FR2692790A1

FR2692790A1 - Percutaneous puncture needle for large double-chamber venous trunks.

Info

Publication number: FR2692790A1
Application number: FR9302709A
Authority: FR
Inventors: Sallerin Thierry
Original assignee: Individual
Current assignee: Individual
Priority date: 1992-03-12
Filing date: 1993-03-09
Publication date: 1993-12-31
Also published as: WO1993017737A1

Abstract

Needle for positioning in an intravascular position, after a single percutaneous puncture of large vein stems, two guiding elements for sensor or catheter implantation using the Seldinger technique. The needle consists of a conventional hub for receiving the end part of a standard syringe, a needle shaft characterized by having an inner lumen consisting of two juxtaposed passage chambers communicating with each other over their whole length, for simultaneously passing the two guiding elements, without any crossing over thereof, a needle level inclined in the largest axis in its first embodiment, in the narrowest access in its variant. The device is especially for percutaneous puncture of large vein stems during anesthetic-resuscitation procedures with a view to minimizing incidence of complications.

Description

AIGUILLE DE PONCTION PERCUTANEE DES GROS TRONCS VEINEUX
A DOUBLE CHAMBRE
DESCRIPTION
La présente invention concerne une aiguille de ponction veineuse à double chambre permettant, en ne réalisant qu'une seule ponction per-cutanée des gros troncs veineux (sous-claviers, jugulaires ou fémoraux), l'implantation intra-vasculaire simultanée de deux sondes ou ca téters par la méthode de SELDINGER.PERCUTANEOUS PUNCTURE NEEDLE OF LARGE VENOUS TRUNKS
DOUBLE ROOM
DESCRIPTION
The present invention relates to a double-chamber venipuncture needle allowing, by performing only a single per-cutaneous puncture of the large venous trunks (subclavian, jugular or femoral), the simultaneous intra-vascular implantation of two probes or ca téters by the SELDINGER method.

Les situations de pratique clinique nécessitant deux voies d'abord per-cutanées des gros troncs veineux sont de plus en plus fréquentes. The situations of clinical practice requiring two routes per-cutaneous first of the large venous trunks are more and more frequent.

Par exemple:
- l'implantation de pace-makers à double stimulation auriculaire et ventriculaire par voie endocavitaire.For example:
- the implantation of pace-makers with double atrial and ventricular stimulation by endocavitary way.

- la réalisation de l'examen du faisceau de His avec double stimulation auriculaire et ventriculaire. - carrying out the examination of the His bundle with double atrial and ventricular stimulation.

- la pose simultanée en réanimation médicale ou chirurgicale d'une sonde de Swan Ganz et d'un cathéter de perfusion. - the simultaneous placement in medical or surgical resuscitation of a Swan Ganz probe and an infusion catheter.

Tous ces cas nécessitent des ponctions itératives des gros troncs veineux. All these cases require iterative punctures of the large venous trunks.

Or, la pratique journalière de ces techniques révèle que si la première ponction d'un gros tronc veineux est la plupart du temps simple pour un opérateur entrainé, la deuxième ponction de la même veine se révèle souvent laborieuse. However, the daily practice of these techniques reveals that if the first puncture of a large venous trunk is most of the time simple for a trained operator, the second puncture of the same vein often proves to be laborious.

En effet, la constitution d'un hématome même bénin ou la présence du leader implanté lors de la première ponction, modifient sensiblement les rapports anatomiques. Indeed, the constitution of a hematoma even benign or the presence of the leader implanted during the first puncture, significantly modify the anatomical relationships.

De ce fait, les risques de complications sont multipliés: pneumothorax par perforation du dôme pleural, volumineux hématome par ponction artérielle accidentelle, voire même constitution d'une fistule artério-veineuse iatrogène à distance d'une ponction difficile pouvant entrainer la nécessité d'une fermeture chirurgicale. As a result, the risks of complications are multiplied: pneumothorax by perforation of the pleural dome, bulky hematoma by accidental arterial puncture, even even the constitution of an iatrogenic arteriovenous fistula at a distance from a difficult puncture which can lead to the need for a surgical closure.

Pour simplifier ces techniques et pour diminuer l'incidence de ces risques ou de ces complications, il semble utile de concevoir une aiguille de ponction per-cutanée des gros troncs veineux, permettant l'introduction de deux sondes ou cathéters. To simplify these techniques and to reduce the incidence of these risks or these complications, it seems useful to design a needle for puncturing the large venous trunks by the skin, allowing the introduction of two probes or catheters.

Pour ce faire, l'aiguille selon l'invention comporte une double lumière interne constituée de la juxtaposition de deux chambres de passage communiquant entre elles sur toute leur longueur (1-2) (11-12) destinée à permettre l'introduction simultanée et sans entrecroisement de deux leaders en position intravasculaire selon la technique de SELDINGER. To do this, the needle according to the invention comprises a double internal lumen consisting of the juxtaposition of two passage chambers communicating with each other over their entire length (1-2) (11-12) intended to allow the simultaneous introduction and without intersection of two leaders in intravascular position using the SELDINGER technique.

La réalisation de cette aiguille doit aboutir à obtenir un diamètre externe entre 0,89 et 1,2 mm le plus proche possible des aiguilles existantes de 18 gauge et 0,89 mm de diamètre externe permettant l'implantation d'un seul leader. The realization of this needle must lead to obtain an external diameter between 0.89 and 1.2 mm as close as possible to the existing needles of 18 gauge and 0.89 mm of external diameter allowing the implantation of a single leader.

La gravité des complications augmente avec le diamètre des aiguilles. De ce fait, une aiguille en double canon de fusil entrainerait un doublement du diamètre usuel, source d'un accroissement des risques de lésions. The severity of complications increases with the diameter of the needles. As a result, a needle in a double rifle barrel would cause a doubling of the usual diameter, a source of increased risk of injury.

Le fut et le biseau constituant les éléments les plus déterminant de l'aiguille selon l'inven tion , il est apparu nécessaire d'en présenter deux modes de réalisation. The barrel and the bevel constituting the most determining elements of the needle according to the invention, it appeared necessary to present two embodiments thereof.

Le mode particulier de réalisation de cette aiguille est constitué:
- d'un pavillon d'entrée standard (5) (15) de forme interne cylindrique de 4 mm de diamètre (8) (18) acceptant l'embout d'une seringue standard (6) (16). Ce diamètre interne d'entrée est supérieur au diamètre interne du fut de l'aiguille à double chambre (entre 0,55 et 0,90 mm dans son diamètre le plus grand),
- de l'aiguille proprement dite:
dans sa première configuration présentant la forme d'un cylindre applati de coupe ovale (3-4) réduisant par son profil en lame épaissie les risques de lésions percutanées, conséquences de la ponction, ( F'9 d)
dans sa variante, présentant la forme d'un parallélépipède triangulaire aux angles arrondis (13) minimisant par son profil de triangle applati les risques de lésions percutanées, conséquences de la ponction, ( Fig 2)
- le raccord pavillon aiguille est constitué d'un cône réducteur (7) (17) permettant le glissement sans heurt des deux leaders du cylindre d'entrée vers le cylindre applati de coupe ovale (3-4) que constitue le fut de l'aiguille dans sa première configuration, ou vers le parallélépipède triangulaire aux angles arrondis (13) (14) que constitue le fut de l'aiguille dans sa variante. The particular embodiment of this needle consists of:
- a standard input pavilion (5) (15) of cylindrical internal shape with a diameter of 4 mm (8) (18) accepting the tip of a standard syringe (6) (16). This internal inlet diameter is greater than the internal diameter of the barrel of the double-chamber needle (between 0.55 and 0.90 mm in its largest diameter),
- the needle itself:
in its first configuration having the shape of a flat cylinder of oval cut (3-4) reducing by its profile in thickened blade the risks of percutaneous lesions, consequences of the puncture, (F'9 d)
in its variant, having the shape of a triangular parallelepiped with rounded angles (13) minimizing by its flat triangle profile the risks of percutaneous lesions, consequences of the puncture, (Fig 2)
- the needle pin connection consists of a reducing cone (7) (17) allowing the smooth sliding of the two leaders of the input cylinder towards the flat oval-cut cylinder (3-4) that constitutes the barrel of the needle in its first configuration, or towards the triangular parallelepiped with rounded angles (13) (14) that constitutes the barrel of the needle in its variant.

- le biseau de la pointe, pour diminuer l'incidence des lésions de ponction:
dans sa première configuration est taillé dans le sens du diamètre le
plus large (9)
dans sa variante est taillé dans le sens du diamètre le plus étroit (19),
- la structure interne de l'aiguille:
dans sa première configuration est constituée de la juxtaposition de deux parties de cylindre (1-2), (à titre d'exemple deux 3/5e de cylindre) réalisant une lumière interne présentant en coupe la forme d'un huit non totalement fermé (4) ou d'un ovale rétréci en sa partie moyenne. Chacun de ces 3/5e de cylindre présente un diamètre interne de 0,45 à 0,55 mm.- the bevel of the tip, to reduce the incidence of puncture lesions:
in its first configuration is cut in the direction of the diameter the
wider (9)
in its variant is cut in the direction of the narrowest diameter (19),
- the internal structure of the needle:
in its first configuration, it consists of the juxtaposition of two cylinder parts (1-2), (for example two 3 / 5ths of a cylinder) producing an internal lumen having in section the shape of an eight not completely closed ( 4) or an oval narrowed in its middle part. Each of these 3 / 5th cylinder has an internal diameter of 0.45 to 0.55 mm.

dans sa variante, présente la forme d'un cylindre dont le toit effondré vers l'intérieur ( 14) réalise une lumière interne présentant en coupe la forme d'un coeur dont les deux cavités communiquent (11-12). Le diamètre interne de la lumière de cette aiguille ne dépassera pas 0,90 mm dans son plus grand diamètre horizontal et 0,45 mm dans son plus petit diamètre vertical (11-12). in its variant, has the shape of a cylinder whose roof collapsed inward (14) provides an internal light having in section the shape of a heart whose two cavities communicate (11-12). The internal diameter of the lumen of this needle will not exceed 0.90 mm in its largest horizontal diameter and 0.45 mm in its smallest vertical diameter (11-12).

cette lumière interne à double chambre dans ses deux configurations admet le passage simultané de deux leaders de calibre 18 gauge standard en leur évitant de s'entrecroiser. this internal double-chamber light in its two configurations admits the simultaneous passage of two leaders of standard 18 gauge caliber while avoiding them to intersect.

Cette aiguille selon l'invention est particulièrement destinée à permettre l'implantation de deux sondes ou de deux cathéters en position intravasculaire en ne réalisant qu'une seule ponction per-cutanée non traumatique des gros troncs veineux grace à un diamètre externe de 0,89 à 1,2 mm, légèrement supérieur aux aiguilles usuelles. This needle according to the invention is particularly intended to allow the implantation of two probes or two catheters in the intravascular position by performing only one non-traumatic percutaneous puncture of the large venous trunks thanks to an external diameter of 0.89 1.2 mm, slightly higher than usual needles.

Claims

1) Puncture needle for large venous trunks, characterized in that it has an internal lumen consisting of the juxtaposition of two passage chambers communicating with each other over their entire length (1-2) (11-12) allowing the simultaneous and seamless intersection of two leaders in the intravascular position.

2) Needle according to claim 1 of external structure in the form of a flat cylinder (3), characterized in that it comprises an internal lumen with double chamber (1-2), consisting of the juxtaposition of two 3 / 5th cylinders ( 1-2) producing an internal lumen having in section the shape of an oval narrowed in its middle part (4) and ending with a bevel cut in the direction of the widest diameter (9).

3) Needle according to claim 1 of external structure, in the shape of a triangular parallelepiped with rounded angles (13), characterized in that it comprises an internal lumen with double chamber (11-12), having in section the shape of a heart whose two cavities communicate (14) and ending with a bevel cut in the direction of the narrowest diameter (19).

4) Needle according to claims 1-2 and 3 characterized in that it comprises a conventional input pavilion of cylindrical internal shape (8) (18) of 4 mm in diameter accepting the tip of a standard syringe (6 ) (16). This internal inlet diameter is greater than the internal diameter of the barrel of the double-chamber needle (4) (14) from 0.55 mm to 0.90 mm in its largest diameter.

5) Needle according to claims 1-2 characterized in that its was made of a flat cylinder (3) having in section an oval shape (4).

6) Needle according to claims 1 and 3 characterized in that its barrel consists of a triangular parallelepiped with rounded angles (13) having in section the shape of a heart (14).

7) Needle according to claims 1-2 and 5 characterized in that its internal lumen consists of the juxtaposition of two cylinder parts (1-2) (for example two 3 / Se cylinder) leading to a cut internal in the shape of a non-closed eight or an oval narrowed in its middle part (4). Each of these 3 / Se cylinders (1-2) has an internal diameter of 0.45 to 0.55 mm.

8) Needle according to claims 1-3 and 6 characterized in that its internal lumen has the shape of a cylinder whose roof is collapsed inwards (14) leading to an internal cup in the shape of a voor, the two cavities communicate (11-12). The internal diameter of this light will not exceed 0.90 mm in the widest horizontal direction and 0.45 mm in the narrowest vertical direction (11-12).

9) Needle according to any one of the preceding claims, characterized in that the inlet-barrel connection of the needle consists of a smooth and progressive reducing cone (7) (17) ensuring the junction of the ring cylindrical inlet (8) (18) up to the double internal lumen of the barrel of the needle (4) (14).

10) Needle according to any one of the preceding claims, characterized in that it allows the simultaneous passage of two leaders separately and without interlacing in an external diameter between 0.89 and 1.2 mm, smaller than that of a needle in double rifle barrel and therefore as close as possible to a standard 18 gauge needle of 0.89 mm external diameter allowing the introduction of a single leader.

11) Needle according to claims 1-2 and 7 characterized in that it has a bevel cut in the direction of its widest external diameter (9).

12) Needle according to claims 1-3-6 and 8 characterized in that it has a bevel cut in the direction of its narrowest external diameter (19).