U.S. patent number 3,918,446 [Application Number 05/466,734] was granted by the patent office on 1975-11-11 for securement device for intravenous catheter and its tubing.
This patent grant is currently assigned to E-Med Corporation. Invention is credited to Philip M. Buttaravoli.
United States Patent |
3,918,446 |
Buttaravoli |
November 11, 1975 |
Securement device for intravenous catheter and its tubing
Abstract
A device for securing to the skin and protecting an infusion
needle or catheter in the body portion of a patient and for holding
a portion of the excess tubing while providing a cushion between
the catheter-tubing assembly and the skin, consisting of a bottom
pad and an associated upper pad, both pads being formed of flexible
material. The bottom pad is provided with at least one slit
extending inwardly from one edge and terminating in an enlarged
perforation comprising a medicament well. A first portion of the
upper pad is affixed to the bottom pad and a second portion of the
upper pad constituting a flap may overlie the slit and well in the
bottom pad. Means are provided to removably affix the second
portion of the upper pad to the bottom pad and to affix the bottom
pad to the skin of a patient.
Inventors: |
Buttaravoli; Philip M.
(Annandale, VA) |
Assignee: |
E-Med Corporation (Cincinnati,
OH)
|
Family
ID: |
23852902 |
Appl.
No.: |
05/466,734 |
Filed: |
May 3, 1974 |
Current U.S.
Class: |
604/180;
128/DIG.26 |
Current CPC
Class: |
A61M
25/02 (20130101); Y10S 128/26 (20130101); A61M
2025/0273 (20130101); A61M 2025/0246 (20130101) |
Current International
Class: |
A61M
25/02 (20060101); A61M 005/00 (); A61M
025/02 () |
Field of
Search: |
;128/214R,133,DIG.26,348-351,221,215,132R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Melvilee, Strasser, Foster &
Hoffman
Claims
I claim:
1. A device securable to the skin of a patient for holding in place
and protecting an infusion needle or catheter in the puncture site
of a body portion of a patient and for holding a portion of the
excess tubing while providing a cushion between the catheter tubing
assembly and the skin, which comprises top and bottom pads, said
bottom pad being formed of flexible material having upper and lower
surfaces and having at least one slit extending from one edge
inwardly of said bottom pad to a termination point within the
confines of said bottom pad; means to affix the lower surface of
said bottom pad to the body portion of the patient; said upper pad
overlying said bottom pad and being formed of flexible material
having upper and lower surfaces; a portion of the lower surface of
said upper pad being affixed to a portion of the upper surface of
said bottom pad, said portions forming a line of juncture dividing
said bottom pad into first and second parts and said upper pad into
first and second flaps overlying said first and second bottom pad
parts, respectively, said one slit being located in one of said
bottom pad parts; and means to releasably affix substantially the
lower surface of said first and second flaps of said upper pad to
the upper surface of said first and second bottom pad parts,
respectively, whereby in use said slit cradles the infusion needle
or catheter and substantially surrounds the puncture site,
protecting it from bacterial infiltration, one of said flaps
overlying said slit and with said slit in said line of juncture
securing the infusion needle or catheter and the tubing behind it
over an extended length to secure against lateral and longitudinal
movement, and the other of said flaps serving to cover and hold an
additional loop portion of the tubing against one of said bottom
pad parts to provide a safety loop of the tubing, thereby
insulating any shock to the tubing transmitted by the infusion
needle or catheter.
2. The securing device according to claim 1, wherein said slit
terminates in an enlarged perforation comprising a medicament
well.
3. The securement device according to claim 1, wherein said means
to affix the lower surface of said bottom pad to the body portion
of said patient comprises an adhesive coating on the lower surface
of said bottom pad.
4. The securement device according to claim 3, wherein said
adhesive coating is protected by a removable sheet prior to
adhering the lower surface of said bottom pad to the body portion
of the patient.
5. The securement device according to claim 4, wherein said
releasable sheet has an exposed, easily accessible portion to
enable it to be readily removed.
6. The securement device according to claim 1, wherein said means
to affix the lower surface of said bottom pad to the body portion
of said patient, and said means to releasably affix the lower
surface of said first and second flaps of said upper pad to the
upper surface of said first and second bottom pad parts,
respectively comprises an adhesive coating on the lower surface of
said bottom pad and the lower surface of said first and second
flaps.
7. The securing device according to claim 6, wherein said adhesive
coating on the lower surface of said bottom pad and on the lower
surface of said first and second flaps is provided with a removable
sheet.
8. The securement device according to claim 1, wherein said upper
pad is permanently affixed to said lower pad along said line of
juncture.
9. The securement device according to claim 1, wherein said upper
pad is integral and one piece with said lower pad along said line
of juncture.
10. The securement device according to claim 1, wherein said first
and second flaps overhang at least one edge of said bottom pad.
11. The securement device according to claim 1, wherein a second
slit is provided in the other one of said first and second bottom
pad parts extending inwardly of said bottom pad to a termination
point within the confines of said bottom pad.
12. The securement device according to claim 2, wherein said bottom
pad includes two slits extending from opposite edges inwardly of
said bottom pad.
13. The securement device according to claim 2, wherein ointment is
provided in said medicament well.
14. The securement device according to claim 2, wherein
encapsulated ointment is provided in said medicament well.
15. The securement device according to claim 1, wherein said slit
widens at said edge whereby to form a lead-in portion.
16. The securement device according to claim 1, wherein a large
notch is provided on one edge of said bottom pad and said slit
extends therefrom.
17. A securement device according to claim 1, wherein said line of
juncture extends substantially parallel to said one slit.
18. The securement device according to claim 1, wherein said line
of juncture is located along the central portion of said bottom
pad.
19. The securement device according to claim 1, wherein said bottom
pad parts are of equal width and said flaps are of equal width.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to the medical field and
more particularly to a device for securing and protecting an
infusion needle or catheter and for holding a portion of the excess
tubing while providing access to and observation of the catheter
and tubing during the intravenous infusion.
2. Description of the Prior Art
Intravenous feeding and transfusions are among the most frequently
accomplished and essential treatments of seriously injured or ill
patients in hospitals. Infusion apparatus employed in the
intravenous feeding of blood, plasma, glucose water, salt water,
and the like includes an infusion needle or catheter, a handle
portion, and a length of tubing connecting the needle to a source
of intravenous fluid. In conventional practice, the needle or
catheter is inserted into the vein of the patient and constrained
in such position by small strips of adhesive tape connected to the
handle so that the needle or catheter will be secured to the skin
and not fall or be pulled out. The puncture site of the needle or
catheter is often protected with an antibacterial ointment and/or a
gauze pad for the purpose of helping to lower the chance of
infection. The gauze pad also serves as a cushion if placed under
the catheter and handle portion. Whether or not the antibacterial
ointment and/or gauze pad is applied, the needle or catheter, along
with the tubing, is commonly secured to the skin or body portion of
the patient with several strips of adhesive tape. A portion of the
excess tubing is then usually coiled closely adjacent to the needle
or catheter and is held in place by several additional strips of
adhesive tape overlying the entire structure. The purpose of this
coil is to absorb any unexpected sudden tension placed upon the
remainder of the tubing (as with accidentally being pulled upon)
without distrubing the catheter.
This procedure poses several problems; namely, (1) the accumulation
of several items (i.e., ointment, gauze pad and tape) into one
convenient location; (2) the separate application of these items at
the time of insertion of the infusion needle or catheter; (3) the
necessity of tearing multiple strips of tape often of varying
lengths and widths; (4) the individual application of each strip of
tape over the infusion needle or catheter and tubing to secure them
to the skin or body portion of the patient and to provide a
U-shaped loop in the tubing to allow for a sudden pull on the
tubing without allowing the needle or catheter to be dislodged; (5)
the resultant pressing of the hub of the needle or catheter and
tubing against the skin or body portion of the patient which can
cause discomfort and actual skin damage unless a cushion is
provided; (6) the difficult and time consuming task of having to
remove each piece of tape carefully and individually when and if
the needle or catheter needs to be inspected without dislodging the
needle or catheter; and (7) the inability to maintain the sterility
of the above mentioned items.
While many prior art securement devices and the like have
endeavored to alleviate certain of the aforementioned problems, for
one reason or another they have generally proven to be
unsatisfactory. Such prior art devices known to applicant are: U.S.
Pat. Nos. 3,046,989 Hill; 2,159,947 Gansel; 2,402,306 Turkel;
2,669,231 Fisher; 2,814,294 Figge; 2,898,917 Wallace; 3,046,984
Eby; 3,059,645 Hasbrouck, et al.; 3,138,158 Gordon, et al.;
3,146,778 Krawiec; 3,286,713 Kurtz, et al.; 3,367,332 Groves;
3,422,817 Mishkin; 3,430,300 Doan; 3,461,869 Hargest; 3,542,321
Kahabka; 3,613,663 Johnson; 3,630,195 Santomieri; 3,670,727
Reiterman; 3,677,250 Thomas; 3,683,911 McCormick; 3,724,456 Waxman;
3,726,280 Lacount; and 3,782,378 Page.
SUMMARY OF THE INVENTION
According to the present invention, the aforementioned problems are
solved by providing an improved device for securing and protecting
an infusion needle or catheter of a variety of dimensions and
configurations in the body portion of a patient to the skin and for
holding a portion of the excess tubing in a U-shaped loop while
providing a cushion between the catheter-tubing assembly and the
skin.
Briefly, in its broadest form, the improved securement device
includes a bottom pad formed of flexible material having upper and
lower surfaces and at least one slit extending from one edge
inwardly of the bottom pad and preferably terminating in an
enlarged perforation comprising a medicament well. Means are
provided to affix the lower surface of the bottom pad to the skin
or body portion of the patient. An upper pad, also formed of
flexible material, is also provided. A first portion of the lower
surface of the upper pad is affixed to the upper surface of the
bottom pad. The upper pad is also provided with a second portion
constituting a flap which may overlie the slit and enlarged
perforation comprising the medicament well. Finally, means are
provided to removably affix the second portion of the upper pad to
the upper surface of the bottom pad.
In a preferred embodiment, the bottom pad is provided with two
substantially parallel slits extending from the same edge, with
each slit terminating in the aforementioned enlarged perforation,
and the first portion of the lower surface of the upper pad is
affixed to the upper surface of the bottom pad along the central
portion thereof between the slits, creating two flap portions. In
practice, one of the flaps serves to cover the perforation being
used and the other of the flaps is used to hold an additional
portion of the tube. The two slits give the operator an option of
sliding either one or the other slit around the intravenous
catheter, thereby allowing the operator to position the bottom pad
on the most propitious area of the body portion of the patient
(i.e., on the dorsal rather than the ventral surface of the forearm
to avoid resting the pad on the bed sheets while the patient rests
in a prone position).
In still another embodiment of the invention, the bottom pad
includes two slits extending from opposite edges thereof inwardly,
with each slit terminating in the aforementioned enlarged
perforation. The upper and lower pads are integral at mating edges
thereof.
The improved securement device of the present invention overcomes
all of the aforementioned and specifically enumerated problems in
connection with the prior art procedure for attaching an
intravenous needle or catheter to the skin of any body portion of a
patient.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a partially exploded view of one embodiment of the
securement device of the present invention.
FIG. 2 is an end view of the securement device of FIG. 1.
FIGS. 3 through 8 are perspective views showing how the securement
device of FIGS. 1 and 2 is placed on a body portion of a
patient.
FIG. 9 is a plan view of a second embodiment of the securement
device of the present invention.
FIG. 10 is an end view of the securement device of FIG. 9.
FIG. 11 is an end view of the securement device of FIG. 9 in the
closed position.
FIG. 12 is a perspective view showing how the securement device of
FIGS. 9 through 11 is placed on a body portion of a patient.
FIG. 13 is a series of enlarged views showing exemplary end
enlarged perforations which may be used with the securement devices
of the present invention.
FIG. 14 is an enlarged view showing a large notch on the side of a
bottom pad, with associated slits extending therefrom, which may be
used with the securement devices of the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings, wherein like parts are designated
with like numerals throughout, and more particularly to FIGS. 1 and
2, one embodiment of the improved securement device of the present
invention is designated at 10. As can be seen, the securement
device 10 includes a bottom pad 12 and an upper pad 14, both formed
of flexible material, and preferably of suitable polyurethane foam
material.
The bottom pad 12 is provided with at least one slit 16 extending
from one edge 18 inwardly of the bottom pad 12 and terminating in a
enlarged perforation 20 comprising a medicament well for ointment
or encapsulated ointment 22, which may be included in the pad 12 or
may be placed in the perforation 20 separately during application
of the pad 12 to the skin, as will be more fully explained
hereinafter. The slit 16 preferably widens, such as in V-notch
fashion 24, at the edge 18 to form a lead-in portion.
The lower surface 12b and 14b of the bottom and upper pads 12 and
14, respectively, are each provided with an adhesive material 26,
which is exaggerated in the drawings for purposes of clarity of
illustration. The adhesive material 26 will preferably contain a
bacteriostatic or bacteriocidal chemical to arrest the growth of or
destroy any organisms present in deep pores or sweat glands or hair
follicles of the skin surface of the body portion of the patient
and securement device. Furthermore, the ointment 22 is antibiotic;
for example ointments such as are presently sold under the
trademarks Polysporin or Betadine, and the bottom and upper pads 12
and 14, if made of foam, may be sterilized and also contain a
bacteriostatic or bacteriocidal chemical. Thus, bacteria are
precluded from reaching the incision through or under the
securement device 10 or along the infusion needle or catheter, and
those which may be present are destroyed. The incision is thereby
insulated from a major source of infection by a physical barrier if
not a chemical one.
A removable backing sheet 28 of paper, plastic or the like is
preferably maintained in contact with the adhesive material or
coating 26, on the lower surface 12b, 14b of the bottom and upper
pads 12 and 14, respectively. The removable backing sheet 28 also
preferably has at least one exposed and easily accessible portion
30 to enable it to be readily removed. For example, this may be
accomplished by rounding the corners 12c and 14c of the bottom and
upper pads 12 and 14, respectively, while maintaining the corners
28a of the removable backing sheet 28 in a square
configuration.
The securement device 10 of FIGS. 1 and 2 may be packaged and
shipped as two separate pads; namely, the bottom and upper pads 12
and 14 as previously described. However, it has been found
preferable to sever the removable backing sheet 28 of the upper pad
14 lengthwise in two parallel lengths defining a strip
substantially at the mid-point thereof and to remove this strip of
backing sheet 28 so as to expose a first portion 34 on the lower
surface 14b of the upper pad 14. The first portion 34 of the lower
surface 14b of the upper pad 14 is then affixed to the central
portion 36 of the upper surface 12a of the bottom pad 12 so as to
form two flaps 38 and 40, each of which may overhang an edge 19 and
21 of the bottom pad 12.
If desirable, perforations 42 may be inserted through the flaps 38
and 40 for purposes of inspection of the infusion needle, tubing
and the like, and for injection of further medication at a
subsequent time into the tubing or intravenous feeding line.
A fabric or other coating 32 may be placed on the upper surface 12a
of the bottom pad 12 to allow for a reversible adhesion between the
bottom of the flaps 38 and 40 and the upper surface 12a of the
bottom pad 12.
A label 44 may be affixed to the upper surface 14a of the upper pad
14 between the flaps 38 and 40 to enable medical personnel to
indicate thereon the type of intravenous needle or catheter, the
size of the catheter and the date and time the infusion needle or
catheter was inserted.
Turning now to FIGS. 3 through 8, the application of the securement
device 10 of FIGS. 1 and 2 will now be explained. As can be seen, a
vein puncture is made in the arm or other suitable body portion 46
by penetrating the flesh and vein (not shown) with a hollow
intravenous needle or catheter 48 as shown in FIG. 3. The infusion
tube 50, which is connected to the needle or catheter 48 by the
coupling 52, is adapted to be coupled to a source of infusion
liquid (not shown). These aforementioned items all vary somewhat in
size, shape, and configuration from one manufacturer to
another.
After the infusion needle or catheter 48 is satisfactorily inserted
in a vein, the appropriate portion of the bottom pad 12 with the
most desirable slit 16 is chosen so as to offer the most
advantageous position of the pad 12 on the patient's body portion.
At this point, it should be emphasized that any slit 16 of the pad
12 may be utilized. The removable backing sheet 28 from the
selected side of the bottom pad 12 is then removed. The flap
portion of the associated upper pad 14, such as the flap 40, is
then folded back and the slit 16 is carefully slid around the
infusion needle or catheter 48 until the skin puncture site is
surrounded to the well 20 at the end of the slit 16. The half of
the base or bottom pad 12 having the slit 16 being used is then
pressed securely against the skin of the body portion 56 of the
patient, such that this half of the base pad 12 is affixed to the
body portion 56 by means of the adhesive 26. If ointment 22 is not
already present in the well, it may be inserted at this time.
As shown in FIG. 4, after the base pad 12 is properly positioned
with respect to the incision and the infusion needle or catheter
48, the backing sheet 28 is removed from the upper flap or wing 40,
and the flap 40 is pressed down over the infusion needle or
catheter 48, and the lower surface 14b, with the adhesive material
or coating 26, is removably or permanently affixed to the upper
surface 12a of the bottom pad 12, as shown in FIG. 5. Accordingly,
the infusion needle or catheter 48 is sandwiched between the lower
surface 14b and the upper surface 12a of the upper and bottom pads
14 and 12, respectively. The removable backing sheet 28 is then
removed from the bottom or base pad 12 on the adjoining unused
side, and pressed against the skin or body portion 56. The infusion
tube 50 is then looped around, and positioned between the upper
surface 12a of the adjoining unused side of the base or bottom pad
12 and the lower surface 14b of the unused wing or flap 38,
ignoring the remaining slit 16 and associated perforation 20, as
best seen in FIGS. 6 and 7. The backing sheet 28 is then removed
from the lower surface 14b of the wing or flap 38, and the wing or
flap 38 is pressed down over the infusion tubing 50, sandwiching
the tubing 50 between the lower surface 14b of the flap 38 of the
upper pad and the upper surface 12a of the base or bottom pad
12.
As can be seen, the full infusion line 50 and the head of the
infusion needle or catheter 48 may be checked or inspected by
lifting the wings or flaps 38 and 40 of the upper pad 14. The wings
or flaps 38 and 40 may then be repositioned over the infusion
tubing 50 and infusion needle or catheter 48 for continued
securement. Any shock to the infusion line 50, such as, for
example, by patient pull and the like, will be absorbed by the
securement device 10 in an area which is isolated from the head of
the infusion needle or catheter 48. In this way pulling upon the
infusion line 50 will not cause the infusion needle or catheter 48
to be disturbed. It will, of course, be seen that the securement
device 10 of the present invention will readily accept infusion
needles or catheters 48 of varying sizes and configurations.
It will, of course, be seen that the entire head of the infusion
needle or catheter 48 is covered so that it can not be disturbed,
or moved, either by patient jarring or disruption by a foreign
object or force. Furthermore, the incision area is continuously
protected by the securement device 10 from any exposure to bacteria
and the like.
It will be seen that the securement device 10, as described in
connection with FIGS. 1 and 2, and as shown in connection with
FIGS. 3 through 8, when applied to the body portion 56 of a
patient, overcomes the aforementioned short comings of prior art
devices. The securement device 10 eliminates the accumulation of
several items, such as, ointment (if ointment is included in the
well 22), gauze pad and multiple tape strips and it eliminates the
separate application of these items at the time of insertion of the
infusion needle or catheter 48. The necessity of tearing multiple
strips of tape, often of varying lengths and widths, is also
eliminated, as is the individual application of each strip of tape
over the infusion needle or catheter 48 and the tubing 50 to secure
these to the skin or body portion 56 and provide a loop 58 in the
tubing 50 to allow for a sudden pull on the tubing 50. In so doing,
the resultant pressing of the hub of the infusion needle or
catheter 48 against the skin or body portion 58, which can cause
discomfort and actual skin damage, is also eliminated. The
difficulty and time consuming task of having to remove each piece
of tape carefully and individually when and if the infusion needle
or catheter 48 needs to be inspected without dislodging the needle
or catheter 48 is also eliminated. Finally, this device may be
packaged in a sterile condition which also protects the patient
from the hazards of potentially contaminated rolls of tape.
FIG. 9 discloses a further embodiment 60 of the securement device
of the present invention. As can be seen, the securement device 60
comprises a base or bottom pad 62 and an upper pad 64, the pads
being integrally hinged at 66 along the mating edges 68 and 70,
respectively.
The pads 62 and 64 are formed of flexible material, preferably of
polyurethane foam, and the upper pad 64 may be of such dimension as
to overhang at least one edge of the bottom pad 62, as at 72.
The lower surface 62b of the base pad is provided with an adhesive
material 63 adapted to affix the lower surface 62b of the base pad
to the skin or body portion of a patient. The upper surface 64a of
the upper pad 64 is provided with an adhesive 65 such that the
upper pad 64 may be folded over and affixed to the upper surface
62a of the base pad 62. The upper surface 62a of base pad 62 may be
covered with a cloth or plastic surface such as is shown at 67, to
assist in the removability of the upper surface 64a of the upper
pad 64 from the upper surface 62a of the base pad 62 once it is
adhered to the base pad 62. As hereinbefore explained, the adhesive
material 63 and 65 is preferably antibacterial in that it possesses
bacteriostatic or bacteriocidal properties which enable it to
arrest the growth of or destroy any organisms present in deep pores
or sweat glands or hair follicles of the skin surface and
securement device 60. Thus, bacteria are precluded from reaching
the incision through or under the securement device 60 or along the
infusion needle or catheter by physical if not chemical means. It
will, of course, be obvious that the thickness of the adhesive
material 63 and 65 is exaggerated in the drawings for clarity of
illustration.
The base or bottom pad 62 is provided with slits 76 extending from
opposite edges 78 and 80 inwardly of the bottom pad 62, with each
slit 76 terminating in an enlarged perforation 82 comprising a
medicament well. The well 82 may hold suitable ointment or
encapsuled ointment 84. The slits 76 preferably widen, such as in
V-notch fashion 81, at the opposite edges 78 and 80 to form lead-in
portions.
As indicated in connection with the embodiment of FIGS. 1 and 2,
suitable removable backing sheet 86 of plastic, paper or the like
may be maintained in contact with the adhesive material or coatings
63 and 65 to prevent the coatings from becoming attached to
material other than desired prior to the actual placement of the
device 60 around the infusion needle or catheter.
In operation, the backing sheet 86 is removed from the lower
surface 62b of the bottom or base pad 62 and the most desirable
slit 76 is slid around the infusion needle or catheter 48 to the
enlarged perforation 82 at the end of the slit 76. The base or
bottom pad 62 is then pressed securely against the skin or body
portion 56 of the patient, thereby being affixed to the skin or
body portion 56 by means of the adhesive 63.
The backing sheet 86 is then removed from the upper surface 64a of
the upper pad 64. The infusion tubing 50 is looped around, and
positioned on the upper surface 62a of the bottom pad 62, after
which time the upper pad 64 is folded over about the hinge 66 and
pressed down over the infusion tubing 50 and infusion needle or
catheter 48 and the upper surface 62a of the bottom pad 62.
It will, of course, be readily seen that the securement device 60,
as described in connection with FIG. 9, eliminates the
aforementioned disadvantages in connection with the prior art as
readily as the securement device 10, as described in connection
with FIGS. 1 through 8.
Turning now to FIG. 13, it will be seen that A, B and C thereof
disclose various enlarged perforations, 88, 90 and 92, each with an
associated slit 94, 96 and 98, in the bottom pads 100, 102 and 104,
respectively, which may be satisfactory with the securing devices
10 and 60 of the present invention. D, E, F and G of FIG. 13 show
other modifications whereby only a perforation, as at 106 and 108
in the base pads 110 and 112 of D and E, respectively, or only a
slit, as at 114 and 116 in the base pads 118 and 120 of F and G,
respectively, may be satisfactory with the securing devices 10 and
60 of the present invention.
While several of the specific embodiments of the securement device
of the present invention have been shown and described, it will be
apparent that various modifications may be made therein without
departing from the scope of the invention. Such modifications
include the forming of a securement device with the base and upper
pads as separate parts, or as integral, the provision of an
adhesive material or coating on less than the entire lower surfaces
of the pads and the elimination of removable sheets if found
desirable, or the use of an additional layer of a fabric or
suitable material in the upper surface of the bottom pads to insure
the removable nature of the upper pad after it is affixed to the
bottom pad, or an upper pad covering less than the full dimension
of the lower pad. Additionally as shown in FIG. 14, the V-notch
lead-in portions 122, each with an associated slit 124 and enlarged
perforation 126, may extend inwardly from a large notch 128 on the
side 130 of a bottom pad 132.
Variations in the features of the invention are set forth in the
following claims.
* * * * *