U.S. patent number 3,911,927 [Application Number 05/461,568] was granted by the patent office on 1975-10-14 for eversible catheter.
This patent grant is currently assigned to Princeton Biomedix, Inc.. Invention is credited to Joseph S. Farrell, Eric Flam, Ernest J. Rich.
United States Patent |
3,911,927 |
Rich , et al. |
October 14, 1975 |
Eversible catheter
Abstract
An instrument is provided for everting a flexible tubing into a
body passage. The instrument comprises a rigid hollow casing having
a flexible tubing located therein in such a manner that the hollow
casing may be pressurized, the tubing everted out of the hollow
casing and into the body passage. Thereafter, the hollow casing may
be detached leaving a fully everted flexible tubing in the body
passage.
Inventors: |
Rich; Ernest J. (Mercer,
NJ), Farrell; Joseph S. (Middlesex, NJ), Flam; Eric
(Middlesex, NJ) |
Assignee: |
Princeton Biomedix, Inc.
(Princeton, NJ)
|
Family
ID: |
23833106 |
Appl.
No.: |
05/461,568 |
Filed: |
April 17, 1974 |
Current U.S.
Class: |
604/271; 604/159;
604/523; 604/104; 604/917 |
Current CPC
Class: |
A61M
25/0122 (20130101); A61M 25/0119 (20130101); A61M
25/1006 (20130101) |
Current International
Class: |
A61M
25/10 (20060101); A61M 25/01 (20060101); A61M
025/00 () |
Field of
Search: |
;128/348,349R,349B,349BV,35R,351,214.4,262,2R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Berman; Steven P.
Claims
What is claimed is:
1. An instrument for everting a flexible tube into a body passage
comprising:
a. a hollow casing having at least one opening extending through
the wall thereof;
b. a connector removably secured to said casing in fluid-tight
communication with said opening, said connector having a bore
extending therethrough in fluid communication with the interior of
said casing;
c. a flexible tube positioned substantially entirely within said
casing and having one end sealed to the periphery of said bore and
having means sealing the other end of said tube;
d. pressure means for increasing the pressure in the interior of
said casing, said increased pressure being effective to cause said
tube to evert through said bore to form a doublewalled tube;
and
e. a fitting near the said other end of said tube adapted to coact
with said connector after said tube has been substantially
completely everted from said casing to form a doublewalled tube so
that said connector and said everted double-walled tube may be
removed from said casing without substantially decreasing the
pressure within said everted tube.
2. The instrument of claim 1 wherein the end of the connector
opposite the casing is in fluid-tight communication with a tip,
said tip having an axial bore therethrough and being adapted to
enter a body passage.
3. The instrument of claim 2 wherein the tip at the end opposite
the end in fluid-tight communication with the connector has
flexible extensions which expand radially outward to permit passage
of the everting flexible tube.
4. The instrument of claim 1 wherein the flexible tube has one end
in which the wall thickness is less than the other end.
5. The instrument of claim 1 wherein the flexible tube has an
eversible, thin-walled balloon portion positioned intermediate the
thinner and thicker portions.
6. The instrument of claim 1 wherein one end portion of the
flexible tube has a wall thickness of from about 0.001 inch to
about 0.024 inch and the other end portion has a wall thickness of
from about 0.010 inch to about 0.035 inch.
7. The instrument of claim 5 wherein one end portion of the
flexible tubing has a wall thickness of from about 0.001 inch to
about 0.024 inch, the balloon portion has a wall thickness of from
about 0.00075 inch to about 0.024 inch and the other end portion
has a wall thickness of from about 0.010 inch to about 0.035
inch.
8. An instrument for everting a flexible tube into a body passage
comprising:
a. a hollow casing having at least one opening extending through
the wall thereof;
b. a connector removably secured to said casing in fluid-tight
communication with said opening, said connector having a bore
extending therethrough in fluid communication with the interior of
said casing;
c. a flexible tube positioned substantially entirely within said
casing and having one end sealed to the periphery of said bore and
having means sealing the other end of said tube;
d. pressure means for increasing the pressure in the interior of
said casing to cause said tube to evert through said bore, said
pressure means comprising an elongated, rigid shaft extending
through a second opening in said casing and having a distal and
proximal end and further having first and second sealing means
attached thereto, said first sealing means being permanently
positioned on the distal end of said shaft, said second sealing
means being positioned proximally of said first sealing means and
slidably attached to said shaft, said sealing means each having
attached thereto sealing rings which frictionally engage the
interior surface of said hollow casing to prevent fluid within said
casing from escaping through said second opening, the distal end of
said shaft having an outer diameter smaller than the diameter of
said second opening; and
e. a fitting near the said other end of said tube adapted to coact
with said connector after said tube has been substantially
completely everted from said casing to form a double-walled tube so
that said connector and said tube may be removed from said casing
without substantially decreasing the pressure within said everted
tube.
9. A retention catheter comprising outer and inner elongated tubes
having proximal and distal ends and having an annular space
therebetween; a retention balloon connecting the proximal ends of
said tubes and sealing the proximal end of said annular space, said
balloon having a toroidal shape with a central opening
therethrough; an inflation fluid filling said annular space and
said balloon; a connector secured to the distal end of said outer
tube and having female seating means therein; a fitting secured
near the distal end of said inner tube and having male seating
means in contact with said female seating means and maintaining
said male and female means together so as to seal the distal end of
said annular space, said fitting having an aperture therethrough
and removable means closing said aperture; and a lumen in said
inner tube extending entirely through said catheter and
communicating said aperture with the central opening in said
balloon.
Description
This invention relates generally to medical instruments and more
specifically to those instruments which are adapted to introduce
medicaments, liquids, medical devices, and the like into various
body cavities. The instruments of this invention may also be
advantageously used to drain accumulated liquids from body
cavities.
More specifically, this invention relates to urinary catheters and
to methods and devices for placing said catheters within the
urethra and bladder of a patient to be treated.
Presently, urinary catheters are used to drain the bladder of
accumulated urine, to introduce medication, to lavage, to correct
physiological defects and to ascertain urinary output.
Generally speaking, there are available two types of urinary
catheters. The first type referred to as a simple urinary catheter,
commonly comprises a rubber or plastic tubing of sufficient length
to extend through the urethra and into the patient's bladder. Such
catheters, after being suitably lubricated, are slid up the
urethra, past the bladder sphincter and into the bladder itself.
Drainage, lavaging or instillation of fluids can then be carried
out.
The second type of urinary catheter is an indwelling or retention
catheter which may comprise a rigid tube assembly having two or
more independent channels. One of the independent channels is used
for drainage or fluid instillation, while another of the
independent channels is connected to an inflatable balloon located
near the tip of the catheter which enters the bladder. The
retention catheter is inserted, in the same fashion as the simple
catheter, until its balloon section passes the bladder sphincter.
Once the catheter is properly positioned, the balloon is inflated
with a suitable fluid such as water or saline solution. The
inflated balloon then functions as an anchor which retains the
catheter within the bladder. This type of catheter is employed when
drainage or treatment of a longer duration is anticipated.
It is necessary that the above described catheters be relatively
stiff and nonflexible in order to preclude their bending or
collapsing while being slid through the urethra, and to prevent
collapse thereof under the stress applied by the bladder sphincter.
At the same time, these catheters must also retain a certain degree
of flexibility in order to conform to the contours of the body
passage with which they come in contact during insertion and use.
In order to facilitate insertion, the stiffness of these prior art
catheters can be increased, for example, by holding the inside
diameter of the catheter constant and increasing the outside
diameter; however, the increased size of the catheter results in
increased pain and discomfort, and even tissue trauma, during the
insertion procedure. In addition, the increased stiffness, while
facilitating insertion and helping to prevent the bending and/or
collapse mentioned above, reduces the ability of the catheter to
readily conform to the contours of various body passages. Stiffness
may also be achieved by holding the outside diameter of the
catheter constant and increasing the wall thickness; this method,
however, is undesirable, since it reduces the size of the catheter
lumen which, in turn, reduces the overall utility of the catheter
when it is used for drainage or instillation purposes.
The degree of stiffness required for effective insertion of the
prior art catheters is such that, once the catheter has been
positioned as desired, there are situations when only portions of
the outer surface thereof contact the wall of the body passage. In
such situations, body or other fluids may pass between the wall of
the passage and the outer surface of the catheter.
Insertion and use of the above-described catheters has long been
recognized as contributing to infections of the urinary tract. In
spite of elaborate precautions to cleanse the entrance to the
urethra, it is generally acknowledged that catheters of the type
described have a tendency to carry infectious organisms into the
bladder. The insertion operation causes pressure and friction along
the walls of the urethra and, in some instances, may result in
mechanical stretching of the urethra itself. This leads to tissue
trauma with its attendant pain and increased susceptibility to
infection.
An object of the present invention, therefore, is to provide a
catheter which can be disposed as desired in a body passage, such
as the urethra, with little or no sliding frictional contact
between the walls of the passage and the outer surface of the
catheter.
It is another object of the present invention to provide a catheter
which will more readily conform to the general contours of the
particular passage in which it is disposed.
It is a further object of the invention to provide a catheter which
has novel means for keeping the catheter inflated while retained in
the body cavity.
Still another object of this invention is to provide a delivery
system for placing a catheter in a desired body passage.
Yet another object of the invention is to provide a catheter which
has means for closing or opening the drainage lumen while the
catheter remains inflated in the body cavity.
These and other objects and advantages will become apparent from
the following description.
For purposes of the present invention, the term "distal" shall
refer to that end or portion of a particular article or device
which, during insertion or use, is relatively distant from the
center of a patient's body. The term "proximal" shall refer to that
portion of a particular article or device which, during insertion
or use, is relatively closer to the center of the patient's
body.
The catheters of this invention operate on the principle of the
toposcope and hence may be sometimes referred to herein as
toposcopic catheters. A toposcope is a tube, one end of which has
been turned back upon itself and which can be made to "develop" or
"grow" in a forward direction to penetrate a space, for example, a
body passage, without exerting any sliding friction on the walls of
the passage. The toposcope grows in a forward direction by being
"everted", that is, by being turned inside out upon itself.
According to the present invention, there is provided a device for
forming a catheter having a tubular conduit disposed within the
lumen of a tubular sheath, said conduit being attached to the
sheath in a manner to form an annulus for retaining a fluid under
pressure. The device comprises a length of tubing, a first end
portion of which is eversible and defines a sheath and a second end
portion of which defines a conduit; sealing means at the conduit
end of said tubing for sealing the lumen of said conduit; and
annulus sealing means at the conduit end of said tubing to seal the
annulus formed between the outer wall of the conduit and inner wall
of the sheath after the tubing has been everted.
According to a further embodiment of the present invention, there
is provided a hollow, generally elongated enclosure or case for
containing a catheter and a fluid. The case is adapted to receive
means for applying pressure to a driving fluid contained therein.
The means for applying pressure may include, for example, an
ordinary medical syringe or similar pressure providing means. A
portion of the case defines an opening, hereinafter referred to as
an eversion aperture, through which a catheter or a portion thereof
may be everted. One end of the catheter tubing is attached to an
adaptor attached to the eversion aperture in such a way that the
driving fluid is sealably contained in the enclosure.
FIG. 1 is a perspective, partial, cross-sectional view of a
catheter comprising an embodiment of this invention.
FIG. 2 is a perspective view of a device for forming the catheter
shown in FIG. 1.
FIG. 3 is a side view of partial cross-section of a unit for
simultaneously forming and placing within a body cavity, the
catheter shown in FIG. 1.
FIG. 4 is a detailed, exploded, perspective view in partial
cross-section of the annulus sealing means shown in FIG. 1.
FIG. 5 is a side view in partial cross-section of the unit shown in
FIG. 3 subsequent to the eversion of the sheath and balloon.
FIG. 6 is a side view in partial cross-section of the unit shown in
FIG. 3, subsequent to the separation of the fully everted
catheter.
FIG. 7 is an exploded, perspective view of a system for forming and
delivering the catheter shown in FIG. 1.
FIG. 8 is a detailed, perspective, partial cross-sectional view of
an annulus sealing means.
FIG. 9 is a side, partial cross-sectional view of the assembled
system of FIG. 7.
FIG. 10 is an enlarged cross-sectional view of a portion of a
connector and annulus sealing means.
FIG. 10 (a) is an enlarged, cross-sectional view of a portion of a
connector and annulus sealing means in a different position than
FIG. 10.
FIG. 11 is a perspective, partially, cross-sectional view of a
catheter comprising an embodiment of this invention.
FIG. 12 is a cross-sectional view of an assembled delivery
system.
FIG. 13 is a cross-sectional view of a fully everted catheter prior
to seating an annulus sealing means.
FIG. 14 is a partial cross-sectional view of FIG. 13 with the
annulus sealing means seated.
Referring now to FIG. 1, there is illustrated a catheter 10 having
a tubular conduit 14 disposed within the lumen of a tubular sheath
12 to form an annulus 18 therebetween for retaining a fluid under
pressure. The catheter includes a retention balloon 16 at its
distal portion which is maintained in the inflated position by a
fluid contained within the annulus 18 and an annulus sealing means
20. The annulus sealing means used in the specific embodiment of
FIG. 1 is illustrated in greater detail in FIG. 4. Annulus sealing
means 20 has an axial bore 21 therethrough and further comprises a
projection 22 at its proximal end, a flange 24, and a projection 26
at its distal end. Projection 22 is generally adapted to sealably
engage conduit 14. Annulus sealing means 20 also has a closure
means, shown in the form of a removable plug 28 which may
alternatively be removed from, or placed in, the opening of bore 21
to allow or preclude the flow of fluid from the lumen of conduit
14.
Referring now to FIG. 2, there is shown a device which can be
formed into the catheter shown in FIG. 1. Device 30 comprises a
length of flexible tubing 32 having a first end portion which is
eversible and defines sheath 12 and a second end portion which
defines conduit 14. As shown in FIG. 2, between conduit 14 and
sheath 12 is positioned a thin, collapsible membrane or
balloon-like portion 16 which is an inflatable intermediate portion
of the length of tubing 32. The end portion of conduit 14 may be
attached and sealed to projection 22 of annulus sealing means 20.
Device 30 may be used to form the catheter 10 as shown in FIG. 1 by
everting, i.e., turning inside out upon itself, sheath 12 and
balloon portion 16 by means of fluid pressure so that conduit 14 is
disposed within the subsequently everted sheath and balloon, and
forming annulus 18 between the sheath and conduit.
Device 30 may be prepared from a single piece of flexible tubing
whereby a continuous, unitary construction is obtained having
sheath 12, conduit 14, and balloon 16. The material of construction
used for sheath 12 should provide a construction having sufficient
strength to withstand moderate pressure without "bubbling" or
bursting, the balloon section 16 being sufficiently flexible and
"collapsible" so that it may pass through the lumen of sheath 12,
in addition to being sufficiently strong to withstand moderate
pressure without breaking or bursting, and a conduit 14 flexible,
yet sufficiently rigid to preclude collapse under pressures exerted
on it such as by fluid in annulus 18 during the eversion process.
Therefore, conduit 14 is generally less flexible and generally has
a thicker wall than sheath 12. In all cases, the proper balance of
strength and flexibility can be obtained by selecting appropriate
materials for construction including materials having desirable
wall thicknesses. Suitable materials from which device 30 may be
constructed include natural and synthetic rubber, silicone based
rubbers, polyurethanes, segmented polyurethanes, polyolefins such
as polyethylene and polypropylene, copolymers of ethylene or
propylene and vinyl acetate, polyvinyl chloride or copolymers of
vinyl chloride and the like. Materials of construction including
reinforcing materials such as synthetic fibers or threads derived
from cotton, silk, nylon, polyester, etc. may also be employed.
It will be understood that tubing 32 may comprise more than one
material of construction, e.g., sheath 12 and conduit 14 could be
made from different materials depending, for example, in the
ultimate size and flexibility desired in each. However, it is
preferred that device 30 be made of a single, continuous
construction. It has been found that certain ranges of inner and
outer diameters for the sheath and conduit may be used for device
30. Furthermore, it has also been found that certain ranges for the
wall thickness and volume may be used for balloon 16. Such ranges,
broad and preferred, for the sheath, conduit and balloon are set
forth below in the Table.
TABLE ______________________________________ Broad Range Preferred
Range from about to about from about to about
______________________________________ Sheath Inner Diameter 1.96mm
13.20mm 3.90mm 7.40mm Outer Diameter 2.00mm 15.00mm 4.00mm 8.00mm
Balloon Wall Thickness 0.02mm 0.90mm 0.03mm 0.10mm Volume 3.00cc
100.00 cc 5.00cc 10.00cc Conduit Inner Diameter 0.80mm 11.10mm
3.30mm 4.80mm Outer Diameter 1.30mm 12.90mm 3.40mm 7.10mm
______________________________________
Tubing 32 may be made as a single unit, for example, by coating a
suitably-designed collapsible mandrel with a solution of the
desired material of construction and subsequently drying, blow
molding and the like. Alternatively, the sheath, conduit, and
balloon may be made separately, e.g., by extrusion, blow molding,
casting, or other known techniques, and then joined together to
form tubing 32. Joining of the parts may be accomplished by such
well-known means as dielectric heating, solvent welding, radio
frequency heating, electromagnetic heating, and the like. It is to
be understood that the particular construction will depend on the
materials used.
It will be understood that balloon 16 is used only when it is
desired to form a retention device or catheter as shown in FIG. 1.
If it is desired to form what is called a simple catheter, balloon
16 may be omitted and the sheath and conduit would form the
flexible tubing. It is also intended that the sheath and conduit,
including the balloon if needed, could be formed from a single
piece of tubing to provide a continuous, "joint-free"
construction.
As previously described, device 30 provides a unique construction
which serves a variety of uses, e.g., as a urinary catheter. The
particular construction provides a one-piece tubing having three
distinct sections wherein each section is of a different wall
thickness. For example, the balloon has a thinner wall thickness
than the sheath and, in turn, the sheath has a thinner wall
thickness than that of the conduit. Such a construction permits the
device to be readily everted into the form of the device as shown
in FIG. 1 with the balloon 16 inflated at the proximal end and the
conduit 14 positioned within the lumen of the everted sheath
12.
FIG. 3 illustrates one embodiment of the present invention wherein
there is provided a unit for simultaneously forming and placing
within a body passage a catheter of the general type shown in FIG.
1. Delivery system 50 comprises a casing 52 and plunger means 70
for applying pressure to a driving fluid and for seating annulus
sealing means 20. Casing 52 comprises interior sections 53, 54, and
55 located, respectively, at its proximal intermediate, and distal
portions. The diameter of proximal interior section 53 is generally
larger than the diameter of distal interior section 55 which in
turn is generally larger than the diameter of intermediate interior
section 54. Section 53 joins section 54 at shoulder 51; similarly,
section 54 joins section 55 at shoulder 59. Proximal end 56 of
casing 52 defines an opening 57, into which is placed a connector
60. Connector 60, which is illustrated in the left hand portion of
FIG. 4, has a flange 61 at its distal end, a projection 63 at its
proximal end, with an axial bore 62 therethrough. Flange 61 has an
interiorly positioned circumferential groove 64 near its distal
end, and has a face 65 which has radially disposed indentations, or
fluid by-passes 66. As can be seen in FIG. 3, when connector 60 is
placed into opening 57, axial bore 62 is in fluid communication
with the interior of casing 51. It is necessary, in order to insure
proper operation of the delivery system, that a fluid tight seal be
formed between the outer surface of flange 61 of connector 60 and
the surface defining opening 57.
Device 30 is disposed within casing 52. As may be seen at the
extreme left hand portion of FIG. 3, end 12(a) of sheath 12 is
placed through axial bore 62 and, for example, turned back upon
itself, and joined in fluid-tight relationship to the outer surface
of projection 63. The fluid-tight seal between end 12(a) and the
outer surface of projection 63 may be obtained by various methods
such as by sealing end 12(a) to projection 63 with suitable
adhesive means, e.g., an epoxy adhesive. When device 30 is disposed
within casing 52 and end 12(a) of sheath 12 is secured to
projection 63 in the manner described, it will be observed that a
fluid contained within casing 52 can neither escape through opening
57 nor enter the lumen of sheath 12. Neither can fluid enter the
lumen of the conduit since the lumen is closed by plug 28 of
annulus sealing means 20.
Plunger means 70, in the embodiment illustrated in FIG. 3, can be a
modified version of a plunger commonly found in, for example, an
ordinary medical syringe. Means 70, in its assembly, is adapted to
cooperate with the interior surface of casing 52 to provide a seal
which prevents escape of fluid from the distal end of casing 52,
and is also adapted for applying pressure to a fluid contained in
the casing and for seating annulus sealing means 20. Means 70
comprises a rigid shaft 72, circumferential seal receiving means 74
and 78, and handle 85. Shaft 72 has a reduced diameter portion
72(a), at its proximal end, and a larger diameter portion 72(b) at
its distal end. Seal receiving means 74 comprises a rigid portion
75 which has a sealing ring 76. Seal receiving means 78 comprises a
rigid portion 79 which has a sealing ring 80. Seal receiving means
78, as seen in FIG. 3, is located on portion 72(a) distally of seal
receiving means 74 and is not permanently fastened to portion
72(a), but is free to slide axially thereon. There is preferably
sufficient frictional engagement between means 78 and portion 72(a)
to preclude the "free" sliding of means 78. The distance means 78
travels along portion 72(a) is generally restricted to the distance
between distal face 73 of means 74 and proximal face 77 of portion
72(b). The outside diameter of sealing rings 76 and 80 is slightly
larger than the diameter of interior section 54 and smaller than
the diameter of interior section 55, therefore, sealing rings 76
and 80 are slightly compressed in order to fit into interior
section 54. The proximal face of sealing ring 76 may be beveled for
convenience so that means 74 may be readily inserted into interior
section 54. On the other hand, the proximal face 81 of sealing ring
80 is not beveled. When means 70 is first inserted into the distal
end of casing 52, the beveled proximal face of sealing ring 76
comes into contact with shoulder 59. As additional pressure is
exerted on rigid shaft 72, sealing ring 76 is simultaneously
compressed and forced into interior section 54. Seal receiving
means 78 enters interior section 55 without difficulty but its
progress in the forward or proximal direction is temporarily
stopped as unbeveled distal face 81 of sealing ring 80 comes into
contact with shoulder 59. However, since means 78 is slidable on
portion 72(a), the latter part continues in the forward direction.
For example, as means 70 is further depressed in the forward
direction, a portion of face 82 of means 78 contacts proximal face
77 of portion 72(b) and, as additional forward pressure is exerted
on shaft 72, seal receiving means 78 together with sealing ring 80
are forced into section 54. Reduced diameter portion 72(a) has an
axial bore 84 extending distally of proximal face 83. The diameter
of bore 84 may be larger than the outside diameter of plug 28 (FIG.
4) and its length is preferably longer than the length of that
portion of plug 28 which projects distally of face 29 of annulus
sealing means 20. Bore 84 receives the projection of plug 28 as
face 83 contacts face 29 to seat the plug into groove 64 of
connector 60.
Casing 52, adaptor 60 and rigid shaft 72 may be made of suitable
materials, for example, glass, polymeric materials such as
polyolefins, e.g., polyethylene and polypropylene, polycarbonates,
polymethylmethacrylate, nylon, polyesters, polystyrene, copolymers
of ethylene/vinyl acetate and the like. Portion 75 and 79, which
must be rigid or semi-rigid, may also be made from any of the
above-mentioned materials. Any desired method may be used for
making the above-mentioned components; such methods as injection
molding, casting, extrusion, machining, and compression molding and
the like have been found to be particularly convenient. Sealing
rings 76 and 80 may be prepared from a variety of well-known
materials such as rubber, styrene-butadiene, polyvinyl chloride,
polyurethane and the like. Neoprene and ethylene-vinyl acetate have
been found to be particularly satisfactory materials. Again, any
convenient method such as compression molding, casting, and
injection molding may be used to make the sealing rings. Annulus
sealing means 20 may be made from rubber, polyurethane, polyvinyl
chloride, ethylene/vinyl acetate and the like. Plug 28 may be
prepared from, for example, polyurethane, polymethylmethacrylate,
nylon or polyvinyl chloride.
The assembly of the delivery system, and the placement of device 30
within a body passage will now be described in conjunction with
FIGS. 3 through 6. For purposes of illustration, it will be assumed
that device 30 is a catheter and is to be placed within a body
passage such as the urethra in order to facilitate the drainage of
fluids from the urinary bladder.
A typical delivery system, in accordance with the present
invention, may be assembled as follows: device 30 of FIG. 2 is
attached to annulus sealing means 20 of FIG. 4 by inserting
projection 22 of annulus sealing means 20 into the lumen of the end
of conduit 14 and forming a fluid-tight seal. The seal may be
established by frictional engagement of the inner wall of conduit
14 with the outer surface of projection 22; it is preferred,
however, to use an adhesive means, such as an epoxy adhesive, to
insure a positive and trouble-free seal. Sheath 12 is inserted into
bore 62 of connector 60 in a direction beginning at distal face 65
and toward projection 63. After being fed through bore 62, the end
of sheath 12 is turned back upon itself and over the outer surface
of projection 63 and sealed thereto. Means 70 is inserted into the
distal end of casing 52 as illustrated in FIG. 3 with distal face
73 of seal receiving means 74 in contact with the proximal face of
seal receiving means 78. When means 70 is thus positioned, the
outer circumferential surface of sealing ring 76 cooperates with a
portion of the wall of inner section 54 to form a fluid tight seal
which will prevent escape of fluid from the distal end of casing
52. Casing 52 may then be turned upright and a driving or everting
fluid placed into casing 52 through opening 57. The fluid may be a
gas such as air or a liquid, such as water, an aqueous soap
solution, a saline solution, mineral oil, or the like. Preferably,
the fluid is a liquid that permits smooth eversion of the catheter.
When casing 52 has been filled with the desired amount of fluid,
device 30 (FIG. 2) is then fed, annulus sealing means 20 first,
into the interior of casing 52 and connector 60 is placed into
opening 57 of casing 52. A flexible tip 100 as shown in FIG. 9 may
be placed over projection 63 of connector 60 and sealed thereto to
facilitate introduction of the catheter into the body cavity. The
connector and tip comprise an adaptor similar in function to
adaptor 135 as shown in FIG. 7. It is to be understood that
connector 60 and tip 100 may be incorporated into a single unit if
desired. The catheter may be simultaneously formed and placed in
its proper position within the body cavity as follows: tip 100 is
inserted into the opening of the urethra. If necessary, a suitable
lubricant may be used to aid insertion of the tip. Means 70 is
moved forwardly to exert pressure on the driving fluid contained in
casing 52. The pressure thus exerted is transmitted through the
fluid until it reaches the proximal portion of connector 60 where
the end of sheath 12 is in its "turned back" configuration. The
pressure being exerted on the driving fluid by the forward motion
of means 70 acts on sheath 12 and drives it from casing 52. Sheath
12 is gradually turned inside out as it is forwardly everted under
the influence of the driving fluid; this is illustrated by position
58 of sheath 12 at the extreme left hand portion of FIG. 3. As
device 30 is everted from casing 52, it simultaneously "grows,"
that is, it progresses forwardly through the urethra in the
direction of the urinary bladder. The inner wall 13 of sheath 12
(as illustrated in FIG. 2) is continually laid down, in a
substantially frictionless manner, against the inner wall of the
urethra and, at the same time, becomes the outermost wall of the
catheter in its everted configuration (FIG. 1). During the eversion
process, annular volume 18 is formed as defined generally by the
inner surface of the everted sheath and the outer surface of
conduit 14. It will be understood that balloon 16 and conduit 14
are being "pulled along" as sheath 12 is gradually everted.
Eventually, sheath 12 is completely everted or turned inside out
upon itself as viewed in FIG. 1. After sheath 12 has been everted,
further application of pressure on the driving fluid will evert
balloon 16. When the sheath and balloon have been everted, and the
conduit is disposed within the lumen of the sheath, the parts of
the delivery system have assumed the position as shown in FIG. 5.
The distal portion of sealing ring 76 is just ready to clear the
wall of inner section 54 at shoulder 51, and the driving fluid is
disposed in the annular volume 18 of the everted catheter and in
inner section 53. Sealing ring 80 cooperates with the surface of
inner section 54 to provide a fluid-tight seal at their common
surface of contact.
Distal face 82 of seal receiving means 78 is in contact with
proximal face 77 of portion 72(b) and sealing ring 80 is
cooperating with the inner surface of section 54 to provide a
fluid-tight seal. It will be understood that, as rigid shaft 72 is
first moved forward to exert pressure on the driving fluid, seal
receiving means 78, being slidably mounted on portion 72(a), is
temporarily held in the position shown in FIG. 3, since proximal
face 81 of sealing ring 80 is in contact with shoulder 59.
The forward motion of shaft 72 eventually brings proximal face 77
of portion 72(b) into contact with distal face 82 of seal receiving
means 78 whereupon, sealing ring 80 is forced passed shoulder 59
and into contact with the inner wall of section 54. Thereafter, the
distance between the distal face 73 of seal receiving means 74 and
proximal face 87 of means 78 generally remains constant, and means
74 and sealing ring 80 travel through section 54 as shaft 72 is
moved forward. Portion 72(a) or at least its proximal end portion
containing bore 84 is slightly smaller in diameter than that of
opening 57.
Referring back to FIG. 5, it will be seen that flange 24 of annulus
sealing means 20 is in contact with face 65 of connector 60. Bore
84 and plug 28 are in axial alignment. As shaft 72 is moved past
its position as shown in FIG. 5 and sealing ring 76 passes shoulder
51, driving fluid is free to flow rearwardly into section 54 and
toward means 78. The driving fluid cannot escape from the distal
portion of casing 52, since sealing ring 80 is in fluid-tight
contact with the inner wall of section 54. As shaft 72 continues to
move forward, flange 24 of means 20 is in contact with face 65 of
connector 60 and driving fluid will continue to enter bore 62
through the by-passes 66 (FIG. 4). The additional fluid entering
through the by-passes permits complete inflation of the balloon 16
(FIG. 1) to insure retention of the catheter in the urinary
bladder. It is to be understood that in uses where the balloon is
not necessary, the by-passes 66 may be omitted. As the projection
of plug 28 enters bore 84, proximal face 83 contacts distal face 29
of annulus sealing means 20. As shaft 72 progresses still further,
flange 24 of annulus sealing means 20 is seated into groove 64 of
connector 60 to seal annular volume 18 of the everted catheter and
to prevent fluid from entering or leaving said annuluar volume. The
proximal edge of flange 24 may be beveled to serve as a means to
guide means 20 into the opening of bore 62. Finally, as additional
pressure is exerted on face 29 by the forward movement of shaft 27,
connector 60 is ejected from opening 57. As illustrated in FIG. 6,
casing 52 and its associated parts have been separated from the
fully everted catheter. The latter has been placed within the body
passage so that the balloon portion thereof is located in the
urinary bladder (FIG. 13), the balloon then acting as a means for
keeping the everted catheter "anchored" in its proper position.
Sheath 12, with conduit 14 disposed therein, is in contact with the
walls of the urethra (FIG. 13). Connector 60 (including tip 100 if
used) with annulus sealing means 20 seated therein, is disposed
outside the entrance of the urethra. When plug 28 is removed from
annulus sealing means 20, the lumen of the conduit is opened to
form an uninterrupted passage for fluids, which passage extends
from the interior of the urinary bladder, through conduit 14, to
the outside of the body. One skilled in the art will recognize that
plug 28, if it comprises a suitable resealable material such as
rubber, or synthetic elastomer, could be pierced by the cannulated
needle of a medical syringe which could then be used to remove or
inject fluids as desired. It is to be understood that the connector
60 is adaptable for attachment to standard urinary drainage
collection systems.
Referring now to FIGS. 7 through 14, there is illustrated a second
embodiment of the present invention. Device 120, shown in the upper
portion of FIG. 7, can be used to form catheter 110 as shown in
FIG. 11. Referring to FIG. 11, catheter 110 has a tubular conduit
114 disposed within the lumen of a tubular sheath 112 to form an
annulus 118 therebetween for retaining a fluid under pressure.
Catheter 110 includes a retention balloon 116 at its proximal end
which is maintained in the inflated position shown in FIG. 11 by a
fluid contained within annulus 118. Such fluid is retained within
annulus 118 by the cooperation of a connector 130 with an annulus
sealing means 180.
Device 120 shown in FIG. 7 comprises a length of tubing 122 and
annulus sealing means 180. Tubing 122 has a first end portion which
is of an eversible and thin-walled construction and defines sheath
112 and a second end portion which has a thicker wall construction
than the first end portion and defines conduit 114. In the
illustration of FIG. 7, sheath 112 and conduit 114 have positioned
therebetween a thin-walled, collapsible, balloon-like portion 116
which is an inflatable intermediate portion of tubing 122. As seen
in FIG. 8, the end of conduit 114 is attached over and sealed to
projection 189 of annulus sealing means 180. The seal must be
fluid-tight and, although frictional engagement of the total
assembly of the respective parts may accomplish this end, it is
preferred that the parts be positively sealed with any suitable
adhesive means such as an epoxy adhesive or the like.
In FIG. 7, there is shown, in exploded perspective, a delivery
system which may be used to form and simultaneously place within a
body passage, a catheter 110 as shown in FIG. 11. The delivery
system 200 comprises tubing 122, annulus sealing means 180, adaptor
135 which comprises connector 130 and tip 100, casing 140, and
pressure providing means 160.
Casing 140 comprises a generally elongated, rigid member 141 having
a chamber 142 therein. Wall 143, which has a centrally located
opening 144 therethrough, is an integral part of member 141. Wall
143 divides chamber 142 into proximal section 142(a) and distal
section 142(b). The volume defined by sections 142(a) and 142(b)
may be varied by changing the position of the wall 143 within
chamber 142. Opening 144 in wall 143 provides a passage way joining
sections 142(a) and 142(b), and the latter is adapted to receive
pressure providing means 160 in fluid-tight arrangement. The
proximal end of member 141 is partially closed by wall 146 which
has a projection 152 of reduced diameter, the projection having a
plurality of flexible extensions 155. Projection 152 has a central
bore 153 therethrough which communicates with section 142(a) of
chamber 142. Projection 152 has secured thereto, on the outer
periphery of its broadest portion 156, a sealing ring 157. Adaptor
135 includes a connector 130 at its distal end and a tip 100 at its
proximal end. Connector 130 has an axial bore 131 therethrough and
includes sections 132, 133 and 134 each having respectively
successively smaller outside diameters. The proximal end of section
132 is joined to the distal end of section 133 by face 132';
similarly, the proximal end of section 133 is joined to the distal
end of section 132 by face 133'.
The proximal portion of section 134 of connector 130, as can be
seen in FIG. 7, serves as the sight of attachment for sheath 112.
Preferably, this attachment is accomplished by folding the end of
sheath 112 back on itself and over the outer periphery of section
134 and adhering them together with any suitable adhesive means,
for example, epoxy adhesive. The seal formed between the
folded-over portion of sheath 112 and the outer periphery of
section 134 must be fluid-tight in order to insure proper operation
of the catheter and the delivery system. Connector 130 also has a
groove 138 (FIG. 10) which is adapted to receive section 186 of
annulus sealing means 180 which in turn provides a fluid-tight seal
to retain fluid within the everted and inflated catheter.
The pressure providing means, one embodiment of which is
illustrated in FIG. 7, may be an ordinary medical syringe 160
comprising a movable plunger 166 which is disposed within casing
161. Proximal face 163 of casing 161 has a tubular tip 162 whose
axial bore 168 communicates with the interior of casing 161 and
which is adapted to cooperate with opening 144 of wall 143 to
provide a fluid-tight seal therebetween. This seal prevents the
escape of fluids from section 142(a) toward the distal end of
casing 140. Casing 161 has an outside diameter slightly less than
the inside diameter of chamber 142 and includes handle 164 on its
distal end to facilitate operation of the plunger. Plunger 166
comprises a rigid shaft 167 which has a handle 170 at its distal
end and which has a sealing means 169 at its proximal end which
includes sealing rings 165 which, when engaged against the inner
walls of casing 161, prevent the escape of fluid from the distal
end of casing 161.
In order to facilitate placement of the catheter within the body,
there is provided a tip 100. The tip as shown in FIGS. 7, 9 and 12
is a hollow, tapered, nozzle-like element through which the
catheter passes after exiting connector 130 and prior to its entry
into a body passage. As can be seen in FIG. 12, the distal end of
the tip is placed over the exposed outer surface of sheath 112
after it has been sealed to section 134 in the manner previously
described. The tip includes a longitudinal slit at its distal end
forming flexible projections 124, which projections expand to allow
the emerging catheter to pass through the tip (FIG. 13). The tip is
constructed of flexible materials and preferably, of a soft
flexible material, such as natural or synthetic rubber, silicone
rubber, ethylene/vinyl acetate copolymer, plasticized
polyvinylchloride, polyurethane and the like.
It is to be understood that connector 130 and tip 100 may be
combined into a single unit to form an adaptor 135 which will
receive sheath 112 in a manner such that the sheath may be everted
in accordance with the procedures previously described.
Referring now to FIG. 8, there is shown an annulus sealing means
180 comprising cylindrical sections 186, 187, 188 and 189. The
proximal end of section 186 is joined to the distal end of section
187 by face 186', the proximal end of section 187 is joined to the
distal end of section 188 by face 187', and the proximal end of
section 188 is joined to the distal end of section 189 by face
188'. Sections 186, 187, 188 and 189 have a bore 181 therethrough.
Section 186 has notched portion 185, also called fluid by-passes,
at the distal end thereof. Sealing means 180 is secured in
fluid-tight relationship to the end of conduit 114 by placing the
end of section 189 within the lumen of conduit 114. As a result,
the lumen of conduit 114 and bore 181 of annulus sealing means 180
are in fluid communication with each other. Prior to and during
placement of the catheter, it is preferable that bore 181 of
sealing means 180 be closed with suitable closure means which, in
the illustration of FIG. 8, may be a removable plug 190.
As in device 30 of FIG. 2, device 120 of FIG. 7 has three (d)
distinct sections, i.e., a sheath 112, a balloon 116, and a conduit
114. Because of its particular construction, each section may have
a different wall thickness where the balloon has the thinnest wall
thickness, the sheath wall is slightly heavier than that of the
balloon and the conduit wall is, in turn, heavier than that of the
sheath. This unique construction permits the practical eversion of
device 120 into, for example, a urinary retention catheter as
illustrated in FIG. 11.
FIG. 9, shown in partial cross-section, illustrates the delivery
system as assembled from the individual parts as shown in FIG. 7.
The system may be assembled by filling the pressure providing means
160, in this illustration a syringe, with the proper amount of
everting fluid. The amount should be sufficient to fully evert
sheath 112 and inflate balloon 116 upon depressing plunger 166.
Syringe 160 is then sealably inserted into opening 144 in wall 143
of casing 140. The connection should be such that a fluid-tight
seal is formed to prevent everting fluid from being forced back
into chamber 142(b) as plunger 166 is depressed. Chamber 142(a) may
then be filled with everting fluid prior to placing device 120
therein. Sheath 112 is attached through bore 131 in a manner such
that the end of the sheath can be turned back on itself, over
projection 134 and attached or sealed thereto. Device 120 with
annulus sealing means attached thereto is placed into chamber
142(a). Connector 130 is placed over projection 152 and sealing
ring 157 to form a fluid-tight seal therebetween. Tip 100 is placed
over sheath 112 and projection 134.
FIG. 10 illustrates a magnification of connector 130 and annulus
sealing means 180 and shows an intermediate position of means 180
between the positions as shown in FIGS. 13 and 14. There is shown a
cross-sectional view of connector 130, wherein the size of bore 131
is progressively smaller in sections 132, 133 and 134 respectively.
The size of bore 131 within section 132 is just slightly larger
than the outside diameter of portion 156 of projection 152 (FIG.
7). This allows projection 152 to be received within bore 131 of
section 132 and positioned so that the proximal ends of flexible
extensions 155 (FIG. 13) are just adjacent to a point where sloping
face 132" joins section 132. At the same time, this positioning
allows sealing ring 157 to engage the inner surface of section 132
to produce a fluid-tight seal therewith. Means 180 is also shown in
a position where face 186' abuts inner-wall bore 132" of means 130.
In such position, there is formed a narrow circumferential space
137 between the outer surface of section 187 and inner-wall bore
131". Although face 186' abuts wall bore 132", the fluid bypasses
185 in section 186 of means 180 (FIG. 8) will permit fluid to pass
into the catheter and through space 137. This construction provides
a means of fully inflating balloon 116 (FIG. 11) to the desired
size.
FIG. 10(a) illustrates an enlarged cross-sectional view of
connector 130 and means 180 as shown in FIG. 14. This figure shows
annulus sealing means 180 in its final sealed position within bore
131' with flange 186 seated in groove 138 of connector 130 to hold
means 180 in place. The outer surface 187' of section 187 is
frictionally engaged against the surface of inner-wall bore 131' to
form a fluid-tight seal which retains the fluid within annulus 118
of inflated catheter 110 (FIG. 11). The assembly of parts is better
understood when referring to FIG. 12 which illustrates many of the
assembly parts in cross-section.
FIG. 12 further illustrates the positioning of connector 130 over
projection 152 and the desired initial position of flexible
extensions 155. Such extensions should be positioned to take
advantage of the full internal bore of section 132, i.e., the
extensions should not extend into the tapered bore area of face
132". Such positioning is important, since the extensions can be
flexed to the maximum bore of section 132 and permit annulus
sealing means 180 to pass through as the eversion process is
completed. This is clearly illustrated in FIG. 13 wherein the
catheter has been everted, the balloon is inflated and in place
within a body passage and extensions 155 are separated or flexed to
permit passage of means 180.
FIG. 14 illustrates the seating of annulus sealing means 180 into
groove 138 of connector 130. At the time the catheter has been
fully everted and is in place within the body passage, face 186' of
means 180 abuts inner-wall bore 132". It is to be understood that
face 186' may be beveled in order that such bevel may act as guide
means to position means 180 for sealing into bore 131'. The
function of by-passes 185 to facilitate final inflation of the
catheter has been previously discussed as to FIG. 10. Extensions
155, having flexed to permit passage of means 180, return to their
original non-flexed position which aligns the extensions to abut
section 186 of means 180. To seat means 180, projection 152 is
advanced toward means 180, whereby extensions 155 contact section
186 and force means 180 into bore 131'. It should also be noted
that, as projection 152 is advanced, extensions 155 come into
contact with inner-wall bore 132". The surface of bore 132"
contacts extensions 155 and causes them to converge radially inward
thereby placing force against the center portion of section 186 to
eventually seat section 186 of means 180 into groove 138 of
connector 130. Once seated, means 180 provides a fluid-tight seal
and maintains the catheter in an inflated position. Projection 152
of casing 140 is detached from connector 130 leaving only the
connector and tip attached to the everted catheter 110. Plug 190
may be removed to drain the body cavity into a collection system
which may be subsequently attached to connector 130.
As an alternative, connector 130 may be constructed of materials to
render it sufficiently flexible such that section 132 may be
manually constricted to force means 180 or similar means into a
fluid-tight relationship within bore 131. Tip 100 and connector 130
may be constructed as a single unit adaptor and adapted to sealably
receive sheath 112 within its internal bore.
The present invention provides a unique delivery system and
eversible tubing which, in combination, may be applied in a variety
of uses, e.g., urinary catheters. A particular advantage of the
present invention is found in the attachment of the eversible
tubing or catheter to the adaptor instead of the casing. Such a
construction permits formation of the catheter into a body passage
and subsequently removing the casing. Since the pressure providing
means is also a part of or attached to the casing, it can also be
removed. This leaves only the adaptor attached to the catheter and
positioned outside the body orifice. The particular adaptor may be
attached to conventional drainage systems for collecting fluid
drained from the body cavity.
It is to be understood that the drawings present various
embodiments of the invention but are not intended to limit the
scope thereof.
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