U.S. patent number 3,698,382 [Application Number 05/080,845] was granted by the patent office on 1972-10-17 for device for measuring veno capillary filling time.
Invention is credited to William L. Howell.
United States Patent |
3,698,382 |
Howell |
October 17, 1972 |
DEVICE FOR MEASURING VENO CAPILLARY FILLING TIME
Abstract
Apparatus for automatically applying intermittent and uniform
pressure to the skin of a patient at predetermined and variable
time intervals, in order to force blood from the blood vessels
subjacent to the skin area to which pressure is applied, and
further apparatus for measuring the rate of return of the blood
into the collapsed blood vessels upon release of pressure from the
skin.
Inventors: |
Howell; William L. (Washington,
DC) |
Family
ID: |
22159990 |
Appl.
No.: |
05/080,845 |
Filed: |
October 15, 1970 |
Current U.S.
Class: |
600/481 |
Current CPC
Class: |
A61B
5/02416 (20130101); A61B 5/021 (20130101) |
Current International
Class: |
A61B
5/021 (20060101); A61B 5/024 (20060101); A61b
005/02 (); A61b 006/08 () |
Field of
Search: |
;128/2R,2A,2L,2S,2.5A,2.5E,2.5F,2.5P,2.5V ;250/217,227,239 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
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|
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|
|
841,934 |
|
Jun 1952 |
|
DT |
|
287,312 |
|
Nov 1967 |
|
AU |
|
Primary Examiner: Howell; Kyle L.
Claims
I claim:
1. Means adapted for intermittently applying uniform pressure to a
skin area of a patient to cause the blood vessels adjacent said
area to collapse and force the blood therefrom, and further means
for measuring and graphically representing the rate of return flow
of the blood to said blood vessels when the pressure on the skin is
released, said means for intermittently applying uniform pressure
including a movable means which is movable upon the application of
pressured fluid thereto, a fluid supply means in communication with
said movable means for intermittently supplying pressured fluid
thereto, automatic means intermittently engageable with said fluid
supply means for intermittently supplying pressured fluid to said
movable means, means connected to said automatic means for causing
the automatic means to operate, said further means including a
transducer electrically connected to a recording oscillograph, an
electric circuit, and said transducer being adapted to be placed in
contact with the skin area of a patient, means connected to said
transducer and adapted to be connected to the skin of a patient for
maintaining said transducer in contact with said skin, said movable
means being connected to said transducer and causing said
transducer to press against the said skin area of a patient upon
application of pressured fluid to said movable means to thereby
force blood from blood vessels adjacent said transducer.
2. Apparatus in accordance with claim 1, wherein said movable means
is extensible and is connected to said transducer in pressure
applying relationship with said transducer upon the application of
pressured fluid to said extensible member to cause extension
thereof to thereby press said transducer against the skin of a
patient.
3. Apparatus in accordance with claim 1, wherein said automatic
means includes an element intermittently engageable with said fluid
supply means, and means for fully and rapidly disengaging said
element from said fluid supply means between engagements therewith,
thereby providing a quick release of said pressure following each
engagement of said element with said fluid supply means.
4. Apparatus in accordance with claim 1, wherein said fluid supply
means comprises a deformable container for said fluid and said
automatic means includes a traveling means and said element is
fixed thereto and travels therewith said deformable container being
mounted in the path of travel of said element for intermittent
deformation thereby to force pressured fluid to said movable
member.
5. Apparatus in accordance with claim 4, wherein said deformable
container is in the form of a bulb, the walls of which converge
from the point of the greatest diameter of said bulb providing a
stem through which fluid may flow and said point of largest
diameter of said bulb being in the path of travel of said
element.
6. A method of measuring and graphically recording the rate of
return flow of blood to collapsed blood vessels, comprising those
steps of fixing a transducer in snug engagement with the skin area
to which pressure is applied, automatically applying intermittent
uniform pressure to said transducer, quickly releasing the pressure
on said transducer following each application of pressure thereto
and measuring and graphically recording by said transducer and
associated electrical apparatus the rate of return of color to the
skin area following quick release of pressure thereon by said
transducer.
7. Means adapted for intermittently applying uniform pressure to a
skin area of a patient to cause the blood vessels adjacent said
area to collapse and force the blood therefrom and for measuring
and indicating the rate of return flow of the blood to said blood
vessels when the pressure on the skin is released, said means
comprising; automatic means adapted to be connected to said skin
area for applying variably periodic intermittent uniform pulses of
pressure to said skin area; a transducer means adapted to be
located between said automatic means and said skin area for
detecting the color of said skin area as it varies in accordance
with the amount of veno capillary blood in said skin area at a
given time and including means for transmitting signals having
characteristics which correspond to said variations; and means
operatively connected with said transmitting means for receiving
said signals and indicating the color condition of said skin areas
during and after each application of pressure in correspondence
with said signals.
8. Means for indicating the rate of return flow of blood to
collapsed blood vessels, comprising automatic means adapted for
intermittently applying uniform pressure to a skin area and for
quickly releasing the pressure following each application of
pressure; an electrical transducer means adapted to be located
between said automatic means and said skin area for detecting the
color of the skin in said skin area; means adapted for maintaining
said transducer adjacent the skin area to which the pressure is
applied; said automatic means adapted for intermittently applying
uniform pressure to skin area being connected to said transducer to
cause said transducer to apply uniform pressure to the skin area;
and means electrically connected with said transducer for measuring
and indicating the rate of return of color to the skin area
following each quick release of pressure thereto.
9. Means adapted for intermittently applying uniform pressure to a
skin area of a patient to cause the blood vessels adjacent said
area to collapse and force the blood therefrom, and further means
for measuring and graphically representing the rate of return flow
of the blood to said blood vessels when the pressure on the skin is
released, said means adapted for intermittently applying uniform
pressure including automatic means adapted to be connected to a
skin area of a patient and to intermittently apply pressure
thereto, said further means including a transducer electrically
connected to a recording oscillograph, an electric circuit, and
said transducer being adapted to be located between said automatic
means and said skin area for detecting the color of the skin in
said skin area.
Description
This invention relates broadly to the art of measuring veno
capillary filling time and in its more specific aspects it relates
to either automatic or non-automatic means for intermittently
applying uniform pressure to the skin and measuring the rate of
return of blood into the collapsed blood vessels; and the nature
and objects of the invention will be readily recognized and
understood by those skilled in the arts to which it relates in the
light of the following explanation and detailed description of the
accompanying drawings illustrating what I at present believe to be
preferred embodiments or mechanical expressions of my invention
from among various other forms, arrangements, combinations and
constructions, of which the invention is capable within the spirit
and scope thereof.
It is well known that upon the application of pressure to the skin
of a patient the blood vessels subjacent to the area upon which
pressure is applied are collapsed and the blood is forced
therefrom, and that upon release of the pressure the blood will
flow back into the formally collapsed blood vessels.
It is also a well known fact in medical science that it is
significant in the diagnosis of certain conditions in a patient to
be aware of the rate of return flow of the blood into the blood
vessels which have previously been collapsed to force the blood
therefrom. As an example of the broad general concept involved in
my invention, when a person is frightened he turns white due to
constriction of blood vessels so that less blood gets into the
skin. Vasoconstriction is a manifestation of abnormal stress and
may be prolonged and severe in impending shock. When a patient is
under anesthesia the anesthetist applies pressure to the skin of
the forehead so that this pressurized area becomes white, and upon
release of pressure the anesthetist watches the rate at which the
color comes back and this rate of return of color is of substantial
significance, since the rate of return of color if delayed is
indicative of vasoconstriction and that the patient may be going
into shock, and additionally the rate of return of color or blood
to the previously collapsed blood vessels is determinative of the
degree of vasoconstriction and the likelihood of shock.
My invention has been designed not only to automatically apply
uniform pressure to the skin of a patient at desired intermittent
intervals but to also monitor and graphically display the rate of
return of blood to the area from which pressure has been removed.
This graphic representation of the rate of return will indicate to
the physician the degree of vasoconstriction and the likelihood of
shock in the patient.
While I have disclosed in this application an apparatus for
automatically applying intermittent and uniform pressure to the
skin of the patient and then monitoring and graphically displaying
the rate of return of blood to the collapsed blood vessels, it is
within my contemplation to apply such pressure to the skin by
non-automatic means and then to monitor the rate of return of blood
to the collapsed blood vessels by means of the novel apparatus
which I have disclosed for monitoring this rate of return of
blood.
With the foregoing general objects, features and results in view,
as well as certain others which will be apparent from the following
explanation, the invention consists in certain novel features in
design, construction, mounting and combination of elements, as will
be more fully and particularly referred to and specified
hereinafter.
Referring to the accompanying drawings:
FIG. 1 is a side view in elevation of one from among many automatic
means for applying intermittent pressure to the skin of a
patient.
FIG. 2 is a top plan view of the apparatus illustrated in FIG.
1.
FIG. 3 is a schematic diagram of the circuitry employed to
graphically represent the rate of return of blood into the
previously constricted blood vessels.
FIG. 4 is a vertical sectional view of the transducer which is in
engagement with the skin and to which pressure is applied, the
transducer comprising a part of the monitoring apparatus of my
invention.
FIG. 5 is a view of a tracing indicating a normal rate of return of
blood to the collapsed blood vessels.
FIG. 6 is a further tracing illustrating a different and slower
rate of return of blood to the collapsed blood vessels.
In the accompanying drawings, and particularly FIGS. 1-4, I have
used the numeral 1 to designate the base or platform upon which the
apparatus is mounted and is operable to apply intermittent and
uniform pressure to the skin of a patient at predetermined time
intervals.
Mounted at one end of the platform 1 is a power means 3, such as an
electric motor, having a pulley 5 extending outwardly of the motor
3 and fixedly attached on the rotary shaft thereof. An endless
strap 7 extends about the pulley 5 and is operated thereby and
extends therefrom about a further pulley 9 to cause rotation of the
pulley 9 when electric motor 3 is energized. A rotary shaft 11 is
fixed to and extends from the pulley 9 and rotates therewith, and
fixed on said rotary shaft in spaced relation are a pair of
sprockets 13. Mounted about each sprocket is a chain 15 which
extends from said sprockets 13 to the opposite end of the platform
where a further pair of aligned sprockets 17 are rotatively mounted
on the upper end of a supporting post 19, the sprockets 13 being
operatively mounted on the upper end of a post 21. The posts 19 and
21 being fixed on the platform 1 and upstanding with respect
thereto.
Fixed to and extending between the chains 15 is a rod 23 which
extends laterally to one side of the chains, and fixed on this
lateral extension for relative rotation with respect thereto is,
what I shall term, a flap board depressing roller 25. Inwardly
spaced from the post 21 is a further post 27 which is fixed to and
extends upwardly from the platform 1. Hingedly fixed, as at 29, on
the upper end of the post 27 is a flap board 31 which, as will
become apparent as this description proceeds, functions under the
abutting operation of the roller 25 to intermittently depress a
bulb which, when depressed, provides air pressure to cause pressure
on the skin of the patient. Consideration of the drawings,
particularly FIG. 2, indicates that the flap board 31 is positioned
so as to be in the path of travel of the roller element 25 as it
travels with the chains 15 in the direction as indicated by the
arrows in FIG. 1.
Slidably mounted in any suitable manner on the base or platform 1
is a bulb supporting member or platform 33 at one end of which is
provided an upstanding flange 35, and adjacent the other end a nut
37 is fixed to and extends upwardly from the member 33. Extending
through the nut 37 is a screw 39 which extends through a retaining
post 41 which is fixed on the platform 1. The screw 39 at its outer
end is provided with a screw head 43 which is in accessible
position for operation by the technician or physician who is
operating the device. It will now be evident that the position of
the bulb supporting member 33 may be varied longitudinally of the
platform 1 by merely turning the screw head 43, the purpose of this
adjustment will become apparent hereinafter. It will be further
apparent from consideration of the drawings that the slidable bulb
supporting member 33 is positioned on the base 1 below and in
substantially the same vertical plane as that in which the flap
board 31 is positioned.
Mounted on the bulb supporting platform 33 is an air pressure bulb
45 which is formed of a material which resists deformation. The
stem end 47 of the bulb 45 extends through an aperture in the
upstanding flange 35 and is fixed therein in any suitable manner.
Since the movable platform 33 is positioned relative to the flap
board 31, as hereinbefore described, and since the bulb 45 is
mounted on the movable platform or member 33, it will be apparent
that the bulb 45 is in substantially the same vertical plane as the
flap board 31. Consideration of FIG. 1 of the drawings indicates
that the bulb 45 at its area of greatest diameter extends upwardly
in a horizontal plane which is above the projected horizontal plane
of the hinge 29 so that in normal inoperative position the flap
board 31 rests on the bulb 45 and thus in inoperative position
inclines upwardly from its hinged connection to the post 27.
Extending from the stem end 47 of the bulb is an air duct 49 which
is adapted to receive air pressure from the bulb when it is
depressed. The air duct at its exhaust end is fixed, in any
suitable manner, to a transducer 53 which is in engagement with the
skin 55 of the patient. While it is within my contemplation to
employ several different methods of operatively arranging the
bellows 51 and the transducer 53 in their proper operative
positions, for purposes of example only I have illustrated in the
drawings such mounting and maintaining means as involving a
non-elastic retaining strap 57 which extends over the bellows 51
and is provided with an opening therein through which the duct 49
extends and the non-elastic strap 57 is adapted to extend about the
head of the patient and to be tied thereabout in position thereon
so that the transducer 57 will be in engagement with the skin 55 in
the forehead area of the patient.
When the electric motor 3 is energized and the drive sprockets 13
are running the chains 15 are driven and the roller 25 in its
course of travel will engage and depress the flap board 31 to
thereby depress the bulb 45 thereby forcing pressured air through
the duct 49 and to the bellows 51 thereby expanding the bellows to
cause the transducer 53 to be pressed against the skin of the
patient. It will be clear that when the roller 25 passes over the
end of the flap board 31 the pressure on the transducer 53 will be
immediately released. The amount of pressure may be regulated by
adjusting the screw 39 in the nut 37 to thereby cause longitudinal
movement of the base 33 and consequently such movement of the bulb
45.
The electric motor 3 is a variable speed motor so that the rate of
the intermittent application of pressure on the skin of the patient
may be varied by varying the speed at which the motor is
operating.
As I have stated, the application of pressure to the transducer
(which will be explained in detail hereinafter) may be caused by
non-automatic means and such will still fall within the spirit and
scope of my invention, since the monitoring means which will be
explained hereinafter will measure and graphically display the rate
of return of blood to the collapsed blood vessels, such monitoring
means being sensitive to the coloration of the skin area.
The transducer 53 comprises an exterior housing 59 formed of an
opaque material, having a cup-like configuration including a top
portion 61, an annular skirt portion 63, and a radial flange 65
forming a light screen. The upper interior of the housing 59
carries an annular light reflector 67. Mounted within the housing
59 is a light pipe 69, such as Lucite, having a top body portion 71
and an annular skirt 73 terminating in the same horizontal plane as
the flange 65. This configuration provides a central recess 75 in
the light pipe which is open at its lower end.
The top body portion 71 of the light pipe is molded or otherwise
formed to provide a centrally disposed opening or duct 77 therein
and extending therethrough, which, at its lower end opens into
recess 75 and extends upwardly through body portion 71 of the light
pipe.
Positioned within the opening or duct 77, in the body portion of
the light pipe, is a light source 79 having leads 81 which extend
upwardly from their connection with the light source and into top
61 of the housing where they are suitably connected to power leads
83 as at 85. Consideration of the drawings indicates that the leads
81 and 83 are electrically connected together at 85 within the top
61 of the housing 59 in which they are molded. Positioned within
the concentric recess 75 is a photoelectric resistor or sensor
casing 87 which is preferably, though not necessarily, formed of
aluminum or the like light reflecting material. The photoelectric
resistor casing 87 is secured by adhesive, or in any other suitable
manner, to the light pipe 69. The photoelectric resistor casing 87
is formed with an open lower end which is closed by means of a
transparent window 89, so that light rays may pass therethrough.
Operatively positioned within the casing 87 is a photoelectric
resistor 91, which may be a cadium sulphide photoelectric resistor,
which is sensitive to light stimulus. Leads 93 connected to the
resistor 91 extend through the top of the casing 87 and through the
duct 77 and into the top 61 of the housing 59 where they are
connected to power leads 95 as at 97. As in the case of the light
source leads 81 and 83, the connections for the leads 93 and 95 are
molded within the top 61 of the housing 59. This feature of the
leads and the power leads and their connections being molded within
the housing 59 provides an effective method of protecting such
leads and electrical connections during use of the transducer.
Referring particularly to FIG. 4 of the drawings, wherein we have
illustrated one of our transducers applied to a skin area by means
of a transparent adhesive, or the like, 99, which is applied by a
brush, or in any other suitable manner to the lower surface of the
foot or base 65 of the skirt 63, to the lower surface of the
annular depending skirt or portion 73 of the light pipe 69 and to
the lower annular surface of the resistor casing 87. Thus, with the
transparent adhesive applied, in any suitable manner, to the lower
surface of the transducer, as just described, it will be recognized
that the transducer may be removably attached to the skin.
It will be recognized that my monitoring system for measuring the
rate of return of blood to the collapsed blood vessels functions
and the tracing is significant, following the quick release of
pressure on the transducer 53 by means of the expanded bellows 51.
In order to secure an accurate reading it is essential that when
the pressure on the transducer is released the transducer will
maintain the snug attachment to the skin and this is accomplished
by the attachment of the transducer to the skin by means of the
transparent adhesive, or the like, 99.
The circuitry of FIG. 3 is fed from any suitable power source by
means of an electric plug 99' having leads 101 extending therefrom
into any suitable regulated power supply 103. The light source 79
is connected by leads 105 with the regulated power supply 103 and
the photoelectric resistor 75 is connected in a bridge circuit
designated generally by the reference numeral 107, and one arm of
this circuitry includes a variable resistor 109 which functions as
a balance. An operational amplifier 111 is connected by a conductor
113 to the bridge circuit between the variable resistor 109 and the
photoelectric resistor 75, the other side of the amplifier 111
being grounded as at 115. A variable resistor 117 in parallel with
the amplifier 111 is connected to conductor 113 at 119 and to the
output 121 at 123. The output 121 feeds to an oscilloscope or
transcribing recorder 125.
In FIG. 5 of the drawings I have illustrated a tracing or graphic
representation of the rate of return flow of the blood to the
collapsed blood vessels as monitored by the transducer and
associated apparatus. I have used the numeral 127 to designate the
line when the transducer 53 is at rest and the numeral 129 to
indicate the point at which pressure is applied on the transducer,
and thus on the skin, to force the blood out of the subjacent blood
vessels. The point 131 indicates when the pressure on the
transducer is released and the curve 133 illustrates the rate of
return of blood to the collapsed blood vessels. FIG. 5 graphically
illustrates a tracing indicating the rate of return of blood in a
normal patient.
FIG. 6 is a further tracing indicating a slow rate of return of
blood to the collapsed blood vessels which will be significant to
the technician or physician indicating the degree of shock in which
the particular patient may be. It will be clear from consideration
of the disclosure of the illustration of FIG. 6 that the curve 133
is substantially less acute than the curve 133 in FIG. 5 to thereby
indicate a relatively slow rate of return of blood to the collapsed
blood vessels.
* * * * *