U.S. patent number 3,757,783 [Application Number 05/183,332] was granted by the patent office on 1973-09-11 for suction drainage apparatus.
Invention is credited to Ralph D. Alley.
United States Patent |
3,757,783 |
Alley |
September 11, 1973 |
SUCTION DRAINAGE APPARATUS
Abstract
Suction drainage apparatus for use in conjunction with vacuum
sources of the type that may fail in either an "open" or a "closed"
state. The system includes a trap chamber having an inlet adapted
to be connected to a catheter for receipt in a body cavity and an
outlet connected to a pressure regulation device which, in turn, is
connected to the vacuum source. To preclude pressure buildup within
the body cavity of the patient in the event of vacuum failure in
the "closed" state, a pressure release path from the trap chamber
is provided. To prevent backflow of ambient air into the body
cavity of the patient in the event the vacuum source fails in an
"open" state, a backflow precluding device in the vacuum flow path
is provided.
Inventors: |
Alley; Ralph D. (Loudonville,
NY) |
Family
ID: |
22672377 |
Appl.
No.: |
05/183,332 |
Filed: |
September 24, 1971 |
Current U.S.
Class: |
604/321 |
Current CPC
Class: |
A61M
1/61 (20210501) |
Current International
Class: |
A61M
1/00 (20060101); A61m 001/00 () |
Field of
Search: |
;128/276-278,299-300 |
References Cited
[Referenced By]
U.S. Patent Documents
|
|
|
3363626 |
January 1968 |
Bidwell et al. |
3363627 |
January 1968 |
Bidwell et al. |
3559647 |
February 1971 |
Bidwell et al. |
|
Other References
Surgery, Vol. 61, No. 2 pp. 196-199 Feb. 1967..
|
Primary Examiner: Rosenbaum; Charles F.
Claims
I claim:
1. Suction drainage apparatus comprising: first means defining a
trap chamber having an inlet adapted to be connected to a catheter
to be received in a body cavity to drain fluids therefrom, and an
outlet, said chamber being adapted to serve as a trap for body
fluids drained from the body cavity; second means defining at least
one additional chamber for receiving liquid and having a first
inlet connected to said first chamber outlet, a second inlet, and
an outlet adapted to be connected to a vacuum source; said
additional chamber first inlet extending thereinto a distance
sufficient to be just immersed in a liquid received in said
additional chamber; said second inlet establishing communication
from the interior of said additional chamber to the exterior
thereof and extending thereinto to be immersed in a liquid received
in said additional chamber a distance sufficient to establish a
desired negative pressure; and means in said apparatus for
preventing reverse flow through said first chamber inlet while
precluding pressure buildup in said first chamber.
2. The suction drainage system of claim 1 wherein said additional
chamber is comprised of two components each adapted to receive a
liquid, a first of said compartments including said first inlet and
the second of said compartments including said second inlet and
said outlet, and means establishing a path of gas flow between said
compartments.
3. The suction drainage apparatus of claim 2 wherein said
preventing means comprises a third chamber adapted to receive a
liquid, said third chamber including an outlet to the exterior of
the third chamber above a desired liquid level therein and an inlet
just slightly below the desired liquid level; and means
establishing a gas flow path between said third chamber inlet and
one of said first chamber and said first and second
compartments.
4. The suction drainage apparatus of claim 3 further including
means establishing a liquid flow path between said third chamber
and said first compartment.
5. The suction drainage apparatus of claim 4 wherein said liquid
flow path includes selectively operable valve means.
6. The suction drainage apparatus of claim 3 wherein said gas flow
path is established to said first chamber.
7. The suction drainage apparatus of claim 1 wherein said
preventing means comprises a third chamber adapted to receive a
liquid, said third chamber including an outlet to the exterior of
the third chamber above a desired liquid level therein and an inlet
just slightly below the desired liquid level; and means
establishing a gas flow path between said third chamber inlet and
one of said first and second chambers.
8. The suction drainage apparatus of claim 7 wherein said gas flow
path is established to said first chamber.
9. Suction drainage apparatus comprising: a chamber defining a body
fluid drainage trap, said chamber including an inlet and an outlet;
a catheter in fluid communication with said inlet; a vacuum source
of the type that may fail in open or closed states;
vacuum-regulating means; means establishing a gas flow path from
said outlet to said vacuum source via said vacuum-regulating means;
means in said gas flow path for precluding the flow of gas therein
from said vacuum source to said cathether should the vacuum source
fail in an open state; and means in fluid communication with said
chamber for establishing a pressure relief path should the vacuum
source fail in a closed state.
10. Suction drainage apparatus comprising: means defining a trap
chamber having an inlet adapted to be connected to a catheter, and
an outlet; means defining a pair of seal chambers, each adapted to
receive liquid to a predetermined level, and each having an inlet
at least just below said predetermined level and an outlet above
said predetermined level; means defining a pressure regulating
chamber adapted to receive liquid to a predetermined level and
having a first inlet and an outlet thereabove and a second inlet
therebelow, said outlet being adapted to be connected to a vacuum
source; means establishing a first gas flow path from said trap
chamber outlet to at least one of said seal chamber inlets; means
establishing a second gas flow path from said one seal chamber
outlet to said pressure regulating chamber first inlet; ane means
establishing a third gas flow path from the other seal chamber
inlet to one of said trap chamber, said one seal chamber and said
pressure-regulating chamber; said other seal chamber outlet and
said pressure-regulating chamber second inlet being open to the
atmosphere.
11. The suction drainage apparatus of claim 10 wherein said third
gas flow path is established between said other seal chamber inlet
and said trap chamber outlet.
12. The suction drainage apparatus of claim 11 further including
means establishing a liquid flow path between said seal
chambers.
13. The suction drainage apparatus of claim 12 further including
selectively operable valve means in said liquid flow path.
14. The suction drainage apparatus of claim 10 further including
means establishing a liquid flow path between said seal
chambers.
15. The suction drainage apparatus of claim 14 further including
selectively operable valve means in said liquid flow path.
16. The suction drainage apparatus of claim 10 further including a
catheter connected to said trap chamber inlet and a vacuum pump
connected to said pressure regulating chamber outlet.
Description
BACKGROUND OF THE INVENTION
This invention relates to suction drainage apparatus of the type
used to drain gases and body fluids from a body cavity as, for
example, the pleural cavity.
Injuries to the lungs and/or various surgical procedures will often
result in the accumulation of air and/or fluid between the lung and
the chest wall, in the pleural space, which will interfere with
respiratory mechanics. Such interference may be fatal and often
invites other complications. Thus, in such instances, the need for
chest drainage has long been recognized and practiced by the
medical profession.
Initial chest drainage techniques employed drainage apparatus
comprised of a single-seal bottle and a chest drainage catheter.
The catheter was connected to a glass tube which led through a
stopper in the bottle to a point beneath the surface of water in
the bottom of the bottle. A second opening in the bottle stopper
permitted escape to the atmosphere of air evacuated from the chest
cavity during the respiratory process. The water in the bottle
served to preclude backflow of ambient air into the chest cavity of
the patient. The principal drawback of the single-bottle drainage
system was that the same could not be used for evacuation of body
fluids from the chest cavity. If so used, the ultimate result would
be a fluid level rise in the bottle which, correspondingly,
increased the depth to which the glass tube was submerged, thereby
increasing the head of back pressure which resulted in a
progressive elevation in resistance to drainage.
Accordingly, the prior art interposed a trap bottle in the system
between the patient's chest cavity and the seal bottle creating a
"two-bottle" system. This system operated satisfactorily so long as
there was no need to operate the same by forces greater than that
of gravity and the patient's respiratory mechanics.
Thereafter, the medical profession determined that in many
instances, evacuation of air and fluid from the chest cavity is
enhanced and could be effected safely by the addition of negative
pressure from an external source with the result that the
"three-bottle" suction drainage system evolved. In one form or
another, the three-bottle system is almost universally employed
today where suction is required, is desirable, and/or is
available.
In all forms, the three-bottle system consists of a trap bottle, a
seal bottle and a pressure-regulating or suction control bottle.
The suction control bottle can be linked to the seal bottle or to
the trap bottle with the result that two schools of practice
evolved. Each arrangement has its respective advantages, and, under
certain operating conditions, hazards.
The most common arrangement of the three-bottle system may be
termed a "series" arrangement wherein the pressure-regulating
bottle is linked to the seal bottle, which, in turn, is linked to
the trap bottle. This arrangement may also be practiced with but
two chambers by appropriately locating the sealing elements and
pressure-regulating elements in a single chamber. The advantage of
a series system is that the seal bottle acts as a
backflow-preventing valve when the pressure-regulating bottle is
not connected to a vacuum source, as, for example, during transport
of a patient from the operating room to the recovery room or when a
vacuum source fails in an "open" state. An additional advantage of
the series system is that an air leak from the lung will be
displayed by air bubbling through the seal bottle, and its
magnitude and variation can be visually assessed.
The hazard of the arrangement emerges when the suction port of the
pressure-regulating bottle becomes obstructed (as when a vacuum
source fails in a "closed" state) for then the system becomes
closed and lethal intrapleural pressures may be generated. When
such occurs, the only possible escape for the patient hinges on his
ability to withstand the pressures necessary to drive the water in
the pressure-regulating bottle through the conventional submerged
tube therein and out of the bottle.
An alternate commonly used system to the series arrangement of the
bottles may be termed the "in parallel" system, wherein both the
pressure-regulating bottle and the seal bottle are separately
connected to the trap bottle. The advantage of this system is that
the seal bottle functions as an escape valve even when the suction
port of the pressure-regulating bottle is obstructed. The
disadvantage is that when the system is not connected to suction,
as in the transport of the patient or when a vacuum source fails in
an "open" state, a connection between the trap bottle and
pressure-regulating bottle must be occluded to prevent ambient air
from backflowing through the open suction port to the patient's
chest cavity causing respiratory embarassment due to collapse of
the lung. Moreover, with this system, the seal does not provide an
indicator of air leakage from the lung.
Thus, there is a need for a suction drainage apparatus that not
only precludes possible lethal pressure buildup from an air leak
from the lung, but prevents the possibility of backflow of ambient
air into the patient's pleural cavity as well, and provides
suitable visual indications of air leaks from the lung.
SUMMARY OF THE INVENTION
It is the principal object of the invention to provide a new and
improved suction drainage apparatus. More specifically, it is an
object of the invention to provide a suction drainage apparatus
that prevents lethal pressure buildup in a patient's chest cavity
from a pulmonary air leak and precludes collapse of the lung from
backflow of ambient air through the drainage system, and which
further can provide visual indications of air leakage from the
lung.
The exemplary embodiment of the invention achieves the foregoing
objects by means of a construction employing four chambers. A first
one of the chambers serves as a trap chamber for collection of
drainage and has an inlet connected to a catheter which is located
in the patient's body cavity to be drained. A second chamber has an
inlet which is submerged below liquid in said chamber and is
connected to the trap chamber. Said second chamber also has an
outlet connected to atmosphere. A third chamber also includes an
inlet which is submerged below liquid and is connected to the trap
chamber. The third chamber has an outlet which is connected to an
inlet of the fourth chamber above a desired liquid level therein.
An outlet is provided in the fourth chamber for connection to a
source of vacuum. A second inlet in the fourth chamber leads from
the atmosphere to a variable depth below the level of the liquid in
the fourth chamber.
As mentioned previously, the second chamber provides a
pressure-release path to dissipate pressures as when the outlet of
the fourth chamber is closed while the third chamber serves to
preclude backflow of ambient air into the patient's chest when the
outlet of the fourth chamber is open.
It is contemplated that the chambers may be defined by separate
bottles or, preferably, in a single, integral disposable unit.
The invention further contemplates the provision of a selectively
operable liquid communication path between the second and third
chambers which may be open when liquid is introduced into the same
so that the user of the device need not fill both chambers
separately.
As will be seen, the invention does away with the disadvantages of
prior systems in that there is no need to concern oneself with the
opening or closing of ports during patient transportation nor need
there be concern for vacuum source failure which could result in
either a closed-system condition or an open-system condition.
Other objects and advantages will become apparent from the
following specification taken in conjunction with the accompanying
drawings.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic illustration of the one-bottle system of the
prior art;
FIG. 2 is a schematic illustration of the two-bottle system of the
prior art;
FIG. 3 is a schematic illustration of the series three-bottle
system of the prior art;
FIG. 4 is a schematic illustration of the parallel three-bottle
system of the prior art; and
FIG. 5 is a schematic illustration of a suction drainage system
made according to the invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
An early form of drainage apparatus for body cavities is
illustrated in FIG. 1 and is seen to include a single container 10
having a stopper 12 and containing a liquid 14 such as water. A
tube 16 extends through the stopper 12 to vent the space above the
liquid level to the atmosphere while a second tube 18 extends
through the stopper 12 to a point just below the liquid level. The
upper end of the tube 18 is connected via a conduit 20 to a
catheter located in a body cavity as, for example, the pleural
cavity. This system may be used successfully to vent air from the
pleural cavity and operates as a result of respiratory mechanics of
the patient. Air existing in the pleural cavity, between the lining
of the chest and the lung, upon exhalation by the patient, is
compressed and forced through the conduit 20, the tube 18, the
liquid 14, the container 10 and out the vent 16 to atmosphere. The
liquid 14 covering the lower end of the tube 18 serves as a seal to
preclude backflow of ambient air into the pleural cavity when the
patient inhales.
The single-bottle system is not suitable for drainage when both air
and body fluids must be drained from the cavity. More particularly,
if body fluids are passed into the conduit 20, gradually, the level
of the liquid 14 within the container will build up. As a result,
there will be a back pressure-head generated corresponding to the
height of the liquid level above the lower end of the tube 18. The
resistance of the pressure-head to the escape of air from the
pleural cavity can become sufficiently great as to seriously
interfere with the patient's breathing mechanics.
In order to accommodate both body fluid and air drainage, the prior
art resorted to the configuration illustrated in FIG. 2. The same
includes a bottle 10 which is identical to the bottle 10
illustrated in FIG. 1 and will hereinafter be referred to as a
"seal bottle" by reason of the fact that the same serves to prevent
backflow. In addition, the system illustrated in FIG. 2 includes a
second container 32 to serve as a trap for body fluids 34. The trap
container 32 includes a stopper 36 through which tubes 38 and 40
extend to terminate well above the contemplated level of the body
fluids 34 within the container 32. The tube 40 is connected via a
conduit 42 to the long tube 18 which has its one end submerged
below the level of the liquid 14 in the seal bottle 10 while the
tube 38 is connected via a conduit 44 to a catheter in the pleural
cavity of the patient. The tube 16 vents the seal bottle to
atmosphere. As a result, when the "two-bottle system" illustrated
in FIG. 2 is employed, drained body fluids 34 are isolated from the
seal bottle 10 so that they can be drained without any accompanying
back pressure buildup that could be detrimental to the patient.
It is self-evident that the function of the foregoing two-bottle
system is dependent upon gravity and the forces of the patient's
respiratory mechanics.
The next step in the evolution of a chest drainage apparatus was to
add an external source of controlled negative pressure to enhance
drainage. This was achieved by the development of three-bottle
drainage systems, and, more particularly, two types of three-bottle
systems, hereinafter termed the "in series" system and the "in
parallel" system.
FIG. 3 illustrates the three-bottle "in series" system which is the
most common in use today. The same consists of a trap bottle 32 in
all respects identical to that shown in FIG. 1; a seal bottle 10
identical to that illustrated in FIG. 1 and a pressure-regulating
bottle 50. The pressure-regulating bottle 50 includes a stopper 52
through which tubes 54, 56 and 58 extend. The pressure-regulating
bottle 50 is further adapted to receive a liquid 60 such as water.
The tube 54 is connected via a conduit 62 to the vent tube 16 of
the seal bottle 10 while a conduit 64 connects the tube 58 to a
source of vacuum such as a pump 66. Both of the tubes 54 and 58
terminate well above the level of the liquid 60 within the pressure
regulating bottle 50.
The tube 56 is in communication with the atmosphere externally of
the bottle 50 and has its lower end located below the level of the
liquid 60 within the bottle 50 to some predetermined distance. The
same operates as follows. The height of the level of the liquid 60
above the lower end of the tube 56 determines essentially the
negative pressure differential from atmospheric pressure to be
ultimately applied to the pleural cavity for draining the same.
Should the pump 66 attempt to draw a greater vacuum than that
needed or desired for drainage, atmospheric air will flow in
through the tube 56 into the bottle 50 to maintain the negative
pressure at the desired level.
This system works well for its intended purpose as long as there is
no failure of the pump 66. As is well known, vacuum pumps typically
alternate between conditions wherein their vacuum port is in
communication with the atmosphere or is cut off from communication
with the atmosphere. Hereinafter, such conditions will be termed
"open" and "closed" states, respectively. Should the pump 66 fail
in an open state, the system illustrated in FIG. 3 is perfectly
adequate in that it may then function much the same way as the
two-bottle system illustrated in FIG. 2 with a proper seal against
backflow being maintained by the seal bottle 10. However, should
the pump 66 fail in the closed state, as air and body fluids are
forced into the system at the trap bottle 32, the resulting
increase in pressure will ultimately be conveyed to the
pressure-regulating bottle 50 from which it cannot escape except
through the tube 56. As mentioned previously, the liquid level
within the bottle 50 to accomplish the pressure-regulating
function, must be well above the lower end of the tube 56 so that
there can be no relief of the pressure buildup except by forcing
the liquid 60 up the entire height of the column defined by the
tube 56 until such time as the liquid level has been decreased by
evacuation to the lower end of the tube 56. Thus, the three-bottle
system illustrated in FIG. 3 can be extremely dangerous should the
pump 66 fail in the closed condition. It is also obvious in view of
the foregoing that this hazard is not always dependent on total
pump failure. For, the same circumstance will occur if the volume
of air leaked from the lung exceeds the cap city of the suction
source.
While not shown herein, there is a variation of the series
three-bottle system illustrated in FIG. 3 which only requires two
separate vessels. According to this variation, the
pressure-regulating bottle 50 also serves as the seal bottle 10 and
the arrangement is constructed by substituting the tube 18 of the
seal bottle 10 for the tube 54 of the pressure-regulating bottle
50. Of course, in so doing, it is necessary that the lower end of
the tube 18 be just below the liquid level of the liquid 60 in the
bottle 50. It is to be understood that reference herein to a
three-bottle system is expressly intended to include this variation
thereof, for the principle is the same.
Another type of three-bottle system, the "in parallel" system, is
illustrated in FIG. 4 and is seen to include a trap bottle 32 in
all respects identical to that illustrated in FIG. 2 with the
exception that its stopper is provided with an additional outlet
tube 70 well above the contemplated level of body fluids 34
therein. The seal bottle 10 has a stopper 12 through which tube 18
extends to a point below the surface level of the liquid 14
therein. The tube 18 is connected into trap bottle 32 by means of
tubes 42 and 40. Seal bottle 10 is vented to the atmosphere by
means of tube 16 extending through the stopper 12.
Pressure-regulating bottle 50 has a stopper 52 with tubes 54, 56,
and 58 passing therethrough. Tube 56 extends from atmosphere to a
point below the surface level of liquid 60 in the bottle. Vacuum
pump 66 is connected into bottle 50 by means of tube 64 connecting
to tube 58 which tube terminates in the bottle above the liquid
level. Tube 54 is connected by tube 72 to the outlet tube 70 in the
trap bottle 32.
Malfunction of the in paralled three-bottle system may occur if
failure of the pump 66 occurs. When the pump 66 fails in the closed
mode, though external suction is lost, pressure buildup is
prevented through the seal bottle 10 which is vented by tube 16 to
atmosphere. However, should the pump 66 fail in the open state, it
will be appreciated that a path of direct communication from the
atmosphere to the pleural cavity of the patient exists which will
result in backflow of ambient air causing collapse of the lung.
Thus, the suction drainage systems heretofore known are subject to
disadvantages under certain operating circumstances and certain
conditions of suction system failure.
The invention overcomes all of the foregoing disadvantages. An
exemplary embodiment of a suction drainage apparatus made according
to the invention is illustrated in FIG. 5. And while the same is
illustrated as being comprised of a plurality of separate
containers interconnected by conduits or tubing, it is to be
understood that the following description is but an exemplification
of the principles and it is contemplated that the invention may be
implemented by the use of separate vessels and connectors as
illustrated or by a unitized construction of a disposable nature
according to techniques well known in the art.
The exemplary embodiment of the invention includes a trap bottle 32
having a stopper 36 through which tubes 38, 70 and 40 extend. All
of the tubes 38, 70, 40 have their lower ends well above any
contemplated level of body fluid drainage 34 within the trap bottle
32.
The tube 38 is connected via a conduit 44 to any suitable form of
catheter 94 which is positioned in a body cavity for drainage while
the tube 40 is connected via a conduit 42 to a tube 18 extending
through the stopper 12 of a first seal bottle 10. The tube 18 has
its lower end just below the level of a liquid 14, such as water,
therein. The first seal bottle 10 is closed by a stopper 12 having
a short tube 16 extending therethrough to establish communication
between the atmosphere and the interior of the bottle 10 above the
liquid 14. The tube 70 in the trap bottle 32 passes through stopper
36 and is connected into a second seal bottle 102 via conduit 72
and tube 98. Tube 98 in the second seal bottle 102 is similar to
the tube 18 in the first seal bottle 10. Again, the lower end of
the tube 98 is located just below the level of a liquid 104 within
the seal bottle 102.
Returning to the second seal bottle 102, the same also includes a
short tube 118 similar to the tube 16 extending through its stopper
100. However, the tube 118 is connected via a conduit 120 to a tube
54 extending through stopper 52 in the pressure-regulating bottle
50 which may be identical to the pressure-regulating bottles 50 of
FIGS. 3 and 5. Tube 56 extends from atmosphere through stopper 52
to a point below the liquid level in bottle 60. A vacuum pump 66 is
also connected to the pressure-regulating bottle 50 by means of a
conduit 64 and tube 58 as illustrated.
In normal operation, the tube 18 in the first seal bottle 10 serves
as a manometer reflecting the negative pressure in the drainage
system. However, should the pump 66 fail in a closed state, it will
be recognized that pressure release will obtain via the first seal
bottle 10 without a detrimental buildup of pressure by reason of
the fact that the tube 16 establishes communication of the interior
of the bottle 10 to the atmosphere while the lower end of the tube
18, in communication with the trap bottle 32 is just below the
level of liquid 14 in bottle 10.
On the other hand, should the pump 66 fail in the "open" state, it
will be appreciated that the location of the lower end of the tube
98 of the second seal bottle 102 just below the level of the liquid
104 therein will preclude any backflow of air into the pleural
cavity of the patient. Thus, the system is adaptable for use with
suction and eliminates any possibility of harm to the patient due
to pump failure. Moreover, it will be appreciated that the same can
be employed without suction in the same way as the two-bottle
system illustrated in FIG. 2. And, as with the "in series"
three-bottle system, air leaks in the lungs may be visually
assessed by observation of the bubbling in the second seal bottle
102.
The invention also contemplates the provision of a liquid flow path
between the first and second seal bottles 10 and 102, respectively.
As illustrated, a conduit 128 extends therebetween and includes a
manually operable valve 130. The purpose of this construction is
simplification of filling of the seal bottles 10 and 102 with a
liquid such as water, particularly when the invention is embodied
in a unitized structure. When such is the case, only one of the
bottles need be filled with the valve 130 open to result in the
other of the bottles being filled to the same level. After filling,
the valve 130 may be closed, the entire operation not requiring
separate filling of each bottle.
It will also be appreciated that the invention does not require
four distinct chambers to practice. For example, the structure of
the seal bottle 102 may be incorporated in the pressure-regulating
bottle 50 as described above in conjunction with the description of
the variation of the "in series" three-bottle system of FIG. 3.
Finally, it should be recognized that vacuum source failure
referred to herein is not limited to failure of a vacuum pump
itself. Source failure of the "open" type can occur due to
large-scale leaks in a vacuum line while "closed" state failure may
result from the closing of a valve in a vacuum line.
* * * * *