U.S. patent number 3,920,023 [Application Number 05/453,318] was granted by the patent office on 1975-11-18 for method and apparatus for placement of a suprapubic catheter.
This patent grant is currently assigned to The Kendall Company. Invention is credited to William J. Binard, John F. Dye.
United States Patent |
3,920,023 |
Dye , et al. |
November 18, 1975 |
Method and apparatus for placement of a suprapubic catheter
Abstract
A suprapubic catheter is inserted into a bladder in a safe,
efficient and simple manner by first inserting a hollow, curved and
rigid tubing member transurethrally into a bladder. The tubing
member has a catheter therewithin onto which a cutting point is
attached, and is constructed in such a manner as to permit the
cutting point to, when pushed through the distal end thereof,
pierce the anterior wall of the bladder after it has been
externally palpated for placement. The cutting point, then emerging
from the bladder, can be grasped externally and the catheter can be
pulled through the tubing member and into the bladder to a
premarked point thereon and may be separated from the main body of
the catheter and connection made to a conventional drainage and
collection assembly. The tubing member is then withdrawn backwardly
leaving the catheter tube safely within the bladder in the proper
position. A stylet may be employed to remove the catheter when
drainage is to be terminated.
Inventors: |
Dye; John F. (Reedsburg,
WI), Binard; William J. (Barrington, IL) |
Assignee: |
The Kendall Company (Boston,
MA)
|
Family
ID: |
23800076 |
Appl.
No.: |
05/453,318 |
Filed: |
March 21, 1974 |
Current U.S.
Class: |
604/506 |
Current CPC
Class: |
A61M
1/84 (20210501); A61M 25/06 (20130101) |
Current International
Class: |
A61M
25/06 (20060101); A61M 1/00 (20060101); A61B
017/34 () |
Field of
Search: |
;128/303,305,311,328,341,343,347,348,349,2B,370 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Layton; Henry S.
Attorney, Agent or Firm: Scahill, Jr.; Edward J.
Claims
What is claimed is:
1. A method of placement for a suprapubic catheter comprising:
inserting the distal end of a rigid, hollow tubing member having an
opening at both ends thereof through the urethra and into the
bladder, said distal end being curved;
locating the opening on said distal end against the anterior wall
of the bladder in the suprapubic region thereof;
pushing a cutting point through said tubing member and through said
opening on said distal end so as to pierce the anterior wall of the
bladder and abdomen in the suprapubic region and through the outer
surface of the skin, said cutting point having a catheter attached
thereto;
pulling said cutting point outwardly away from said tubing member
leaving a portion of said catheter within the bladder; and
withdrawing said tubing member backwardly from said bladder leaving
said catheter at the desired position within said bladder.
2. The method of claim 1 wherein said bladder is externally
palpated prior to locating said opening on said distal end against
the anterior wall of said bladder.
3. The method of claim 1 wherein said catheter is withdrawn from
the bladder to a predetermined mark on said catheter.
4. The method of claim 1 wherein said catheter tube has a coiled
configuration on the end thereof, and said coiled configuration has
a plurality of openings thereon.
5. The method of claim 1 wherein said cutting point is pushed
through said distal end of said tubing member by means of a rigid
plunger in telescopic relationship with said tubing member.
6. The method of claim 5 wherein said plunger is hollow and open at
at least one end thereof, and said catheter is contained therein
prior to insertion into the bladder and abdomen.
7. A device for inserting a suprapubic catheter comprising:
a rigid, hollow, tubing member having a curved distal end portion
thereon, said tubing member having an opening at both ends
thereof;
a rigid, hollow, metal plunger tube open at at least one end
thereof, in which a catheter tube may fit within, is disposed
telescopically within said tubing member for pushing a cutting
point disposed within said tube outwardly through said distal end
portion, said plunger tube has a ringed configuration on the
proximal end thereof for holding and guiding said plunging means
and for convolutely storing said catheter tube therearound prior to
insertion into a bladder, said cutting point having said catheter
tube attached thereto.
8. The device of claim 7 wherein said plunger tube is open at both
ends.
9. The device of claim 8 wherein said plunger tube and said tubing
member are of a metal.
10. The device of claim 8 wherein said plunging means and said
tubing member are of a reinforced plastic material.
11. The device of claim 10 wherein said tubing member has a pair of
flanging rings on the proximal end thereof for holding and guiding
said tubing member.
12. The device of claim 7 wherein said catheter tube has a coiled
configuration on the end thereof for retaining said tube
intracystically, and said coiled configuration has a plurality of
openings thereon.
13. The device of claim 12 wherein said catheter tube is marked to
show the proper level for positioning said tube within the
bladder.
14. The device of claim 13 wherein said mark on said tube is a
shouldered portion that also serves as an engaging means for
enabling said plunger tube to push said catheter out of said tubing
member.
15. The device of claim 13 wherein said cutting point is a beveled,
three-sided, electropolished needle.
16. A device for inserting a suprapubic catheter comprising:
a rigid, hollow, metal tubing member having a curved distal end
portion thereon, said tubing member having an opening at both ends
thereof, and having a pair of flanging rings on the proximal end
thereof; and,
a rigid, hollow, metal plunger tube, being open at at least one end
thereof, and having a ringed configuration on the proximal end
thereof, disposed telescopically within said tubing member for
pushing a cutting point disposed within said tubing member
outwardly through said distal end portion thereof, said cutting
point being a beveled, three-sided, electropolished needle and
having a catheter tube attached thereto, said tube having a coiled
configuration on the end thereof and a plurality of openings
thereon, and said tube has a mark thereon for properly positioning
said tube within the bladder.
Description
BACKGROUND OF THE INVENTION
This invention relates to a method and apparatus for placement of a
suprapubic catheter, and more particularly to a method for
suprapubic cystotomy wherein the catheter initially pierces the
bladder wall from within and is drawn outwardly therefrom for final
placement.
Suprapubic catheterization is the insertion into the urinary
bladder of a drainage tube through the skin in the lower abdomen
above the pubic bone, i.e., the suprapubic area. The procedure is
normally carried out by placing a regular transurethral catheter
into the bladder and instilling sterile liquid therein until the
bladder is sufficiently full that it can be palpated through the
skin. This catheter is then removed and the suprapubic catheter is
placed into the bladder by one of two means - the trocar method or
the needle method.
These methods of insertion can be potentially dangerous unless
great care is taken during insertion. Complications often arise due
to over-penetration of the "cutting point" into the surrounding
bowel or bladder area, since these insertions are made blindly.
Another technique of inserting suprapubic catheters involves
inserting a rigid instrument having a curved distal portion that
has a clamp thereon into the bladder and depressing the handle of
the instrument so as to cause a protrusion on the suprapubic area.
An incision is made from without at this point down to the tip of
the distal portion of the rigid instrument, which is then brought
through the incision. The clamp on the distal end thereof is opened
to accept and grasp a catheter, which is then withdrawn backwardly
into the bladder. The clamp is released and the catheter is
retained within the bladder while the rigid instrument is withdrawn
through the urethra. This method of insertion also can produce
dangerous complications. For example, whenever a separate incision
must be made there is always the attendant possibility of
infection. This possibility is further increased in that the distal
portion of the rigid instrument is first pushed out into the local
environment and exposed to possible contamination and is then drawn
back into the bladder and out through the urethra.
Still another prior art suprapubic insertion technique is described
in U.S. letters Pat. No. 3,640,281 to Robertson. This technique can
be described as including the steps of: inserting a curved distal
portion of a rigid instrument into the bladder through the urethra,
the curved distal portion having a closure thereon; inflating the
bladder with a fluid through the instrument; engaging the distal
end of the instrument with the anterior wall of the bladder with
sufficient force to provide a visible protrusion of the suprapubic
region of the abdominal wall; making an incision through the
abdominal wall and the anterior wall of the bladder in register
with the distal end of the instrument; displacing same outwardly
through the incision, and removing the closure from the distal end
of the instrument; inserting a portion of a catheter into the
distal end of the instrument; withdrawing the instrument through
the incision from the bladder and the urethra, leaving a portion of
the catheter within the bladder; and inflating the inflatable
portion of the catheter within the bladder to insure retention.
This technique, while it appears to be more satisfactory than the
others mentioned herein, still has an increased possibility of
contamination and infection since the distal portion of the
instrument comes up through the bladder and through the externally
made incision, is handled at that position from without, and is
then withdrawn backwardly through the incision, bladder and
urethra.
Accordingly, it is an object of this invention to provide a means
of inserting suprapubic catheters that minimizes infection, or the
possibility thereof by employing a unidirectional movement of a
catheter through the bladder and through the abdomen from within to
the external environs.
Another object of this invention is to provide a means of making an
incision in the anterior wall of the bladder and the abdominal wall
from within the bladder, so as to reduce the possibility of
contamination from without.
A further object of the present invention is to provide a method of
inserting a suprapubic catheter into the bladder that insures that
no portion of the catheter or inserting apparatus must pass from
the bladder to the outside and back to the bladder.
SUMMARY OF THE INVENTION
Apparatus for, and a method of, inserting a suprapubic catheter
into the bladder is provided in a safe, efficient and simple manner
comprising a hollow, curved and rigid tubing member having a
shielded catheter therewithin onto which a cutting point is
attached. The tubing member is inserted transurethrally into a
bladder in such a manner as to permit the cutting point to, when
pushed through the distal end thereof, pierce the wall of the
bladder from within after the bladder has been externally palpated.
The cutting point, then emerging from the abdomen, is grasped
externally and the catheter is pulled through the bladder and
abdominal wall, via the tubing member, to a predetermined and
premarked point thereon. The curved tubing member can then be
easily withdrawn therefrom, leaving the catheter tube safely within
the bladder in the proper position. This technique provides a novel
and efficient means for inserting suprapubic catheters
transurethrally while minimizing the possibility of infection.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of the insertion device of this
invention;
FIG. 2 is a partial sectional view of the device of this invention
being inserted into a patient's bladder transurethrally;
FIG. 3 is a partial sectional view of the cutting point within the
device making a puncture from within the bladder;
FIG. 4 is a partial sectional view of a suprapubic catheter in
place within the bladder, and the insertion device being withdrawn
therefrom; and,
FIG. 5 is a sectional view of the catheter assembly of this
invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to the drawings, FIG. 1 shows the device 10 used in this
invention to insert a suprapubic catheter into a patient's bladder
transurethrally. The device 10 includes a rigid, curved, hollow,
tubing member, being curved in such a manner as to permit the
member to easily be inserted transurethrally into a patient's
bladder. The member is open at both ends, the distal end 11 being
the curved portion and having an opening 12 thereon, while the
proximal end 13 has an opening 15 thereon and can have a pair of
flanging rings 14 or the like attached thereto for holding and
guiding the member into the bladder. It should be noted that the
rings 14 are added for convenience, and are not necessary parts in
this invention.
A catheter 16, such as a spring catheter, having a cutting point 17
thereon, is preloaded in a rigid, hollow plunger 18 having an
opening on at least the proximal end thereof. The plunger 18 can
advantageously have a ringed configuration, such as shown by 19,
situated at the proximal end thereof. The ringed configuration 19
provides a convenient means for handling the plunger 18 and for
convolutely storing the catheter 16 therewithin. Such a ringed
arrangement is, of course, preferred but is not necessary. The
distal end of the plunger 18 is telescopically placed within the
curved member so that when the plunger 18 is pushed all the way
into the member the cutting point 17 is capable of extending out
through the opening 12 of the curved member.
Referring now to FIGS. 2, 3 and 4, a suprapubic catheter can easily
and efficiently be inserted into a patient's bladder 30, by
externally palpating the bladder and inserting the device 20, by
urethral entry, into the bladder so that the curved distal portion
21 points toward the abdomen and until resistance of the anterior
wall of the bladder is felt against the catheter tip 22 having the
opening thereon. At this point, an internal to external puncture
can be made in the suprapubic region by pushing the plunger 28
inwardly, thereby forcing the cutting point 27 to pierce through
the bladder wall 31 and abdominal wall 32 and exiting through the
outer surface of the skin. As can be seen from the drawings, the
curved distal portion of the insertion device 20 is shaped so that
it can easily be inserted through the urethra, and so that the
plunger 18 can be handled and operated from a convenient position.
The emerging cutting point 27 can then be grasped externally and
the catheter 26 can be pulled therethrough to a predetermined and
premarked point 41 thereon. The device 20 can then be withdrawn
backwardly, as shown in FIG. 4, leaving the suprapubic retention
catheter 26 safely within the patient's bladder 30 at the proper
level. A stylet can then be employed to remove the catheter when
drainage is to be terminated.
The catheter tube can advantageously have a coiled configuration 34
on the end thereof for assisting in the retention of the catheter
intracystically. This coiled portion may advantageously have a
plurality of openings 35 thereon for facilitating drainage.
Turning finally to FIG. 5, a sectional view of the catheter
assembly 10 shows the catheter 16 having a predetermined mark or
shoulder 41 which serves a two-fold purpose. The shoulder 41 serves
firstly as a means of enabling the plunger 18 to push the catheter
16 out through the opening 12 of the device 10, and secondly, as a
marker to show how far the catheter 16 should be pulled out of the
patient's bladder. As shown in FIG. 4, the catheter is properly
placed when the shoulder 33 becomes visible externally. The
catheter assembly should have sufficient compressive strength so
that an axial force applied to it from plunger 18 by means of the
shoulder portion 41 will be transmitted axially to the cutting
point 17 sufficiently to drive the point 17 through an abdominal
wall. The catheter 16 is shown here as a semi-rigid vinyl tubing of
a relatively heavy wall, but it can be of a variety of materials,
such as a more flexible tubing containing a reinforcement such as a
bead chain or tightly wound spring running from the shoulder 41 to
the cutting point 17.
The cutting point 17 is advantageously a beveled, three sided,
electropolished metal point. Other configurations of cutting points
should work as well, and excessive cutting action should be avoided
which could cause hematuria and clogging of the catheter.
This method of insertion makes a small, clean, pin-point incision
from within the bladder, and does not allow any possible sources of
contamination to come into contact with the incision. An obvious
advantage of this invention is, of course, that complications that
often arise due to over-penetration of the trocar or cutting point
into the surrounding bowel area or the like, are completely
eliminated, since the cutting point does not come into contact with
any body parts until its exact location is precisely known.
While it is preferred that the curved, hollow tubing member and the
hollow plunger are of a sturdy metallic material, any rigid,
durable material such as an impregnated or reinforced plastic, or
the like would work with similar results. The length and diameter
of the device should be such that it can be suitably used for human
beings, and will vary according to whether it is to be used for
male or female patients. The drawings here, of course, show the
device being used on female patients.
Since it is obvious that many changes and modifications can be made
in the above-described details without departing from the nature
and spirit of the invention, it is to be understood that the
invention is not limited to said details except as set forth in the
appended claims.
* * * * *