U.S. patent number 3,730,187 [Application Number 05/108,762] was granted by the patent office on 1973-05-01 for sew-in urethral catheter.
Invention is credited to Verne J. Reynolds.
United States Patent |
3,730,187 |
Reynolds |
May 1, 1973 |
SEW-IN URETHRAL CATHETER
Abstract
A securing means for a drainage catheter is disclosed,
comprising a securing collar on the catheter, a fixation material
being embedded in the collar for use in attaching the catheter
firmly and without slippage to a patient. The fixation material may
be a suture and needle, a wire clasp, or the like, the fixation
material, collar and catheter forming a unitary, ready-to-use
device. The catheter also carries a fixation band spaced from the
securing collar, the band being attached to the catheter to provide
further anchoring means for securing the catheter.
Inventors: |
Reynolds; Verne J. (Boise,
ID) |
Family
ID: |
22323899 |
Appl.
No.: |
05/108,762 |
Filed: |
January 22, 1971 |
Current U.S.
Class: |
604/178;
128/DIG.26; 604/179 |
Current CPC
Class: |
A61M
25/02 (20130101); A61M 2025/0286 (20130101); Y10S
128/26 (20130101) |
Current International
Class: |
A61M
25/02 (20060101); A61m 025/02 () |
Field of
Search: |
;128/348,349,350,351,325,327,DIG.26 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
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|
|
|
|
|
791,297 |
|
Feb 1958 |
|
GB |
|
699,253 |
|
Nov 1953 |
|
GB |
|
Other References
Khouri et al., Journal of Applied Physiology, Vol. 23, No. 3, Sept.
1967, pp. 395-397.
|
Primary Examiner: Truluck; Dalton L.
Claims
I claim:
1. A drainage device comprising a catheter, securing means
including annular collar means surrounding said catheter and
holding it against movement, and unitary fixation means embedded in
said collar and at least partially encircling said catheter, said
fixation means having free ends extending out of said collar and
adapted to provide a secure connection between said catheter and
adjacent tissue.
2. The drainage device of claim 1, wherein said collar means
comprises a split collar which may be adjustably positioned on said
catheter, and sleeve means fastened to the inner surface of said
collar to prevent relative movement between said collar and said
catheter when said collar is tightened around said catheter.
3. The drainage device of claim 2, wherein said sleeve means is a
malleable metal having a plurality of upstanding teeth, said teeth
being adapted to grip without puncturing the outer surface of said
catheter to anchor said collar to said catheter.
4. The drainage device of claim 3, wherein said collar is generally
C-shaped, and sized to fit around said catheter without compressing
said catheter.
5. The drainage device of claim 1, wherein said collar is
permanently attached to said catheter to prevent relative motion
between said catheter and said collar, the collar being of the same
material as the catheter and effectively forming an integral part
thereof, whereby said catheter, collar, and fixation means comprise
a unitary device.
6. The drainage device of claim 1, wherein said unitary fixation
means comprises suture means encircling said catheter, with at
least one of said free ends carrying a swedged needle.
7. In a drainage device for providing continuous or intermittent
drainage of fluids from a body cavity, a catheter having a proximal
end for insertion into said cavity and a distal end for drawing off
said fluids, and securing means at the proximal end of said
catheter for holding said catheter in a selected position, said
securing means including a collar and unitary fixation means
embedded in said collar and at least partially encircling said
catheter, said fixation means extending out of said collar and
adapted to provide a quick, secure connection between said catheter
and tissue adjacent the opening to said body cavity.
8. The drainage device of claim 7, wherein said collar is
permanently attached around said catheter whereby said catheter,
collar and fixation means form a unitary device, and whereby said
unitary fixation means comprises suture means embedded in and
encircling said catheter and having at least one free end to which
a needle is permanently affixed, whereby said catheter may be
attached to said tissue by said suture.
9. The drainage device of claim 7, wherein said collar is
permanently attached around said catheter, said unitary fixation
means comprising an anchor wire embedded in and said collar and
encircling said catheter and spring clasp means hingedly attached
to said anchor wire, said spring clasp means permitting said
catheter to be attached to said tissue.
10. The drainage device of claim 7, wherein said collar is
adjustably attached around said catheter, said collar including an
inner face comprised of a plurality of small sharp teeth adapted to
grip said catheter when said collar is closed around said
catheter.
11. The drainage device of claim 10, wherein said fixation means
comprises suture means having at least two free ends extending out
of said collar for securing said collar to said catheter.
12. The drainage device of claim 7, wherein said catheter is a
urethral catheter having a plurality of drainage openings at its
proximal end for bladder drainage, said securing means being so
located on said catheter as to be adjacent the external urethral
meatus of a female patient when said catheter is positioned for
urethral bladder drainage, whereby said unitary fixation means
permits connection of said catheter to said meatus.
13. The drainage of claim 12, further including a fixation band at
the distal end of said catheter for securing said distal end.
14. A drainage device comprising a catheter, securing means
including annular collar means surrounding said catheter and
holding it against movement, and unitary fixation means including
an anchor wire embedded in said collar and spring clasp means
attached to said anchor wire.
15. The drainage device of claim 14, wherein said spring clasp
means comprises a first curved needle-like arm and a second
generally straight arm adapted to receive the end of said first
arm.
16. The drainage device of claim 15, wherein said first arm has a
sharp, pointed end and said second arm has a hollow end adapted to
receive said pointed end of said first arm to close said clasp,
said first arm being resilient whereby said clasp can be opened and
closed.
17. The drainage device of claim 14, wherein said anchor wire and
said spring clasp means are formed with cooperating eyelets whereby
said spring clasp may be hingedly attached to said anchor wire.
Description
BACKGROUND OF THE INVENTION
The present invention relates, in general, to a novel method and
apparatus for securing a catheter to a patient so that the catheter
will function without the danger of displacement due to motion of
the patient. More particularly, the invention relates to a securing
collar for a catheter, the collar containing a permanently embedded
fixation material by which the catheter may be quickly and securely
fastened to the patient.
As is well known in the medical arts, after many types of surgical
procedures it is necessary to provide continuous or intermittent
drainage in the area of the incision, or to provide such drainage
for body cavities affected by the operation. This is particularly
the case in gynecologically related operations, where it becomes
necessary to provide postoperative bladder drainage. Several
methods for providing such drainage are known, wherein one end of a
suitable catheter is placed in the cavity, with the other end
leading to an external container for receiving the fluids so
removed. Such catheters must be secured in place after they are
properly positioned so that motion by the patient will not displace
them, and numerous catheters and securing procedures have been
designed to accomplish this purpose.
Among the prime requirements for drainage catheters is that they be
of a material which is durable, yet non-irritating, pliable,
non-hardening, and easy to clean, so that they do not require
frequent replacement. The catheters must be easily placed and
attached, and must be held securely, so that drainage may be
established without trauma. Although prior art catheters and
methods of attaching catheters meet many of these requisites, to
date no catheter is available which provides all of the foregoing
features, yet can be positioned and secured by medical personnel in
a very short period of time, with essentially no tissue injury, and
with minimal risk of complications. Inasmuch as a major application
of the present invention is in the provision of postoperative
bladder drainage by way of a urethral catheter, the present
invention will be described in terms of a catheter specifically
designed for such a purpose; however, it will be evident that the
securing means and the resultant method of securing the catheter in
position are applicable to catheters used for other purposes.
In general, two methods of providing postoperative bladder drainage
in female patients have been practiced in the prior art. The first
method involved the insertion of a thin tube through the urethra
into the bladder, the tube being enlarged at the interior end to
hold it in place. The enlarged end of this type of catheter rests
on the trigonum vesicae, a triangular area of the interior of the
bladder, thus covering the orifice of the urethra and preventing
normal urination. This method, known as Foley catheterization,
inhibits recovery of the patient by failing to encourage voluntary
control of micturition, and in addition exerts a downward pull on
the urethral orifice and its sphincter which is detrimental,
particularly after surgery in this area, thereby often producing
patient discomfort and a resultant psychological block to
micturition.
A second method of obtaining bladder drainage is by surgical
placement of a catheter through the abdominal wall, as by
suprapubic insertion of a catheter into the bladder through a
trocar. This procedure has the advantages of permitting continuous
drainage and of encouraging the patient to micturate at the
earliest possible time, but, as in any surgical operation, the
possibility exists of complications such as hematuria or hematoma
formation due to hemorrhaging. In addition, the performance of
suprapubic cystostomy raises the possibility of drainage to
abdominal organs, prolongs the operation time, and increases
trauma. For these reasons, the surgical procedure has not found
wide acceptance, and work continues in an effort to find a
satisfactory and reliable substitute for the conventional Foley
catheterization.
Recently it has been found that many of the problems of the prior
art could be overcome through the use of a small diameter catheter
which is inserted into the bladder through the urethra. The
catheter, which may be, for example, a number 10 Bard plastic
utility catheter, is then sutured to the urethral meatus, or
opening. Care must be taken, however, that there is an adequate
inclusion of tissue to prevent the silk suture from cutting through
the meatus, and the suture must be tied to the catheter three times
with knots spaced at 1cm intervals to prevent the catheter from
slipping. This catheter arrangement permits continuous drainage,
and since it does not close off the urethral orifice in the
bladder, it may be plugged to allow the patient to attempt to void
around the catheter. The advantages of this technique include
reduction in the length of time the catheter must remain in place,
improvement in patient comfort, ease of obtaining accurate
measurement of residual urine, and avoidance of the complications
inherent in the prior surgical procedures.
Although a marked improvement in the art, the use of the small
catheter described above presents certain practical problems in its
use, for it is difficult to fix the catheter in place securely so
that it will not be displaced when the patient moves about; it has
been found that even with three spaced sutures, the catheter may
still slip. There is also a problem of the suture cutting through
the catheter tubing, or of the catheter pulling out of place when
the distal end is moved. Finally, there is some problem in the use
of the foregoing catheter arrangement in that adhesives are often
used in an attempt to hold the catheter in place, and these may
retain soilage from discharges, and thus accumulate infected
materials.
SUMMARY OF THE INVENTION
It is, therefore, an object of the present invention to provide a
drainage catheter which will permit secure, continuous or
intermittent drainage of a body cavity with minimal movement of the
tube, and no irritation from the fixation.
It is a further object of the invention to provide means for
quickly and easily securing a catheter to a patient in order to
permit drainage of a body cavity, the securing means firmly holding
the catheter in place.
It is another object of the present invention to provide a simple
yet effective securing means for catheters which permits
establishment of drainage without trauma.
Another object of the present invention is the provision of a
securing means for a drainage catheter, the securing means being
strong, non-irritating, easy to use, and resistant to soilage.
A further object of the present invention is the provision of a
securing means for a drainage catheter which is formed as a part of
the catheter, thereby providing a unitary piece of equipment which
is easy to handle, and which results in an insertion procedure that
is simple and which can be performed by medical personnel in a very
short time.
Another object of the invention is the provision of a securing
collar for a catheter, the collar being either a part of the
catheter itself or separate and adjustable, a suitable fixation
material such as a dacron suture, a steel wire, or the like, being
embedded in the collar and carrying at one end a penetrating
needle, the collar fixation material and needle being a unitary
securing means.
An additional object of the present invention is the provision of a
drainage catheter having at or near its proximal end a securing
collar, and at or near its distal end a fixation band, whereby both
ends of the catheter may be secured to the patient to prevent
displacement of the catheter.
In a preferred embodiment of the invention, a discharge catheter is
formed of a slender, flexible tube having a proximal end adapted to
be inserted into a body cavity. A securing collar is permanently
located on the outer surface of the catheter a predetermined
distance from the proximal end, the collar being of the same
material as the catheter and effectively forming a unitary part
thereof. Embedded in the collar and encircling the catheter is a
length of fixation material, such as a dacron suture, for use in
anchoring the catheter to the patient. The ends of the suture
extend from the collar, with one end being affixed to a curved
penetrating needle. This unitary arrangement of the collar, suture
and needle assures ready availability of the means for securing the
catheter in place, and thus reduces the time required to anchor the
catheter.
In a second embodiment of the invention, the securing collar is not
permanently attached to the catheter, but is adjustable and adapted
to be firmly fastened to a selected location on the catheter. This
adjustable collar is generally C-shaped, and is made of a flexible
material so that it can be drawn tightly against the outer surface
of the catheter. The inner periphery of the collar is provided with
a metal sleeve carrying a plurality of inwardly-extending gripping
teeth so arranged that when the collar is closed about the
catheter, the teeth slightly penetrate, or indent, the surface
thereof to hold the collar in a selected position.
In either embodiment of the collar, the suture and needle
arrangement described above may be replaced by other suitable
fixation materials. For example, a steel wire may be embedded in
the collar in place of the suture, with the ends of the wires being
joined to form an eyelet at the outer surface of the collar. A
metal needle anchor, or clasp, may then be connected to the eyelet,
the clasp consisting of a first curved arm forming a penetration
needle and a second spring clasp arm adapted to receive the needle
point in the manner of a safety pin, thereby to form a loop which
may be opened to send the curved arm through the tissue to which
the catheter is to be attached.
The distal end of the catheter carries a fixation band which may be
formed as a unitary part of the catheter, and which serves to hold
the exposed end of the catheter in place. The band may be attached
to the patient or to a dressing by an elastic band, may be sewed
into place with a suitable suture material, or may be fixed with
adhesive, thereby to prevent pull on the proximal fixation
area.
BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing and additional objects, features and advantages of
the present invention will be further appreciated from a
consideration of the following detailed description of the
preferred embodiments thereof, selected for purposes of
illustration, and shown in the accompanying drawings, in which:
FIG. 1 is a side elevation of a drainage catheter including a
unitary securing collar at its proximal end and a fixation band at
its distal end;
FIG. 2 is a cross-sectional view of the catheter and securing
collar of the invention, taken along the lines 2--2 of FIG. 1;
FIG. 3 is an enlarged view of the swedged needle used in the device
of FIG. 1;
FIG. 4 is a cross-sectional view at 4--4 of FIG. 3;
FIG. 5 is a cross-sectional view of the catheter and fixation band
of the invention, taken along line 5--5 of FIG. 1;
FIG. 6 is a top plan view of a securing collar made in accordance
with a second embodiment of the invention;
FIG. 7 is a top plan view of a securing collar made in accordance
with a third embodiment of the invention; and
FIG. 8 is an enlarged cross-sectional view of the clasp illustrated
in FIG. 7.
DESCRIPTION OF PREFERRED EMBODIMENTS
Turning now to a detailed consideration of the drawings, there is
illustrated in FIG. 1 a preferred form of the present invention,
wherein a drainage catheter 10 is shown with a securing collar 12
located at its proximal end 14 and with a fixation band 16 at its
distal end 18. The catheter is preferably fabricated in the form of
a small diameter tube from a pliable, easy-to-clean,
non-irritating, non-hardening material such as Silastic, a
rubber-like composition containing organosilicon polymers produced
by Dow Corning Corporation. When the catheter is to be used for
placement in a patient's urethra to effect bladder drainage, the
maximum size of the tube should be about that of a standard number
10 catheter, having an outer diameter of about 0.125 inch and an
inner diameter of about 0.062 inch. This size is sufficiently large
to provide proper drainage, yet is small enough to permit the
patient to void around the catheter as soon as bladder tone is
sufficient to execute micturition. Where other than urethral
bladder drainage is to be performed, larger diameter tubes may be
used, the securing collar and fixation band providing the same
advantages for such applications as are available in the preferred
usage.
The proximal end 14 of the catheter is adapted for insertion into
the body cavity which is to be drained, and for this reason
includes a rounded end 20 and a plurality drainage openings such as
those illustrated at 22 through 26. The number, size, and spacing
of these openings may vary, depending on the particular use of the
catheter, in accordance with known procedures.
When the catheter is used for urethral catheterization, the
securing collar 12 preferably is located about 10cm from the
rounded end 20 of the catheter, thereby providing an adequate
length of tubing to insure that the openings 22-26 are positioned
in the bladder when the collar 12 is located at or near the
urethral meatus. The collar, which is further illustrated in FIG.
2, is generally annular in shape, having an inner diameter 28
corresponding to the outer diameter of the catheter tubing.
Embedded in the collar is a fixation material such as a suture 30,
the suture extending around the collar and thus encircling the
catheter. The suture extends out of the collar to provide first and
second free ends 32, 34, one of the free ends 34 carrying a swedged
needle 26, which is a conventional suturing needle that is
permanently attached to the suture material.
The collar may be formed by placing a length of the fixation
material in an annular mold and filling the mold with a flowable
plastic material, preferably the same material used to form the
catheter. The plastic may then be cured to firmly hold the suture
so that it cannot easily be pulled out. After removal from the
mold, the collar may be placed over the catheter and fixed in
position by an appropriate adhesive or solvent, whereby the collar
is fused to the catheter to form a single unit. The suture
encircles the catheter and is embedded in the collar so that it
cannot cut the catheter, with the ends of the suture extending from
the collar for use in anchoring the device in place.
Needle 36, which is illustrated in greater detail in FIG. 3, is
permanently attached to the fixation material 30 in known manner so
that it will form a part of the unitary catheter and securing
collar structure, whereby ti will be immediately and conveniently
accessible to medical personnel when placing the catheter. The
needle is preferably of a somewhat oval cross-sectional shape, as
illustrated in FIG. 4, and is of a size sufficient to permit easy
handling without the use of a needle holder.
The arrangement described above thus provides a unitary catheter
set which is ready to use, and which allows trained medical
personnel to insert or replace a urethral drainage catheter and to
anchor it in position by suturing or stitching it to adjacent
tissue, and more particularly to the anterior portion of the
external urethral meatus, quickly and easily, without pain, and
with essentially no tissue injury. When the collar has been thus
sutured in place, the catheter is firmly anchored and thereby
eliminates the problems of prior devices, as described above.
To insure stability of the catheter, and to prevent the suture from
cutting through the tissue to which the catheter is anchored, the
additional anchoring means 16 is provided at the distal end 18 of
the catheter. This fixation band, which is shown in elevation in
FIG. 1 and in a top view in FIG. 5, preferably is fabricated from
the same material as the collar 12, and may be formed in a suitable
mold. The band includes a central tubular portion 40 having an
inner diameter corresponding to the external diameter of tube 10,
whereby after formation the band may be slipped over tube 10 and
secured at the distal end 18 thereof by means of a suitable
adhesive or solvent. The band is formed with a pair of flaps 42 and
44 extending laterally of the tubular portion 40, the three parts
of the band defining at least one generally flat surface 46 adapted
to lie against the patient's skin or against a dressing. Flaps 42
and 44 carry a plurality of small holes 50 through which a needle
and suture may pass, and include elongated openings 52 and 54,
respectively, near their ends for receiving a belt or elastic band
56.
The fixation band 16 may be used to secure the distal end of the
catheter in any one of several ways in order to prevent pulling on
the urethral fixation area. Thus, band 16 may be attached to the
patient's leg or abdomen, to a dressing, or the like, by means of a
suitable adhesive; alternatively, the band may be affixed by means
of sutures passed through holes 50. Finally, it may be desired to
attach the band to the patient by means of an elastic belt 56,
which may be connected to the band by means of slots 52 and 54, and
which may be adjusted as to its length by means of a buckle 58. The
end of the catheter extending beyond band 16 provides the drainage
outlet, and thus should be sufficiently long to permit easy
connection to a suitable drainage container, preferably through a
valve such as a stopcock.
FIG. 6 is illustrative of a modification of the securing collar
shown in FIGS. 1 and 2, and is adapted for use in a drainage
catheter where a variable length of tubing may be required between
the end 20 of the catheter and the collar. The modified securing
collar 60 is a split collar, being generally C-shaped rather than
annular, and further differs from the device of FIGS. 1 and 2 in
the provision of an inner gripping sleeve 62. Sleeve 62 is a
malleable metal facing for the inner surface of collar 60, and is
provided with a plurality of small, upstanding sharp teeth, or
prongs, 64 which may be formed, for example, by perforating the
sleeve with a sharp instrument. As before, a suture material 66 is
embedded in the collar, with free ends 68 and 70 extending
therefrom, and one end of the suture carrying a swedged needle (not
shown). The ends of the suture extend out of the collar at or near
the split 72, but preferably on the upper or outer surface of the
collar so that the suture can be used to tie the collar firmly
around the catheter, after the collar is positioned at the desired
location, and to form the stitches necessary to secure the collar
in place.
The split collar may be formed in a mold substantially in the
manner described above with respect to collar 12, with the metal
sleeve 62 preferably being first placed in the mold so as to be
securely bonded to the collar by means of plastic flowing through
or into the holes in the sleeve which remain after formation of
prongs 64. The collar so formed may then be placed on the catheter
at the desired location, and when the suture is tied, the collar is
closed around the catheter so that the metal prongs will produce
slight indentations in its outer surface, thereby holding the
collar in place and preventing slippage of the catheter. The size
of the collar will depend upon the diameter of the catheter, the
collar being selected so that when properly positioned and tied it
will grip the catheter without compressing it. The adjustable
collar permits variation of the length of the catheter in the
bladder, in the case of urethral catherization, as well as
facilitating the use of the catheter for drainage of other body
cavities.
As illustrated in FIGS. 7 and 8, the fixation material used with
the securing collar need not be a conventional suture material, but
instead may consist of a metal spring clasp, as generally indicated
at 74. In this embodiment, securing collar 76 takes the general
form of collar 12, but in place of suture 30 a wire anchor 78 is
embedded in the collar during fabrication. The anchor extends out
of the collar to form an eyelet 80 adjacent the outer surface of
the collar, by means of which the spring clasp 74 is hingedly
connected to the collar.
Clasp 74 consists of a first, curved, needle-like arm 82 having a
sharp, pointed end 84 (FIG. 8), and a second, generally straight
arm 86 having a hollow end 88 adapted to receive needle point 84.
The first arm of clamp 74 forms a loop at its upper end, the loop
having a diameter of about 1 to 11/2 cm, and is of a size to permit
easy insertion through tissue to secure the collar 76 and the
catheter 10 to which it is fixed. Arm 82 is preferably formed from
a resilient spring-like metal so that its end 84 may be placed in
the hollow end 88 or arm 86, and will remain there, keeping the
clasp closed in the manner of a safety pin. The clasp may then be
opened by flexing the arm 82, to attach or remove the clasp from
tissue, as desired.
The lower end of clasp 74 is formed into a second eyelet 90 which
is adapted to engage eyelet 80, thereby forming a hinged connection
between the clasp and collar 76 which is freely movable for ease of
handling. The collar 76 is fused or otherwise secured to the
exterior surface of the catheter 10 so that anchor wire 78
encircles the tubing and holds it securely, without danger of
slippage or of having the wire cut through the catheter wall. The
clasp thus becomes an integral part of a unitary catheter and
securing device. Although the securing collar has been shown in
each embodiment as being fabricated separately from and then
fastened to the catheter, it will be apparent that the collar may
be molded directly onto the surface of the tubing, or may be formed
as a part of the tube. Similarly, the distal fixation band may be
molded directly on the catheter, or otherwise fabricated, instead
of being formed in a separate mold and attached to the catheter in
the manner disclosed.
Thus, there has been described a new and novel means for securing
drainage catheters to patients quickly, easily and without trauma.
The fixation material is permanently embedded in a securing collar
and thus encircles the catheter to hold it securely, without
slippage or cutting of the tubing, whereby a single unitary device
is provided. The securing device is relatively free from soilage,
and does not produce the irritation and allergies that can be
caused by adhesives. The catheter may be used for urethral bladder
drainage, for suprapubic insertion, or for drainage of other
cavities, and provides in each case substantial advantages over
prior art methods and devices. With the present arrangement, the
patient may be permitted to go home with the device in place,
without increased risk of displacement or injury.
Numerous variations and modifications of the inventive concept
herein described will be apparent to those skilled in the art, and
it is therefore described that the foregoing description be taken
as illustrative and that the true spirit and scope of the invention
be defined by the following claims.
* * * * *