U.S. patent number 3,780,733 [Application Number 05/274,438] was granted by the patent office on 1973-12-25 for catheter.
Invention is credited to Manuel Martinez-Manzor.
United States Patent |
3,780,733 |
Martinez-Manzor |
December 25, 1973 |
CATHETER
Abstract
For use in administering continual spinal anesthesia, a catheter
for longitudinal movement within the lumen of a relatively large
needle used to approach just about to the spinal column to the end
of the catheter, a thin needle with a through opening is secured
and a stylet is provided in the catheter to advance the small
needle relative to the large needle to pierce the wall of the
spinal column in a relatively fine opening through which the
anesthesia is administered.
Inventors: |
Martinez-Manzor; Manuel
(Homestead, FL) |
Family
ID: |
23048198 |
Appl.
No.: |
05/274,438 |
Filed: |
July 24, 1972 |
Current U.S.
Class: |
604/158;
604/274 |
Current CPC
Class: |
A61M
25/0069 (20130101) |
Current International
Class: |
A61M
25/00 (20060101); A61m 005/00 () |
Field of
Search: |
;128/215,214.4,214.2,214R,221,347,348 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
What is claimed is:
1. A spinal anethesia administering apparatus comprising in
combination, a first big needle defining a lumen and a catheter
sized for longitudinal movement removable received in the lumen of
said big needle, said catheter including, a tubular length having a
first end zone and a second end zone and of a diameter smaller than
the lumen of the big needle,
a thin needle portion on the first end zone of said tubular length
having a through passageway and a distal end portion having a
tissue wall piercing tip and a proximal end portion and with said
through passageway being in fluid transmitting engagement with said
tubular length,
an elongated stylet having a first end and a second end and with
said first end in said tubular length and with said second end
being exterior of said tubular length, and said stylet being of a
length greater than said tubular length and being sized for
longitudinal coaxial movement in the tubular length and being sized
less than said through opening in said thin needle portion, and
mutually inter-co-operating means on the first end of the stylet
and said thin needle for applying a longitudinal force to advance
the thin needle and tubular length relative to the big needle after
said big needle has been utilized to penetrate to a predetermined
depth for a second stage of penetration by said thin needle,
whereupon the stylet may be removed from said combination and
material be injected through said tubular length and thin
needle.
2. The combination as set forth in claim 1 wherein the
interco-operating means on the first end of the stylet and said
thin needle comprise walls included in said thin needle converging
to a constricted opening at the distal end, said opening being of a
diameter greater than the diameter of the first end of said stylet
and the diameter of said stylet being less than the span between
the walls of said thin needle at its proximal end to bear against
the wall of the needle for advancing movement of the catheter
relative to the big needle when longitudinal force is applied to
the stylet.
3. The catheter as set forth in claim 1 wherein the catheter is of
about 20 gauge size, the thin needle is of about 25 gauge size and
the longitudinal dimension of the small needle is about 0.5cm.
4. The catheter as set forth in claim 1 wherein means are provided
securing the proximal end of the thin needle to the first end zone
of the tubular length and said means comprise an annular recess in
the first end zone of said tubular length and said end zone is of
plastic material and a pattern in relief on the proximal end of the
needle is provided and said pattern is disposed within said recess
and imbedded in the plastic material of said tubular length, with
said pattern in relief keying the needle and tubular length
together as a unitary piece.
5. The combination as set forth in claim 4 wherein the
intercooperating means on the inner end of the stylet and catheter
comprises walls included in said thin needle converging to a
constricted opening at the distal end of a diameter greater than
the diameter of the first end of said stylet and the diameter of
said stylet is less than the span between the wall of said thin
needle at its proximal end to nest between the walls and thin
needle ends and to bear against the needle for advancing movement
when longitudinal force is applied to the stylet.
Description
FIELD OF THE INVENTION
This invention relates to continuous spinal anesthesia; and, more
particularly, this invention relates to an improved needle carrying
catheter for use in piercing the spinal column wall and through
which anesthesia is to be introduced as required into the column of
the spine through a relatively small opening.
BACKGROUND OF THE INVENTION
In the past, it has been learned and subsequently widely recognized
that there are advantages to continual spinal anesthesia in that
the response to the introduction of anesthesia directly into the
spinal column can produce more precise results and control. Albeit
recognized however, as a practical matter, actual application of
the procedure has been limited because it has heretofore been
difficult to pass a needle through the back of a patient to the
exact depth required for the procedure and to introduce the
anesthesia through an opening small enough so that there are not
attendant side effects which are very undesirable, as is explained
more fully hereinafter.
OBJECTS OF THIS INVENTION
It is an object of this invention to provide an improved catheter
which carries on its end a small needle and means to advance it
relative to a larger needle, after the tip of the larger needle has
been prepositioned near the spinal column, so that on being
advanced, the small needle will pierce the spinal column wall in a
fine opening sufficient for introducing anesthesia but not so large
as to cause injury to the spinal wall and attendant difficulties
described herein.
In accordance with this general object and purpose, the instant
invention will now be described with reference to the accompanying
drawings in which :
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of the improved catheter;
FIG. 2 is a diagrammatic view of the first step in the process of
introducing a large needle into the spine area;
FIG. 3 is a view in cross section illustrating the use of the
catheter of FIG. 1 and details of its construction; and
FIG. 4 is a view of the spinal area in cross section illustrated in
the affected area of the operation in which the improved catheter
is employed.
DETAILED DESCRIPTION OF THE INVENTION
Continuous spinal anesthesia is a recognized, accepted and highly
effective technique. This invention relates to an improved catheter
for use in administering continuous spinal anesthesia. Generally,
to perform the task, the anesthesic solution is introduced directly
into the dura mater 8 and arachnoid using the improved catheter, to
be described, which carries a relatively small needle 19 to pierce
the dura wall 21. The wall is pierced by the smaller needle after
the extradural space 10 has been reached by a larger needle 12 by
advancing the smaller needle carried by the catheter. This is done
in the following manner.
First, an appropriate interspinous vertebral space is selected; the
surrounding skin is scrubbed with an antiseptic solution and dried
completely; and anesthesia of the skin and soft tissues performed.
The extradural space 10 is reached with a straight relatively large
needle 12, preferably about 15 gauge, with a stylet in place. To
the extent possible the bevel 13 of the needle is presented in
longitudinal position, for an easier pass through the skin and
supra-spinous and interspinous ligaments 14. When the
characteristic major resistance of the flavum ligament 15, between
the extra dura 10 and the zone 14 is perceived, the stylet, not
shown, is removed and the distal end of the big needle is connected
to a specially treated, very sensitive, small, 2 cc. syringe of
glass filled with air, not shown.
The extradural space 10 on the proximal side of the flavum ligament
15 is reached in the following manner. The needle 12 is very gently
advanced or introduced while with the other hand an effort is made
to force the penetration of the air in the syringe through the
needle. The introduction of air will be unsuccessful until there
occurs the penetration of the needle through the favum ligament 15
and penetration begins into the extradural space 10. This will be
recognized because, when the extradural space is reached, there
will be a sudden lack of resistance which is characteristic of this
area contrasting to the resistance offered by the flavum ligament.
The lack of resistance confirms that the extradural space has been
reached. It is also confirmed because, when the extradural space is
reached, the air of the syringe is introduced easily and rapidly
and, simultaneously, there occurs a sudden inversion of the
resistance against removal of the big needle. This is sometimes
referred to as the double inverted resistance sign; in other words,
the resistance given by the flavum ligament 15 is overcome and the
negative pressure which characterizes the penetration to the
extradural space is sensed.
As shown in FIG. 2, once the extradural space 10 is reached by the
tip of the 12, the improved catheter 17, shown in FIG. 1 and to be
described hereinafter, is introduced through the lumen 18 of the
needle 12, with a stylet 16, see FIG. 3, in place in the catheter
17. A firm and quick pressure is then applied to the catheter 17 by
means of the stylet 16 which will cause a small needle 19 on the
end of the catheter to penetrate the dura wall 21 and enter the
dura mater 8 and arachnoid, reaching the subarachnoid space.
Thereafter, the stylet 16 is removed. Then, a syringe is connected
to the distal end of the needle carrying catheter and a gentle
suction is made until the CEF, or spinal fluid, is obtained,
confirming the location of the tip of the small needle. The
anesthetic solution, which is ready in another syringe, may then be
introduced directly into the dura through the catheter in
intermittent injections of the anesthetic solution any time it will
be needed during the surgical procedure.
It will be helpful to refer to FIG. 3 at this juncture in summary
of the procedure. The extradural space 10 between the flavum
ligament 15 and the dura wall 21 is reached by a relatively big
needle 12; and the location of the tip or bevel 13 of the big
needle is sensed in the manner described above. The catheter 17 is
inserted through the column 18 of the needle 12 and the wall 21 of
the dura is penetrated by a small needle 19 fixed on the tip 20 of
the catheter. A preferred embodiment of the small needle carrying
catheter will now be more particularly described with reference to
FIG. 3 and FIG. 1.
The catheter 17 is composed of a plastic catheter tube 31 of
suitable length, which may be similar to a urethral catheter in
consistence and calibration and of about 20 gauge. To the tip 20 of
the catheter tube 31, a thin needle 19 of about 25 gauge is secured
with the needle extending beyond the tube end about 0.5 centimeter,
which corresponds for the purposes described above to the
extradural and dura space cross sectional dimension and with the
catheter and needle being sized so as to be able to pass through
the column of the big needle, which is preferably 15 gauge.
Means are provided to secure the smaller needle 19 to the tube; in
the embodiment shown the means are as follows. In the plastic wall
31 at the tip 20 of the catheter the surface of the proximal end 33
of the needle 19 is provided with a key surface or pattern in
relief 33 to join it to the tube, i.e., the needle is embedded in
the tube wall. It will be seen that the lumen 37 of the needle is
characterized by converging side walls 39 to the distal end 41,
which has an opening or mouth 43.
In use, through the center or column 45 of the catheter 17 the
stylet 16 is passed; it has a terminal end of a dimension greater
than the mouth 43 of the needle, but less than the inside diamter
of the catheter tube, so that, when a longitudinally directed force
is applied to the stylet, its leading edge will bear against the
inside wall 37 of the needle for use in driving the relatively
small needle 19 through the dura wall and into the dura mater.
It is thus seen that the above described needle carrying catheter
provides a means for introducing anesthetic solution into the dura
through a small opening relative to that which would be made if the
big needle were advance through the dura wall, which heretofore,
when done has been attendant with great disadvantage because of an
increase in the rate of postanesthesia sequalae from the relatively
large perforation of the dura wall, dura mater and arachnoid.
Because of the relatively large perforation caused by a large
needle, in the past, direct introduction of anesthesic solution
directly into the dura has been limited to a relatively small
number of patients denying to others the recognized benefits of
continuous spinal anesthesia introduced directly into the dura
which has been widely recognized to have special advantages but for
the injury to the dura wall, etc., as explained above. In summary,
this invention provides a catheter for subarachnoid anesthesia
adopted for wide application in surgery. It will be seen that the
catheter comprises a tubular length of plastic material of a
diameter small enough to be passed through a larger needle of
appropriate size for passage through the skin and supraspinous and
interspinous ligaments, including the flavum ligament, which
catheter has fixed to its leading end a thin needle which is used
to extend through the mouth of the larger needle and is used to
pierce the dura wall in a small perforation when advanced using a
stylet, or introducer, sized for longitudinal movement of advance
through the catheter to bear against the inside wall of the
relatively small needle to advance it and the catheter and
penetrate the dura wall, which stylet can then be removed for the
introduction of anesthetic solution directly into the dura or
subarachnoid space through the column of the catheter. In the
preferred embodiment means are provided on the inner end 51 of the
stylet 16 to coact with the wall of the needle. The means of the
embodiment shown are simply the inner end of the stylet being sized
so as not to pass through the opening of the small needle but
rather to bear against the walls which converge to the tip to apply
an advancement force. Other types of mutually intercooperating
means may optionally be provided to interconnect the stylet and the
catheter. Also, the outer end 61 of the catheter stylet may be
provided with means 63 to aid in advancing the catheter, the
preferred embodiment including a plastic body 65 having an enlarged
outer end and a somewhat smaller end in which the outer end of the
stylet is captivated by suitable means.
* * * * *