 by an inward force applied to the catheter, as stiffened by the probe 54. At the same time, the distal end 20 of the instrument 10 is withdrawn through the incision 44 into the bladder 28. It will be understood that such movement of the instrument-catheter combination may readily be carried out by concurrent movement of the physician's hands. In effect, the instrument-catheter combination is threaded through the patient's body by the physician, with one hand on the instrument 10 and the other on the probe-stiffened catheter 50, until the catheter has been inserted to the required extent. The Foley or other catheter 50 is provided with external indicia, not shown, indicating the depth of insertion.

After the catheter 50 has been inserted to the proper extent, the instrument 10 is withdrawn from the bladder 28 and the urethra 26, as shown in FIG. 6. Thereafter, as shown in FIG. 7, the inflatable portion 58 of the Foley catheter 50 is inflated through the inflation branch 60 of the bifurcated device. The inflated portion 58 then retains the tip portion 52 within the bladder 28 in draining communication with the interior thereof. Although the invention has been disclosed in connection with the Foley catheter 50, it will be understood it may be employed with any catheter capable of being retained in position once inserted. It will also be understood that if the physician desires to run the catheter 50 all the way through the patient's body for any reason, this can be done without contamination by pushing or pulling it through the tubular instrument 10. It may be pushed through by means of the catheter probe 54, or pulled through by a wire, not shown, threaded through the drainage openings in the tip portion 52 of the catheter.

Reviewing some of the advantages of the present invention, it will be apparent that it minimizes urethral irritation since the only operations involving the urethra are insertion and subsequent withdrawal of the instrument 10 therethrough. Another advantage is that the suprapubic incision 44 is made with the protrusion 36 formed by the closed distal end 20 of the instrument 10 as a positive reference, thereby avoiding all of the hazards inherent in making a blind or obscured puncture or incision. As previously pointed out, it is necessary only to make an incision large enough to permit the instrument 10 to act as a trocar. In view of the smallness of the incision, and the fact that the outside diameter of the portion of the catheter 50 to be disposed in the incision can be about the same as the outside diameter of the instrument 10 itself, or even larger if it is stretched during insertion by means of the catheter probe 54, the tissues surrounding the incision engage the catheter snugly to prevent urine leakage around the outside of the catheter.

Another distinct advantage of the invention is that the entire procedure hereinbefore discussed can be carried out without an assistant, which is an important feature.

Although an exemplary embodiment of the invention has been disclosed herein for purposes of illustration, it will be understood that the invention is susceptible of other applications and that various changes, modifications and substitutions may be incorporated in the specific embodiment disclosed, all without departing from the spirit of the invention as defined by the claims appearing hereinafter.

Claims

I claim:

1. A method of inserting a suprapubic catheter, characterized by the use of an instrument having a curved distal portion terminating in a tubular distal end provided with a removable closure, and including the steps of:

a. inserting the distal end of the instrument through the urethra into the bladder and into engagement with the anterior wall of the bladder in register with the suprapubic area of the abdominal wall;

b. making an incision through the abdominal wall and the anterior wall of the bladder in register with the distal end of the instrument;

c. displacing the distal end of the instrument outwardly through the incision;

d. removing the closure from the distal end of the instrument;

e. inserting a portion of the catheter into the distal end of the instrument;

f. displacing the distal end of the instrument and a portion of the catheter into the bladder through the incision; and

g. withdrawing the instrument from the bladder and the urethra, leaving a portion of the catheter within the bladder.

2. A method as set forth in claim 1 wherein the instrument is a tube provided with a lateral opening therein adjacent its distal end, and including the additional step of inflating the bladder with a fluid through the tube and the lateral opening prior to making the incision.

3. A method as defined in claim 1 including the additional step of inserting a catheter probe into the catheter prior to displacing the distal end of the instrument and said part of the catheter into the bladder through the incision.

4. A method according to claim 1 wherein the catheter is a Foley catheter, and including the additional step of inflating the Foley catheter within the bladder.

5. A method of inserting a suprapubic catheter into the bladder, characterized by the use of an instrument having a curved distal portion terminating in a distal end, and including the steps of:

a. inserting the distal end of the instrument through the urethra into the bladder and into engagement with the anterior wall of the bladder in register with the suprapubic area of the abdominal wall;

b. making an incision through the abdominal wall and the anterior wall of the bladder in register with the distal end of the instrument;

c. displacing the distal end of the instrument outwardly through the incision;

d. connecting a portion of the catheter to the distal end of the instrument;

e. displacing the distal end of the instrument and a part of the catheter into the bladder through the incision;

f. disengaging the distal end of the instrument from said portion of the catheter entirely within the bladder, without displacing any element of the catheter from the bladder into the urethra; and

g. withdrawing the instrument from the bladder and the urethra, leaving said part of the catheter within the bladder.