Surgical Valve Assembly For Urinary Bladder Irrigation And Drainage

Abstract

An arrangement for irrigating a patient's bladder following prostate or bladder surgery which includes a four-position valve having four ports, the valve core being rotatable for interconnecting any two of the four ports so that the bladder may be irrigated with fluid by means of a compressible bulb or syringe connected to one of the ports and the bladder may also be conventionally drained into a bedside urinary bag without physically disconnecting the valve from either the urinary catheter, the source of irrigating fluid, the bulb or syringe, or the urinary drainage bag.

Description

The present invention relates to a surgical valve arrangement for urinary bladder irrigation and drainage.

Following prostate or any other urinary bladder surgery frequency and systematic bladder irrigation is usually considered an absolute necessity. Blood clots which form in the urinary tract or the bladder must be removed periodically and with frequency in order to arrest bleeding and hemorrhaging. The bladder irrigation procedure is normally performed every 20 to 30 minutes for a period of about one to three days. This is a bedside procedure and conventional practice involves the intermittent connection and disconnection of a urinary catherer with a syringe or bulb and with a source of irrigating fluid. After each irrigation procedure the urinary catheter is connected with a bedside urinary bag to permit conventional drainage and urination. Since this procedure is repeated frequently and at the bedside of the patient the ends of the uninary catherer are by necessity normally placed upon the bed sheet or other surrounding supporting surface and absolute sterilization is therefore impossible as a practical matter Consequently, infection is not an uncommon occurrence in the course of such procedure.

In addition to the problem caused by lack of proper sterilization, the manipulation required of the various elements used is very time consuming. When it is realized that this procedure is performed perhaps 20 to 50 times a day the problem of sterilization and the inordinate time consumed is readily apparent.

The present invention has for its object the provision of a surgical valve designed specifically for use in irrigating the bladder in a minimum of time and under sterile conditions.

More specifically, the invention contemplates a closed irrigation circuit, that is, a circuit wherein the catheter, syringe, source of irrigating fluid and the bedside urinary drainage bag, are adapted to be connected to a specifically designed valve and remain connected during the entire period of irrigation and normal drainage. The valve is adapted to be rotated to various positions to effect the necessary procedural sequences; namely, establishing communication between the irrigation fluid and the syringe, then between the syringe and the urinary catheter, thereafter between the syringe and urinary drainage bag and finally between the urinary catheter and the drainage bag.

Furthermore, the valve of this invention is designed so that it is relatively small in size while the passageways therethrough are relatively large to permit the passage of large blood clots and any loose tissue in the urinary tract and bladder which must be cleared without obstructing flow through the valve.

In the drawings:

Fig. 1 is a somewhat diagrammatic view of the valve of the present invention connected with a source of irrigating fluid, a urinary catheter, a compressible bulb and a urinary drainage bag in the manner contemplated for irrigating a patient's bladder;

Figs. 2, 3, 4 and 5 are sectional views through the valve showing the various positions thereof for performing the necessary sequence steps in the irrigation procedure;

Fig. 6 is a fragmentary vertical sectional view of the valve; and

Fig. 7 shows a surgical syringe connected to one port of the valve in place of the compressible bulb illustrated in FIG. 1.

In FIG. 1 the valve is generally designated 10 and includes an outer body 12 having a valve core 14 rotatably retained therein. Valve body 12 is fashioned with a generally cylindrical bore 16 and is provided with four ports communicating with the bore; these ports are designated 18, 20, 22 and 24. Each port includes a short sleevelike extension. Thus, the extension of port 18 is connected to a flexible tube 26 at one end which has its other end connected to a container 28 of irrigating fluid; the extension of port 20 is connected to one end of a catheter 30, the other end of which is inserted in the patient's urinary tract or bladder diagrammatically designated 32; the extension of port 22 is connected to one end of a flexible tube 34, the other end of which connects to a bedside urinary drainage bag; and the extension of port 24 is formed with annular ribs 38 for secure connection to an adaptor sleeve 40 secured to the end of a compressible bulb 42.

Referring now to FIG. 6, valve core 14 has an upper flange 44 which overlies the flat upper face 46 of valve body 12. Valve core 14 has a body portion 48 which has a close fit with bore 16. If desired, bore 16 and body 48 can be formed with a slight taper to insure a sealed relationship between body 48 and bore 16 when they are telescopically engaged. The lower end of valve core 14 is formed with an annular groove 50 adapted to receive a snap ring 52 which bottoms against the lower flat face 54 of valve body 12 to retain valve core 14 firmly seated in bore 16.

Referring now to FIGS. 2 through 5, body 48 of valve core 14 is fashioned with two peripheral portions 56, 58. The portion 56 has a straight inner side 60 and an arcuate outer surface 62 provided with vertically extending ribs 64 for sealed engagement with bore 16. It will be observed that the circumferential extent of the outer peripheral surface 62 is just sufficient to overlap and block any two of the circumferentially adjacent ports 18,20,22,24. It will also be observed that when valve core 14 is rotated to the position shown in FIG. 3 the arcuate outer surface 62 of portion 56 overlies and blocks only one of the ports (port 22 in FIG. 3) and does not in any way obstruct the two ports adjacent the blocked port (that is, ports 20 and 24 in FIG. 3). Thus, the straight side 60 of portion 56 defines through valve core 14 a central passageway 66 which extends diametrically through the valve core.

Portion 58 of the valve core 14 is disposed diametrically opposite the portion 56 and, like portion 56, is provided around its outer peripheral surface 68 with a pair of vertical ribs 70 for establishing sealed engagement with bore 16. The body portion 48 of valve core 14 is also provided with circumferentially extending ribs 72 adjacent the upper and lower edges thereof which likewise seal with bore 16. As shown in FIG. 2, the arcuate extent of the peripheral surface 68 of portion 58 is generally equal to the arcuate extent of bore 16 between the adjacent side edges of adjacent ports. For example, as illustrated in FIG. 2, the outer peripheral surface 68 of portion 58 corresponds in extent generally to the circumferential extent of bore 16 between the adjacent sides of ports 18 and 24 without in any way blocking either of these ports. Portion 58 has radially inwardly extending straight side edges (designated 74) which intersect as at 76. The line of intersection 76 is diametrically opposite the center of the straight side 60 of the portion 56 of valve core 14 and is offset from the diameter of bore 16 oppositely to the straight side 60 of portion 56. While the arcuate extent of the peripheral surface 68 of portion 58 is not greater than the circumferential extent of the bore between adjacent sides of adjacent bores, nevertheless as shown in FIG. 3 the arcuate surface 68 is of sufficient arcuate extent to completely overlie and block any one of the four ports. Thus, while the straight side 60 of portion 56 of valve core 14 defines passageway 66 which extends diametrically through the valve core, the straight sides 74 of portion 58 define two passageways 78,80 which are oppositely inclined at an angle of about 45.degree. to the axis of passageway 60 and which communicate therewith. It will be observed that one side of passageway 78 is defined by the straight side 74 of portion 58 while the opposite side thereof is open to passageway 66. Likewise, one side of passageway 80 is defined by other straight side 74 of portion 58 and the opposite side of passageway 80 is, likewise, open to passageway 66. Thus, passageways 66,78,80 define within valve core 14 a single cavity having a straight side 60 at one sid of the valve body 48 and two short perpendicularly related sides 74 at the opposite side of body 48. This arrangement enables the passageways within the valve member to be of maximum size in relation to the diameter of the valve body 12 and the diameter of the various ports therein. As an example, successful results have been obtained with the valve structure disclosed when the arcuate surface 62 of portion 56 has an extent of about 130.degree. to 140.degree. and the arcuate extent of the peripheral surface 68 of portion 58 is about 40.degree. to 50.degree.. Thus the body portion 48 of valve core 14 in the plane of ports 18,20,22,24 is in open communication with the ports around approximately onehalf of its circumferential extent. This is considered one of the important features of the present invention since it allows the passageways through the valve to accommodate relative large blood clots and any body tissue that must flow through the valve.

In operation valve core 14 is initially positioned as shown in FIG. 2 to permit selection of the proper relative position of valve core 14; it is conventionally provided with a handle 82 on the top face thereof, one end of which is shaped as a pointer for registering with numerals located on the top face 46 of valve body 12 to designate the proper location and the proper sequence of valve rotation to effect a bladder irrigation procedure. In the position shown in FIG. 2 the pointer end of handle 82 registers with numeral 1 and internally port 18 is connected with port 24; thus, bulb 42 can be squeezed and then released to draw a quantity of irrigating fluid into bulb 42. Thereafter the valve core is rotated in a clockwise direction to position 2 illustrated in FIG. 3 where the portion 58 of valve core 14 blocks port 18 and communication is established between port 24 and port 20 so that, when bulb 42 is squeezed, the irrigating fluid is forced through the catheter 30 through the urinary tract and bladder 32. After bulb 42 is compressed and released several times the bladder is irrigated and the fluid along with blood clots and tissue is drawn back into bulb 42. Thereafter valve core 14 is preferably rotated in a counterclockwise direction to position 3 which is illustrated in FIG. 4. In this position the portion 56 of valve core 14 blocks port 18 and 20 and communication is established between ports 24 and 22. Now, when bulb 42 is squeezed, the fluid, blood clots and tissue irrigated from the bladder are discharged into the urinary drainage bag 36.

After the above procedure is repeated several times the irrigating fluid being discharged into bag 36 is clear and there is no need for continued irrigation for a short interval of time. Accordingly, valve core 14 is rotated to the position shown in FIG. 4 to permit the bladder to drain in a conventional manner into the urinary bag 36.

Under some circumstances unusually large blood clots are formed in the bladder and the suction capabilities of the plastic bulb 42 ar not sufficient to discharge these blood clots from the bladder. In this event bulb 42 is removed from adaptor 40 and a a conventional medical syringe 84 is connected to the extension or port 24 as illustrated in FIG. 7. Syringe 84 comprises an outer cylindrical sleeve 86 having an axial extension 88 adapted to be connected in sealed relation with adaptor 40 and an internal plunger 90 which is axially slideable within sleeve 86 to alternately produce a pressure and vacuum at port 24 which normally exceeds those obtainable with a plastic bulb such as illustrated at 42.

Thus it will be seen that the valve arrangement of the present invention not only provides a completely closed circuit at all times which eliminates the necessity for disconnecting the catherer between successive irrigation steps and, thus, avoids the problem of sterility, but also reduces considerably the time required for actually completing the irrigation procedure. In addition, the valve is constructed so that the passageways therethrough are relatively large and can accommodate any blood clots or tissue which are required to be flushed from the bladder. The larger passageways in the valve core facilitate sterilization in the event that it is constructed for repeated use. On the other hand, the entire valve assembly can be molded from plastic, if desired, and will be sufficiently low in cost so that it can be discarded after being used just once.

A further feature of the present valve, and more specifically to the passageway arrangement in the valve core, resides in the fact that all three passageways simply comprise a single relatively large cavity. With this arrangement, when any of the passageways are connected to port 22 which extends downwardly to drainage bag 36, all of the fluid in the cavity freely drains into bag 36 so that, upon subsequent use of the valve, substantially no fluid remains therein.

Claims

I claim:

1. In a uninary catheter arrangement for irrigating the bladder in post-operative prostate or bladder surgery the combination comprising, a valve body having a circular bore and a valve core rotatably retained in said bore, said body having four generally perpendicularly related ports therein communicating with said bore, said valve core having a first peripheral portion in sealed relation with said bore and having a circumferential extent substantially only sufficiently large to block any two circumferentially adjacent ports when rotated to any one of four positions and sufficiently small to block only the intermediate one of three circumferentially successively positioned ports in an intermediate position thereof without blocking the other two of said three successively positioned ports, said vlave core having a second peripheral portion in sealed relation with said bore and positioned diametrically opposite the first portion, said second portion having a circumferential extent substantially only sufficient to completely block any one of said ports without blocking any of the other three ports, said two portions cooperating to define in said valve core a diametrically extending passageway and two additional passageways on the same side of the first-mentioned passageway whose axes are inclined to the axis of the first passageway at an angle of about 45.degree. a catheter connected to a first of said ports and adapted to be inserted into the urinary tract of a patient, a supply of irrigating fluid connected to a second port circumferentially adjacent the first port, a urinary drainage bag connected to the third port, said third port being generally diametrically opposite the second port, and an expandable-collapsible receptacle connected to a fourth port diametrically opposite the first port, whereby to enable rotation of the valve core in the following sequence to irrigate the bladder: first rotate the valve core to establish communication between the second and fourth ports to enable a quantity of irrigating fluid to be drawn into the receptacle; then rotate the valve core to interconnect the first and fourth ports to successively discharge the irrigating fluid into the urinary tract and withdraw the same from the urinary tract back into the receptacle; then rotate the valve core to interconnect the third and fourth ports to discharge from the receptacle the irrigated fluid and the matter withdrawn therewith from the urinary tract and into the urinary bag; finally rotate the valve core to interconnect the first and third ports to permit conventional drainage from the urinary tract into the urinary drainage bag.

2. The combination called for in claim 1 wherein said first portion has a circumferential extent substantially only sufficient to block communication between the first and third ports when the valve core is rotated to establish communication between the second and fourth port, said first portion blocking only the third port and said second portion blocking only the second port when the valve core is rotated to establish communication between the first and fourth ports, said first portion blocking communication between the first and second ports when the valve core is rotated to establish communication between the second and fourth ports when the valve core is rotated to establish communication between the first and third ports.

3. The combination called for in claim 2 wherein said receptacle comprises a compressible plastic bulb.

4. The combination called for in claim 2 wherein said receptacle comprises a syringe which includes a hollow sleeve connected to the fourth port and an axially shiftable plunger within said sleeve for alternately creating substantial pressure and vacuum at said fourth port.

5. The combination called for in claim 2 wherein the periphery of the valve core in the plane of said ports is open from the circumferentially opposite ends of the first portion to the adjacent one of the opposite ends of the second portion.

6. The combination called for in claim 2 wherein the periphery of the valve core in the plane of said passageways consists of two diametrically opposite portions in sealed relation with said bore which are separated by two open sections defining said passageways and which extend between the circumferentially adjacent ends of the two portions sealed with said bore.

7. An arrangement for irrigating a patient's bladder following prostate or bladder surgery comprising, a valve having a valve body and a valve core rotatable in said body, said valve body having four generally perpendicularly related ports thereon and a conduit connected with each port, one of said conduits comprising a urinary catheter adapted to be inserted in the patient's urinary tract, the second conduit being connected to a source of irrigating fluid, the third conduit being connected to an expandable collapsible receptacle for drawing fluid into said receptacle from said source through said valve and for discharging said fluid into said catheter through said valve, said fourth conduit being connected with a urinary drainage bag disposed at a level below said valve, a rotatable valve core in said valve body having passageways therein which, when the valve core is rotated to predetermined positions, are adapted to connect any two of said ports while blocking the two remaining ports, said passageways being arranged so that the valve core is rotatable in the following sequence: first connecting the source of irrigating fluid with the receptacle to draw a quantity of irrigating fluid into the receptacle; then connecting the receptacle to the catheter to first discharge the fluid from the receptacle into the patient's urinary tract when the receptacle is collapsed and to retract the fluid from the urinary tract back into the receptacle when the latter is expanded; thereafter connecting the receptacle to the drainage bag to discharge the irrigating fluid and the matter irrigated from the bladder to the drainage bag; and finally connecting the catheter to the drainage bag to permit normal drainage of the bladder, said passageways comprising a first passageway extending diametrically through the valve core and two additional passageways angularly inclined to said first passageway, each of said two additional passageways having one side thereof in common throughout substantially its entire radial extent with said first passageway so that, when the valve core is disposed in any of said positions, all of the passageways therein are in communication with two of said ports at the radially outer ends thereof, whereby said three passageways form a single cavity in said valve core having substantially only three sides in the plane of said ports (namely, one side comprising one side of said first passageway and the other two sides each comprising the inclined side of each of the other two passageways) so that, when any of said passageways are connected to said drainage bag, the fluid in each of said passageways drains into the drainage bag.

8. An arrangement as called for in claim 7 wherein the first conduit extends upwardly from the valve to the source of irrigating fluid and the second conduit extends downwardly from the valve to the urinary drainage bag.