U.S. patent number 3,894,540 [Application Number 05/404,400] was granted by the patent office on 1975-07-15 for catheter.
Invention is credited to Francis J. Bonner, Jr..
United States Patent |
3,894,540 |
Bonner, Jr. |
July 15, 1975 |
Catheter
Abstract
A catheter for urinary and other purposes is disclosed,
comprising means forming an elongated flexible conduit having an
insertion end, the conduit also having a distal end spaced from the
insertion end. Means are provided forming a protective sheath
extending in continuous form from the insertion end toward the area
of the distal end, and maintaining a substantially sterile
condition on the entire outer surface of the conduit. The
protective sheath may be a pair of telescopically-arranged tubes,
or may be an accordion pleated light-weight material, for example.
Catheters of this type may be provided for intermittent use or as
indwelling catheters.
Inventors: |
Bonner, Jr.; Francis J.
(Gladwyne, PA) |
Family
ID: |
23599447 |
Appl.
No.: |
05/404,400 |
Filed: |
October 9, 1973 |
Current U.S.
Class: |
604/171 |
Current CPC
Class: |
A61M
25/0111 (20130101) |
Current International
Class: |
A61M
25/01 (20060101); A61m 025/00 (); A61m
027/00 () |
Field of
Search: |
;128/348,349R,349B,349BV,35R,351,214.4 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Medbery; Aldrich F.
Claims
The following is claimed:
1. A catheter comprising means forming an elongated flexible
conduit an operative portion of the length of which is intended to
be inserted into the body, said conduit having an insertion end
constructed and arranged for insertion through a passage in the
body, and for flow of fluid through said conduit, said conduit
having a distal end spaced apart from said insertion end, and means
forming an extendible and retractable protective sheath extending
at least about said operative length from said insertion end toward
said distal end and sealed to inhibit invasion of foreign
micro-organisms to the entire corresponding surface of said conduit
and maintaining a substantially sterile condition on the entire
corresponding surface of said conduit, the outer surface of said
conduit being sealed with respect to said sheath against invasion
of foreign micro-organisms, and said conduit having an opening for
the discharge of said fluid beyond said sheath, said conduit being
longitudinally slidable relative to said sheath for insertion into
the body, and at least a portion of said sheath being retractable
without interfering with the integrity of the protective seal to
permit such relative sliding of said conduit, said outer surface of
said operative length which is to be inserted into the patient's
body being protected from bacterial invasion through said sheath
during the period of insertion and the period of use.
2. The catheter defined in claim 1, wherein said catheter is an
intermittent use catheter and said distal end is free.
3. The catheter defined in claim 1, wherein said catheter is an
indwelling catheter and a fluid collecting chamber is formed
integrally on said distal end and sealed thereto.
4. The catheter defined in claim 1, wherein said sheath comprises a
pair of tubes slidably arranged on said conduit, one of said tubes
also being slidable over the other said tube, whereby said tubes
are telescopically contractable to facilitate insertion of said
conduit into the body, while maintaining the integrity of the
protective sheath.
5. The catheter defined in claim 4, wherein at least one of said
tubes are substantially rigid when manually gripped for insertion
of said conduit.
6. The catheter defined in claim 4, wherein a light-weight,
flexible supplemental sheath is sealed to each of said tubes and
encloses completely the zone in which one said tube is telescoped
over the other said tube.
7. The catheter defined in claim 1, wherein said sheath has an end
of reduced size which extends beyond said insertion end of said
conduit and comprises a dilator which is insertable into the body
before insertion of said insertable conduit end.
8. The catheter defined in claim 1, wherein said sheath is
substantially accordion-pleated.
9. The indwelling catheter defined in claim 3, wherein said sheath
is substantially accordion-pleated.
10. The indwelling catheter of claim 3, wherein said sheath
comprises a pair of tubes slidably arranged on said conduit, one of
said tubes also being slidable over the other said tube.
11. The indwelling catheter defined in claim 3, wherein sealing and
anchoring means is secured to said protective sheath outside of
said conduit and is also secured to the body into which said
conduit is inserted.
12. The indwelling catheter defined in claim 3, wherein a check
valve is provided in said conduit, between said insertion end and
said collection chamber, preventing flow of body fluid from said
chamber back into said body.
13. The indwelling catheter defined in claim 12, wherein a
plurality of said check valves are provided in said conduit.
14. The indwelling catheter defined in claim 13, wherein one said
valve is adjacent to said container and another said valve is
adjacent to said insertion end of said conduit.
15. The catheter defined in claim 1, wherein said sheath extends
beyond the insertion end of said conduit and is sealed beyond said
end.
16. The catheter defined in claim 2, wherein a collection chamber
is mounted on said distal end.
17. A body fluid removable catheter having a means for sterile
insertion into a body comprising:
means forming a catheter conduit having a body insertion end
portion and a fluid discharge end portion, said body insertion
portion having a first protective tube slidably enclosing a length
of said insertion portion, a means for extending said catheter
insertion portion comprising a second protective tube portion
fixed, sealed to and enclosing a length of said fluid discharge end
portion, said first and second protective tube portions being
telescopically connected and having a combined length greater than
the sealed length of said catheter conduit, whereby sliding motion
of said first protective tube with respect to said second
protective tube extends said catheter.
18. The catheter defined in claim 17 including a contamination
prohibiting means comprising a collapsible flexible supplemental
sheath, one end thereof being attached adjacent to an end of said
first protective tube and the second end thereof being attached
adjacent to an end of said second protective tube.
19. The catheter defined in claim 17 wherein said catheter has a
dilator portion on said body insertion end portion.
20. The catheter defined in claim 19 wherein said dilator is
provided with a seal cap.
21. The catheter defined in claim 20 wherein a lubrication medium
is contained within said seal cap.
22. The catheter defined in claim 17 wherein said catheter is an
intermittent use catheter and said body insertion end portion is
free.
23. The catheter defined in claim 17 wherein said first and second
protective tubes are slidably arranged on said body insertion end
portion of said catheter conduit and said fluid discharge end
portion of said catheter conduit, one of said tubes also being
slidable over the other said tube, whereby said tubes are
telescopically contractable to facilitate insertion of said body
insertion end portion into the body, while maintaining the
integrity of the protective sheath formed by said pair of
tubes.
24. The catheter defined in claim 17, wherein said first protective
tube is substantially rigid when manually gripped for insertion of
said body insertion end portion.
25. The catheter defined in claim 17, wherein a lightweight,
flexible supplemental sheath is sealed to said first and second
protective tubes and encloses completely the zone in which one said
tube is telescoped over the other said tube.
26. The catheter defined in claim 17, wherein said body insertion
end portion has an end of reduced size which extends beyond said
insertion end and comprises a dilator which is insertable into the
body before insertion of said body insertion end portion.
27. The catheter defined in claim 17 wherein a lightweight,
flexible supplemental sheath is sealed to each of said first and
second protective tubes, said sheath being substantially
accordion-pleated.
28. The catheter defined in claim 27, wherein said first and second
protective tubes are slidable with respect to each other, and are
also slidable with respect to the body insertion end portion and
the fluid discharge end portion.
29. The catheter defined in claim 17, wherein a supplemental sheath
is provided which is sealed to each of said first and second
protective tubes and which extends beyond said body insertion end
portion and is sealed beyond said end.
30. An improved catheter substantially sealed against the invasion
of micro-organism infection of the type comprising a means for
forming an elongated flexible conduit a portion of the length of
which is intended to be inserted into the body, said conduit having
an insertion end constructed and arranged for insertion through a
passage in the body, and for flow of fluid into and through said
conduit, said conduit having a distal end spaced apart from said
insertion end and having an opening for the discharge of said
fluid;
the improvement which consists of means forming an extendible and
retractable protective sheath extending at least about said length
from said insertion end toward said distal end, means for providing
against the invasion of micro-organisms comprising a sealed
connection between said conduit and said sheath located adjacent
said distal end of said conduit, and maintaining a substantially
sterile condition on the entire corresponding surface of said
conduit, said distal end having said opening beyond said sheath,
said conduit being longitudinally slidable relative to said sheath
for insertion into the body and said sheath being retractable to
permit such relative sliding of said conduit.
Description
BRIEF DESCRIPTION OF THE INVENTION
This invention relates to a catheter having special construction
features providing for protection of the patient against infection.
More particularly, this invention relates to a catheter of the
urinary type, which is used in large numbers by practitioners of
rehabilitation medicine, particularly in the care of patients who
have suffered spinal injury or strokes or are otherwise unable to
control muscular functions.
In some instances a catheter of the intermittent type is
prescribed, in which situation the catheter may be subjected to a
single use and then discarded. In other situations, the catheter is
allowed to remain within the patient's body for several days or
more, with substantially continuous drainage of body fluid into a
collector. This invention relates to catheters of a highly useful
form, as compared to catheters of the prior art.
DISCUSSION OF THE PRIOR ART
One of the most serious problems in the use of indwelling
catheters, particularly indwelling urinary catheters, is the
problem of infection. When a urinary catheter is allowed to remain
in the patient`s bladder for a period as long as 4 days or more,
substantially every patient contracts a bladder infection,
particularly when the patient is situated in a hospital
environment.
Although various proposals have been made in the past to provide
protection for such catheters, and various bacteriostats and
bactericides have been applied to the surfaces of urinary catheters
in order to prevent infection, none of these in my experience have
been completely effective and the danger of infection is always
present, particularly in the case of indwelling catheters.
Although a system called a "closed drainage system" is sometimes
used, and has lengthened the time before the patient becomes
infected, it does not address itself to the theoretical and actual
modes of urinary tract infections as a result of catheter
utilization.
Contrary to current thought, it has now been discovered that
contamination of a catheter which is used continuously, or
intermittently as well, is a source of morbidity and a risk to the
patient.
OBJECTS OF THE INVENTION
It is accordingly an object of this invention to provide a catheter
which may readily be used by the attending physician or even by the
patient himself or herself, without subjecting the patient to any
substantial risk of infection. Another object of this invention is
to provide a catheter wherein the surfaces of the catheter tube
that is inserted into the patient's body are completely protected
from bacterial invasion, not only during the period of insertion
but also during the period of actual use.
Other objects and advantages of this invention, including the
simplicity of the same and the ease of its operation, will further
become apparent hereinafter and in the drawings, of which:
FIG. 1 is a view in perspective of a catheter comprising one form
of this invention, particularly adapted for intermittent use;
FIG. 2 is a longitudinal sectional view of the catheter of FIG.
1;
FIG. 3 is an enlarged view of the end portion of the catheter of
FIG. 2, showing the manner of its insertion into the patient's
body;
FIG. 4 is a longitudinal view, partially in section, showing a
catheter of the indwelling type, in accordance with this
invention;
FIG. 5 is a view of the end portion of the catheter of FIG. 4,
showing the manner of its insertion into and connection to the
patient's body, and;
FIG. 6 is a view in longitudinal elevation, showing a still further
form of catheter, which is particularly adapted for use as an
intermittent catheter.
DETAILED DESCRIPTION OF THE INVENTION
In the description that follows, specific terms will be used in
describing specific forms of the catheter, as shown in the
drawings. The use of such specific terms is not intended to limit
the scope of this invention, which is defined in the appended
claims.
Turning now to FIG. 1 of the drawing, the number 10 designates a
conduit which has the shape of an elongated tube, usually made of
rubber or plastic, which is intended to be inserted into a passage
in the patient's body, such as insertion into the urethra or
trachea, for example. The conduit 10 has an insertion end 11 and a
distal end 12 through which the body fluid is discharged.
A protective tube 13 extends beyond the insertion end 11 of the
conduit 10, but terminates at an end portion 14 along the length of
the conduit 10. Another protective tube 15 is sealed to the conduit
10 at a point near its distal end 12, and extends in telescoping
relationship within the end portion 14 of the protective tube 13 to
form an extendible and retractable protective sheath over the
conduit 10. Thus, even before the catheter is inserted into the
patient's body, a telescopic overlap occurs between the tubes 13
and 15 in the area 16 which appears in FIGS. 1 and 2 of the
drawings.
Further referring to FIGS. 1 and 2, a light-weight flexible
material, shown as having a collapsible accordion-pleat
configuration, comprises a supplemental extendible and retractable
protective sheath 20 which is secured at one end to the tube 13,
which bridges across the telescopic portion 16, and is secured to
the other tube 15 at the other end of the supplemental sheath 20.
Although the supplemental sheet 20 is shown with accordion-pleats
21, it may have any form at all, so long as it is longitudinally
collapsible in a manner to allow the tubes 15, 13 to telescope.
As shown in FIG. 2, the insertion end 11 of the conduit 10 is
located within a dilator portion 22 of the tube 13, which extends
beyond the end of the insertion end 11 of conduit 10. As shown in
FIG. 1, a sealing cap 23 is provided to cover, seal and lubricate
the dilator 22.
In the operation of the apparatus appearing in FIGS. 1 to 3, the
physician (or even the patient himself) removes the sealing cap 23
and inserts the dilator 22 into the patient's body, such as the
meatus. Holding the tube 13 on one hand and the tube 15 in the
other hand, he slides the tube 15 within the tube 13. Preferably,
one or both of the tubes 13, 15 are quite rigid so that they may be
telescoped (even by a patient whose neuromuscular control or
skeletal alignment is poor) without substantially bending or
kinking the conduit 10. Since the tube 15 is connected to the
conduit 10, the entire conduit 10 slides longitudinally through the
tube 13, through the meatal dilator 22 and into the urethra and
ultimately into the bladder, for example. Urinary fluid thus
released from the bladder flows out through the distal end 12 of
the catheter.
Since the catheter of FIGS. 1 to 3 is intended primarily for
intermittent use, the usual practice, after all of the fluid has
been drained, is to simply withdraw the tube 15 telescopically
rearwardly through the tube 13 until the insertion end 11 of the
catheter conduit 10 has been withdrawn completely from the
patient's body. The catheter may be discarded or cleaned,
re-sterilized and re-used.
FIGS. 4 and 5 show a modified form of the apparatus, intended for
indwelling use. The number 30 designates the conduit having an
insertion end 31 for insertion into the patient's body. The distal
end 32 of the conduit 30 is formed integrally with a collecting bag
33 and is sealed thereto. Extending all the way from the bag to the
insertion end 31 is an extendible and retractable protective sheath
34, which again has been shown as having accordion-pleats. 35. The
protective sheath 34 is sealed to a plug 36 which carries a
rolled-up, flexible tube or sheath of rubber or the like 37
sealingly secured to its end.
FIG. 5 shows the manner of insertion of the catheter into the
patient's body, with the sheath 37 unrolled and forming an anchor
and a seal to the patient's body, while the conduit 30 is inserted
into the urethra or other body passage, sealed completely from
bacterial invasion from outside by the plug 36 and by the
protective sheath 34. In the act of insertion, the bag is moved
toward the patient's body, sliding the entire conduit 30 in the
same direction while the collapsing of the protective sheath 34
permits such movement without interfering with the integrity of the
protective seal.
Since the catheter of FIGS. 4 and 5 is intended for indwelling use,
it is often provided with a balloon, not shown, which is of the
usual type and which is well known per se, and which is inflated in
order to form an anchoring means within the bladder, once the
catheter has been inserted into the bladder.
In indwelling use, it will be appreciated that fluids are
substantially continuously being drained from the body, and that
the bag 33 is being filled on a continuous basis. Accordingly, a
valve 40 is provided for the occassional removal of collected
liquids from the bag. The number 41 designates a check valve
located near the insertion end 31 of the conduit 30. Such check
valve may be of a conventional form, but it is arranged in such a
manner as to prevent the refluxing of liquid that has already been
drained, back into the patient's body. A similar valve 42, with its
check valve feature similarly arranged, is located within the
conduit 30, near the distal end 32.
FIG. 6 of the drawings shows a modified form in accordance with
this invention, wherein the conduit 50 is not provided with any
telescoping tube such as those disclosed in FIGS. 1 and 2, but is
instead provided with an extendible and retractable protective
sheath 51 running substantially the entire length of the conduit
50. In this case, the protective sheath extends beyond the
insertion end 52 of the conduit 50, and is sealed upon itself,
using a seal such as that identified by the number 53. In the use
of the catheter of FIG. 6, the physician or the patient merely
grasps the protective sheath 52 near its distal end and slides the
conduit 50 through the seal 53, upon inserting it into the
patient's body.
Accordingly, it will be appreciated that the catheter in accordance
with this invention has solved the problem that stands out above
all the rest in patients using urinary catheters --the problem of
infection. Such infection is usually the result of contamination of
the urinary catheter with pathogenic micro-organisms.
Usually, such contamination occurs either by contamination of the
catheter by the individual inserting the catheter, by contamination
of the catheter by the patient receiving the catheter
(micro-organisms living in the distal part of the urethra), or by
contamination of the external wall of a catheter which is
indwelling. In the latter case, the most common source of infection
is the patient's own perineum followed by the bed clothes, and by
the attending staff which manipulates the catheter. Infection may
also occur from infected urine which has been extruded into a
urinary collection device and remains attached to a catheter.
In accordance with this invention, infection is substantially
precluded notwithstanding the potential sources of contamination
referred to above.
In the past, closed systems have consisted of indwelling catheters
having a tubular extension that is adjoined to the catheter itself.
Studies have shown that bacteria can migrate from the bag up the
wall of the catheter to reach the bladder. Such migration is
effectively prevented in accordance with this invention.
A further point which is relevant to this invention is the fact
that bacteria capable of causing disease live in the distal
urethra. These bacteria are often pushed into the bladder with the
introduction of the catheter. The catheter equipped with the meatal
dilator described in this specification markedly reduces this
occurrence since the meatal dilator contacts and covers the area
involved and insulates it from the catheter tube which is
introduced into the bladder.
It has also been demonstrated that, in devices of the prior art,
bacteria can migrate up the external wall of the catheter reaching
the bladder by way of the urethra. Further, if oftens occurs that a
urinary collecting device is displaced by someone on the hospital
staff to a level higher than the bladder itself, with reflux
occurring into the bladder from the collecting device and the
collecting tube. This is the result of lifting the collecting
device either by the patient himself, or by the hospital staff,
above the level of the bladder.
Although one-way valves have been suggested in the prior art with
respect to the collecting device, to prevent reflux from the bag
when the bag is lifted above the level of the bladder, it is now
been discovered that it is also important to provide for prevention
of reverse flow from the catheter tube itself. Accordingly, in
accordance with this invention, a check valve has been provided
adjacent to the insertion end of the catheter, thus preventing the
fluid to drain back from the catheter into the patient's body.
The prior art shows the concept of placing flutter valves on the
collecting device to prevent reflux of already infected urine. This
ignores the fact that has been developed, that the major source of
reflux is from the catheter itself, and the placement of valves in
the catheter as well as in the collecting tube joining the catheter
to the collecting device is important. It should preferably include
a drop-well at the termination of the catheter conduit.
Although this invention has been described in connection with a
urinary catheter, it will be appreciated that the catheter may be
used for a variety of other purposes. Further, although various
anchoring devices may be used for anchoring the catheter to the
penis, equivalent devices may be applied such as a vaginal dilator,
in the female.
Further, the catheter according to this invention has special
advantage in catheterizing a female. The role of catheterizing a
female is usually delegated to a female, i.e. nurse, orderly, etc.,
and quite commonly one may observe the catheter being inadvertently
or mistakenly placed in the vagina only to be withdrawn and
replaced in the urethra and fed into the bladder with resulting
danger of initiating bladder infection. Heretofore, no catheter
manufacturer has provided a vaginal occluder which denies access to
the vagina by the catheter, thereby insuring initial placement in
the urethra.
It will be appreciated that various alternate forms of collecting
devices may be used for the fluid, and that antiseptic material may
be contained within the collecting bag. Time-release capsules may
be used, so that antiseptic or bactericidal or bacteriostatic
materials can be released at various points in time.
In using catheters according to this invention, many patients are
enabled to employ self-catheterization which, in rehabilitation
medicine, is frequently the most desirable.
Self-catheterization is the treatment of choice for the neurogenic
bladder secondary to spinal cord or brain malfunction. Many
patients, especially quadraplegic patients with a functional cord
level at the sixth cervical spinal cord level (C-6, a common spinal
cord functional level after trauma) have been denied this treatment
of choice by the catheters of the prior art, since they do not
account for the inability of the patient to use fine hand movement.
Accordingly, it is an object of this invention to provide a
catheter offering this type of patient the best opportunity for
self-catherization. This often prevents the necessity for major
abdominal and genito-urinary surgery, which is always
life-threatening and is usually associated with substantial
morbidity and increased hospital stay. This morbidity is also
operative in preventing optimum physical, mental and social
restoration to the patient. The catheter which is the object of
this invention is, accordingly, ideally adapted to be used by
patients with neurological disorders involving the bladder and also
the upper extremities.
Although the telescoping tubes in the forms of the invention shown
in FIGS. 1, 2 and 6 are tight fitting, and are capable of
substantially completely impeding the migration of bateria along
the catheter tube 10, it is sometimes desirable to apply a
bactericidal ointment or jelly to the surfaces of these tubes
before they are enclosed by the supplemental protective sheet 21,
51. Other variations in the actual use of the catheter will further
become apparent to skilled physicians.
It will be appreciated that catheters in accordance with this
invention are useful for other uses than urinary catheters. For
example, they can be used for tracheal aspiration as in the case,
for example, of a patient who has had a tracheotomy where his
respirations are embarrased by excess secretions. In such a
situation the patient has difficulty coughing up, because of the
open tracheotomy tube, and therefore excess fluids need to be
suctioned out. Catheters in accordance with this invention are
ideally suited for that purpose, and their capability of preventing
bacterial infection is an important factor in such use.
Although this invention has been described with reference to
specific forms thereof, it will be appreciated that many variations
may be made without departing from the spirit and scope of this
invention. For example, certain parts may be reversed and, as has
been observed in connection with FIGS. 2 and 6, certain parts may
be omitted. Further, equivalent elements may be substituted for
those specifically shown and described, all within the spirit and
scope of this invention and defined in the appended claims.
* * * * *