EP1008126A1

EP1008126A1 - Device for teaching and training thorax drainage

Info

Publication number: EP1008126A1
Application number: EP97947728A
Authority: EP
Inventors: Thomas Fleischmann-Sperber
Original assignee: FLEISCHMANN SPERBER THOMAS
Current assignee: FLEISCHMANN SPERBER THOMAS
Priority date: 1996-10-26
Filing date: 1997-10-24
Publication date: 2000-06-14
Also published as: AU5398498A; WO1998019287A1; DE29723995U1

Abstract

A device for teaching and training thorax drainage has an artificial thoracic cage (3) which reproduces in a simplified manner the natural thoracic cage with a cavity (12), several ribs (4) and at least one intercostal region (5) arranged between the ribs, as well as an envelope (16) which surrounds the thoracic cage in the same manner as the natural tissues surround a natural thoracic cage. The envelope consists of three layers, namely one inner layer (13) which corresponds to the muscle layer of the natural thoracic cage, a medium layer which corresponds to the subcutaneous adipose tissues and an outer layer (15) which corresponds to the natural skin. Each of the three layers opposes to the penetration of a scalpel and trocar a resistance which is comparable to that of the corresponding natural layers of tissues.

Description

description

Device for learning and practicing thoracic drainage

The invention relates to a device for practicing thoracic drainage, hereinafter referred to as “thorax drainage trainer”. Thoracic drainage is a life-saving measure that is usually still to be carried out by a doctor at the emergency site and in which the chest is opened The purpose of this measure is to lead away or drain an injury or illness-related accumulation of blood or air in the pleural space to the outside. An accumulation of blood, in particular, in the pleural space impedes or prevents the normal breathing activity of the lungs and leads to suffocation In the case of thoracic drainage, a scalpel is first used to cut the skin with an incision approximately in the longitudinal direction of the ribs, and then a trocar catheter is inserted into the skin opening formed with the scalpel and through the subcutaneous fatty tissue in the direction of the Chest cavity advanced before the trocar cath eter can penetrate into the pleural space filled with air or liquid, the muscle layer surrounding the rib cage or existing in the area between the ribs must be penetrated. In an alternative method, the trocar is removed from the catheter and the tip of the catheter is gripped with a clamp. The inter-rib area is pierced with the clamp and the catheter tip that is held with it. This procedure requires a little more force, but its blunt approach reduces the risk of injury to structures of the chest wall and lungs. Finally, the rib cage can also be opened by cutting the skin with a scalpel, as usual, but perforating the subcutaneous fat and muscles alternately bluntly with a finger and scissors. In the following, reference is made to the first-mentioned method using a trocar catheter for the sake of simplicity. It is in the nature of things that the practice of thoracic drainage on living people is extremely problematic. Based on this, it is the object of the invention to propose a device with which thoracic drainage can be learned and practiced.

This object is achieved by a device according to claim 1. Thereafter, an artificial chest, which is simulated in a simplified manner from the natural chest, is surrounded with a covering corresponding to the natural tissue covering, which has the following three layers: an inner layer corresponding to the muscle layer of the natural chest, an middle layer corresponding to the natural subcutaneous fatty tissue and one of the natural skin corresponding outer layer. The material of the three layers is chosen so that the penetration resistance opposing a scalpel and a trocar corresponds as far as possible to the natural conditions. When practicing thoracic drainage, it is not just a question of penetrating any kind of material layer with the scalpel or the trocar catheter. Rather, the natural conditions should rather be replicated in such a way that the resistances of the individual material layers occurring on the thorax drainage trainer and the loss of resistance occurring after penetration of a material layer are as true to nature as possible. As with the human body, an outer layer with a scalpel must first be penetrated in the device according to the invention. If the outer layer or the skin is severed, this can be recognized by the associated loss of resistance. The prerequisite for this, however, is that a middle layer adjoins the outer layer, which provides the scalpel with a much lower resistance than the outer layer or the skin. If a thorax drainage trainer were to be followed by two layers of material of comparable strength, the "loss of resistance" when penetrating the skin layer would not be felt or would not be felt to a sufficient extent. The loss of resistance is the signal for the doctor, with the scalpel the cutting force to reduce damage to the underlying tissue layers. The subcutaneous fatty tissue can reach a considerable thickness in obese people. Nevertheless, this layer uses a trocar catheter only a relatively low penetration resistance. Before the trocar penetrates into the pleural space, the innermost layer, namely the muscle tissue of the chest, has to be penetrated. The thoracic muscle tissue, and in particular the intercostal muscles, is only possible with the trocar using relatively high feed forces. A cut with the scalpel, such as was done on the skin, is dangerous because of the risk of injury to the lungs. When the trocar penetrates the muscle layer, there is a sudden loss of resistance, which is a signal that the trocar can no longer be pushed forward with force, which could result in injury to the lungs. With a device according to the invention, the force-path or resistance-path curve that occurs when the thoracic tissue layer penetrates can thus be simulated relatively true to life. This is an important aspect insofar as in the often confusing and stress-laden emergency situation, the aforementioned loss of resistance or the course of resistance when penetrating the tissue layer gives the emergency doctor information about the depth of penetration of the trocar. It is advantageous if the inner layer in the intermediate rib area is lowered in the direction of the chest cavity compared to the rib area specified by the rib surface. As a result, as in the case of the natural rib cage, the intermediate rib region is easier to feel compared to an embodiment in which the inner layer extends flat over the ribs. The lowering or the deepening of the intercostal region is covered by the middle layer, which represents the subcutaneous fatty tissue, and this makes it difficult to find the intercostal region suitable for penetration with increasing thickness of the middle layer. By combining the inner layer, which is lowered in the area between the ribs, with a middle layer, in particular made of glass or rock wool, it is possible to simulate conditions that actually occur in thicker or obese people. The lowering of the inner layer in the area of the intercostal ribs can be accomplished in that the intercostal area is arched in a channel-shaped manner in the direction of the chest cavity. Another advantageous possibility is that the inner layer, which extends essentially over the entire length of the rib cage, has a greater thickness in the rib region than in the intermediate rib region. A lowering of the intercostal area can also be accomplished in that a thickening layer covering the rib region is arranged on the upper side of the inner layer, which in turn can be constructed from different layers. The material of the thickening layer plays a subordinate role insofar as it does not have to be penetrated by the trocar catheter. In an advantageous embodiment of the device according to the invention, the thickening layer is in each case formed by at least one clamping bracket, which is pivotably mounted between a release position and a clamping position about a pivot axis running in the longitudinal direction of the chest. In the release position, the clamping bracket is lifted off the rib so that a used inner layer can be exchanged for a new one. In the clamping position, the clamping bracket clamps the inner layer between itself and the respective rib. The inner layer is preferably formed from a nonwoven, in particular a nonwoven plastic. Such plastic fleeces are commercially available, for example, as self-adhesive carpet tiles at relatively low prices. Such self-adhesive carpet tiles or self-adhesive nonwoven materials can easily be glued onto the ribs of the device according to the invention, if necessary after appropriate cutting. The above-mentioned thickening layer can preferably consist of the same material as the inner layer, in particular of a self-adhesive carpet tile.

The middle layer consisting of glass or rock wool is preferably formed from a commercially available heat insulation material and preferably extends over the entire length of the chest. Glass or rock wool has the property that it can be compressed to a certain extent when palpating the intercostal region, similar to the subcutaneous fatty tissue. This compression is not such that the trocar can no longer penetrate it. When using foam material as a middle layer, however, there is this risk. Foam material can be easily compressed by hand and thus feel the area between the ribs. The punctiform compression of a foam material leads to such a solidification that it can only be penetrated with a trocar with an unnaturally high effort. In the used according to the invention Rock or glass wool is not. Here the individual rock or glass fibers are laterally displaced by the penetrating trocar tip.

An elastomer material, in particular a vulcanized natural or synthetic rubber, is used as the outer layer. Such a material, which is used, for example, to sheath water pipelines in domestic installations, has a cut resistance and a tear resistance that are comparable to human skin. In a particularly preferred embodiment, the inner layer, the middle layer and the outer layer are connected to one another to form a wrapping unit which is adapted to the contour of the chest and can be replaced as a whole. In a further preferred embodiment, the device according to the invention is combined with a ventilation trainer. A respiratory trainer is a head and chest model, with the lungs in the chest cavity being simulated by inflatable balloons. An advantage of the combination according to the invention is that the same device can be used for ventilation and drainage training. In the case of inflated lung balloons practically filling the chest cavity, the danger of penetrating the trocar too far can also be demonstrated.

The invention will now be explained in more detail with reference to exemplary embodiments illustrated in the accompanying drawings. Show it:

1 shows a thoracic drainage trainer according to the invention in front view, FIG. 2 shows the thoracic drainage trainer according to FIG. 1 in a perspective side view, FIG. 3 shows an enlarged detail section along line III in FIG. 2, FIG. 4 shows a detail section corresponding to FIG. 3 of a further embodiment, and FIG. 5 an exchangeable wrapping unit consisting of inner layer, middle layer and outer layer. 1 and 2, a thoracic drainage trainer is shown in front or perspective side view, in which a head-chest model 2 is fixed on a base plate 1. The thorax 3 is formed in this model by three strip-shaped ribs arranged parallel to one another and convexly bulging out of the plane of the base plate. The ribs are made of a stable material, in particular sheet metal, and are arranged in the direction of the central longitudinal axis 6 of the head-chest model 2 with an axial distance defining an intermediate rib region 5. The ribs 4 are fixed to the base plate, for example in that the ends of the ribs are bent into fixing tabs 8 which are penetrated by a screw 9 screwed into the base plate 1. The ribs 4 all have the same outline shape, so that their surfaces 11 are arranged in an imaginary circumferential surface surrounding the chest cavity 12.

The rib cage 3 or the ribs 4 are surrounded by an envelope 16 formed from an inner layer 13, a middle layer 14 and an outer layer 15. The inner layer 13 extends over the entire length 17 of the chest and also over its entire circumference. The inner layer consists of a nonwoven, in particular a plastic fleece. In a particularly preferred embodiment, the inner layer consists of a commercially available self-adhesive carpet tile or from a cut thereof. Such a self-adhesive carpet tile can easily be pulled off the ribs in order to change the inner layer 13, in particular if these consist of a sheet metal material. The inner layer is followed by a more or less thick middle layer 14, which corresponds to a more or less thick subcutaneous fat tissue of the human chest. The middle layer consists of glass or rock wool or a comparable material. It is important that the material chosen is a relatively loose fiber mat in which the fibers are arranged in the manner of a scattering texture. If pressure is exerted on such a mat, the mat is compressed. When you let go, the mat does not immediately return to its original position, but a dent remains for a certain time, as is the case with human adipose tissue. The outer layer 15, which corresponds to the human skin, adjoins the middle layer 14 on the outside. An elastomer material, preferably a vulcanized natural or synthetic rubber, is used as the material for the outer layer. In a particularly preferred embodiment, the outer layer consists of a commercially available rubber material which is used, for example, for the sheathing of water pipes. Such a material has a relatively high cut resistance corresponding to human skin. Generally speaking, an elastomeric material can be easily adjusted to have the desired cut resistance. The outer layer 14, like the middle layer 14, completely covers the inner layer 13 and is fastened to the base plate 1 with its edges 18, as indicated in FIG. 1. To change individual layers or all of the layers mentioned, the outer layer 15 is first removed from the thorax 3. The inner layer 13 is accessible after removing the loosely lying middle layer 14. The casing 16 consisting of the layers mentioned can also be designed such that the individual layers are firmly connected to one another and together form a completely exchangeable casing unit 19 (FIG. 5). Such a wrapping unit 19 can, for example, be attached to the chest in a form-fitting or material-locking manner. But it is also conceivable that it is fixed to the base plate 1 by means of push buttons 21.

3 shows a thorax section of a further embodiment of a thoracic drainage trainer according to the invention. In this embodiment, the top 23 of the inner layer 13 is lowered in the intermediate rib region 5. In other words, the inner layer 13 in the intermediate rib area 15 has a groove-shaped recess 24, the bottom surface of which corresponds approximately to the area of the intermediate rib area 5. The recess 24 can be formed in different ways. In Fig. 3 two possibilities are shown schematically: In the left rib 4a, the inner layer 13 in the rib region 25 has a greater thickness than in the intermediate rib region 5. This creates a step 26 at the transition between the rib and intermediate rib region, which the side walls of the groove-shaped recess 24 forms. In the rib 4b shown on the right in FIG. 3, the recess 24 is formed in that a thickening layer 27 is arranged in the inner layer 13 in the rib region 25, which may optionally consist of a plurality of individual layers 28, 29, for example of cuts of a self-adhesive carpet tile. Also in the case of a thickening layer 27, a step 26a is formed at the transition to the intermediate rib region 5, which step forms a side wall of the groove-shaped recess 24.

4, the recess 24 can be formed in that strip-shaped clamping brackets 31 are placed on the inner layer 13, which spans the ribs 4 and are of substantially uniform thickness, each rib 4 being assigned at least one clamping bracket 31 which is attached to the rib or to the base body is fixed so that the inner layer between the clamp bracket 31 and rib is clamped. The inner layer can then be easily replaced by loosening the clamp bracket 31 and removing the used inner layer. In a preferred embodiment, the clamping brackets are mounted on the base plate or on the chest 3 so as to be pivotable about a pivot axis extending parallel to the central longitudinal axis 6. 4, the pivot axis 32 extends in the region of the apex 33 of the chest. In this case, the clamping brackets consist of two halves which can be pivoted with their abutting ends in the region of the apex 33 between a release and a clamping position in the direction of the double arrow 34. The recess 24 can, however, also be formed in that the inner layer 13 has a channel which bulges in the direction of the chest cavity 12 and projects into the intermediate rib region 5 (not shown).

The thoracic drainage trainer according to the invention can be combined with an intubation trainer. For this purpose, lung balloons 35 simulating the human lungs are arranged in the chest 3. With a device designed in this way, both thoracic drainage and intubation and ventilation can be learned and practiced. It is also possible to arrange between the lung balloons 35 and the inside of the chest a liquid-filled bag or sponge which can be penetrated by a trocar, in order to simulate the outflow of liquid from the chest. Reference list

Base plate 19 wrapping unit

Head-chest model 21 push button

Chest 22 line

Rib 23 top

Intermediate rib area 24 recess

Central longitudinal axis 25 rib area

Fixing tab 26 level

Screw 27 thickening layer

Surface 28 single layer

Cavity 29 single layer

Inner layer 31 clamps

Middle class 32 swivel axis

Outer layer 33 crowns

Wrapping 34 double arrow

Length 35 lung balloon

edge

Claims

Expectations

1. Device for learning and practicing thoracic drainage with a simulated artificial chest (3) with a cavity (12), a plurality of ribs (4) and at least one intermediate rib region (5) and - one arranged between the ribs Chest (3) according to the type of natural tissue covering (16), with

an inner layer (13) corresponding to the muscle layer of the natural chest,

- A middle layer (14) corresponding to the natural subcutaneous fatty tissue and

- An outer layer (15) corresponding to the natural skin, each of the three layers having a penetration resistance comparable to the respective natural tissue layers compared to a scalpel and a trocar.

2. Device according to claim 1, characterized in that the upper side (23) of the inner layer (13) in the intermediate rib region (5) with respect to the rib region (25) formed by the rib surface (11) is lowered in the direction of the chest cavity (12).

3. Apparatus according to claim 2, characterized in that the inner layer (13) in the intermediate rib region (5) is arched groove-shaped on the chest cavity.

4. The device according to claim 2, characterized in that the inner layer (13) in the rib region (25) has a greater thickness than in the intermediate rib region (5).

5. The device according to claim 2, characterized in that a thickening layer (27) covering the rib region (25) is arranged on the upper side (23) of the inner layer (13).

6. The device according to claim 5, characterized in that the thickening layer (27) is in each case formed by at least one strip-shaped clamping bracket (31) which extends about a pivot axis (32) extending in the direction of the central longitudinal axis (6) of the device between one of the Ribs lifted release position and a clamping position clamping the inner layer (13) between itself and the respective rib (4) is pivotally mounted.

7. Device according to one of claims 1 to 6, characterized in that the inner layer is formed by a nonwoven fabric.

8. The device according to claim 7, characterized in that the inner layer is formed from a plastic fleece.

9. The device according to claim 8, characterized in that the inner layer (13) is a commercially available carpet tile or a blank of such a tile.

10. The device according to one of claims 7 to 9, characterized in that the inner layer (13) on its on the ribs (4) attachable underside is self-adhesive.

11. Device according to one of claims 7 to 10, characterized in that the inner layer (13) on its the ribs (4) facing away from the top is self-adhesive.

12. The apparatus according to claim 11, characterized in that the thickening layer (27) consists of the same material as the inner layer (13).

13. Device according to one of claims 1 to 12, characterized in that the middle layer (14) consists essentially of glass or rock wool.

14. The apparatus according to claim 13, characterized in that the middle layer is formed from a commercially available heat insulating material.

15. The device according to one of claims 1 to 14, characterized in that the outer layer (15) consists essentially of an elastomer material.

16. The apparatus according to claim 15, characterized in that the elastomeric material is a vulcanized natural or synthetic rubber.

17. The apparatus according to claim 16, characterized in that the outer layer (15) is formed by a commercially available rubber material for sheathing water pipes.

18. Device according to one of claims 1 to 17, characterized in that the inner layer (13), the middle layer (14) and the outer layer (15) to one of the thorax contour adapted and as a whole replaceable wrapping unit (19) are interconnected.

19. Device according to one of claims 1 to 18, characterized in that it is combined with a device for learning and practicing intubation and ventilation.